Search

Objective/background: Elementary school nurses are an important component of health care systems. However, translational research of their role in interventions is limited. This study aimed to determine the feasibility, acceptability and sustainability of training the school nursing workforce to deliver a brief behavioral sleep intervention and the associated delivery costs., Participants: Twenty-four primary school nurses from the Victorian Department of Education and Training, Melbourne, Australia, involved in delivering the school-based sleep intervention as part of the Sleep Well - Be Well trial participated in three surveys and a focus group over 30 months., Methods: An embedded mixed methods design utilizing quantitative and qualitative data sources was used., Results: Qualitative and quantitative evidence demonstrated training school nurses to deliver a brief sleep intervention was feasible and acceptable. Competence and confidence levels were maintained 12 months after the completion of intervention delivery demonstrating sustainability for this low cost model. Benefits of school nurses' participation in translational research projects were also identified., Conclusions: These findings highlight the potential for utilizing school nurses directly in interventions at the health and education interface. Further research is required to address the challenges of intervention implementation and to identify policy implications for other intervention opportunities which may exist.

Background: Improving children's sleep could lead to significant benefits in several functional domains. Recent research in adults suggests that intensive, adaptive cognitive training may be beneficial in improving sleep, although there is limited understanding whether this approach yields similar results in children., Objective: To determine whether a working memory training program improved sleep latency, sleep problems, and sleep duration on school and nonschool nights and whether there was a differential effect of the timing of training during the school day on sleep outcomes., Design/methods: Design: Population-based randomised controlled trial., Setting: Forty-four schools in Melbourne, Australia., Participants: All Grade 1 children (mean age = 6.9 years, SD 0.4) underwent WM screening using two subtests from the Automated Working Memory Assessment. Children with low verbal and/or visuo-spatial WM scores relative to their peers ('low WM', ∼25%) were randomised to intervention or control arms., Intervention: 20 to 25 computerised 25-min training sessions were conducted using the CogMed program, over 5-7 weeks at school., Outcomes: Parent-reported child sleep characteristics (time, latency, duration and problem) at 6 months post randomisation., Results: A total of 452 (26.0%) of 1723 children screened (64.1% of approached) met trial eligibility criteria, with 226 in each study arm. Of intervention children, 91% completed the minimum 20 days of training. Retention was 90.5% at 6 months. Adjusted regressions showed that intervention children did not have better sleep latency, duration, bedtime consistency or less sleep problems., Conclusion: It does not appear that adaptive working memory training during the school day can be used as a novel approach to improve children's sleep attributes up to 6 months post-randomisation, regardless of the time of day training is delivered., (Copyright © 2017 Elsevier B.V. All rights reserved.)

Objectives: The aim of this study is to use national Australian time-diary data to examine both (1) cross-sectionally and (2) longitudinally whether being late versus early to sleep or wake is associated with poorer child behavior, quality of life, learning, cognition and weight status, and parental mental health., Design/setting: Data from the first three waves of the Longitudinal Study of Australian Children were taken., Participants: A national representative sample of 4983 4-5-year-olds, recruited in 2004 from the Australian Medicare database and followed up biennially, was taken; 3631 had analyzable sleep information and a concurrent measure of health and well-being for at least one wave., Exposure: Parents completed 24-h child time-use diaries for one week and one weekend day at each wave. Using median splits, sleep timing was categorized into early-to-sleep/early-to-wake (EE), early-to-sleep/late-to-wake (EL), late-to-sleep/early-to-wake (LE), and late-to-sleep/late-to-wake (LL) at each wave., Outcomes: The outcomes included parent-reported child behavior, health-related quality of life, maternal/paternal mental health, teacher-reported child language, literacy, mathematical thinking, and approach to learning. The study assessed child body mass index and girth., Results: (1) Using EE as the comparator, linear regression analyses revealed that being late-to-sleep was associated with poorer child quality of life from 6 to 9 years and maternal mental health at 6-7 years. There was inconsistent or no evidence for associations between sleep timing and all other outcomes. (2) Using the count of the number of times (waves) at which a child was categorized as late-to-sleep (range 0-3), longitudinal analyses demonstrated that there was a cumulative effect of late-to-sleep profiles on poorer child and maternal outcomes at the child age of 8-9 years., Conclusions: Examined cross-sectionally, sleep timing is a driver of children's quality of life and maternal depression. Examined longitudinally, there appears to be cumulative and adverse relationships between late-to-sleep profiles and poorer child and maternal outcomes at the child age of 8-9 years. Understanding how other parameters - such as scheduling consistency, sleep efficiency and hygiene - are also related to child and parent outcomes will help health professionals better target sleep management advice to families., (Copyright © 2016 Elsevier B.V. All rights reserved.)

Aim: Using national Australian time-diary data, we aimed to empirically determine sleep duration thresholds beyond which children have poorer health, learning, quality of life, and weight status and parents have poorer mental health., Design/setting: Cross-sectional data from the first three waves of the Longitudinal Study of Australian Children., Participants: A nationally representative sample of 4983 4-5-year-olds, recruited in 2004 from the Australian Medicare database and followed biennially; 3631 had analyzable sleep information and a concurrent measure of health and well-being for at least one wave., Exposure: At each wave, a parent completed 24-h time-use diaries for one randomly selected weekday and one weekend day, including a "sleeping/napping" category., Outcomes: Parent-reported child mental health, health-related quality of life, and maternal/paternal mental health; teacher-reported child language, literacy, mathematical thinking, and approach to learning; and assessed child body mass index and girth., Results: Linear regression analyses revealed weak, inconsistent relationships between sleep duration and outcomes at every wave. For example, children with versus without psychosocial health-related quality of life problems slept slightly less at 6-7 years (adjusted mean difference 0.12 h; 95% confidence interval 0.01-0.22, p = 0.03), but not at 4-5 (0.00; -0.10 to 0.11, p = 1.0) or 8-9 years (0.09; -0.02 to 0.22, p = 0.1). Empirical exploration using fractional polynomials demonstrated no clear thresholds for sleep duration and any adverse outcome at any wave., Conclusions: Present guidelines in terms of children's short sleep duration appear misguided. Other parameters such as sleep timing may be more meaningful for understanding optimal child sleep., (Copyright © 2015 Elsevier B.V. All rights reserved.)

Objective: Poor sleep and working memory difficulties are both associated with learning difficulties, but it is not known whether they are linked with each other in childhood. We aimed to determine, in a population-based sample of grade 1 children, whether poor sleep is associated with reduced working memory capacity., Methods: Cross-sectional population-based study. All grade 1 children in 44 elementary schools in metropolitan Melbourne, Australia; 1749 children were included (participation rate 65%, mean age 6.9 years). Parents completed a written questionnaire at home, after which researchers administered one-on-one child computerized assessments at school. Predictor measures were parent-reported 1) perceptions of poor sleep, 2) regularity of bedtime, 3) sleep duration, and 4) sleep onset latency. Outcome measures were backward digit recall (verbal working memory) and Mister X (visuospatial working memory) subtests of the Automated Working Memory Assessment (AWMA). Associations were examined using linear regression, adjusted for duration of schooling, gender, age, and social status., Results: Increasing poor sleep (P = .03), less regularity of bedtime (P < .001), and shorter sleep duration (P = .03) were all associated with poorer verbal working memory, with effect sizes ranging from 0.3 to 1.2. Poor sleep was not associated with visuospatial working memory., Conclusions: At a population level, poor sleep in early school-age children is associated with poorer verbal working memory, an important predictor of academic difficulties., (Copyright © 2015 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.)

Objective: To provide accurate population normative data documenting cross-sectional, age-specific sleep patterns in Australian children aged 0-9 years., Design and Setting: The first three waves of the nationally representative Longitudinal Study of Australian Children, comprising two cohorts recruited in 2004 at ages 0-1 years (n=5107) and 4-5 years (n=4983), and assessed biennially., Participants: Children with analysable sleep data for at least one wave., Measures: At every wave, parents prospectively completed 24-h time-use diaries for a randomly selected week or weekend day. 'Sleeping, napping' was one of the 26 precoded activities recorded in 15-min time intervals., Results: From 0 to 9 years of age, 24-h sleep duration fell from a mean peak of 14 (SD 2.2) h at 4-6 months to 10 (SD 1.9) h at 9 years, mainly due to progressively later mean sleep onset time from 20:00 (SD 75 min) to 21:00 (SD 60 min) and declining length of day sleep from 3.0 (SD 1.7) h to 0.03 (SD 0.2) h. Number and duration of night wakings also fell. By primary school, wake and sleep onset times were markedly later on weekend days. The most striking feature of the centile charts is the huge variation at all ages in sleep duration, sleep onset time and, especially, wake time in this normal population., Conclusions: Parents and professionals can use these new centile charts to judge normalcy of children's sleep. In future research, these population parameters will now be used to empirically determine optimal child sleep patterns for child and parent outcomes like mental and physical health.

Key Points: Question: How are individual trajectories of sleep problems prospectively associated with internalizing and externalizing symptoms across the child to adolescent transition period? Findings: In this cohort study including 10 313 individuals, individualized profiles of sleep problems were concurrently and prospectively associated with psychopathology symptoms in both late childhood and early adolescence. Whereas psychopathology symptoms in late childhood were not associated with trajectories of sleep problems over time, sleep problem trajectories were associated with psychopathology symptoms in early adolescence. Meaning: These findings highlight the key role of problematic sleep in contributing to the emergence and exacerbation of internalizing and externalizing symptoms in youth and underline the importance of sleep health in supporting young adolescents' mental well-being. This cohort study evaluates individual changes in profiles of sleep problems and their prospective associations with psychopathology symptoms across the transition from childhood to adolescence. Importance: Sleep problems and psychopathology symptoms are highly comorbid and bidirectionally correlated across childhood and adolescence. Whether these associations are specific to discrete profiles of sleep problems and specific internalizing and externalizing phenomena is currently unclear. Objective: To characterize individual changes in profiles of sleep problems and their prospective associations with psychopathology symptoms across the transition from childhood to adolescence. Design, Setting, and Participants: This observational cohort study used baseline data (participant age of 9 to 11 years) and 2-year follow-up data (participant age of 11 to 13 years) from the community-setting, multicenter Adolescent Brain Cognitive Development (ABCD) study. Individuals were assessed for a range of sleep problems at both waves and categorized into profiles via latent profile analysis. The stability and change in these profiles over time was assessed via latent transition analysis. Logistic regression models examined whether psychopathology symptoms were cross-sectionally associated with profile membership and whether transitions between profiles were associated with changes psychopathology symptoms over time. Data were collected from September 2016 to January 2020, and data were analyzed from August 2021 to July 2022. Exposures: Sleep problems were assessed at both baseline and follow-up via the parent-reported Sleep Disturbance Scale for Children (SDSC). Main Outcomes and Measures: Psychopathology symptoms at both baseline and follow-up were assessed using the internalizing and externalizing dimension scores derived from the parent-reported Child Behavior Checklist. Results: A total of 10 313 individuals (4913 [47.6%] were female) were categorized into 4 latent profiles of sleep problems at both baseline and follow-up: a low disturbance profile, a sleep onset/maintenance problems profile, a moderate and nonspecific disturbance profile (termed mixed disturbance), and a high disturbance profile. Individuals in the 3 more severe problem profiles displayed greater risk of concurrent internalizing symptoms (sleep onset/maintenance problems: odds ratio [OR], 1.30; 95% CI, 1.25-1.35; P <.001; mixed disturbance: OR, 1.29; 95% CI, 1.25-1.33; P <.001; high disturbance: OR, 1.44; 95% CI, 1.40-1.49; P <.001) and externalizing symptoms (sleep onset/maintenance problems: OR, 1.20; 95% CI, 1.16-1.23; P <.001; mixed disturbance: OR, 1.17; 95% CI, 1.14-1.20; P <.001; high disturbance: OR, 1.24; 95% CI, 1.21-1.28; P <.001). Transitions between sleep profiles over time were associated with prospective internalizing and externalizing symptoms, but not vice versa. Conclusions and Relevance: There are substantial changes in sleep problems across the transition to adolescence that are associated with later internalizing and externalizing symptoms. Sleep profiles could be targeted in future intervention and treatment programs to improve sleep-related and mental health–related outcomes across development. [ABSTRACT FROM AUTHOR]

Background: This study examined whether distinct sleep problem trajectories from infancy through middle childhood were associated with multiple aspects of child well‐being at ages 10–11 years. Methods: Data were from the first six waves of the Longitudinal Study of Australian Children – Birth Cohort (5,107 children recruited at birth). Caregivers reported on child sleep problems at each time point. A combination of caregiver‐reported, teacher‐reported and child‐completed tasks were used to index child well‐being outcomes at ages 10–11 years including emotional/behavioural functioning (internalizing and externalizing symptoms; self‐control), health‐related quality of life, cognitive skills and academic achievement. Results: Latent class analysis identified five distinct sleep problem trajectories over time: persistent sleep problems through middle childhood (7.7% of the sample), limited infant/preschool sleep problems (9.0%), increased middle childhood sleep problems (17.0%), mild sleep problems over time (14.4%) and no sleep problems (51.9%). Compared to those with no sleep problems, children with persistent sleep problems had the greatest impairments across all outcomes except cognitive skills (perceptual reasoning), with moderate to large effect sizes. Children with increased middle childhood sleep problems similarly experienced greater internalizing and externalizing symptoms and worse quality of life, but few academic impairments. Both the limited infant/preschool sleep problems and mild increases over time trajectories also showed internalizing concerns and worse caregiver‐reported quality of life, although effects were smaller than the other sleep trajectories. Conclusions: The linkages between sleep problems and negative child outcomes across domains underscore the importance of early identification and targeted intervention to address sleep problems and promote child well‐being. [ABSTRACT FROM AUTHOR]

Objective/Background: Determine the effects and costs of a brief behavioral sleep intervention, previously shown to improve child social-emotional functioning, sleep, and parent mental health, in a translational trial. Participants: Three hundred thirty-four school entrant children from 47 primary schools in Melbourne, Australia, with parent-reported moderate to severe behavioral sleep problems. Methods: intervention group received sleep hygiene practices and standardized behavioral strategies delivered by trained school nurses in 2013 and 2014. Control group children could receive usual community care. Results: Outcome measures: child social-emotional functioning (Pediatric Quality of Life Inventory 4.0 psychosocial health summary score—primary outcome), sleep problems (parent-reported severity, Children's Sleep Habits Questionnaire), behavior, academic function, working memory, child and parent quality of life, and parent mental health. At six months post randomization, 145 (of 168) intervention and 155 (of 166) control families completed the primary outcome for which there was no difference. Intervention compared with control children had fewer sleep problems (35.2% vs. 52.7% respectively, OR 0.5; 95% CI 0.3 to 0.8, p = 0.002) and better sleep patterns (e.g., longer sleep duration). Their parents reported fewer symptoms of depression. All differences attenuated by 12 months. There was no difference in other outcomes at either time point. Intervention costs: $AUS 182/child. Conclusions: A brief behavioral sleep intervention, delivered by school nurses to children with behavioral sleep problems, does not improve social emotional functioning. Benefits to child sleep and parent mental health are evident at 6 but not 12 months. Approaches that increase intervention dosage may improve outcomes. [ABSTRACT FROM AUTHOR]

This study explored longitudinal and bidirectional associations among behavioral sleep problems and self-regulation difficulties across the elementary school years. Analyses drew data from the Kindergarten Cohort (N = 4983) of the Longitudinal Study of Australian Children (LSAC) across five data waves, when children were aged 4–13 years (49% female, 86% English-speaking). Cross-lagged structural equation models revealed significant bidirectional associations, with greater sleep problems consistently predicting classroom self-regulation two years later, while poorer self-regulation predicted later sleep problems only at certain time points. Greater behavioral sleep problems were associated with poorer post-elementary achievement and social-emotional wellbeing, while stronger classroom self-regulation skills supported more positive outcomes in these constructs. Findings indicate strong developmental associations among sleep problems and dysregulation. • Across 4- to 13-years of age, sleep problems consistently predicted poorer classroom self-regulation two years later. • Poorer self-regulation predicted later sleep problems only at certain time points. • Fewer behavioral sleep problems and stronger self-regulation were linked with better longer-term outcomes. • Intervening early in school on sleep problems and self-regulation has potential to boost achievement and wellbeing. [ABSTRACT FROM AUTHOR]