Trajectories of Actigraphy-Derived Sleep Duration, Quality, and Variability from Childhood to Adolescence: Downstream Effects on Mental Health.

STUDY OBJECTIVES: We examined growth trajectories of four actigraphy-derived sleep parameters (sleep minutes, sleep efficiency, and variability in sleep minutes and efficiency across a week of assessments) across childhood and adolescence and examined individual differences in trajectories according to participants' race/ethnicity and sex. We also assessed the predictive effect of growth trajectories of sleep parameters on growth trajectories of mental health outcomes and moderation by race and sex. METHOD: Youth (N=199, 49% female, 65% White, 32% Black, 3% biracial) and their parents participated in five waves of data (M ages were 9, 10, 11, 17, and 18 across waves). Participants were from a diverse range of socioeconomic backgrounds. RESULTS: Across participants, sleep minutes, sleep efficiency, and variability in sleep minutes and efficiency demonstrated significant linear change across childhood and adolescence. Whereas sleep duration shortened over time, sleep efficiency improved. Youth exhibited increases in night-to-night variability in sleep minutes and reductions in night-to-night variability in sleep efficiency. Highlighting the importance of individual differences, some race- and sex-related effects emerged. Black youth and male youth experienced steeper declines in their sleep duration across development relative to their respective counterparts. Black youth also demonstrated smaller improvements in sleep efficiency and greater variability in sleep efficiency compared to White youth. Finally, trajectories of sleep efficiency and variability in sleep minutes predicted trajectories of internalizing symptoms and externalizing behaviors. CONCLUSIONS: Findings showed significant changes in developmental trajectories of four sleep parameters across childhood and adolescence. We discuss empirical and translational implications of the findings.

Socioeconomic Disparities, Nighttime Bedroom Temperature, and Children's Sleep.

We investigated associations between family income-to-needs, nighttime bedroom temperature (NBT), and children's sleep. Using a sample of 46 children (M age = 11.5), we recorded NBT and objective sleep parameters via actigraphy nightly for one week to evaluate within- (night-to-night) and between-person associations. We found consistent evidence for a curvilinear association between NBT and sleep variables at the between-person level, indicating that children who slept in rooms that were "too hot" or "too cold" experienced poorer sleep. Moreover, children in lower income-to-needs families had more extreme NBTs. There was some evidence that family income-to-needs is indirectly related to sleep via NBT, but with interpretational caveats. These findings point to NBT as a potentially modifiable variable, which has implications for practical applications to mitigate effects of socioeconomic disparities on children's sleep.

Sleep and disparities in child and adolescent development.

Sleep is a robust predictor of child and adolescent development. Race/ethnicity, socioeconomic status (SES), and related experiences (e.g., discrimination) are associated with sleep, but researchers have just begun to understand the role of sleep in the development of racial/ethnic and SES disparities in broader psychosocial adjustment and cognitive functioning during childhood and adolescence. In this article, we discuss poor sleep as a potential mechanism contributing to the development of such disparities, and better sleep as a potential protective factor that diminishes such disparities. We conclude by offering recommendations for research to advance understanding of sleep as a key bioregulatory system that may underlie or protect against detrimental developmental outcomes related to socioeconomic adversity and belonging to a historically minoritized group.

The development of a scale to assess children's and adolescents' sleep environments.

STUDY OBJECTIVES: To develop a measure of children's sleep environments and to assess its initial reliability and validity. METHODS: This cross-sectional study consisted of an online survey for parents of children ages 5-18 years across the United States. A total of 840 parents/caregivers (Mage = 40.6 years, standard deviation = 8.6; 72.0% female) completed surveys regarding a target child (Mage = 10.4 years, standard deviation = 3.8). The items on the scale that was developed were evaluated with exploratory and confirmatory factor analyses in separate random sample halves of the dataset. Cronbach's alpha coefficients were calculated to assess internal consistency across multiple demographic groups. We explored convergent and discriminant validity by examining associations with measures from the nomological net of constructs surrounding the children's sleep environment. Finally, we examined incremental/unique predictive validity of the full scale and its subscales through regression analyses. RESULTS: The Children's and Adolescents' Sleep Environment Scale (13 items) produced 3 factors: general environmental hazards (7 items), availability of bedding materials (2 items), and presence of electronics (4 items). The full scale and its subscales showed strong discriminant validity, and analyses suggested that the Children's and Adolescents' Sleep Environment Scale and its subscales were generalizable across diverse demographic groups. Finally, after controlling for children's sleep hygiene, sleep disturbances, behavioral problems, and family functioning, the full-scale Children's and Adolescents' Sleep Environment Scale significantly predicted children's sleepiness, as did the general environmental hazards and presence of electronics subscales in a separate regression analysis. CONCLUSIONS: The Children's and Adolescents' Sleep Environment Scale shows strong psychometric properties and has emerged as both a reliable and valid indicator of children's and adolescents' sleep environments and their potential impact on children's sleep and sleep-related behavior. CITATION: Peltz JS, Rogge RD, Elmore-Staton L, Spilsbury J, Buckhalt JA. The development of a scale to assess children's and adolescents' sleep environments. J Clin Sleep Med. 2022;18(10):2353-2365.

Linear and nonlinear associations between the sleep environment, presleep conditions, and sleep in adolescence: moderation by race and socioeconomic status.

OBJECTIVE/BACKGROUND: The role of the sleep environment and presleep conditions that may influence adolescents' sleep are understudied. The aims of the current study were to examine linear and nonlinear associations between the sleep environment and presleep conditions and adolescents' daytime sleepiness and sleep/wake problems. METHOD: Participants included 313 adolescents (Mage = 17.39 years, SD = 10.38 months; 51.4% girls, 48.6% boys; 59.1% White/European American, 40.3% Black/African American) from a wide range of socioeconomic backgrounds living in the southeastern United States. Adolescents completed surveys assessing the sleep environment (eg, light, bedding), four presleep conditions (ie, general worries, family concerns, arousal, somatic complaints), and sleep (daytime sleepiness, sleep/wake problems). RESULTS: Sleep environment disruptions and worse presleep conditions were positively associated with sleepiness and sleep/wake problems in a linear fashion. Nonlinear associations emerged such that levels of sleepiness increased rapidly between low and average levels of the sleep environment and two presleep conditions (worries, arousal); the slope leveled off between average and high levels. Moreover, linear effects of environmental disruptions, family concerns, somatic complaints, and presleep arousal on sleep/wake problems were moderated by race and/or SES, indicating that positive associations between some presleep conditions and sleep/wake problems were more pronounced for Black and lower SES youth. CONCLUSIONS: Results support the importance of the sleep environment and multiple presleep conditions and assessments of both linear and nonlinear effects for a better understanding of factors that may contribute to sleep. Additionally, results indicate the sleep environment and some presleep conditions may be more consequential for disadvantaged youth.

Equal Benefits? An Examination of the Potential Consequences of Later School Start Times for Adolescents and Their Mental Health.

BACKGROUND: Given the documented benefits of later school start times on adolescents' mental health, the aim of the current study was to examine if the association between school start times and depressive symptoms differed across adolescents from families of different socioeconomic status levels. METHODS: Using a cross-sectional design, the current study incorporated an online survey for high school students and their parents across the United States, with average sleep duration measured through a 7-day sleep diary. A total of 193 adolescent (Meanage  = 15.7 years old, SD = .94; 54.4% female; 71% white) and parent (Meanage  = 47.6 years old, SD = 5.4; 80% female; 79% white) dyads participated. Adolescents reported on depressive symptoms, sleep quality and duration, chronotype, and demographic covariates; parents reported on school start times and socioeconomic status. RESULTS: Results suggested that only in adolescents from higher socioeconomic status families (+1 SD) did the association between later start times and fewer depressive symptoms emerge as significant. CONCLUSIONS: Although more school start times research is needed to understand its impact across diverse groups of students, current findings suggest a disproportionate benefit of reduced depression for youth from families of higher socioeconomic status with having a later start time.

Longitudinal relations between sleep and cognitive functioning in children: Self-esteem as a moderator.

Short and poor-quality sleep disrupt cognitive functioning, yet associations vary across studies, underscoring the importance of examining individual differences and moderators of risk. Utilizing a multi-method, two-wave longitudinal design, we examined self-esteem as a moderator of relations between actigraphy-derived sleep duration (minutes) and quality (efficiency, long-wake episodes) and children's cognitive functioning 1 year later. During the first study wave (T1), participants were 243 children (47% female) with a mean age of 10.4 years (SD = 8.0 months). The sample was representative of its community, with 37% identifying as Black/African American and 63% White/European American. Children completed a self-esteem measure and wore actigraphs for seven consecutive nights. Participants returned to the lab 1 year later and completed a standardized assessment of cognitive functioning. Results indicated that self-esteem moderated longitudinal associations between sleep quality and cognitive functioning. Specifically, children with both better sleep quality and higher self-esteem performed better relative to other children in the sample.

Sleep and development in adolescence in the context of socioeconomic disadvantage.

INTRODUCTION: Sleep problems are associated with negative developmental outcomes in youth, and identification of vulnerability and protective factors is needed to explicate for whom and under which conditions adolescents may be most at risk. Towards this end, we examined socio-economic status (SES) as a moderator of associations between multiple sleep parameters and adolescents' socio-emotional adjustment and cognitive functioning. METHODS: Participants were 272 adolescents (M age = 17.3 years; 49% girls) and their parents, residing in the Southeastern U.S.A. The sample was socioeconomically diverse and included 41% Black/African American and 59% White/European American youth. Using a cross-sectional design, adolescents' sleep was assessed with actigraphy (total sleep minutes; efficiency indicated by % of time asleep from sleep onset to wake time) and self-reports of sleep quality (sleep-wake problems). Mothers reported on youths' internalizing and externalizing symptoms, and cognitive functioning was assessed with a standardized test battery. RESULTS: Moderation effects were found and illustrated that, for youth from families with lower SES, shorter and less efficient sleep and subjective sleep problems were associated with higher levels of internalizing and externalizing symptoms as well as lower cognitive performance. Conversely, longer and better-quality sleep protected against socio-emotional and cognitive difficulties otherwise observed for socioeconomically disadvantaged youth. Fewer relations between sleep and adjustment emerged for adolescents from families with higher SES. CONCLUSIONS: Results reinforce a growing literature indicating that the relation between sleep and adjustment is stronger for youth from families with lower SES, who may especially benefit from better sleep.

Socioeconomic status and sleep in adolescence: The role of family chaos.

Low socioeconomic status (SES) has been associated with poor sleep in youth, yet mechanisms underlying this association are not well-understood. The present study examined greater chaos as a mediator of associations between low SES and 2 indices of poor sleep. Two hundred fifty-two adolescents (53% girls; 66% White/European American, 34% Black/African American) participated in the 3-wave longitudinal study. The sample was socioeconomically diverse. At age 16, parents reported on 2 indices of SES: family income and perceived economic well-being. Adolescents reported on chaos within their family at age 17 and on 2 key sleep-wake processes-sleep quality and daytime sleepiness-at age 18. Family chaos functioned as a mediating or intervening variable in longitudinal associations between lower SES and both poorer sleep quality and greater daytime sleepiness. The findings suggest the potential utility of targeting family level processes that exemplify chaos, such as unpredictability, noise, and interruptions, to improve sleep among adolescents. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Linear and Nonlinear Associations between Sleep and Adjustment in Adolescence.

BACKGROUND & OBJECTIVES: A growing body of work supports linear associations between sleep and socioemotional adjustment in adolescence. However, associations between sleep and adjustment are not necessarily linear and investigations of nonlinear effects are scarce. This study examined linear and nonlinear relations between several sleep-wake parameters and externalizing behavior and internalizing symptoms in adolescence, and assessed the role of adolescent sex as a moderator of effects. PARTICIPANTS: Participants were high school students (N = 180; M age = 17.49, SD = .62; 59% female; 68% White/European American, 32% Black/African American) from a wide range of socio-economic backgrounds living in semirural communities and small towns in Alabama. METHODS: Sleep-wake parameters were indexed by actigraphy-derived sleep minutes and adolescents' reports on morningness-eveningness (circadian preference), sleep-wake problems (sleep quality), and sleepiness. Adolescents completed questionnaires on externalizing behaviors and internalizing symptoms. RESULTS: Controlling for sleep duration, a higher preference for eveningness and poor sleep quality were associated in a linear fashion with increased externalizing and internalizing symptoms. Nonlinear relations between sleepiness and internalizing symptoms emerged with pronounced sex-related effects, including somewhat delayed accelerating relations for males and rapidly accelerating associations that tended to plateau for females. CONCLUSIONS: Results illustrate the importance of examining multiple sleep-wake and adjustment variables as well as linear and nonlinear associations.

Community violence concerns and adolescent sleep: Physiological regulation and race as moderators.

Prior work has demonstrated that greater community violence concerns are associated with poor sleep quality among adolescents. However, these effects may not be uniform across all youth. The present study examined the role of individual difference variables, physiological regulation and race, as moderators of risk in the relation between adolescents' community violence concerns and their sleep. Adolescents (N = 219; 55.3% female; 69.9% White/European American, 30.1% Black/African American) participated in the study when they were 18 years old (M = 17.7 years, SD = 1.0). Physiological regulation was assessed via respiratory sinus arrhythmia, a measure of parasympathetic regulation, at rest and in response to a stressor. Adolescents wore actigraphs for 7 nights to assess their sleep duration and quality, and reported on their community violence concerns via a well-validated questionnaire. Results demonstrated a consistent pattern of interactions, such that African American adolescents who showed less adaptive patterns of regulating physiological arousal experienced shorter sleep duration and poorer sleep quality in the context of greater community violence concerns. Community violence concerns were not associated with sleep for White adolescents. The findings may suggest that race-related stressors exacerbate risk for poor sleep among African American adolescents who experience more community violence concerns and have more difficulty regulating physiological arousal. Coping strategies for managing stress and arousal may be helpful for improving sleep for some youth.

What does a good night's sleep mean? Nonlinear relations between sleep and children's cognitive functioning and mental health.

STUDY OBJECTIVES: We attempted to identify the duration and quality of sleep associated with the optimal child outcomes in key developmental domains including cognitive functioning, academic performance, and mental health. In doing so, we examined nonlinear associations between the sleep and developmental variables. Based on racial/ethnic disparities in children's sleep, we assessed this variable as a moderator of examined relations. METHODS: Two hundred eighty-two children participated (Mage = 9.4 years, SD = .72; 52% boys; 65% white/European American, 35% black/African American). Sleep was examined with actigraphy for seven consecutive nights and with self-reports. Actigraphy-based sleep duration (minutes) and quality (efficiency), as well as self-reported sleep quality were derived. Children reported on their mental health and were administered cognitive performance tests. Mothers and teachers reported on children's mental health; teachers also reported on academic functioning. Schools provided academic achievement data. RESULTS: Sleep duration had an accelerating nonlinear negative association with externalizing behaviors. Nonlinear associations were also detected between both actigraphy-derived and subjective reports of sleep quality and multiple developmental domains including academic functioning and mental health and the best functioning corresponded with the highest levels of sleep quality. Emphasizing the importance of individual differences, several examined associations were moderated by race/ethnicity. CONCLUSIONS: Sleep duration and quality emerged as nonlinear predictors of multiple domains of child development. Findings illustrate that the benefits of longer and better-quality sleep did not taper off and that assessments of nonlinear relations may enhance understanding of the nature of associations between sleep and child functioning.

Sleepiness as a pathway linking race and socioeconomic status with academic and cognitive outcomes in middle childhood.

OBJECTIVES: This study examined self-reported sleepiness as a pathway of effects underlying racial and socioeconomic disparities in children's academic and cognitive performance. DESIGN: The study design was longitudinal, and path modeling was used to test study hypotheses. SETTING: Data were collected from participants residing in semirural communities and small towns surrounding Auburn, AL. PARTICIPANTS: Children (N = 282; 52% boys) participated in the study when they were 9 (M = 9.44, SD = .71) and 11 (M = 11.33, SD = .69) years old. The sample was 65% White/European American and 35% Black/African American. The majority of the children (63%) were living at or below the poverty line. MEASUREMENTS: At age 9, children reported on their daytime sleepiness over the prior 2 weeks. At ages 9 and 11, children completed cognitive assessments in the laboratory, teachers reported on children's academic functioning, and schools provided state (Alabama) standardized test scores. RESULTS: African American children and children from lower socioeconomic status homes reported greater sleepiness. Greater sleepiness, in turn, predicted lower academic functioning, cognitive performance, and Alabama standardized test scores. Sleepiness was a significant intervening variable, but not a mediator, in these pathways. Race was a stronger predictor of sleepiness than socioeconomic status when both were entered in the same model. CONCLUSIONS: Results highlight sleepiness as a pathway of effects linking race and socioeconomic status to academic and cognitive outcomes. Psychoeducation targeting sleepiness for African American and lower-socioeconomic status children may be beneficial for boosting achievement.

The link between maternal sleep and permissive parenting during late adolescence.

Utilizing a multi-method design, the present study examined the association between maternal sleep, assessed via actigraphy and self-reports, and permissive parenting (e.g. lax, inconsistent discipline) during adolescence, as well as the extent to which this association differed by mothers' race/ethnicity and socioeconomic status. The sample was comprised of 234 mothers (M age = 41.76 years, SD = 6.25; 67% European-American, 31% African-American, 2% other race/ethnicities) and 237 adolescents (113 boys, 124 girls; M age = 15.80 years, SD = 0.80; 66% European-American, 34% African-American). Mothers' sleep duration (actual sleep minutes) and quality (sleep efficiency, latency, long wake episodes) were assessed using actigraphy. Mothers also reported on their sleep problems and adolescents reported on mothers' permissive parenting behaviours. Results revealed that actigraphy-based longer sleep duration and shorter sleep latency were associated with lower levels of permissive parenting. Further, mothers' race/ethnicity and socioeconomic status moderated the association between actigraphy-based sleep quality (i.e. sleep efficiency, long wake episodes) and permissive parenting. Specifically, a negative association between sleep efficiency and permissive parenting was evident only for African-American mothers. In addition, a positive association between more frequent night wakings and permissive parenting was evident only for mothers from lower socioeconomic status households. The findings highlight the benefits of longer and higher-quality sleep for reducing the risk of permissive parenting, especially among ethnic minority mothers and mothers from lower socioeconomic status households.

Sleep and cognitive functioning in childhood: Ethnicity, socioeconomic status, and sex as moderators.

We examined children's sleep at age 9 as a predictor of developmental trajectories of cognitive performance from ages 9 to 11 years. The effects of sleep on cognition are not uniform and thus we tested race/ethnicity, socioeconomic status (SES), and sex as moderators of these associations. At the first assessment, 282 children aged 9.44 years (52% boys, 65% European American [EA], 35% African American [AA]) participated. Two more waves of data collection spaced 1 year apart followed. The majority of children (63%) were living at or below the poverty line. Children's sleep was measured objectively with actigraphy and 2 well-established sleep parameters were derived: duration, indexed by sleep minutes between sleep onset and wake time, and quality, indexed by efficiency. Multiple cognitive functioning domains were examined with the Woodcock Johnson Tests of Cognitive Abilities (WJ III). Across the sample, higher sleep efficiency, but not duration, was associated with better cognitive performance. Significant moderation effects emerged. Controlling for SES, AA children scored lower on general intellectual ability and working memory (WM) at age 11 only if they experienced lower sleep efficiency at age 9. Further, boys scored lower on general abilities and processing speed (PS) at age 11 only if their sleep efficiency was lower at age 9. Findings indicate that lower sleep efficiency may contribute to lower cognitive functioning especially for AA children and boys. These vulnerabilities appear to emerge early in development and are maintained over time. Results underscore the importance of individual differences in explicating relations between sleep and children's cognitive performance. (PsycINFO Database Record

Community violence concerns and adolescent sleep.

OBJECTIVE: The goal of this study was to examine links between concerns about community violence and objective and subjective sleep parameters in an adolescent sample. Sex was considered as a moderator of effects. DESIGN: The study used a cross-sectional design. PARTICIPANTS: The community-based sample included 252 adolescents (53% girls) with an average age of 15.79 years (SD = 0.81) from the Southeastern United States. The sample included 34% African American and 66% European American adolescents from a wide range of socioeconomic backgrounds. MEASUREMENTS: Adolescent-reported community violence concerns were assessed using a composite of 3 separate subscales that measured perceived community safety and threats of community and school violence. Sleep duration and quality were assessed using actigraphy, and subjective sleep problems and daytime sleepiness were measured with subscales of the School Sleep Habits Survey. RESULTS: Community violence predicted lower sleep efficiency, more long-wake episodes, and more sleep/wake problems and sleepiness. Sex-related moderation effects revealed that girls in the sample were more vulnerable to the effects of violence concerns on their objective sleep quality. CONCLUSIONS: Findings highlight the role of community violence concerns on adolescents' sleep, revealing that greater community violence concerns are linked with lower levels of actigraphy-based and subjective reports of sleep quality, particularly for adolescent girls. Consideration of the mechanisms by which violence concerns may affect sleep is discussed.

Perceived discrimination and youths' adjustment: sleep as a moderator.

Adolescents' sleep duration was examined as a moderator of the association between perceived discrimination and internalizing (anxiety, depression) and externalizing symptoms. Participants were 252 adolescents (mean: 15.79 years; 66% European American, 34% African American) who reported on their perceived discrimination (racial and general) and adjustment. Sleep duration was measured using actigraphy. Moderation effects were evident. The lowest levels of internalizing symptoms were observed for adolescents with longer sleep duration in conjunction with lower levels of perceived racial discrimination. Further, general perceived discrimination was associated more strongly with externalizing behaviours for youth with shorter versus longer sleep. Findings highlight the importance of sleep as a bioregulatory system that can ameliorate or exacerbate the effects of discrimination on youths' adjustment.

Associations between children's intelligence and academic achievement: the role of sleep.

Sleep problems (long wake episodes, low sleep efficiency) were examined as moderators of the relation between children's intelligence and academic achievement. The sample was comprised of 280 children (55% boys; 63% European Americans, 37% African Americans; mean age = 10.40 years, SD = 0.65). Sleep was assessed during seven consecutive nights of actigraphy. Children's performance on standardized tests of intelligence (Brief Intellectual Ability index of the Woodcock-Johnson III) and academic achievement (Alabama Reading and Math Test) were obtained. Age, sex, ethnicity, income-to-needs ratio, single parent status, standardized body mass index, chronic illness and pubertal development were controlled in analyses. Higher intelligence was strongly associated with higher academic achievement across a wide range of sleep quality. However, the association between intelligence and academic achievement was slightly attenuated among children with more long wake episodes or lower sleep efficiency compared with children with higher-quality sleep.