Bed- and room-sharing in Chinese school-aged children: prevalence and association with sleep behaviors

OBJECTIVE: To survey the prevalence of bed- and room-sharing and assess associations with sleep/wake patterns, duration of sleep, and sleep problems among urban school-aged children in China. METHODS: Students representing eight Chinese cities were studied during November and December, 2005. A total of 19,299 elementary-school children (49.7% boys and 50.3% girls with a mean age of 9.00 years) participated in the survey. A parent-administered questionnaire and the Chinese version of the Children's Sleep Habits Questionnaire were completed to quantify children's sleep arrangements and to characterize sleep behaviors. RESULTS: Co-sleeping was a common practice, with a prevalence of 37.6% (routine bed-sharing: 23.0%; room-sharing: 14.6%) in Chinese school-aged children. Bed- and room-sharing did not show significant gender difference but gradually decreased with increasing age. Compared to room-sharing and sleeping alone, bed-sharing was correlated with later bedtimes, later awakening times, and a shorter duration of sleep. However, the small difference was unlikely to have clinical significance. Bed- and room-sharing tended to be associated with the increased probability of six types of sleep problems: bedtime resistance, sleep anxiety, night waking, parasomnia, sleep-disordered breathing, and daytime sleepiness. Compared to bed-sharing, room-sharing had a lower odds ratio. Among six sleep problems, bedtime resistance and sleep anxiety had the strongest association with bed-sharing. CONCLUSIONS: Sleep problems were common in Chinese school-aged children. Co-sleeping was highly prevalent and may be potentially associated with negative effects on sleep hygiene and sleep quality, although the context of the co-sleeping must be taken into consideration.