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OBJECTIVES: At the peak of COVID-19, adolescent life was disrupted as schools adapted their instructional approaches such as online, in-person, or hybrid instruction. We and others have previously commented on how these shifts facilitated longer, later and (more developmentally appropriate) sleep. Here, we report how sleep contributed to associations between remote instruction and broader academic well-being (e.g., cognitive function, school connectedness, and stress). METHODS: Adolescents from all 50 U.S. states (n = 4068) completed online self-report surveys in fall 2020. Instructional approach was operationalized from fully in-person instruction to fully asynchronous online education. Sleep parameters included sleep timing and duration, sleep disturbances, and sleep-related impairments. Perceived academic well-being was defined as cognitive function, school connectedness, and school-related stress. Sleep and perceived academic well-being are examined across instructional approaches, in their association, and in structural models. RESULTS: Sleep and perceived academic well-being differed between hybrid and online instruction groups. Less variable or disturbed sleep was associated both with in-person instruction, and with positive outcomes in cognitive function, school connectedness, and stress domains. Sleep mediated a substantial portion of variance in perceived academic well-being attributable to instructional approach. CONCLUSION: These data highlight the need to protect both healthy sleep and in-person instruction. Appropriate sleep timing and duration, fewer sleep disturbances and sleep-related impairments accounted for a substantial degree of variance in the association between remote instruction on academic outcomes. While many students experienced "lost learning" because of COVID-19, this study joins a broader discussion of ensuring developmentally appropriate school-start times to support both sleep and achievement.
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COVID-19 , Educação a Distância , Sono , Humanos , COVID-19/prevenção & controle , COVID-19/psicologia , COVID-19/epidemiologia , Adolescente , Feminino , Masculino , Estados Unidos/epidemiologia , Instituições Acadêmicas , Estudantes/psicologia , Estudantes/estatística & dados numéricos , AutorrelatoRESUMO
Cultural differences in the experience of sleep warrant consideration in the measurement of sleep across populations. This requires careful attention to both language and culture when translating survey measures. While forward and back translation is the most commonly used approach, it has numerous limitations if used as an isolated method. Best practice guidelines recommend a multi-step team-based approach for translating questionnaires. We present our recent experience applying best practices in a study with both Spanish and English-speaking Mexican American mothers of toddlers. This work is part of a larger project that will measure parental sleep-related beliefs and parenting practices in Mexican American parents of toddlers. We utilized a team-based approach to translation and cultural adaptation, assembling a diverse, bilingual, and bicultural team. The translation process started with items and measures that we had selected, revised as needed, or created. New items were based on constructs identified in semi-structured interviews and focus groups used to explore parental sleep-related beliefs and parenting practices in the target population. Following this, our translation process included forward and back translation, harmonization and decentering, cognitive interviewing, debriefing, adjudication, and proofreading. We outline details of our process and the rationale for each step. We also highlight how each step contributes to ensuring culturally appropriate items with conceptual equivalence across languages. To ensure inclusivity and scientific rigor within the field of sleep research, investigators must utilize best practices for translations and cultural adaptations, building on the foundation of cultural constructs often identified in qualitative work.
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OBJECTIVE: The study objective was to inform patient-centered care for adolescent insomnia by describing adolescents' perspectives on insomnia. Specific constructs of interest included: 1) factors that contributed to insomnia development or maintenance, 2) impact of insomnia on day-to-day life, 3) recommended research priorities, and 4) overall experience living with insomnia. METHOD: A convenience sample of adolescents (ages 13-18 years) self-identifying with insomnia symptoms was recruited through social media. Respondents (n = 3,014) completed an online survey. Responses to an open-ended item assessing patient experience were coded using thematic analysis. RESULTS: Participants identified as 70.8% White non-Hispanic, 77.0% female, and lived in one of five English-speaking countries (United States, United Kingdom, Canada, Australia, or New Zealand). Most (87.5%) met DSM-V diagnostic criteria for insomnia. The most common contributory factors to insomnia endorsed were stress (72.1%) and depressed mood (63.6%), while common impact areas were mood (72.2%), focus (61.0%), and pain (49.7%). Patient-centered research priorities were identifying insomnia causes (66.4%) and early detection (66.1%). Common adolescent experiences included high distress levels, feelings of invalidation, and helplessness about their insomnia. CONCLUSIONS: Adolescents with insomnia offer a unique perspective that should inform patient-centered research and care. There is a need for heightened screening and awareness about insomnia as a condition that causes significant distress and impairment for adolescents. To provide validating care, providers should recognize the multifaceted causes of insomnia.
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Assistência Centrada no Paciente , Distúrbios do Início e da Manutenção do Sono , Humanos , Adolescente , Distúrbios do Início e da Manutenção do Sono/terapia , Feminino , Assistência Centrada no Paciente/estatística & dados numéricos , Masculino , Inquéritos e Questionários , Austrália , Estados Unidos , Canadá , Reino Unido , Nova ZelândiaRESUMO
OBJECTIVES: To test whether adolescents' mental health during the COVID-19 pandemic is associated with the combination of their instructional approach(es) and their sleep patterns. DESIGN: Cross-sectional. SETTING: Adolescents were recruited through social media outlets in October and November 2020 to complete an online survey. PARTICIPANTS: Participants were 4442 geographically and racially diverse, community-dwelling students (grades 6-12, 51% female, 36% non-White, 87% high schoolers). MEASUREMENTS: Participants completed items from the PROMIS Pediatric Depressive Symptoms and Anxiety scales. Participants reported their instructional approach(es), bedtimes, and wake times for each day in the past week. Participants were categorized into five combined instructional approach groups. Average sleep opportunity was calculated as the average time between bedtime and waketime. Social jetlag was calculated as the difference between the average sleep midpoint preceding non-scheduled and scheduled days. RESULTS: Emotional distress was elevated in this sample, with a large proportion of adolescents reporting moderate-severe (T-score ≥ 65) levels of depressive symptoms (49%) and anxiety (28%). There were significant differences between instructional approach groups, such that adolescents attending all schooldays in-person reported the lowest depressive symptom and anxiety T-scores (P < .001, ηp2 = .012), but also the shortest sleep opportunity (P < .001, ηp2 = .077) and greatest social jetlag (P < .001, ηp2 = .037) of all groups. Adolescents attending school in person, with sufficient sleep opportunity (≥8-9 hours/night) and limited social jetlag (<2 hours) had significantly lower depressive (ηp2 = .014) and anxiety (ηp2 = .008) T-scores than other adolescents. CONCLUSIONS: Prioritizing in-person education and promoting healthy sleep patterns (more sleep opportunity, more consistent sleep schedules) may help bolster adolescent mental health.
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COVID-19 , Depressão , Saúde Mental , Sono , Humanos , Adolescente , COVID-19/epidemiologia , Feminino , Masculino , Estudos Transversais , Depressão/epidemiologia , Ansiedade/epidemiologia , Estudantes/psicologia , Estudantes/estatística & dados numéricos , Inquéritos e Questionários , Criança , PandemiasRESUMO
INTRODUCTION: Youth with type 1 diabetes (T1D) and parents experience reduced quality of life and sleep quality due to nocturnal monitoring, hypoglycemia fear, and diabetes-related disruptions. This study examined the sleep and quality of life impact of advanced technology. METHODS: Thirty-nine youth with T1D, aged 2-17 years, starting an advanced hybrid closed-loop (HCL) system and a parent participated in an observational study. Surveys, actigraphy, sleep diaries, and glycemic data (youth) were captured prior to HCL, at one week, 3 months, and 6 months. Outcomes were modeled using linear mixed effects models with random intercepts to account for within-subject correlation, with least-squares means at each timepoint compared to baseline. RESULTS: Parents and youth reported improvements in health-related quality of life and fear of hypoglycemia after HCL initiation. Concurrently, nocturnal glycemia improved. Actigraphy-derived sleep outcomes showed improved 6 month adolescent efficiency and 3 and 6 month parent wake after sleep onset. Additionally, parents reported improved subjective sleep quality and child sleep-related impairment at 3 months. CONCLUSIONS: With nocturnal glycemic improvements in youth using HCL technology, some aspects of parent and youth sleep and quality of life improved. This may reflect decreased parental monitoring and worry and highlights benefits for youth beyond glycemia.
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Diabetes Mellitus Tipo 1 , Hipoglicemia , Adolescente , Criança , Humanos , Glicemia , Automonitorização da Glicemia , Diabetes Mellitus Tipo 1/psicologia , Hipoglicemia/psicologia , Hipoglicemiantes , Insulina , Pais/psicologia , Qualidade de Vida , Sono , Pré-EscolarRESUMO
INTRODUCTION: This cross-sectional quantitative study investigated the sleep hygiene and disturbances of adolescent female survivors of domestic minor sex trafficking (DMST) compared to an online sample of community-dwelling adolescent females. METHOD: Community-dwelling adolescent females (aged 13-17 years, n = 61) and survivors of DMST housed in residental care (aged 12-17 years, n = 19) completed the Children's Report of Sleep Patterns (adolescent version). Descriptive statistics on sleep health in both samples were computed and compared using chi-square and t-tests. RESULTS: Among the survivors of DMST, the majority reported insufficient sleep duration, okay-to-poor sleep quality, waking thirsty, and frequent nightmares. Compared with community-dwelling adolescents, survivors of DMST had more symptoms of insomnia, sleepiness, nightmares, and waking thirsty (p < .05). DISCUSSION: Sleep disturbances among adolescent female survivors of DMST may be more prevalent than in community-dwelling adolescent females. Further empirical research on appropriate assessment and trauma-informed treatment of sleep in this population is needed.
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Tráfico de Pessoas , Distúrbios do Início e da Manutenção do Sono , Transtornos do Sono-Vigília , Criança , Humanos , Adolescente , Feminino , Estudos Transversais , Transtornos do Sono-Vigília/epidemiologia , Transtornos do Sono-Vigília/etiologia , Distúrbios do Início e da Manutenção do Sono/epidemiologia , Sobreviventes , Higiene do Sono , Higiene , SonoAssuntos
Fibrose Cística , Indóis , Pirazóis , Piridinas , Pirrolidinas , Quinolonas , Adulto , Humanos , Fibrose Cística/complicações , Fibrose Cística/diagnóstico , Fibrose Cística/tratamento farmacológico , Sono , Regulador de Condutância Transmembrana em Fibrose Cística/genética , Aminofenóis/efeitos adversos , Benzodioxóis/efeitos adversos , Mutação , Agonistas dos Canais de Cloreto/efeitos adversos , Combinação de MedicamentosRESUMO
Healthy sleep and optimal ventilatory control begin in early development and are crucial for positive child outcomes. This paper summarizes information presented at the Sleep and Ventilatory Control sessions of the National Heart, Lung, and Blood-sponsored 2021 Defining and Promoting Pediatric Pulmonary Health workshop. These sessions focused on pediatric sleep health, screening for sleep health and sleep disorders in primary care using the electronic health record, infant sleep and ventilatory control, and home sleep testing. Throughout this summary, we discuss key gaps in and barriers to promoting sleep and ventilatory health that were identified during the workshop sessions. We conclude with strategies to address these gaps and barriers and directions for future multidisciplinary research, patient care, and training.
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Registros Eletrônicos de Saúde , Coração , Lactente , Humanos , Criança , Pesquisa Interdisciplinar , Sono , PulmãoRESUMO
This study tested the efficacy of a 5 × 1.5 h/session, group-based, parent-focused, behavioural intervention (BI) targeting sleep problems in preschool children. Parents were randomised to either the BI (N = 62) or care as usual (CAU; N = 66) conditions. Outcomes included sleep, anxiety, behavioural problems, internalising and externalising symptoms, transition to school and academic achievement. Assessments were conducted at pre- and post-BI intervention (in the year prior to formal schooling), and then at follow-ups 1 and 2 in the first year of formal schooling. Relative to the CAU, the BI condition demonstrated significantly greater improvements in sleep, anxiety, behaviour problems and internalising and externalising symptoms from pre-to post-intervention. Improvements in sleep, anxiety, and internalising symptoms were maintained, while behaviour and externalising symptoms were further improved upon at school follow-up 2. For the BI group, improvements in sleep at post-intervention were found to mediate improvements in anxiety, internalising, and externalising symptoms, but not behaviour problems, at school follow-ups 1 and 2. There were no significant effects of condition on school transition or academic outcome measures. The results suggest that the BI is effective for sleep, anxiety, behaviour, internalising and externalising symptoms, but not for school transition or academic outcomes. ANZCTR NUMBER: ACTRN12618001161213.
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Comportamento Problema , Transtornos do Sono-Vigília , Pré-Escolar , Humanos , Pais , Ansiedade/terapia , Transtornos do Sono-Vigília/terapia , SonoRESUMO
STUDY OBJECTIVES: Despite the negative impact of poor sleep on mental health, evidence-based insomnia management guidelines have not been translated into routine mental healthcare. Here, we evaluate a state-wide knowledge translation effort to disseminate sleep and insomnia education to graduate psychology programs online using the RE-AIM (reach, effectiveness, adoption, implementation, and maintenance) evaluation framework. METHODS: Using a non-randomized waitlist control design, graduate psychology students attended a validated 6-hour online sleep education workshop delivered live as part of their graduate psychology program in Victoria, Australia. Sleep knowledge, attitudes, and practice assessments were conducted pre- and post-program, with long-term feedback collected at 12 months. RESULTS: Seven out of ten graduate psychology programs adopted the workshop (adoption rate = 70%). The workshop reached 313 graduate students, with a research participation rate of 81%. The workshop was effective at improving students' sleep knowledge and self-efficacy to manage sleep disturbances using cognitive behavioral therapy for insomnia (CBT-I), compared to the waitlist control with medium-to-large effect sizes (all p < .001). Implementation feedback was positive, with 96% of students rating the workshop as very good-to-excellent. Twelve-month maintenance data demonstrated that 83% of students had used the sleep knowledge/skills learned in the workshop in their clinical practice. However, more practical training is required to achieve CBT-I competency. CONCLUSIONS: Online sleep education workshops can be scaled to deliver cost-effective foundational sleep training to graduate psychology students. This workshop will accelerate the translation of insomnia management guidelines into psychology practice to improve sleep and mental health outcomes nationwide.
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STUDY OBJECTIVES: We evaluated the impact of bed provision and sleep education through the Beds for Kids (BfK) program on early childhood sleep and behavior and maternal mood and sleep. METHODS: Twenty-seven mother-child dyads (childage= 2-5 years, 85.2% Black) living in poverty and without an individual child bed were randomly assigned (multimethod randomized waitlist control trial design) to BfK intervention â¼1 week postbaseline (initial intervention) or â¼2 weeks postbaseline (waitlist control), with follow-up at 1 month. BfK intervention (home bed delivery and written sleep health education) was provided to all families. Children wore actigraphs and mothers completed daily diaries to assess child and maternal sleep, child behavior, and maternal mood for the initial 1-week comparison period. Maternal-reported child sleep and behavior (internalizing and externalizing problems) were collected at 1 month after BfK participation for all families; 11 families completed a qualitative interview at 1-month follow-up. RESULTS: At 1 week after BfK, mothers' sleep duration increased by 1 hour compared to that of waitlist controls. No changes were found in child sleep, child behavior, or maternal mood. However, at 1 month after BfK intervention, improvements were found in mother-reported child night awakenings, sleep quality, sleep problems, and behavior. Mothers qualitatively reported significant BfK benefits for child sleep and family well-being, although they noted challenges to transitioning young children to sleeping independently. CONCLUSIONS: Bed provision and sleep education for families living in poverty has an immediate impact on maternal sleep and reported well-being. Child sleep and behavioral improvements are seen by 1 month, with children experiencing an initial adjustment period to sleeping independently. CLINICAL TRIAL REGISTRATION: Registry: ClinicalTrials.gov; Name: Impact of Beds for Kids Program on Child Sleep; URL: https://www.clinicaltrials.gov/ct2/show/NCT03392844; Identifier: NCT03392844. CITATION: Williamson AA, Min J, Fay K, Cicalese O, Meltzer LJ, Mindell JA. A multimethod evaluation of bed provision and sleep education for young children and their families living in poverty. J Clin Sleep Med. 2023;19(9):1583-1594.
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Mães , Distúrbios do Início e da Manutenção do Sono , Feminino , Humanos , Pré-Escolar , Lactente , Sono , Educação em Saúde , Distúrbios do Início e da Manutenção do Sono/terapia , PobrezaRESUMO
This chapter reviews the Peds B-SATED model of pediatric sleep health and common pediatric sleep problems. Aspects of pediatric sleep health and sleep problems are considered across development, from infants through adolescents. Finally, information about clinical screening in both primary and specialty care is discussed, and subjective sleep questionnaires are reviewed.
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Transtornos do Sono-Vigília , Lactente , Adolescente , Criança , Humanos , Polissonografia , Transtornos do Sono-Vigília/diagnóstico , Sono , Inquéritos e QuestionáriosRESUMO
OBJECTIVES: Despite the clear influence of poor sleep on mental health, sleep education has been neglected in psychology training programs. Here, we develop a novel behavioral sleep medicine (BSM) education workshop, the Sleep Psychology Workshop, designed for integration within graduate psychology programs. We also examined the potential efficacy and acceptability of the workshop to upskill trainee psychologists in sleep and insomnia management. METHODS: The Sleep Psychology Workshop was developed using a modified Delphi Method. Eleven trainee psychologists completing their Master of Psychology degrees (90% female, 24.4 ± 1.6 years old) attended the workshop, delivered as three, two-hour lectures (total of six hours). Sleep knowledge, attitudes, and practice assessments were completed pre-and post-intervention using the GradPsyKAPS Questionnaire. A focus group and 6-month follow-up survey captured feedback and qualitative data. RESULTS: Trainees' sleep knowledge quiz scores (% correct) increased from 60% to 79% pre- to post-workshop (p = .002). Trainees' self-efficacy to use common sleep-related assessment instruments and empirically supported interventions to manage sleep disturbances increased, along with their confidence to manage insomnia (all p < .02). Participant feedback was positive, with 91% of trainees rating the workshop as "excellent" and qualitative data highlighting trainees developing practical skills in BSM. Six months post-intervention, 100% of trainees endorsed routinely asking their clients about sleep, with 82% reporting improvements in their own sleep. CONCLUSIONS: The Sleep Psychology Workshop is a potentially effective and acceptable introductory BSM education program for trainee psychologists, ready for integration within the graduate psychology curriculum.
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Distúrbios do Início e da Manutenção do Sono , Humanos , Feminino , Adulto Jovem , Adulto , Masculino , Distúrbios do Início e da Manutenção do Sono/terapia , SonoRESUMO
BACKGROUND: The benefits of delaying school start times for secondary students are well-established. However, no previous study has considered how changing school start times impacts sleep and daytime functioning for K-12 teachers. METHODS: Teachers in a large suburban school district completed 3 annual surveys (pre-change n = 1687, post-change n = 1857, follow-up n = 1812) assessing sleep and daytime functioning. RESULTS: With delayed start times, high school teachers had later rise times (high school [HS]: 28 minutes, middle school [MS]: 14 minutes), increased sleep duration (HS: 22 minutes, MS: 13 minutes), and improved daytime functioning. Improvements for middle school teachers were noted but were not statistically significant. With earlier start times, elementary teachers reported earlier bedtimes (9 minutes) and wake times (9 minutes), with no changes in sleep duration or daytime functioning. IMPLICATIONS FOR SCHOOL HEALTH POLICY, PRACTICE, AND EQUITY: Today's school health policies often focus on wellness. Findings from this study reveal that the policy of healthy school start times can have a significant, positive impact on adults who teach in later-starting secondary schools. Later school start times for secondary teachers provide greater parity with their elementary colleagues in terms of sleep opportunity. CONCLUSIONS: This study extends previous findings on how the policy of later secondary school start times improves the health and well-being of adolescents, highlighting that healthy start times contribute to increased sleep opportunity for MS and HS teachers and improved daytime functioning for HS teachers, with changed start times having no significant negative effect on elementary school teachers.
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Professores Escolares , Sono , Adolescente , Adulto , Humanos , Fatores de Tempo , Inquéritos e Questionários , Instituições AcadêmicasRESUMO
INTRODUCTION: Motor vehicle crashes (MVC) are the second leading cause of death for adolescents in the United States, with drowsy driving a major contributing factor. Early school start times have been identified as a significant factor that reduces adolescent sleep duration, which in turn contributes to drowsy driving and MVC. This paper examined the longitudinal impact of delaying secondary school start times on self-reported student drowsy driving and teen MVC. METHODS: Secondary school students (10th and 11th grade, 51.7% female, 67.8% White) in the United States completed annual surveys 1 year before and 2 years after implementation of later school start times (70-min delay, n range 1642-2452 per year), reporting frequency of drowsy driving (less than once/week vs. at least once/week). Teen (16-18 years) MVC data from the Colorado Department of Transportation for the 2 years before and 2 years after later start time implementation were compared for Arapahoe County (where start times changed) and neighboring Adams County and Douglas County (where start times did not change). RESULTS: With later start times, there was a significant drop in the percent of students who reported frequent drowsy driving (pre-change: 32.6%, post-change: 21.9%, follow-up: 22.8%). Weekday teen MVC rates went down in Arapahoe County (p = .04) during the school year, while no change or increases in MVC rates were seen in neighboring counties. CONCLUSIONS: Healthy school start times are important for adolescent health and safety, with study findings highlighting the downstream effects of increased sleep duration following a 70-min delay in secondary school start times on adolescent drowsy driving and teen MVC rates.
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Acidentes de Trânsito , Condução de Veículo , Adolescente , Feminino , Humanos , Masculino , Veículos Automotores , Instituições Acadêmicas , Inquéritos e Questionários , Estados Unidos/epidemiologiaRESUMO
PURPOSE OF REVIEW: The purpose of this review is to present a review of sleep science, the relationship between sleep and type 1 diabetes, and highlight the current literature on sleep outcomes in adult and pediatric diabetes technology research. RECENT FINDINGS: Sleep quality is associated with glycemic outcomes, diabetes self-management, and mental health in people with type 1 diabetes. Diabetes technologies, including insulin pumps, continuous glucose monitors, and hybrid closed-loop systems improve glycemic outcomes. However, many people find this technology challenging for a variety of reasons, including increased burden and frequent alarms, especially during the night. The impact of different devices on sleep quality and quantity has been mixed. The newest technology, the hybrid closed-loop systems, offers the best opportunity for nocturnal glycemic regulation and has improved patient and family perspectives on sleep quality. However, objective sleep assessment has not shown significant improvement on sleep duration. Sleep quality and quantity in people with type 1 diabetes are widely recognized as an important component of health care, and the literature regarding the impact of diabetes devices on sleep is increasing. However, sleep disruptions are common and a barrier to device use. Despite finding minimal changes to sleep duration with device use, subjective accounts of sleep quality are overall positive, especially in those using hybrid closed-loop systems. Sleep quantity and quality are important outcomes to consider as diabetes technology continues to evolve.
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Diabetes Mellitus Tipo 1 , Adulto , Glicemia , Automonitorização da Glicemia , Criança , Diabetes Mellitus Tipo 1/tratamento farmacológico , Diabetes Mellitus Tipo 1/terapia , Humanos , Hipoglicemiantes/uso terapêutico , Insulina/uso terapêutico , Sistemas de Infusão de Insulina/psicologia , Sono , TecnologiaRESUMO
BACKGROUND: Secondary school start times are associated with student sleep and daytime functioning; however, no study examining this association has included linked longitudinal data for both primary and secondary students. To understand the interplay between biology (ie, normal developmental changes in sleep) and ecology (ie, school start times), this study examined sleep and daytime functioning in elementary/primary and secondary school students over a three-year period that included changes to school start times. METHODS: Students (grades 3-10, n = 6168) and parents (for student grades Kindergarten-2, n = 2772) completed annual surveys before (pre-change) and for two-years after (post-change, follow-up) implementation of new school start times (elementary/primary: 60 min earlier, secondary: 50-80 min later). Participants were 48.9% female, 65.5% White, and 16.2% qualified for free/reduced lunch. RESULTS: With new school start times, significant changes were found for weekday wake times and sleep duration; elementary/primary students woke earlier (23 min) and obtained less sleep (14 min), while secondary students woke later (44 min) and obtained more sleep (31 min). Small changes in weekend sleep duration (<7 min) were found across levels. Secondary school students had significant improvements in daytime functioning post-change, due in part to changes in sleep duration. Minimal changes in elementary/primary students' daytime functioning was found, despite shorter sleep duration. CONCLUSIONS: School start times are a significant factor in weekday wake times for students across grade levels, while later bedtimes are more a factor of normal development. Later start times positively affected secondary students' daytime functioning, with non-significant findings for earlier elementary/primary start times.
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Instituições Acadêmicas , Sono , Biologia , Criança , Feminino , Humanos , Masculino , Estudantes , Fatores de TempoRESUMO
OBJECTIVE: To examine the impact of changing school start times on sleep in parents of students in elementary, middle, and high school. METHODS: Annual surveys were completed by parents of K-12 students (n = 8190-10,592 per year) before (pre-change) and for 2 years (post-change, follow-up) after implementation of new school start times (elementary school [ES]: 60 minutes earlier, middle school [MS]: 40-60 minutes later, high school [HS]: 70 minutes later), providing parent self-reported weekday bedtime and wake time, sleep quality, and feeling tired. RESULTS: Significant level-by-year interactions were found for parent bedtime, wake time, and sleep duration (all p < .0001). Post hoc analyses show ES parents reporting earlier bedtimes and wake times at post-change, with no change in sleep duration, while MS and HS parents reported later post-change wake times. Post-change, more MS and HS parents reported sufficient sleep duration (p < .0001) and good sleep quality (p < .0001), with fewer HS parents reporting feeling tired (p < .0001). CONCLUSIONS: This is the first study to consider the impact of a policy change aimed at improving child sleep on parent sleep. Healthy school start times has a significantly positive downstream effect on secondary school parents' sleep and daytime functioning, with minimal impact reported by parents of elementary school students.
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Instituições Acadêmicas , Sono , Criança , Fadiga , Humanos , Pais , Estudantes , Inquéritos e QuestionáriosRESUMO
STUDY OBJECTIVE: Adverse childhood experiences (ACEs) are associated with sleep problems in adulthood, but less research has focused on ACEs and sleep during adolescence. The goal of the present study was to explore associations between ACEs reported at ages 5 and 9 years, and sleep (ie, total sleep time (TST), social jetlag, and insomnia symptoms) at age 15. METHODS: Participants comprised 817 families from the Fragile Families and Child Wellbeing Study, a nationally representative sample of children born to unwed parents. Number of ACEs was constructed from primary-caregiver reports at ages 5 and 9, and sleep measures (ie, TST, social jetlag, and insomnia symptoms) were derived from adolescent-reported sleep behaviors at age 15. RESULTS: Adjusting for sex and race/ethnicity, ACEs at age 9 were associated with longer weekend TST (B = 0.16, 95% CI = 0.04, 0.28), more social jetlag (B = 0.17, 95% CI = 0.07, 0.27), and higher odds of trouble falling asleep ≥3 times per week (Odds Ratio = 1.24, 95% CI = 1.01, 1.53). In females only, ACEs were associated with greater school night TST (B = 0.12, 95% CI = 0.01, 0.23). Results were similar after further adjustment for symptoms of anxiety and depression. Associations among ACEs, social jetlag, and insomnia symptoms appeared strongest among Non-Hispanic Black adolescents. CONCLUSION: ACEs appear to be related to multiple aspects of sleep in adolescence. Additional research is needed to confirm these associations and examine the extent to which sleep disturbances associated with ACEs account for later health outcomes.
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Experiências Adversas da Infância , Distúrbios do Início e da Manutenção do Sono , Adolescente , Adulto , Ansiedade/epidemiologia , Ansiedade/etiologia , Criança , Pré-Escolar , Feminino , Humanos , Síndrome do Jet Lag , Sono , Distúrbios do Início e da Manutenção do Sono/epidemiologia , Distúrbios do Início e da Manutenção do Sono/etiologiaRESUMO
STUDY OBJECTIVES: To examine associations among instructional approaches, school start times, and sleep during the COVID-19 pandemic in a large, nationwide sample of U.S. adolescents. METHODS: Cross-sectional, anonymous self-report survey study of a community-dwelling sample of adolescents (grades 6-12), recruited through social media outlets in October/November 2020. Participants reported on instructional approach (in-person, online/synchronous, online/asynchronous) for each weekday (past week), school start times (in-person or online/synchronous days), and bedtimes (BT) and wake times (WT) for each identified school type and weekends/no school days. Sleep opportunity was calculated as BT-to-WT interval. Night-to-night sleep variability was calculated with mean square successive differences. RESULTS: Respondents included 5,245 racially and geographically diverse students (~50% female). BT and WT were earliest for in-person instruction; followed by online/synchronous days. Sleep opportunity was longer on individual nights students did not have scheduled instruction (>1.5 h longer for online/asynchronous than in-person). More students obtained sufficient sleep with later school start times. However, even with the same start times, more students with online/synchronous instruction obtained sufficient sleep than in-person instruction. Significantly greater night-to-night variability in sleep-wake patterns was observed for students with in-person hybrid schedules versus students with online/synchronous + asynchronous schedules. CONCLUSIONS: These findings provide important insights regarding the association between instructional approach and school start times on the timing, amount, and variability of sleep in U.S. adolescents. Given the public health consequences of short and variable sleep in adolescents, results may be useful for education and health policy decision-making for post-pandemic secondary schools.