Sleep disturbances and correlates among a sample of preschool children in rural China

Abstract

This study aimed to explore the prevalence of sleep disturbances among preschool children in rural areas of China and identify the underlying associated factors. A cross-sectional study was conducted in rural areas of Anhui Province, China, from September 2019 to January 2020. The caregivers of children from 26 kindergartens completed the demographic questionnaire, the Children's Sleep Habits Questionnaire (CSHQ), the Strengths and Difficulties Questionnaire (SDQ), the Self-rating Anxiety Scale (SAS), and the adapted Identification and Management of Feeding Difficulties (IMFeD) tool. One-way analysis of variance, independent-samples t-test, and hierarchical multiple linear regression were conducted to explore the potential influencing factors of sleep disturbances in preschool children. For the specific sleep disturbances based on each subscale of the CSHQ, bedtime resistance (54.9%) and sleep anxiety (47.9%) were the most common types of sleep disturbances, followed by daytime sleepiness (21.3%), sleep duration (20.8%), parasomnias (16.5%), sleep-onset delay (12.6%), night wakings (12.2%) and sleep-disordered breathing (10.3%). The ages of children, children's emotional/behavioral problems, children's feeding difficulties, inconsistent parenting attitudes of parents, poor parenting styles, non-parent caregivers, and caregiver anxiety contributed significantly to the CSHQ total score, accounting for approximately 27.1% (R 2 = 0.271) of the variance. Our study indicates that the prevalence of sleep disturbances among preschool children in rural areas of China is quite high. Furthermore, the potential risk factors are complicated, including factors related to both children and their caregivers.

Evaluation of the association between excessive screen use, sleep patterns and behavioral and cognitive aspects in preschool population. A systematic review

“…The results of the review suggest that less than half of the 3-to 6-year olds meet health authorities' recommendations for exposure to screens (less than an hour a day), which coincides with the findings of a recent meta-analysis [64]. This prolonged use may affect sleep parameters through the following: both active and passive exposure, especially at night; increased presence of digital devices in a child's environment; and displacement of other activities that may favor sleep onset [49,54,55,58,62,65]. These patterns of digital device use are consistently associated with (a) a reduction in the total amount of sleep, which is in line with previous research (e.g., [61,62,66]); and (b) worse sleep patterns, observable in aspects such as increased bedtime resistance, more nighttime awakenings and daytime sleepiness, results which also align with those of other studies (e.g., [63,64,67,68]).…”

“…Furthermore, small to moderate effects of screen use on behavioral and cognitive problems were found [52,55,62]. Exposure to more than one hour of screen time in preschoolers appears to be associated with a greater risk of an onset of emotional difficulties, increased negative affect and anxiety, as well as aggressive, hostile, or hyperactive behaviors.…”

“…This prolonged use may affect sleep parameters through the following: both active and passive exposure, especially at night; increased presence of digital devices in a child's environment; and displacement of other activities that may favor sleep onset [49,54,55,58,62,65]. These patterns of digital device use are consistently associated with (a) a reduction in the total amount of sleep, which is in line with previous research (e.g., [61,62,66]); and (b) worse sleep patterns, observable in aspects such as increased bedtime resistance, more nighttime awakenings and daytime sleepiness, results which also align with those of other studies (e.g., [63,64,67,68]). Therefore, our findings point towards a multifaceted impact of screen use on preschoolers' sleep, such that those presenting greater exposure to screens are the most likely to have shorter duration and poorer quality of sleep.…”

“…Shorter sleep duration than recommended is significantly related to internalizing and externalizing problems in various studies [60][61][62][63], although these associations are less clear in the case of internalizing behaviors. Wu et al [61], for example, find that children whose sleep duration was lower than the group mean presented a greater risk of behavioral problems and hyperactivity, but report no significant increase in the risk of emotional symptoms.…”

“…Direct exposure is consistently associated with shorter total sleep duration, both as measured by actigraphy [54] and by parent reports [49,55,59]. Positive associations are also found between prolonged exposure and increased daytime sleepiness [58,59,62], increased onset latency [55], increased bedtime resistance [58], and parasomnias [62]. Environmental or passive exposure is also associated with lower total sleep duration [49] and increased daytime sleepiness [59].…”