Sleep and Adjustment in Preschool Children: Sleep Diary Reports by Mothers Relate to Behavior Reports by Teachers

Bates, John E.; Viken, Richard J.; Alexander, Douglas B.; Beyers, Jennifer M.; Stockton, Lesley

doi:10.1111/1467-8624.00392

Cited by 221 publications

(178 citation statements)

References 55 publications

(52 reference statements)

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“…Much of the previous work in this area has been cross-sectional or has not taken account of factors that might confound the association between sleep and behavioral difficulties. [8][9][10][11][12] Some studies have involved in-depth investigations using diary methods and actigraphy to monitor sleep, [13][14][15] but the generalizability of these findings from highly selective study samples is questionable. Only a couple of studies 16,17 have considered these relationships longitudinally, and a recent review article 7 highlighted the need for large-scale population-based studies to look at the links between sleep and behavior prospectively.…”

Section: Resultsmentioning

confidence: 99%

Changes in Bedtime Schedules and Behavioral Difficulties in 7 Year Old Children

Kelly

Sacker

2013

Pediatrics

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WHAT'S KNOWN ON THIS SUBJECT: Links between clinically diagnosed sleep problems and adverse behavioral outcomes are well documented. However, in nonclinical populations, causal links between disrupted sleep and the development of behavioral difficulties are far from clear. WHAT THIS STUDY ADDS:Seven-year-old children with nonregular bedtimes had more behavioral difficulties than children who had regular bedtimes. There were clear doseresponse relationships, and the effects of not having regular bedtimes appeared to be reversible. abstract OBJECTIVES: Causal links between disrupted sleep and behavioral problems in nonclinical populations are far from clear. Research questions were as follows: Are bedtime schedules associated with behavioral difficulties? Do effects of bedtime schedules on behavior build up over early childhood? Are changes in bedtime schedules linked to changes in behavior?METHODS: Data from 10 230 7-year-olds from the UK Millennium Cohort Study, with bedtime data collected at 3, 5, and 7 years, and behavioral difficulties scores as rated by mothers and teachers were analyzed. RESULTS:Children with nonregular bedtimes had more behavioral difficulties. There was an incremental worsening in behavioral scores as exposure through early childhood to not having regular bedtimes increased: mother rated (nonregular any 1 age, b = 0.53; nonregular any 2 ages, b = 1.04; nonregular all 3 ages, b = 2.10, P , .001) and teacher rated (b = 0.22, b = 0.73, b = 1.85, P , .001). Difference in differences analysis showed that for children who changed from nonregular to regular bedtimes there were clear nontrivial, statistically significant improvements in behavioral scores: A change between age 3 and 7 corresponded to a difference of b = 20.63, and a change between age 5 and 7 corresponded to a difference of b = 21.02). For children who changed from regular to nonregular bedtimes between ages 5 and 7 there was a statistically significant worsening in scores, b = 0.42. Much of the previous work in this area has been cross-sectional or has not taken account of factors that might confound the association between sleep and behavioral difficulties. [8][9][10][11][12] Some studies have involved in-depth investigations using diary methods and actigraphy to monitor sleep, [13][14][15] but the generalizability of these findings from highly selective study samples is questionable. Only a couple of studies 16,17 have considered these relationships longitudinally, and a recent review article 7 highlighted the need for large-scale population-based studies to look at the links between sleep and behavior prospectively. CONCLUSIONS:In this article we add to what is known by examining data from a large, nationally representative prospective population-based cohort study to see whether and how bedtimes through early childhood relate to markers of child behavior at 7 years of age. We address the following research questions:1. Are bedtime schedules associated with behavioral difficulties?2. Do the effects of bedtime schedules build...

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Section: Resultsmentioning

confidence: 99%

Changes in Bedtime Schedules and Behavioral Difficulties in 7 Year Old Children

Kelly

Sacker

2013

Pediatrics

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“…7 In fact, results suggest that when the sleep of preschoolers is insuffi cient or fragmented by wakefulness, they show more diffi culty inhibiting emotional responses and more frequent impulsive and aggressive behavior. 8 Poor sleep quality also seems associated with obesity in preschool children.…”

Section: S C I E N T I F I C I N V E S T I G a T I O N Smentioning

confidence: 99%

Validating Actigraphy as a Measure of Sleep for Preschool Children

Bélanger

Bernier²,

Paquet³

et al. 2013

Journal of Clinical Sleep Medicine

115

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Study Objectives:The algorithms used to derive sleep variables from actigraphy were developed with adults. Because children change position during sleep more often than adults, algorithms may detect wakefulness when the child is actually sleeping (false negative). This study compares the validity of three algorithms for detecting sleep with actigraphy by comparing them to PSG in preschoolers. The putative infl uence of device location (wrist or ankle) is also examined. Methods: Twelve children aged 2 to 5 years simultaneously wore an actigraph on an ankle and a wrist (Actiwatch-L, MiniMitter/Respironics) during a night of PSG recording at home. Three algorithms were tested: one recommended for adults and two designed to decrease false negative detection of sleep in children. Results: Actigraphy generally showed good sensitivity (> 95%; PSG sleep detection) but low specifi city (± 50%; PSG wake detection). Intraclass correlations between PSG and actigraphy variables were strong (> 0.80) for sleep latency, sleep duration, and sleep effi ciency, but weak for number of awakenings (< 0.40). The two algorithms designed for children enhanced the validity of actigraphy in preschoolers and increased the proportion of actigraphyscored wake epochs scored that were also PSG-identifi ed as wake. Sleep variables derived from the ankle and wrist were not statistically different. Conclusion: Despite the weak detection of wakefulness, Actiwatch-L appears to be a useful instrument for assessing sleep in preschoolers when used with an adapted algorithm. S C I E N T I F I C I N V E S T I G A T I O N SS leep is considered to be of paramount importance for brain development during the fi rst two years of life.1 In fact, children spend over half of their fi rst two years of life sleeping, with daily sleep duration decreasing from 14.5 to about 13 hours between 6 months and 2 years of age. 2,3 In the preschool years, daily sleep needs remain high, decreasing from 13 hours at 2 years to about 11 hours at 5 years.2-4 During infancy and childhood, frequent night awakenings or diffi culty falling asleep are among the most frequent developmental complaints. Studies estimate that from 10% to 75% of parents report that their children have sleep problems.5 Importantly, sleep problems tend to persist during childhood 6 and are associated with several adverse consequences for behavioral, cognitive, and emotional health. For example, it has been shown that sleep problems are associated with behavioral and emotional self-regulation problems.7 In fact, results suggest that when the sleep of preschoolers is insuffi cient or fragmented by wakefulness, they show more diffi culty inhibiting emotional responses and more frequent impulsive and aggressive behavior.8 Poor sleep quality also seems associated with obesity in preschool children. 9Studies further suggest that sleep problems, whether occurring in infancy 10 or at school age, 4,11 are associated with lower cognitive performance. In light of the prevalence and the serious consequences of pediatr...

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“…Published evidence supports actigraphy as the most widely used and convenient objective method followed by polysomnography (Natale 2009;Owens 2009). Sleep diaries present the most subjective evidence for monitoring sleep quality (Bates 2002). Therefore, primary outcome measures will be assessed in accordance with the following ranking of these techniques: 1. actigraphy, 2. polysomnography, 3. sleep diaries.…”

Section: Outcome and Analysismentioning

confidence: 99%