Avi Sadeh

Sleep, Neurobehavioral Functioning, and Behavior Problems in School-Age Children.

The aim of this study was to examine the associations between sleep and neurobehavioral functioning (NBF) in school-age children. These variables were assessed for 135 unreferred, healthy school children (69 boys and 66 girls), from second-, fourth-, and sixth-grade classes. Objective assessment methods were used on the participants in their regular home settings. Sleep was monitored using actigraphy for 5 consecutive nights; and NBF was assessed using a computerized neurobehavioral evaluation system, administered twice, at different times of the day. Significant correlations between sleep-quality measures and NBF measures were found, particularly in the younger age group. Children with fragmented sleep were characterized by lower performance on NBF measures, particularly those associated with more complex tasks such as a continuous performance test and a symbol-digit substitution test. These children also had higher rates of behavior problems as reported by their parents on the Child Behavior Checklist. These results highlight the association between sleep quality, NBF, and behavior regulation in child development; and raise important questions about the origins of these associations and their developmental and clinical significance.

The Effects of Sleep Restriction and Extension on School‐Age Children: What a Difference an Hour Makes

This study assessed the effects of modest sleep restriction and extension on childrens neurobehavioral functioning (NBF). The sleep of 77 children (age: M = 10.6 years; range = 9.1-12.2 years) was monitored for 5 nights with activity monitors. These children (39 boys and 38 girls) were all attending regular 4th- and 6th-grade classes. Their NBF was assessed using computerized tests on the 2nd day of their normal sleep schedule. On the 3rd evening, the children were asked to extend or restrict their sleep by an hour on the following 3 nights. Their NBF was reassessed on the 6th day following the experimental sleep manipulation. Sleep restriction led to improved sleep quality and to reduced reported alertness. The sleep manipulation led to significant differential effects on NBF measures. These effects may have significant developmental and clinical implications.

The role and validity of actigraphy in sleep medicine: An update

Activity-based sleep-wake monitoring or actigraphy has gained a central role as a sleep assessment tool in sleep medicine. It is used for sleep assessment in clinical sleep research, and as a diagnostic tool in sleep medicine. This update indicates that according to most studies, actigraphy has reasonable validity and reliability in normal individuals with relatively good sleep patterns. The validity of actigraphy in special populations or with individuals with poor sleep or with other sleep-related disorders is more questionable. The most problematic validity issue is the low specificity of actigraphy in detecting wakefulness within sleep periods reported with certain devices or samples. Overall, the recent literature adds to previous reports in demonstrating that actigraphy is sensitive in detecting unique sleep patterns associated with specific sleep disorders as well as with other medical or neurobehavioral disorders. Furthermore, actigraphy is sensitive in detecting sleep changes associated with drug treatments and non-pharmacologic interventions. Recent developments include the development of devices specially tailored to detect periodic limb movement in sleep and the introduction of new devices and algorithms. Because of the limitations of actigraphy, it is recommended to use complementary assessment methods (objective and subjective) whenever possible.

Sleep patterns and sleep disruptions in school-age children

This study assessed the sleep patterns, sleep disruptions, and sleepiness of school-age children. Sleep patterns of 140 children (72 boys and 68 girls; 2nd-, 4th-, and 6th-grade students) were evaluated with activity monitors (actigraphs). In addition, the children and their parents completed complementary sleep questionnaires and daily reports. The findings reflected significant age differences, indicating that older children have more delayed sleep onset times and increased reported daytime sleepiness. Girls were found to spend more time in sleep and to have an increased percentage of motionless sleep. Fragmented sleep was found in 18% of the children. No age differences were found in any of the sleep quality measures. Scores on objective sleep measures were associated with subjective reports of sleepiness. Family stress, parental age, and parental education were related to the childs sleep-wake measures.

Sleep, emotional and behavioral difficulties in children and adolescents.

Links between sleep and psychopathology are complex and likely bidirectional. Sleep problems and alteration of normal sleep patterns have been identified in major forms of child psychopathology including anxiety, depression and attention disorders as well as symptoms of difficulties in the full range. This review summarizes some key findings with regard to the links between sleep and associated difficulties in childhood and adolescence. It then proposes a selection of possible mechanisms underlying some of these associations. Suggestions for future research include the need to 1) use multi-methods to assess sleep; 2) measure sleep in large-scale studies; 3) conduct controlled experiments to further establish the effects of sleep variations on emotional and behavioral difficulties; 4) take an interdisciplinary approach to further understand the links between sleep and associated difficulties.

Parenting and infant sleep

Infant sleep undergoes dramatic evolution during the first year of life. This process is driven by underlying biological forces but is highly dependent on environmental cues including parental influences. In this review the links between infant sleep and parental behaviors, cognitions, emotions and relationships as well as psychopathology are examined within the context of a transactional model. Parental behaviors, particularly those related to bedtime interactions and soothing routines, are closely related to infant sleep. Increased parental involvement is associated with more fragmented sleep. Intervention based on modifying parental behaviors and cognitions have direct effect on infant sleep. It appears that parental personality, psychopathology and related cognitions and emotions contribute to parental sleep-related behaviors and ultimately influence infant sleep. However, the links are bidirectional and dynamic so that poor infant sleep may influence parental behaviors and poor infant sleep appears to be a family stressor and a risk factor for maternal depression.

Sleep and sleep ecology in the first 3 years: a web‐based study

This study was designed to provide data on sleep patterns during the first 3 years, based on a large US–Canada Internet sample, to assess the prevalence of parental interventions and related factors of infant sleep ecology and to evaluate the links between sleep ecology and sleep. Five thousand six parents completed a web‐based online questionnaire about their children, aged from birth to 36 months. The questionnaire included items pertaining to sleep patterns, sleep environment, sleep‐related parental interventions, sleep position, and demographic information. The results reflected clear sleep‐related developmental changes including a decrease in daytime sleep and total sleep time, as well as consolidation of sleep during the night, which was manifested in a decrease in night wakings and nocturnal wakefulness. Sleep ecology and parental behaviors significantly explained a portion of the variance in the child’s sleep patterns. Parental interventions that encourage independence and self‐soothing were associated with extended and more consolidated sleep, especially in comparison to more active interactions that were associated with shorter and more fragmented sleep. These findings provide parents and professionals reference data for assessing sleep in young children. Furthermore, the results provide information on specific ecological factors that are associated with increased risk for sleep problems.

Cross-cultural differences in infant and toddler sleep

BACKGROUND To characterize cross-cultural sleep patterns and sleep problems in a large sample of children ages birth to 36 months in multiple predominantly-Asian (P-A) and predominantly-Caucasian (P-C) countries. METHODS Parents of 29,287 infants and toddlers (predominantly-Asian countries/regions: China, Hong Kong, India, Indonesia, Korea, Japan, Malaysia, Philippines, Singapore, Taiwan, Thailand, Vietnam; predominantly-Caucasian countries: Australia, Canada, New Zealand, United Kingdom, United States) completed an internet-based expanded version of the Brief Infant Sleep Questionnaire. RESULTS Overall, children from P-A countries had significantly later bedtimes, shorter total sleep times, increased parental perception of sleep problems, and were more likely to both bed-share and room-share than children from P-C countries, p<.001. Bedtimes ranged from 19:27 (New Zealand) to 22:17 (Hong Kong) and total sleep time from 11.6 (Japan) to 13.3 (New Zealand) hours, p<.0001. There were limited differences in daytime sleep. Bed-sharing with parents ranged from 5.8% in New Zealand to 83.2% in Vietnam. There was also a wide range in the percentage of parents who perceived that their child had a sleep problem (11% in Thailand to 76% in China). CONCLUSIONS Overall, children from predominantly-Asian countries had significantly later bedtimes, shorter total sleep times, increased parental perception of sleep problems, and were more likely to room-share than children from predominantly-Caucasian countries/regions. These results indicate substantial differences in sleep patterns in young children across culturally diverse countries/regions. Further studies are needed to understand the basis for and impact of these interesting differences.

Sleep and Psychological Characteristics of Children on a Psychiatric Inpatient Unit

OBJECTIVE To assess the association of objective measures of sleep-wake patterns and psychological status and abuse history of children hospitalized in a psychiatric inpatient unit. METHOD Thirty-nine inpatient children participated in the study. They were monitored for one to three consecutive nights with miniature wrist activity monitors for objective assessment of sleep-wake patterns. In addition, a thorough psychiatric and psychosocial assessment was completed with each child and the parents. RESULTS Childrens self-ratings of depression, hopelessness, and low self-esteem were significantly correlated with objective sleep measures indicating poorer sleep quality. No significant correlations between intelligence scores and sleep measures were found. Nonabused and sexually abused children had better sleep quality than physically abused children. CONCLUSIONS Sleep quality during hospitalization is strongly associated with self experiences of depression, hopelessness, and low self-esteem in children with severe behavior disorders.

Sleep Patterns and Sleep Disruptions in Kindergarten Children

Assessed sleep patterns and sleep disruptions in kindergarten children and investigated the relation between sleep measures derived from objective and subjective evaluation methods. The sleep patterns of 59 normal kindergarten children (mean age = 5.5 years) were monitored for 4 to 5 consecutive nights by means of activity monitors (actigraph) and by means of parental daily sleep logs. The correlation between the actigraphic measures and the daily parental logs indicated that parents were accurate reporters of sleep schedule measures. However, parents were less accurate in assessing sleep quality measures, significantly underestimating the number of night-wakings and overestimating the quality of their childrens sleep. Fragmented sleep was found, by means of activity monitoring, in 41% of the children.