A meta-analysis of accelerometer sleep outcomes in healthy children based on the Sadeh algorithm: the influence of child and device characteristics

Abstract Study Objectives Children often experience sleep problems, with a negative impact on mood, behavior, cognitive function, and other aspects of mental and physical health. Accelerometers are widely used to assess sleep, but general reference values for healthy children do not yet exist. The aim of this meta-analysis was to determine mean values for wake after sleep onset (WASO), sleep efficiency (SE), total sleep time (TST) and sleep onset latency (SOL), and to determine the effect of child and accelerometer-characteristics. Methods A search included studies with healthy children, 0–18 years, reporting WASO, SE, TST, and/or SOL, calculated with the Sadeh algorithm. Meta-analyses with random effects produced pooled estimate means per outcome. Meta-regression analyses determined the effect of age, sex, placement site and accelerometer type. Results Eighty-three studies (9,068 participants) were included. Pooled means were 63 min (95% CI 57 to 69) for WASO, 88% (95% CI 87 to 89) for SE, 477 min (95% CI 464 to 491) for TST and 19 min (95% CI 17 to 22) for SOL. Heterogeneity was high (95%–99%). TST decreased with age and there was an age-effect on SOL. SE differed between wrist and ankle (used in age 0–24 months) placement, and between piezoelectric and MEMS-type accelerometers. No differences were found between boys and girls, although this number of studies was small. Conclusions We found differences in almost all investigated outcomes and heterogeneity was high. Therefore, we advise to use a study-specific control sample until more robust reference values are available. Future research should narrow the methodological heterogeneity and produce larger datasets, needed to establish these reference values.

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706 Sleep and Mental Health in College Students Before and During the Initial COVID-19 Shutdown

SLEEP ◽

10.1093/sleep/zsab072.704 ◽

2021 ◽

Vol 44 (Supplement_2) ◽

pp. A275-A276

Author(s):

Michele Okun ◽

Allison Walden ◽

Leilani Feliciano

Keyword(s):

Mental Health ◽

College Students ◽

Sleep Quality ◽

Online Survey ◽

Sleep Problems ◽

Negative Impact ◽

Sleep Onset ◽

Sleep Onset Latency ◽

Physical And Mental Health ◽

The U.S

Abstract Introduction The COVID-19 pandemic has had an unparalleled impact on college students. Following the initial and abrupt shutdown of campuses in March 2020, several investigators assessed the immediate effects on University students. Early reports found that college students reported a higher prevalence of anxiety and depression, sedentary behavior, and sleep problems. Most were conducted outside the U.S. Data from U.S. college students are critical to identify which areas are should receive resources and interventions as the U.S. continues to experience exponential COVID cases along with continued remote learning, social restrictions and/or lockdowns. Methods Students enrolled in the Spring 2020 semester (18 years of age +) were invited to participate in an online survey (April – May 2020). A final sample of 491 completed the entire survey (length ~45 minutes) which asked about sleep quality, psychological stress, depression, and exercise.Paired t-tests were conducted to compare pre-COVID and during COVID data. Results There were significant differences in sleep onset latency (26.44 ± 23.53 min vs 32.06 ± 26.88 min; t = -3.81, P < .001), sleep duration (7.30 ± 1.45 hours vs 7.63 ± 2.07 hours; t = -2.23, p = 0.027) and overall sleep quality (6.29 ± 3.29 vs 7.44 ± 3.86; t = -7.26, p < .001), as well as depression scores (IDS no sleep questions) (5.61 ± 4.18 vs 17.59 ± 5.45; t = -54.9, P < .001). There was no difference in perceived stress (28.03 ±5.27 vs 28.39 ±5.53, t = -1.49, p = .138). Exercise (vigorous, moderate and walking) all decreased with regards to days and time spent, (all P’s < .001), whereas minutes sitting significantly increased (426.50 ± 239.88 vs 542.26 ± 249.63, p < .001). Conclusion These data empirically support the claim that the pandemic is having a significant negative impact on physical and mental health among college students. In the best of times, college students have irregular sleep patterns and significant depression, but these behaviors are worsened under government restrictions. These findings underscore the need to prioritize prevention and intervention of modifiable behaviors, especially if the pandemic extends into 2021. Support (if any):

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767 Sleep architecture and sleep problems in adolescents and young adults with and without ADHD: A systematic review and meta-analysis

SLEEP ◽

10.1093/sleep/zsab072.764 ◽

2021 ◽

Vol 44 (Supplement_2) ◽

pp. A298-A299

Author(s):

Finja Marten ◽

Lena Keuppens ◽

Dieter Baeyens ◽

Bianca Boyer ◽

Marina Danckaerts ◽

...

Keyword(s):

Sleep Problems ◽

Total Sleep Time ◽

Meta Analysis ◽

Sleep Onset ◽

Sleep Hygiene ◽

Sleep Time ◽

Sleep Architecture ◽

Adhd Group ◽

Sleep Onset Latency ◽

Onset Latency

Abstract Introduction During the past years, an increasing number of articles has focused on comparing sleep in youths with and without ADHD. However, so far no meta-analysis has been conducted summarizing the findings. Therefore, the current study assesses sleep architecture (i.e. the basic sleep structure), sleep problems, and sleep hygiene. Sleep was assessed both subjectively and objectively and the two groups were compared on multiple variables. Methods Two researchers independently performed a literature search (1980–2020). Studies using a case-control design comparing sleep in youths (12–25 years) with and without ADHD were included. Study quality was evaluated using the Newcastle-Ottawa Scale. Standardized mean differences were calculated for each outcome domain being reported by at least two studies. Results 10379 publications were screened, resulting in 11 studies and 52 effect sizes (nADHD=2377, ncontrol=21687). These effect sizes were summarized into 7 objective and 11 subjective variables measuring sleep. Two objective sleep variables were significantly worse in the ADHD group; total sleep time (z=2.16, p=.03) and sleep onset latency (z=2.39, p=.02). The two groups did not differ on sleep efficiency, sleep onset/offset time, and time in bed. Comparing the groups on subjective variables resulted in the same pattern, with total sleep time (z=21.27, p<.001) being significantly shorter in the ADHD group, and sleep onset latency (z=15.39, p<.001) and wake after sleep onset (z=13.50, p<.001) being significantly longer. Additionally, the ADHD group reported a significantly lower sleep efficiency (z=20.15, p<.001) and subjective sleep satisfaction (z=3.50, p<.001). Wake time and number of awakenings during the night were not significant. Youths with ADHD also reported significantly more sleep problems, including insomnia (z=6.38, p<.001), daytime sleepiness (z=26.68, p<.001) and sleep disturbances (z=8.00, p<.001). Due to only two studies measuring it, with a focus on different variables, sleep hygiene could not be included. Conclusion In general, youths with ADHD have a disrupted sleep architecture and experience more sleep problems compared to their typically developing peers. Consequently, sleep assessment should become a routine part during the diagnostic process of ADHD. Additionally, more research is needed focusing on sleep architecture and sleep hygiene, and on the development of a sleep intervention for youths with ADHD. Support (if any):

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Melatonin for the management of sleep problems in children with neurodevelopmental disorders: a systematic review and meta-analysis

Archives of Disease in Childhood ◽

10.1136/archdischild-2017-314181 ◽

2018 ◽

Vol 103 (12) ◽

pp. 1155-1162 ◽

Cited By ~ 22

Author(s):

Ibtihal Siddiq Abdelgadir ◽

Morris A Gordon ◽

Anthony K Akobeng

Keyword(s):

Neurodevelopmental Disorders ◽

Sleep Problems ◽

Total Sleep Time ◽

Meta Analysis ◽

Sleep Onset ◽

Sleep Time ◽

Controlled Trials ◽

Sleep Onset Latency ◽

Onset Latency ◽

Randomised Controlled

ImportanceChildren with neurodevelopmental disorders have a higher prevalence of sleep disturbances. Currently there is variation in the use of melatonin; hence, an up-to-date systematic review is indicated to summarise the current available evidence.ObjectiveTo determine the efficacy and safety of melatonin as therapy for sleep problems in children with neurodevelopmental disorders.Data sources and study selectionsPubMed, Embase, the Cumulative Index to Nursing and Allied Health Literature and the Cochrane Central Register of Controlled Trials were searched from inception up to January 2018. Two reviewers performed data assessment and extraction. We assessed randomised controlled trials that compared melatonin with placebo or other intervention for the management of sleep disorders in children (<18 years) with neurodevelopmental disorders.Data extraction and synthesisWe identified 3262 citations and included 13 studies in this meta-analysis.Main outcomesMain outcomes included total sleep time, sleep onset latency, frequency of nocturnal awakenings and adverse events.ResultsThirteen randomised controlled trials (n=682) met the inclusion criteria. A meta-analysis of nine studies (n=541) showed that melatonin significantly improved total sleep time compared with placebo (mean difference (MD)=48.26 min, 95% CI 36.78 to 59.73, I2=31%). In 11 studies (n=581), sleep onset latency improved significantly with melatonin use (MD=−28.97, 95% CI −39.78 to −18.17). No difference was noted in the frequency of nocturnal awakenings (MD=−0.49, 95% CI −1.71 to 0.73). No medication-related serious adverse event was reported.ConclusionMelatonin appeared safe and effective in improving sleep in the studied children. The overall quality of the evidence is limited due to heterogeneity and inconsistency. Further research is needed.

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he effects of neurofeedback on attention and sleep in individuals with and without ADHD or insomnia: a literature review

10.31739/anamh.2021.1.30 ◽

2021 ◽

Vol 1 (1) ◽

pp. 30-49

Author(s):

Annel Koomen ◽

◽

Daniel Keeser ◽

Verhagen Sonja ◽

◽

...

Keyword(s):

Sleep Problems ◽

Brain Activity ◽

Sleep Onset ◽

Attention Problems ◽

Sleep Onset Latency ◽

Healthy Children ◽

Healthy Individuals ◽

Positive Effects ◽

Children And Young Adults ◽

Inattention And Hyperactivity

Electroencephalography-Neurofeedbacktraining (E-NFT) is a method to support subjects in learning to self-regulate their own brain activity. Besides that E-NFT may improve cognitive functions in healthy people, it may improve symptoms in different disorders, such as Attention Deficit and Hyperactivity Disorder (ADHD) and insomnia. The evidence of E-NFT for the treatment of attention problems in ADHD is still under debate just as the suggested efficacy of E-NFT for reducing sleep problems in individuals suffering from insomnia and for improving attention and sleep in the general population. Therefore, this review examines the efficacy of E-NFT on attention and sleep in patients and healthy individuals. The reviewed literature provides evidence that standard E-NFT protocols may have a positive long-lasting effect on the inattention and hyperactivity/impulsivity symptoms in children with ADHD. In healthy children and young adults, E-NFT has been found to improve different aspects of attention and to reduce impulsivity. In addition, positive effects of E-NFT have been documented on sleep onset latency and on tiredness in healthy individuals. Sleep improvements have also been found in insomnia patients after standard E-NFT, although these subjective sleep improvements may likely depend on unspecific E-NFT training effects.

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Effect of early intervention for anxiety on sleep outcomes in adolescents: a randomized trial

European Child & Adolescent Psychiatry ◽

10.1007/s00787-021-01795-6 ◽

2021 ◽

Author(s):

Bente Storm Mowatt Haugland ◽

Mari Hysing ◽

Asle Hoffart ◽

Åshild Tellefsen Haaland ◽

Jon Fauskanger Bjaastad ◽

...

Keyword(s):

Early Intervention ◽

Standard Length ◽

Sleep Problems ◽

Sleep Onset ◽

Cognitive Behavioral ◽

Control Group ◽

Sleep Onset Latency ◽

Post Intervention ◽

Clinical Trial Registration

AbstractThe potential effect of early intervention for anxiety on sleep outcomes was examined in a sample of adolescents with anxiety (N = 313, mean 14.0 years, SD = 0.84, 84% girls, 95.7% Norwegians). Participants were randomized to one of three conditions: a brief or a standard-length cognitive-behavioral group-intervention (GCBT), or a waitlist control-group (WL). Interventions were delivered at schools, during school hours. Adolescents with elevated anxiety were recruited by school health services. Questionnaires on self-reported anxiety symptoms, depressive symptoms, and sleep characteristics were administered at pre- and post-intervention, post-waitlist, and at 1-year follow-up. Adolescents reported reduced insomnia (odds ratio (OR) = 0.42, p < 0.001) and shorter sleep onset latency (d = 0.27, p < 0.001) from pre- to post-intervention. For insomnia, this effect was maintained at 1-year follow-up (OR = 0.54, p = 0.020). However, no effect of GCBT on sleep outcomes was found when comparing GCBT and WL. Also, no difference was found in sleep outcomes between brief and standard-length interventions. Adolescents defined as responders (i.e., having improved much or very much on anxiety after GCBT), did not differ from non-responders regarding sleep outcomes. Thus, anxiety-focused CBT, delivered in groups, showed no effect on sleep outcomes. Strategies specifically targeting sleep problems in adolescents should be included in GCBT when delivered as early intervention for adolescents with elevated anxiety.Trial registry Clinical trial registration: School Based Low-intensity Cognitive Behavioral Intervention for Anxious Youth (LIST); http://clinicalrials.gov/; NCT02279251, Date: 11.31. 2014

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Abstract P199: Sleep Health Varies By Immigration Status And Acculturation Level In Women: Results From The American Heart Association Go Red For Women Strategically Focused Research Network

Circulation ◽

10.1161/circ.143.suppl_1.p199 ◽

2021 ◽

Vol 143 (Suppl_1) ◽

Author(s):

Ivan A Samayoa ◽

Nour Makarem ◽

Vivian Cao ◽

Moorea Maguire ◽

Huaqing Xi ◽

...

Keyword(s):

Sleep Duration ◽

Sleep Problems ◽

Immigrant Women ◽

Sleep Onset ◽

Research Network ◽

Sleep Onset Latency ◽

Onset Latency ◽

Immigration Status ◽

Sleep Health ◽

The Us

Introduction: The Healthy Immigrant Effect refers to the phenomenon that recent immigrants are on average healthier than their native-born counterparts. Greater immigrant acculturation to the US has been linked to increased risk of cardiovascular disease (CVD), frequently attributed to factors including the adoption of Western diets and decreased physical activity. While immigrants may have healthier habits than US adults, which may confer protection from CVD, there is little research on sleep health, particularly in immigrant women. Hypothesis: We hypothesized that immigrants, particularly those with greater acculturation, would have more sleep problems. Methods: Baseline data from a 1-y, community-based cohort of 506 women (61% racial/ethnic minority, mean age=37±16y) was used to evaluate cross-sectional associations between acculturation and sleep. Women self-reported their immigration status and national origin. Acculturation was measured from responses to questions regarding language preference, nativity (sorted by regions: Asia, Caribbean, Latin America, other), length of residency in the US, and age at immigration. Sleep duration, sleep quality, risk of obstructive sleep apnea (OSA) and insomnia were assessed using validated questionnaires. Logistic regression models adjusted for age, health insurance, education and BMI were used to evaluate associations between acculturation measures and sleep characteristics. Results: Women who were immigrants (n=176) reported lower mean sleep duration (6.60 ± 1.25 vs. 6.85 ± 1.22 h, p=0.02) compared to non-immigrants (n=323); non-immigrants were more likely than immigrants to sleep ≥7h/night (OR: 1.50, CI: 1.01-2.22, p=0.04). Women who immigrated to the US before vs. after age 25 y had lower odds of having sleep onset latency ≥26 min (OR:0.97, CI:0.95-1.00, p=0.03). Immigrant women living in the US >10y vs. <10y had more than 2-fold higher odds of having longer sleep onset latency (≥26 min) (OR:2.43, CI:1.09-5.41, p=0.03). Immigrants from the Caribbean were more likely than immigrants from other regions to be at a high risk for OSA (OR:2.65, CI:1.07-6.55, p=0.04). Conclusions: Compared to non-immigrants, immigrant women exhibit shorter habitual sleep duration. Sleep problems may vary by age of immigration, years lived in the US, and region of origin, as those who immigrated when they were older and those who had lived in the US>10 y required more time to fall asleep and Caribbean immigrants had higher OSA risk.

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Multicomponent Cognitive-Behavioural Intervention to Improve Sleep in Adolescents: A Multiple Baseline Design

Behavioural and Cognitive Psychotherapy ◽

10.1017/s1352465813000623 ◽

2013 ◽

Vol 42 (3) ◽

pp. 368-373 ◽

Cited By ~ 14

Author(s):

Melissa C. Hendricks ◽

Cynthia M. Ward ◽

Lauren K. Grodin ◽

Keith J. Slifer

Keyword(s):

Relaxation Training ◽

Sleep Problems ◽

Sleep Onset ◽

Multiple Baseline ◽

Behavioural Intervention ◽

Sleep Onset Latency ◽

Multiple Baseline Design ◽

Baseline Design ◽

Cognitive Behavioural ◽

Cognitive Behavioural Intervention

Background: Adolescents are prone to sleep problems that have unique developmental aspects and contribute to physical, emotional, and behavioural problems. Aims: This study evaluated an individualized, multicomponent intervention that considered developmental factors, and promoted age-appropriate autonomy in three adolescent females with disrupted sleep. Method: Adolescents recorded sleep data on daily logs. A nonconcurrent multiple baseline design was used to evaluate a cognitive-behavioural intervention including sleep hygiene training, bedtime routine development, cognitive restructuring, relaxation training, stimulus control, sleep restriction, bedtime fading, and problem-solving, along with clinically indicated individualization. Results: Outcomes demonstrated clinically meaningful improvements and decreased variability in sleep parameters following intervention. Each participant's sleep log data indicated improvement in, or maintenance of, adequate total sleep time (TST), decreased sleep onset latency (SOL), improved sleep efficiency (SE), improvement in time of sleep onset, and decreased or continued low frequency of night awakenings (NA). Anecdotally, adolescents and parents reported improvement in daytime functioning, coping, and sense of wellbeing. Conclusions: These cases highlight the potential for cognitive-behavioural interventions to facilitate healthy sleep in adolescents with challenging sleep problems.

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Development and Evaluation of a Cognitive Behavioural Intervention for Chronic Post-Stroke Insomnia

Behavioural and Cognitive Psychotherapy ◽

10.1017/s1352465818000061 ◽

2018 ◽

Vol 46 (6) ◽

pp. 641-660 ◽

Cited By ~ 7

Author(s):

Katie Herron ◽

Lorna Farquharson ◽

Abigail Wroe ◽

Annette Sterr

Keyword(s):

Sleep Onset ◽

Community Dwelling ◽

Post Treatment ◽

Dysfunctional Attitudes ◽

Future Research ◽

Behavioural Intervention ◽

Sleep Onset Latency ◽

Post Stroke ◽

Cognitive Behavioural

Background:Cognitive behavioural therapy for insomnia (CBTI) has been successfully applied to those with chronic illness. However, despite the high prevalence of post-stroke insomnia, the applicability of CBTI for this population has not been substantially researched or routinely used in clinical practice.Aims:The present study developed a ‘CBTI+’ protocol for those with post-stroke insomnia and tested its efficacy. The protocol also incorporated additional management strategies that considered the consequences of stroke.Method:A single-case experimental design was used with five community-dwelling individuals with post-stroke insomnia. Daily sleep diaries were collected over 11 weeks, including a 2-week baseline, 7-week intervention and 2-week follow-up. The Insomnia Severity Index, Dysfunctional Attitudes and Beliefs About Sleep Scale, Epworth Sleepiness Scale, Fatigue Severity Scale and Stroke Impact Scale were administered pre- and post-treatment, as well as at 2-week follow-up.Results:At post-treatment, three participants no longer met diagnostic criteria for insomnia and all participants showed improvements on two or more sleep parameters, including sleep duration and sleep onset latency. Three participants showed a reduction in daytime sleepiness, increased quality of life and reduction in unhelpful beliefs about sleep.Conclusions:This study provides initial evidence that CBTI+ is a feasible and acceptable intervention for post-stroke insomnia. Furthermore, it indicates that sleep difficulties in community-dwelling stroke populations are at least partly maintained by unhelpful beliefs and behaviours. The development and delivery of the CBTI+ protocol has important clinical implications for managing post-stroke insomnia and highlights directions for future research.

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Quality of Research Design Moderates Effects of Grade Retention on Achievement: A Meta-Analytic, Multilevel Analysis

Educational Evaluation and Policy Analysis ◽

10.3102/0162373709352239 ◽

2009 ◽

Vol 31 (4) ◽

pp. 480-499 ◽

Cited By ~ 65

Author(s):

Chiharu S. Allen ◽

Qi Chen ◽

Victor L. Willson ◽

Jan N. Hughes

Keyword(s):

Grade Retention ◽

Negative Impact ◽

Meta Analysis ◽

Median Number ◽

Effect Sizes ◽

Future Research ◽

Negative Effects ◽

Design Quality ◽

Individual Level

The present meta-analysis examines the effect of grade retention on academic outcomes and investigates systemic sources of variability in effect sizes. Using multilevel modeling (MLM), the authors investigate characteristics of 207 effect sizes across 22 studies published between 1990 and 2007 at two levels: the study (between) and individual (within) levels. Design quality is a study-level variable. Individual-level variables are median grade retained and median number of years postretention. Quality of design is associated with less negative effects. Years postretention is negatively associated with retention effects, and this effect is stronger for studies using grade comparisons versus age comparisons. The results challenge the widely held view that retention has a negative impact on achievement. Suggestions for future research are discussed.

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Reference values for Cobb angles when evaluating the spine in the sagittal plane: a systematic review with meta-analysis

Motricidade ◽

10.6063/motricidade.10890 ◽

2018 ◽

Vol 14 (2-3) ◽

pp. 115-128 ◽

Cited By ~ 1

Author(s):

Tássia Silveira Furlanetto ◽

Juliana Adami Sedrez ◽

Cláudia Tarragô Candotti ◽

Jefferson Fagundes Loss

Keyword(s):

Systematic Review ◽

Reference Values ◽

Sagittal Plane ◽

Meta Analysis ◽

Spinal Curvature ◽

Cervical Region ◽

Healthy Children ◽

X Rays ◽

Spinal Curvatures ◽

Cobb Method

The present systematic review of observational studies with meta-analysis aim to identify the reference values of the spinal curvatures in the sagittal plane, as evaluated using the Cobb angle in X-rays, in healthy individuals. Electronic searches were undertaken in MEDLINE, Scopus, ScienceDirect and LILACS. Studies that evaluated the spinal curvature of healthy children, adolescents, adults, and elderly using Cobb method and presented reference values for those curvatures were incluced. Thirty-one studies were eligible for inclusion. The reference values found (confidence interval 95%) were: for children, thoracic (28.7°-37.9°), lumbar L1-L5 (34.5o-44.8º), and lumbar L1-S1 (41.7o-54.1o); for adolescents: thoracic (31.5o-39.2o), lumbar L1-L5 (39.8o-45.6o), and lumbar L1-S1 (51.9o-59.1o); for adults: thoracic (33.7o-40.3o), lumbar L1-L5 (38.1o-45.6o), and lumbar L1-S1 (54.2o-61.7o); and for the elderly: thoracic (37.7º-50.4o), and lumbar L1-S1 (56.6º-65.9o). For the cervical region, it was impossible to establish consistent reference values. The present study supports that precise reference intervals were identified for the sagittal curvatures of the thoracic and lumbar spine in healthy children, adolescents, adults and elderly, as evaluated by means of the Cobb Method.

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