Lisa Matricciani

In search of lost sleep: Secular trends in the sleep time of school-aged children and adolescents

BACKGROUND Sleep deficits are associated with a wide range of detrimental physical and mental health outcomes. There is concern that children are not getting enough sleep, and that sleep duration has been declining. However, evidence is sparse. METHODS A systematic review of world literature was conducted to locate studies reporting the sleep duration of children aged 5-18 years. Monte Carlo simulation was used to generate pseudodata from summary data, which were combined with raw data and analysed by linear regression of sleep duration on year of measurement at the age × sex × day type × country level. RESULTS Data were available on 690,747 children from 20 countries, dating from 1905 to 2008. From these data, 641 regressions were derived. The sample-weighted median rate of change was -0.75 min nightly per year, indicating a decrease of more than 1 h per night over the study period. Rates of change were negative across age, sex and day type categories, but varied according to region, with Europe, the USA, Canada and Asia showing decreases and Australia, the UK and Scandinavia showing increases. CONCLUSION Over the last 103 years, there have been consistent rapid declines in the sleep duration of children and adolescents.

Never Enough Sleep: A Brief History of Sleep Recommendations for Children

BACKGROUND AND OBJECTIVE: There is a common belief that children are not getting enough sleep and that children’s total sleep time has been declining. Over the century, many authors have proposed sleep recommendations. The aim of this study was to describe historical trends in recommended and actual sleep durations for children and adolescents, and to explore the rationale of sleep recommendations. METHODS: A systematic literature review was conducted to identify recommendations for children’s sleep requirements and data reporting children’s actual total sleep time. For each recommendation identified, children’s actual sleep time was determined by identifying studies reporting the sleep duration of children of the same age, gender, and country in the same years. Historical trends in age-adjusted recommended sleep times and trends in children’s actual sleep time were calculated. A thematic analysis was conducted to determine the rationale and evidence-base for recommendations. RESULTS: Thirty-two sets of recommendations were located dating from 1897 to 2009. On average, age-specific recommended sleep decreased at the rate of –0.71 minute per year. This rate of decline was almost identical to the decline in the actual sleep duration of children (–0.73 minute per year). Recommended sleep was consistently ∼37 minutes greater than actual sleep, although both declined over time. CONCLUSIONS: A lack of empirical evidence for sleep recommendations was universally acknowledged. Inadequate sleep was seen as a consequence of “modern life,” associated with technologies of the time. No matter how much sleep children are getting, it has always been assumed that they need more.

Sleep duration or bedtime? Exploring the relationship between sleep habits and weight status and activity patterns.

STUDY OBJECTIVES To assess the effects of early and late bedtimes and wake up times on use of time and weight status in Australian school-aged children. DESIGN Observational cross-sectional study involving use of time interviews and pedometers. SETTING Free-living Australian adolescents. PARTICIPANTS 2200 9- to 16-year-olds from all states of Australia INTERVENTIONS NA. MEASUREMENTS AND RESULTS Bedtimes and wake times were adjusted for age and sex and classified as early or late using median splits. Adolescents were allocated into 4 sleep-wake pattern groups: Early-bed/Early-rise; Early-bed/Late-rise; Late-bed/Early-rise; Late-bed/Late-rise. The groups were compared for use of time (screen time, physical activity, and study-related time), sociodemographic characteristics, and weight status. Adolescents in the Late-bed/Late-rise category experienced 48 min/d more screen time and 27 min less moderate-to-vigorous physical activity (MVPA) (P<0.0001) than adolescents in the Early-bed/Early-rise category, in spite of similar sleep durations. Late-bed/Late-rise adolescents had a higher BMI z-score (0.66 vs. 0.45, P=0.0015). Late-bed/Late-rise adolescents were 1.47 times more likely to be overweight or obese than Early-bed/Early-rise adolescents, 2.16 times more likely to be obese, 1.77 times more likely to have low MVPA, and 2.92 times more likely to have high screen time. Late-bed/Late-rise adolescents were more likely to come from poorer households, to live in major cities, and have fewer siblings. CONCLUSIONS Late bedtimes and late wake up times are associated with an unfavorable activity and weight status profile, independent of age, sex, household income, geographical remoteness, and sleep duration.

Sleep duration or bedtime? Exploring the association between sleep timing behaviour, diet and BMI in children and adolescents.

Objective:To determine whether sleep timing behaviour is associated with energy intake and diet quality in children and adolescents.Design:Cross-sectional analysis of nationally representative survey data.Sample:A total of 2200 participants of the 2007 Australian National Children’s Nutrition and Physical Activity Survey aged 9–16 years with 2 days of food intake data, 4 days of use of time data and complete anthropometry. Participants were grouped into one of four sleep–wake behaviour categories: early bed–early rise (EE); early bed–late rise (EL); late bed–early rise (LE) and late bed–late rise (LL). The four categories were compared for body mass index (BMI) z-score, energy intake and diet quality assessed using the Dietary Guideline Index for Children and Adolescents. Analyses were adjusted for survey design, sociodemographic characteristics, sleep duration and physical activity level (PAL).Results:In adjusted multivariate regression models with sleep timing behaviour group as the independent variable, the ‘LL’ category compared with the ‘EE’ category had a higher BMI z-score (β=0.20, 95% confidence interval (CI) 0.06 to 0.34, P=0.007), and lower diet quality (β=−4.0, 95% CI −5.7 to −2.3, P<0.001). Children and adolescents who went to bed late also had a higher intake of extra foods (that is, energy-dense, nutrient-poor foods) while those whom went to bed early consumed more fruit and vegetables. Energy intake was associated with sleep duration (β=−4.5 kJ, 95% CI −6.7 to −2.4, P<0.001), but not sleep timing behaviour.Conclusion:Late bedtimes and late wake up times are associated with poorer diet quality, independent of sleep duration, PAL and child and sociodemographic characteristics.

Children's sleep needs: is there sufficient evidence to recommend optimal sleep for children?

It is widely recognized that sleep is important for childrens health and well-being and that short sleep duration is associated with a wide range of negative health outcomes. Recently, there has been much interest in whether or not there are sufficient data to support the specific recommendations made for how much sleep children need. In this article we explore concepts related to childrens sleep need, discuss the theory, rationale, and empirical evidence for contemporary sleep recommendations, and outline future research directions for sleep recommendations. If sleep is to be treated as a therapeutic intervention, then consensus guidelines, statements, and evidence-based best-practice documents are needed to underpin sleep recommendations for children.

Can a school-based sleep education programme improve sleep knowledge, hygiene and behaviours using a randomised controlled trial.

OBJECTIVES The present study investigated the effectiveness of a school-based sleep education programme in improving key sleep behaviours, sleep knowledge, and sleep hygiene. DESIGN AND METHODS A cross-sectional cluster-randomised controlled trial with two groups (Intervention and Control) and three assessment time points [baseline, immediately post intervention (6 weeks post baseline) and follow-up (18 weeks post baseline)] was employed. A total of 296 students (mean age = 12.2 ± 0.6 years; 59% female) from 12 schools in Adelaide, South Australia, were recruited, with 149 participants in the Intervention group and 147 in the Control group. The intervention consisted of four classroom lessons delivered at weekly intervals, followed by a group project on sleep topics, which students presented at a parental information evening. Sleep patterns were assessed objectively (actigraphy, n = 175) and subjectively (time-use recall, n = 251) at three time points. Sleep knowledge and sleep hygiene (n = 296) were also measured. RESULTS Generalised estimating equations were used to compare changes in the Intervention and Control groups. The programme increased time in bed by 10 min (p = 0.03) for the Intervention group relative to the Control group, due to a 10-min delay in wake time (p = 0.00). These changes were not sustained at follow-up. There was no impact on sleep knowledge or sleep hygiene. CONCLUSION Investment in the sleep health of youth through sleep education is important but changes to sleep patterns are difficult to achieve. More intensive programmes, programmes with a different focus or programmes targeting different age groups may be more effective.

Sixty-Five Years of Physical Therapy: Bibliometric Analysis of Research Publications From 1945 Through 2010

Background The generation of research can be likened to the production of consumer goods, with a producer (the study authors and funders), a product (the study and publications arising from it), and consumers (those who read and cite the published study). Objective The aim of this study was to use bibliometric indexes to track changes in the producers, products, and consumers of the journal Physical Therapy from 1945 through 2010. Design An analysis of published manuscripts (excluding letters, editorials, corrections, commentaries, and book reviews) in Physical Therapy was performed using a reliable bibliometric audit tool. Articles were sampled every 3 months and at 5-year intervals over a 65-year period. Information relating to authorship, the research methods used, and citation patterns was collected. Data were analyzed descriptively. Results There have been substantial shifts in the nature of research published over the last 65 years in Physical Therapy. In 1945, the typical paper was anecdotal and authored by 1.4 American authors (working in hospitals), and consisted of 4 pages and 4 references. In 2010, the typical paper used a cross-sectional survey or randomized controlled trial design, with 4.6 multinational authors (working in universities), and consisted of 12 pages and 49 references. Limitations Findings are specific to the articles published in Physical Therapy that were sampled in this bibliometric analysis. Conclusions The changes seen in the research published in Physical Therapy mirror the shifts that have occurred in other industries: increasing quantification, standardization, collaboration, and internationalization. These trends are likely to continue in the future.

Who Cares About Foot Care? Barriers and Enablers of Foot Self-care Practices Among Non-Institutionalized Older Adults Diagnosed With Diabetes: An Integrative Review

Purpose Appropriate and timely foot self-care practices may prevent diabetes-related foot complications. However, self-care practices are often neglected, particularly by older adults. The purpose of this study was to conduct an integrative, systematic literature review of the psychosocial barriers and enablers of foot self-care practices among older adults diagnosed with diabetes. Methods An integrative, systematic literature review and a deductive thematic analysis was conducted to determine psychosocial barriers and enablers of foot self-care practices among older adults. Results A total of 130 different studies were retrieved from the search strategy. From these, 9 studies were identified and included for review. Physical ability, perceived importance, patient knowledge, provision of education, social integration, risk status, and patient-provider communication were identified as key barriers and enablers of foot self-care. Participants at high risk of foot complications were found to perceive themselves at greater risk of complications, receive more education, and engage in better overall foot self-care practices compared to those at low risk of foot complications. Conclusion Foot self-care practices appear underutilized as primary prevention measures by older adults and are instead adopted only once complications have already occurred. Likewise, facilitators of foot self-care practices, such as education, appear to be reserved for individuals who have already developed foot complications. Health care professionals such as diabetes educators, podiatrists, and general practitioners may play an important role in the prevention of foot complications among older adults by recognizing, referring, and providing early education to older adults.

Past, present, and future: trends in sleep duration and implications for public health

&NA; Sleep is important for the physical, social and mental well‐being of both children and adults. Over the years, there has been a general presumption that sleep will inevitably decline with the increase in technology and a busy 24‐hour modern lifestyle. This narrative review discusses the empirical evidence for secular trends in sleep duration and the implications of these trends.

Investigating Individual- and Area-Level Socioeconomic Gradients of Pulse Pressure among Normotensive and Hypertensive Participants

Socioeconomic status is a strong predictor of cardiovascular disease. Pulse pressure, the difference between systolic and diastolic blood pressure, has been identified as an important predictor of cardiovascular risk even after accounting for absolute measures of blood pressure. However, little is known about the social determinants of pulse pressure. The aim of this study was to examine individual- and area-level socioeconomic gradients of pulse pressure in a sample of 2,789 Australian adults. Using data from the North West Adelaide Health Study we estimated the association between pulse pressure and three indices of socioeconomic status (education, income and employment status) at the area and individual level for hypertensive and normotensive participants, using Generalized Estimating Equations. In normotensive individuals, area-level education (estimate: −0.106; 95% CI: −0.172, −0.041) and individual-level income (estimate: −1.204; 95% CI: −2.357, −0.050) and employment status (estimate: −1.971; 95% CI: −2.894, −1.048) were significant predictors of pulse pressure, even after accounting for the use of medication and lifestyle behaviors. In hypertensive individuals, only individual-level measures of socioeconomic status were significant predictors of pulse pressure (education estimate: −2.618; 95% CI: −4.878, −0.357; income estimate: −1.683, 95% CI: −3.743, 0.377; employment estimate: −2.023; 95% CI: −3.721, −0.326). Further research is needed to better understand how individual- and area-level socioeconomic status influences pulse pressure in normotensive and hypertensive individuals.