OBJECTIVES The COVID-19 virus has resulted not only in high rates of morbidity and mortality acro... more OBJECTIVES The COVID-19 virus has resulted not only in high rates of morbidity and mortality across the globe, but in widespread mental health problems and sleep disruption, likely as a result of pandemic-related stressors. The current study examines associations among COVID-related stress, sleep quality, and mental health. DESIGN Cross-sectional data were collected via online surveys in May 2020. PARTICIPANTS were 2541 community adults ages 18-70 from Israel (N = 1969) and the U.S. (N = 572). MEASUREMENT Participants completed measures of COVID-related stress, sleep quality, and symptoms of anxiety, depression and adjustment disorder. RESULTS Participants reported high rates of depression and anxiety symptoms, adjustment difficulties, and poor sleep quality. In both countries, COVID-related stressors were associated with both anxiety and depression, and these associations were mediated by sleep disturbances. CONCLUSIONS These results support the role of sleep in mental health difficulties. Widespread, accessible, evidence-based interventions are urgently needed to improve health and mental health and to promote resilience in preparation for future global crises.
Introduction Limited research exists regarding the sleep environment and sleep health of youth in... more Introduction Limited research exists regarding the sleep environment and sleep health of youth in juvenile justice facilities. We examined the perspectives of facility night staff on the sleep-living environment and conditions of detained youth using semi-structured interviews. Methods In collaboration with Maryland’s Department of Juvenile Services (DJS) we conducted virtual semi-structured interviews (45 minutes) with superintendents, medical staff, and night staff at all state facilities. We present the data reported by night staff (n=10) here, each representing a different facility. Interview questions focused on facility structure, protocols, and youth healthcare. Inductive qualitative analyses examined high frequency themes with the aim of understanding the sleep environment, sleep patterns, and overall youth wellbeing. After transcription of each interview, coder 1 examined each transcript to identify high frequency themes; coder 2 reviewed these first codes. Few disagreement...
Introduction Sleep during childhood has a major impact on physiological, psychological, and cogni... more Introduction Sleep during childhood has a major impact on physiological, psychological, and cognitive development, yet sleep health is a neglected part of training/education for foster parents and agency staff. This study examined foster care agency staff perceptions of child sleep problems encountered by foster caregivers in order to inform the development of a sleep health training program for foster care agency staff and caregivers. Methods N=36 staff members from public and private foster care agencies in Texas, New York, New Jersey, and Maryland were interviewed remotely. Questions included knowledge of sleep policies, concerns surrounding sleep, methods for addressing sleep concerns, and sleep training recommendations. Two members of the research team coded the interviews using the Atlas.ti program. Coders first independently reviewed and coded transcriptions for thematic key words without formal concepts before reviewing and refining themes/codes with the full research team f...
OBJECTIVES To assess changes in sleep parameters and circadian rhythm metrics measured by actigra... more OBJECTIVES To assess changes in sleep parameters and circadian rhythm metrics measured by actigraphy in preschool-aged children. DESIGN Longitudinal analysis over 1 year. PARTICIPANTS Ninety-four children living in Tijuana and Ensenada, Mexico. MEASUREMENTS Children wore accelerometers on the right hip for one continuous week at baseline and 1-year follow-up. Parents recorded child bedtime, waketime, and naps in sleep diaries. We used cosinor and nonparametric approaches to calculate circadian rhythm metrics. RESULTS At baseline, children had a mean age of 4.2 years, and 51.1% were girls. In multivariable models adjusted for age, gender, BMI category, parental education, household income and city, at follow-up children had significantly earlier waketimes (β = -7.99 minutes, p < .001) compared to baseline. Children also had lower sleep onset latency (β = -2.32 minutes, p = .057), and longer nighttime sleep (β = 9.38 minutes, p = .079), but these changes were not significant at the α < 0.05 level. We found significant increases in log relative amplitude (β = 0.017, p = .009), and decreases in log midline estimated statistic of rhythm (β = -0.084, p = .017) and log of the least active 5-hour period (β = -0.057, p = .010). When we adjusted for co-sleeping, we found significant decreases in the number of nighttime awakenings (β = -1.29, p = .011) but otherwise similar results. There were no other changes in sleep parameters or circadian rhythm metrics. CONCLUSIONS Mean increases in nighttime sleep and earlier wake times over one year were concomitant with decreases in overall activity levels and increases in circadian rhythm robustness. Co-sleeping was a predictor of sleep disturbances. This study provides longitudinal evidence regarding changes in sleep and circadian metrics in a sample of children from an under-researched sociodemographic group during an important, early life period.
Introduction Adolescents who experience insufficient, poor quality sleep, and sleep problems migh... more Introduction Adolescents who experience insufficient, poor quality sleep, and sleep problems might experience difficulties with externalizing behaviors including aggression and impulse control (Bauducco et al., 2019; Brown et al., 2022). Surprisingly, sleep and behavior for youth residing in long and short-term juvenile justice facilities is understudied. The present preliminary analysis explores self-reported sleep problems and aggressive and impulse control symptoms for youth under the care of the Department of Juvenile Services (DJS). Methods Participants (N=62, 86% male, mean age = 16.8, SD=1.2) were recruited from 11 DJS detention and treatment facilities in Maryland. Racial Backgrounds: 55% Black, 18% White, 14% Multiracial, and 12% Other. They completed an online questionnaire focused on sleep behaviors (daytime sleepiness, sleep-wake behavior problems) and daytime functioning including aggressive and impulse control behaviors (e.g., modified Aggression Questionnaire, Buss & ...
Introduction Sleep during childhood has a major impact on physiological, psychological, and cogni... more Introduction Sleep during childhood has a major impact on physiological, psychological, and cognitive development. Limited research has focused on vulnerable populations such as children in foster care. Foster care children endure placement instability, which may contribute to disrupted sleep patterns and unpredictability around bedtime (Leathers, et al., 2019). The Fostering Sleep study examined foster caregivers’ perceptions of children’s sleep challenges and strategies for improving sleep difficulties. Methods Foster caregivers of children ages 4–11 throughout the US were invited to complete the Qualtrics Sleep Health among Children in Foster Care Survey via foster care Facebook groups. The survey included quantitative and qualitative questions focused on sleep patterns and behaviors. Qualitative questions on barriers and opportunities to improve sleep were examined: what helps foster care children sleep well; what kinds of difficulties do foster care children experience at bedti...
Introduction Insufficient and disordered sleep are common among developing adolescents and can re... more Introduction Insufficient and disordered sleep are common among developing adolescents and can result in poor health and behavioral consequences. Previous studies have examined sleep and adolescent criminal behavior; however, little is known about adolescent sleep difficulties or disorders while residing in juvenile detention and treatment facilities. The current study explores psychiatric and sleep disorder diagnoses and medication use of youth under the care of the Department of Juvenile Services (DJS). Methods Participants were recruited from 11 detention and treatment facilities across Maryland. Youth (N = 67) were 13-19 years old (M = 16.8, SD = 1.2) and 84% male and 16% female. Racial Backgrounds: 55% Black, 18% White, 14% Multiracial, and 12% Other. A Healthcare staff member from each facility completed an online medical questionnaire regarding each youth’s sleep history, medical diagnoses, and current medications. Results The most common youth diagnoses were Insomnia (N = 26...
Introduction Adolescents are susceptible to sleep loss due to biological and environmental factor... more Introduction Adolescents are susceptible to sleep loss due to biological and environmental factors such as delayed circadian timing and schedule demands. Few studies have examined sleep-wake patterns for adolescents residing in juvenile justice facilities. The current study assessed youth’s self-reported sleep-wake schedules, sleep environment perceptions, and sleep quality. Methods Participants were recruited from 11 juvenile services detention and treatment facilities in Maryland. For seven consecutive mornings, youth completed a sleep-wake diary reporting their bed/wake times, sleep onset, and type of (nocturnal) light exposure. Youth wore digital wristwatches to accurately depict their sleep-wake schedules. Sleep quality and wake difficulty were rated on a scale from 1-10 (1=very poor/easy to 10=very good/hard, respectively). Results Participants (N= 64) were 13-19 years old (M= 16.7, SD= 1.3 years) and 85.9% male. Racial backgrounds: 61% Black, 18% White, 8% Multiracial, and 13...
Introduction COVID-19 fundamentally altered education in the United States. A variety of in-perso... more Introduction COVID-19 fundamentally altered education in the United States. A variety of in-person, hybrid, and online instruction formats took hold in Fall 2020 as schools reopened. The Nationwide Education and School in TEens During COVID (NESTED) study assessed how these changes impacted sleep. Here we examined how instruction format was associated with sleep disruption and learning outcomes. Methods Data from 4148 grade 6-12 students were included in the current analyses (61% non-male; 34% non-white; 13% middle-school). Each student’s instructional format was categorized as: (i) in-person; (ii) hybrid [≥1 day/week in-person]; (iii) online/synchronous (scheduled classes); (iv) online/asynchronous (unscheduled classes); (v) online-mixed; or (vi) no-school. Sleep disturbances (i.e., difficulty falling/staying asleep) were measured with validated PROMIS t-scores. A bootstrapped structural equation model examined how instructional format and sleep disturbances predict school/learning...
Introduction A strong association between sleep disturbances and externalizing symptoms has been ... more Introduction A strong association between sleep disturbances and externalizing symptoms has been found among school-aged children. In particular, there is a known association between sleep disturbances, irritability, emotional dysregulation, and hyperactivity (e.g., Coto et al., 2018). Limited research, however, has examined this association in a high-risk population of children, such as those in foster care who are at increased risk for sleep disturbances due to heightened exposure to trauma. Thus, the following study sought to assess the association between sleep quality and externalizing symptoms in a population of children in foster care. Methods Caregivers with children ages 4–11 were sampled from private Facebook community foster care groups across the United States (n = 410). Caregivers were provided a link to a survey powered by Qualtrics where they were asked to report on the children under their care’s weekday bedtime, overall sleep quality (e.g., “Please rate your child’s...
Using data from the Nationwide Education and Sleep in TEens During COVID (NESTED) study (N=6,578)... more Using data from the Nationwide Education and Sleep in TEens During COVID (NESTED) study (N=6,578), we investigated if race/ethnicity (64.6% were White and 35.4% identified as a racial/ethnic minority, mixed, or “other”) and community social vulnerability affected the association between COVID stress and sleep disturbance. Data on sociodemographic factors (age, race, sex, grade, zip code [for neighborhood social vulnerability index, SVI]), COVID-related stress, depression, anxiety, instructional format (online, in-person, or hybrid), and sleep disturbance (PROMIS Pediatric Sleep Disturbance) were captured through an online survey. Descriptive and inferential analyses (Hierarchical Binary Logistic Regression (HBLR), SPSS v. 25) in 4171 adolescents examined associations between sleep disturbance and COVID-related stress, adjusting for race, sex, SVI, grade level, learning format, household density, and mental health factors. Sleep disturbance was prevalent among adolescents (89% above ...
Introduction Adolescents are vulnerable to short, insufficient sleep stemming from a combined pre... more Introduction Adolescents are vulnerable to short, insufficient sleep stemming from a combined preference for late bedtimes and early school start times, and also circadian disruptions from frequent shifts in sleep schedules (i.e., social jetlag). These sleep disruptions are associated with poor mental health. The COVID-19 pandemic has impacted education nationwide, including changes in instructional formats and school schedules. With data from the Nationwide Education and Sleep in TEens During COVID (NESTED) study, we examined whether sleep variability and social jetlag (SJL) during the pandemic associate with mental health. Methods Analyses included online survey data from 4767 students (grades 6-12, 46% female, 36% non-White, 87% high school). For each weekday, participants identified if they attended school in person (IP), online-scheduled synchronous classes (O/S), online-no scheduled classes (asynchronous, O/A), or no school. Students reported bedtimes (BT) and wake times (WT) ...
Electronic media (EM) use has long been associated with poor sleep in children. Children’s use of... more Electronic media (EM) use has long been associated with poor sleep in children. Children’s use of EM may also be related to emotional distress – anxiety being one of the more prevalent issues, which has been tied to sleep-related problems as well (e.g., Fors & Barch, 2019; Alfano et al., 2007). Children in foster care have often been victims of trauma, which can lead to significant emotional and sleep difficulties (e.g., Kovachy et al., 2013). The Fostering Sleep study examined the association between EM use and sleep among children in foster care; and the additional influence of anxiety. Participants were caregivers of foster care children recruited from private Facebook foster care support groups across the United States. The study used a cross-sectional design examining sleep patterns and behaviors, EM use and mental health among children in foster care. An online survey, hosted by Qualtrics, was distributed to caregivers via Facebook. The data of 443 foster care children between...
not male’ and ‘male not female’ publications, respectively. Limit More recent studies have includ... more not male’ and ‘male not female’ publications, respectively. Limit More recent studies have included women, but most of our options do not include ‘men’ and ‘women’ as key-phrases. The present knowledge about normal sleep, sleep disorders and the term ‘female’ is listed for searches on disease, organ, physiology, consequences of disrupted sleep have come from studies of genetics and so on while the term ‘woman’ refers to human men. adult females as cultural, psychological, sociological, political There is a need to study gender differences in sleep (Ehlers and and economic entities (see MEDLINE). Scientific literature Kupfer 1997), the effects of environment and pharmacological searches on women are therefore best conducted using the interventions, as well as aspects of sleep physiology and sleep word ‘female’ as a limit option. disorders that are unique to women (Carskadon and Sharkey For a more focused analysis of the gender representation in 1993). Given the historical lack of fem...
Early school bell times incompatible with adolescent sleep needs and patterns are a major contrib... more Early school bell times incompatible with adolescent sleep needs and patterns are a major contributor to widespread adolescent sleep insufficiency. Biological delay in sleep onset and social pressures during puberty, combined with the need to arise early on weekdays, make obtaining adequate and optimally timed sleep difficult for most adolescents, potentially impacting physical and emotional wellbeing, safety, and academic performance. Accumulating studies demonstrate that delaying school start times can effectively counter chronic insufficient sleep in adolescents, as well as enhance health, safety, and school success. That many secondary schools continue requiring attendance at times incompatible with healthy sleep suggests that empirical data have played a smaller role in influencing school hours than social and political factors. Overcoming the fear of change, failure of imagination, and ignorance about sleep currently blocking policy changes will require reframing school start ...
Over the last 25 years, we have developed a clear understanding of the implications of early scho... more Over the last 25 years, we have developed a clear understanding of the implications of early school start times for delayed and insufficient sleep for adolescents and, in turn, the consequences include daytime sleepiness, challenges to academic performance, increased automobile accidents, substance use, emotional instability, and health concerns including weight gain and obesity [1-6]. Likewise, increasingly, researchers, educators, health care providers, secondary school administrators, and families are collaborating on research, policy changes, and the practical work needed to carefully consider how to effectively implement such a countermeasure to insufficient sleep: later school start times for middle and high school-age adolescents (e.g. Refs. 7-10). Since Carskadon and colleagues' landmark study [11] demonstrating that adolescents' biological sleep-wake schedules are constrained by early school start times, three recent systematic reviews and a recent special issue on school start times in Sleep Health capture the body of work, to date, on school start times and adolescents' sleep [8, 12-14]. Taking these reviews together, there is significant evidence that delaying start times at the middle and high school level increases school-night sleep duration by at least 30 min, primarily by delaying rise times, and that later start times generally correspond to improved attendance, lower tardiness records, better grades, improved mood, decreased school health center/ nurse's office visits, and fewer motor vehicle crashes [8, 12-18]. At this juncture, additional and new questions arise regarding the effectiveness of delaying school start time for adolescents' sleep and other outcomes including cultural nuances and differences, sustained benefits, role of sleep knowledge and hygiene, and a range of implementation and assessment questions that are particularly relevant to policy and education experts and researchers. Furthermore, the overwhelming majority of school start time outcome studies, to date, were convenience studies, utilized self-reported sleep patterns and other variables, and were conducted in the United States [12-19].
Provide actigraphic reference values for motor activity during sleep for children and adolescents... more Provide actigraphic reference values for motor activity during sleep for children and adolescents ages 8-17 years. Participants were 671 healthy community-dwelling children and adolescents (52% female, mean age 13.5+2.4 years) from the United States (64%) and Australia (36%). All participants wore an Ambulatory-Monitoring Inc. (AMI, Ardsley, NY) actigraph on their non-dominant wrist for ≥5 nights and completed daily sleep diaries. Actigraphy data were scored with standard methods and a validated algorithm. Reference values were calculated for three outcome variables: percent sleep (sleep minutes/sleep period), mean activity count (average activity count over the sleep period), and restlessness measured by the activity index (% of epochs in sleep period > 0). Between group differences were examined for sex and age group. In addition, changes to activity level across the sleep period were explored. All participants had a minimum of 3 scorable nights of data, with 95% having at leas...
OBJECTIVES The COVID-19 virus has resulted not only in high rates of morbidity and mortality acro... more OBJECTIVES The COVID-19 virus has resulted not only in high rates of morbidity and mortality across the globe, but in widespread mental health problems and sleep disruption, likely as a result of pandemic-related stressors. The current study examines associations among COVID-related stress, sleep quality, and mental health. DESIGN Cross-sectional data were collected via online surveys in May 2020. PARTICIPANTS were 2541 community adults ages 18-70 from Israel (N = 1969) and the U.S. (N = 572). MEASUREMENT Participants completed measures of COVID-related stress, sleep quality, and symptoms of anxiety, depression and adjustment disorder. RESULTS Participants reported high rates of depression and anxiety symptoms, adjustment difficulties, and poor sleep quality. In both countries, COVID-related stressors were associated with both anxiety and depression, and these associations were mediated by sleep disturbances. CONCLUSIONS These results support the role of sleep in mental health difficulties. Widespread, accessible, evidence-based interventions are urgently needed to improve health and mental health and to promote resilience in preparation for future global crises.
Introduction Limited research exists regarding the sleep environment and sleep health of youth in... more Introduction Limited research exists regarding the sleep environment and sleep health of youth in juvenile justice facilities. We examined the perspectives of facility night staff on the sleep-living environment and conditions of detained youth using semi-structured interviews. Methods In collaboration with Maryland’s Department of Juvenile Services (DJS) we conducted virtual semi-structured interviews (45 minutes) with superintendents, medical staff, and night staff at all state facilities. We present the data reported by night staff (n=10) here, each representing a different facility. Interview questions focused on facility structure, protocols, and youth healthcare. Inductive qualitative analyses examined high frequency themes with the aim of understanding the sleep environment, sleep patterns, and overall youth wellbeing. After transcription of each interview, coder 1 examined each transcript to identify high frequency themes; coder 2 reviewed these first codes. Few disagreement...
Introduction Sleep during childhood has a major impact on physiological, psychological, and cogni... more Introduction Sleep during childhood has a major impact on physiological, psychological, and cognitive development, yet sleep health is a neglected part of training/education for foster parents and agency staff. This study examined foster care agency staff perceptions of child sleep problems encountered by foster caregivers in order to inform the development of a sleep health training program for foster care agency staff and caregivers. Methods N=36 staff members from public and private foster care agencies in Texas, New York, New Jersey, and Maryland were interviewed remotely. Questions included knowledge of sleep policies, concerns surrounding sleep, methods for addressing sleep concerns, and sleep training recommendations. Two members of the research team coded the interviews using the Atlas.ti program. Coders first independently reviewed and coded transcriptions for thematic key words without formal concepts before reviewing and refining themes/codes with the full research team f...
OBJECTIVES To assess changes in sleep parameters and circadian rhythm metrics measured by actigra... more OBJECTIVES To assess changes in sleep parameters and circadian rhythm metrics measured by actigraphy in preschool-aged children. DESIGN Longitudinal analysis over 1 year. PARTICIPANTS Ninety-four children living in Tijuana and Ensenada, Mexico. MEASUREMENTS Children wore accelerometers on the right hip for one continuous week at baseline and 1-year follow-up. Parents recorded child bedtime, waketime, and naps in sleep diaries. We used cosinor and nonparametric approaches to calculate circadian rhythm metrics. RESULTS At baseline, children had a mean age of 4.2 years, and 51.1% were girls. In multivariable models adjusted for age, gender, BMI category, parental education, household income and city, at follow-up children had significantly earlier waketimes (β = -7.99 minutes, p < .001) compared to baseline. Children also had lower sleep onset latency (β = -2.32 minutes, p = .057), and longer nighttime sleep (β = 9.38 minutes, p = .079), but these changes were not significant at the α < 0.05 level. We found significant increases in log relative amplitude (β = 0.017, p = .009), and decreases in log midline estimated statistic of rhythm (β = -0.084, p = .017) and log of the least active 5-hour period (β = -0.057, p = .010). When we adjusted for co-sleeping, we found significant decreases in the number of nighttime awakenings (β = -1.29, p = .011) but otherwise similar results. There were no other changes in sleep parameters or circadian rhythm metrics. CONCLUSIONS Mean increases in nighttime sleep and earlier wake times over one year were concomitant with decreases in overall activity levels and increases in circadian rhythm robustness. Co-sleeping was a predictor of sleep disturbances. This study provides longitudinal evidence regarding changes in sleep and circadian metrics in a sample of children from an under-researched sociodemographic group during an important, early life period.
Introduction Adolescents who experience insufficient, poor quality sleep, and sleep problems migh... more Introduction Adolescents who experience insufficient, poor quality sleep, and sleep problems might experience difficulties with externalizing behaviors including aggression and impulse control (Bauducco et al., 2019; Brown et al., 2022). Surprisingly, sleep and behavior for youth residing in long and short-term juvenile justice facilities is understudied. The present preliminary analysis explores self-reported sleep problems and aggressive and impulse control symptoms for youth under the care of the Department of Juvenile Services (DJS). Methods Participants (N=62, 86% male, mean age = 16.8, SD=1.2) were recruited from 11 DJS detention and treatment facilities in Maryland. Racial Backgrounds: 55% Black, 18% White, 14% Multiracial, and 12% Other. They completed an online questionnaire focused on sleep behaviors (daytime sleepiness, sleep-wake behavior problems) and daytime functioning including aggressive and impulse control behaviors (e.g., modified Aggression Questionnaire, Buss & ...
Introduction Sleep during childhood has a major impact on physiological, psychological, and cogni... more Introduction Sleep during childhood has a major impact on physiological, psychological, and cognitive development. Limited research has focused on vulnerable populations such as children in foster care. Foster care children endure placement instability, which may contribute to disrupted sleep patterns and unpredictability around bedtime (Leathers, et al., 2019). The Fostering Sleep study examined foster caregivers’ perceptions of children’s sleep challenges and strategies for improving sleep difficulties. Methods Foster caregivers of children ages 4–11 throughout the US were invited to complete the Qualtrics Sleep Health among Children in Foster Care Survey via foster care Facebook groups. The survey included quantitative and qualitative questions focused on sleep patterns and behaviors. Qualitative questions on barriers and opportunities to improve sleep were examined: what helps foster care children sleep well; what kinds of difficulties do foster care children experience at bedti...
Introduction Insufficient and disordered sleep are common among developing adolescents and can re... more Introduction Insufficient and disordered sleep are common among developing adolescents and can result in poor health and behavioral consequences. Previous studies have examined sleep and adolescent criminal behavior; however, little is known about adolescent sleep difficulties or disorders while residing in juvenile detention and treatment facilities. The current study explores psychiatric and sleep disorder diagnoses and medication use of youth under the care of the Department of Juvenile Services (DJS). Methods Participants were recruited from 11 detention and treatment facilities across Maryland. Youth (N = 67) were 13-19 years old (M = 16.8, SD = 1.2) and 84% male and 16% female. Racial Backgrounds: 55% Black, 18% White, 14% Multiracial, and 12% Other. A Healthcare staff member from each facility completed an online medical questionnaire regarding each youth’s sleep history, medical diagnoses, and current medications. Results The most common youth diagnoses were Insomnia (N = 26...
Introduction Adolescents are susceptible to sleep loss due to biological and environmental factor... more Introduction Adolescents are susceptible to sleep loss due to biological and environmental factors such as delayed circadian timing and schedule demands. Few studies have examined sleep-wake patterns for adolescents residing in juvenile justice facilities. The current study assessed youth’s self-reported sleep-wake schedules, sleep environment perceptions, and sleep quality. Methods Participants were recruited from 11 juvenile services detention and treatment facilities in Maryland. For seven consecutive mornings, youth completed a sleep-wake diary reporting their bed/wake times, sleep onset, and type of (nocturnal) light exposure. Youth wore digital wristwatches to accurately depict their sleep-wake schedules. Sleep quality and wake difficulty were rated on a scale from 1-10 (1=very poor/easy to 10=very good/hard, respectively). Results Participants (N= 64) were 13-19 years old (M= 16.7, SD= 1.3 years) and 85.9% male. Racial backgrounds: 61% Black, 18% White, 8% Multiracial, and 13...
Introduction COVID-19 fundamentally altered education in the United States. A variety of in-perso... more Introduction COVID-19 fundamentally altered education in the United States. A variety of in-person, hybrid, and online instruction formats took hold in Fall 2020 as schools reopened. The Nationwide Education and School in TEens During COVID (NESTED) study assessed how these changes impacted sleep. Here we examined how instruction format was associated with sleep disruption and learning outcomes. Methods Data from 4148 grade 6-12 students were included in the current analyses (61% non-male; 34% non-white; 13% middle-school). Each student’s instructional format was categorized as: (i) in-person; (ii) hybrid [≥1 day/week in-person]; (iii) online/synchronous (scheduled classes); (iv) online/asynchronous (unscheduled classes); (v) online-mixed; or (vi) no-school. Sleep disturbances (i.e., difficulty falling/staying asleep) were measured with validated PROMIS t-scores. A bootstrapped structural equation model examined how instructional format and sleep disturbances predict school/learning...
Introduction A strong association between sleep disturbances and externalizing symptoms has been ... more Introduction A strong association between sleep disturbances and externalizing symptoms has been found among school-aged children. In particular, there is a known association between sleep disturbances, irritability, emotional dysregulation, and hyperactivity (e.g., Coto et al., 2018). Limited research, however, has examined this association in a high-risk population of children, such as those in foster care who are at increased risk for sleep disturbances due to heightened exposure to trauma. Thus, the following study sought to assess the association between sleep quality and externalizing symptoms in a population of children in foster care. Methods Caregivers with children ages 4–11 were sampled from private Facebook community foster care groups across the United States (n = 410). Caregivers were provided a link to a survey powered by Qualtrics where they were asked to report on the children under their care’s weekday bedtime, overall sleep quality (e.g., “Please rate your child’s...
Using data from the Nationwide Education and Sleep in TEens During COVID (NESTED) study (N=6,578)... more Using data from the Nationwide Education and Sleep in TEens During COVID (NESTED) study (N=6,578), we investigated if race/ethnicity (64.6% were White and 35.4% identified as a racial/ethnic minority, mixed, or “other”) and community social vulnerability affected the association between COVID stress and sleep disturbance. Data on sociodemographic factors (age, race, sex, grade, zip code [for neighborhood social vulnerability index, SVI]), COVID-related stress, depression, anxiety, instructional format (online, in-person, or hybrid), and sleep disturbance (PROMIS Pediatric Sleep Disturbance) were captured through an online survey. Descriptive and inferential analyses (Hierarchical Binary Logistic Regression (HBLR), SPSS v. 25) in 4171 adolescents examined associations between sleep disturbance and COVID-related stress, adjusting for race, sex, SVI, grade level, learning format, household density, and mental health factors. Sleep disturbance was prevalent among adolescents (89% above ...
Introduction Adolescents are vulnerable to short, insufficient sleep stemming from a combined pre... more Introduction Adolescents are vulnerable to short, insufficient sleep stemming from a combined preference for late bedtimes and early school start times, and also circadian disruptions from frequent shifts in sleep schedules (i.e., social jetlag). These sleep disruptions are associated with poor mental health. The COVID-19 pandemic has impacted education nationwide, including changes in instructional formats and school schedules. With data from the Nationwide Education and Sleep in TEens During COVID (NESTED) study, we examined whether sleep variability and social jetlag (SJL) during the pandemic associate with mental health. Methods Analyses included online survey data from 4767 students (grades 6-12, 46% female, 36% non-White, 87% high school). For each weekday, participants identified if they attended school in person (IP), online-scheduled synchronous classes (O/S), online-no scheduled classes (asynchronous, O/A), or no school. Students reported bedtimes (BT) and wake times (WT) ...
Electronic media (EM) use has long been associated with poor sleep in children. Children’s use of... more Electronic media (EM) use has long been associated with poor sleep in children. Children’s use of EM may also be related to emotional distress – anxiety being one of the more prevalent issues, which has been tied to sleep-related problems as well (e.g., Fors & Barch, 2019; Alfano et al., 2007). Children in foster care have often been victims of trauma, which can lead to significant emotional and sleep difficulties (e.g., Kovachy et al., 2013). The Fostering Sleep study examined the association between EM use and sleep among children in foster care; and the additional influence of anxiety. Participants were caregivers of foster care children recruited from private Facebook foster care support groups across the United States. The study used a cross-sectional design examining sleep patterns and behaviors, EM use and mental health among children in foster care. An online survey, hosted by Qualtrics, was distributed to caregivers via Facebook. The data of 443 foster care children between...
not male’ and ‘male not female’ publications, respectively. Limit More recent studies have includ... more not male’ and ‘male not female’ publications, respectively. Limit More recent studies have included women, but most of our options do not include ‘men’ and ‘women’ as key-phrases. The present knowledge about normal sleep, sleep disorders and the term ‘female’ is listed for searches on disease, organ, physiology, consequences of disrupted sleep have come from studies of genetics and so on while the term ‘woman’ refers to human men. adult females as cultural, psychological, sociological, political There is a need to study gender differences in sleep (Ehlers and and economic entities (see MEDLINE). Scientific literature Kupfer 1997), the effects of environment and pharmacological searches on women are therefore best conducted using the interventions, as well as aspects of sleep physiology and sleep word ‘female’ as a limit option. disorders that are unique to women (Carskadon and Sharkey For a more focused analysis of the gender representation in 1993). Given the historical lack of fem...
Early school bell times incompatible with adolescent sleep needs and patterns are a major contrib... more Early school bell times incompatible with adolescent sleep needs and patterns are a major contributor to widespread adolescent sleep insufficiency. Biological delay in sleep onset and social pressures during puberty, combined with the need to arise early on weekdays, make obtaining adequate and optimally timed sleep difficult for most adolescents, potentially impacting physical and emotional wellbeing, safety, and academic performance. Accumulating studies demonstrate that delaying school start times can effectively counter chronic insufficient sleep in adolescents, as well as enhance health, safety, and school success. That many secondary schools continue requiring attendance at times incompatible with healthy sleep suggests that empirical data have played a smaller role in influencing school hours than social and political factors. Overcoming the fear of change, failure of imagination, and ignorance about sleep currently blocking policy changes will require reframing school start ...
Over the last 25 years, we have developed a clear understanding of the implications of early scho... more Over the last 25 years, we have developed a clear understanding of the implications of early school start times for delayed and insufficient sleep for adolescents and, in turn, the consequences include daytime sleepiness, challenges to academic performance, increased automobile accidents, substance use, emotional instability, and health concerns including weight gain and obesity [1-6]. Likewise, increasingly, researchers, educators, health care providers, secondary school administrators, and families are collaborating on research, policy changes, and the practical work needed to carefully consider how to effectively implement such a countermeasure to insufficient sleep: later school start times for middle and high school-age adolescents (e.g. Refs. 7-10). Since Carskadon and colleagues' landmark study [11] demonstrating that adolescents' biological sleep-wake schedules are constrained by early school start times, three recent systematic reviews and a recent special issue on school start times in Sleep Health capture the body of work, to date, on school start times and adolescents' sleep [8, 12-14]. Taking these reviews together, there is significant evidence that delaying start times at the middle and high school level increases school-night sleep duration by at least 30 min, primarily by delaying rise times, and that later start times generally correspond to improved attendance, lower tardiness records, better grades, improved mood, decreased school health center/ nurse's office visits, and fewer motor vehicle crashes [8, 12-18]. At this juncture, additional and new questions arise regarding the effectiveness of delaying school start time for adolescents' sleep and other outcomes including cultural nuances and differences, sustained benefits, role of sleep knowledge and hygiene, and a range of implementation and assessment questions that are particularly relevant to policy and education experts and researchers. Furthermore, the overwhelming majority of school start time outcome studies, to date, were convenience studies, utilized self-reported sleep patterns and other variables, and were conducted in the United States [12-19].
Provide actigraphic reference values for motor activity during sleep for children and adolescents... more Provide actigraphic reference values for motor activity during sleep for children and adolescents ages 8-17 years. Participants were 671 healthy community-dwelling children and adolescents (52% female, mean age 13.5+2.4 years) from the United States (64%) and Australia (36%). All participants wore an Ambulatory-Monitoring Inc. (AMI, Ardsley, NY) actigraph on their non-dominant wrist for ≥5 nights and completed daily sleep diaries. Actigraphy data were scored with standard methods and a validated algorithm. Reference values were calculated for three outcome variables: percent sleep (sleep minutes/sleep period), mean activity count (average activity count over the sleep period), and restlessness measured by the activity index (% of epochs in sleep period > 0). Between group differences were examined for sex and age group. In addition, changes to activity level across the sleep period were explored. All participants had a minimum of 3 scorable nights of data, with 95% having at leas...
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