Management of phenylketonuria in European PKU centres remains heterogeneous.

Phenylketonuria (PKU) is a genetic disorder that follows an autosomal recessive inheritance pattern. Dietary treatment is the cornerstone of therapy and is based on natural protein restriction, Phe-free L-amino acid supplements (protein substitutes) and low protein foods. The aim of this project was to collect information about the clinical management of patients with PKU, focusing on understudied or unresolved issues such as blood phenylalanine (Phe) fluctuations and clinical symptoms, particularly gastro intestinal (GI) discomfort and sleep problems. The survey consisted of 10 open-ended and 12 multiple-choice questions that collected information about size of the PKU population in each center, the center's clinical practices and the outcomes observed by the center concerning adherence, clinical and biochemical abnormalities and clinical symptoms (GI and sleep). The questionnaire was sent to 72 experts from metabolic centers in 11 European countries. Thirty-three centers answered. The results of this survey provide information about the clinical practice in different age groups, concentrating on dietary tolerance, treatment adherence, and metabolic control. All the centers prescribed a Phe-restricted diet, with Phe-free/low Phe protein substitutes and low protein foods. Daily doses given of protein substitutes varied from 1 to 5, with adherence to the prescribed amounts decreasing with increasing age. Respondents identified that improvement in the flavor, taste, volume and smell of protein substitutes may improve adherence. Finally, the survey showed that clinical symptoms, such as GI discomfort and sleep problems occur in patients with PKU but are not systematically evaluated. Twenty-four-hour Phe fluctuations were not routinely assessed. The results highlight a strong heterogeneity of approach to management despite international PKU guidelines. More clinical attention should be given to gastrointestinal and sleep problems in PKU.

Effect of daily light exposure on sleep in polar regions: A meta-analysis.

Although studies have shown that light affects sleep in polar populations, the sample size of most studies is small. This meta-analysis provides the first systematic review of the effects of summer glare, spring and fall moderate daylight, and artificial lighting on general sleep problems (sleep duration, efficiency, and delay). This analysis included 18 studies involving 986 participants. We calculated the random effect size via an evidence-based meta-analysis that analysed the effect of bright/auxiliary light on sleep and the effect of three different types of light on sleep compared with conventional light. There was no significant correlation between specific light types and sleep duration. Intense summer light has a negative effect on sleep time and efficiency. Moderate, natural light in spring and autumn effectively delayed sleep but could not improve sleep efficiency. For artificial fill light, neither blue light nor enhanced white light has been found to have a significant effect. In summary, summer light has a detrimental effect on sleep in polar populations, and moderate natural light may be superior to conventional light. However, specific strategies to improve sleep and artificial lighting in polar populations must be explored further.

It's past your bedtime, but does it matter anymore? How longitudinal changes in bedtime rules relate to adolescents' sleep.

This study investigated how changing or maintaining parent-set bedtimes over time relates to adolescents' sleep timing, latency, and duration. Adolescents (n = 2509; Mage = 12.6 [0.5] years; 47% m) self-reported their sleep patterns, and whether they had parent-set bedtimes on two separate occasions in 2019 (T1; 12.6 years) and 2020 (T2; 13.7 years). We identified four groups based on parent-set bedtimes: (1) bedtime rules at both T1 and T2 (46%, n = 1155), (2) no bedtime rules at T1 nor T2 (26%, n = 656), (3) bedtime rules at T1 but not T2 (19%, n = 472), (4) no bedtime rules at T1 but a parent-set bedtime at T2 (9%, n = 226). As expected, the entire sample showed that bedtimes generally became later and sleep duration shorter across adolescence, but the change differed among the groups. Adolescents whose parents introduced bedtime rules at T2 reported earlier bedtimes and longer sleep duration (~20 min) compared with adolescents with no bedtime rules at T2. Importantly, they no longer differed from adolescents who consistently had bedtimes across T1 and T2. There was no significant interaction for sleep latency, which declined at a similar rate for all groups. These results are the first to suggest that maintaining or re-introducing a parent-set bedtime may be possible and beneficial for adolescents' sleep.

Efficacy of oral and non-oral migraine prophylactic treatment on self-reported subjective sleep quality in migraine patients with sleep problems: A review and meta-analysis.

This study aims to investigate the effects of oral and non-oral migraine prophylaxis on subjective sleep quality in migraine patients with sleep problems. A bidirectional relationship between migraine and sleep is presumed, although this relationship is not fully clarified. Possibly, prophylactic treatment of migraine aiming at a reduction of migraine attack frequency can also positively affect the quality of sleep for patients with migraine with sleep problems. PubMed, Cochrane, Embase and CINAHL databases were searched in March 2022 for studies evaluating prophylactic treatment of migraine and the impact on perceived sleep quality (Pittsburgh Sleep Quality Index or Insomnia Severity Index). A systematic review using the McMaster Tool and a random-effects meta-analysis (effect size Cohen's d) were conducted. Seven studies were identified, including 989 participants, of which 844/989 (85.3%) female, with a mean (SD) age of 41.3 (12.1) years. In 6/7 (85.7%) studies, monthly migraine days improved (p < 0.002). Five out of six (83.3%) studies presented a relevant improvement in quality of sleep (p < 0.05), and one study reported a clinically meaningful improvement in the treatment group (Insomnia Severity Index change >7, in >50% of participants). The meta-analysis showed a large effect size of 1.09 (95% confidence interval 0.57-1.62; overall p < 0.001; Cochran's Q < 0.0001) for migraine prophylaxis on improving sleep quality. In conclusion, prophylactic migraine treatment improves sleep quality in patients with migraine and sleep problems, as measured with self-reported questionnaires Pittsburgh Sleep Quality Index and Insomnia Severity Index. Unfortunately, some included studies used prophylactic treatment that is not in current (international) guidelines. The evidence for this improvement in quality of sleep is strong, and seems a generic effect of migraine prophylaxis.

Longitudinal associations between insomnia, cannabis use and stress among US veterans.

Insomnia is highly prevalent among military veterans, with rates nearly double that of civilian populations. Insomnia typically co-occurs with other psychological problems, including substance use (e.g. cannabis) and perceived stress. Much of the research focused on insomnia, stress and cannabis use explores cannabis as a sleep aid and a mechanism for stress relief. However, recent theoretical and empirical evidence suggests a dynamic interplay between insomnia, cannabis use and perceived stress, yet few longitudinal studies exist. Using a sample of 1105 post-9/11 veterans assessed over four time points across 12 months, we used latent difference score modelling to examine proportional change between insomnia, perceived stress and cannabis use. Results revealed a complex interplay between all three constructs. In particular, we show that higher prior levels of insomnia are associated with greater increases in perceived stress, and greater prior levels of stress are associated with greater increases in cannabis use. Perhaps more importantly, our results also point to cannabis use as a catalyst for greater increases in both stress and insomnia severity. Our results suggest there may be both benefits and costs of cannabis use among veterans. Specifically, for veterans who experience chronic sleep problems, perceived stress may become overwhelming, and the benefit of stress reduction from increased cannabis use may come at the cost of increasing insomnia symptomology.

The efficacy of weighted blankets for sleep in children with attention-deficit/hyperactivity disorder-A randomized controlled crossover trial.

Weighted blankets are a non-pharmacological intervention for treating sleep and anxiety problems in children with attention-deficit/hyperactivity disorder. However, research on the efficacy of weighted blankets is sparse. The aim of this randomized controlled trial with a crossover design (4 + 4 weeks) was to evaluate the efficacy of weighted blankets on sleep among children with attention-deficit/hyperactivity disorder and sleeping problems. Children diagnosed with uncomplicated Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition attention-deficit/hyperactivity disorder with verified sleep problems were randomized to start with either a weighted blanket or a lighter control blanket. Data collection was performed at weeks 0, 4 and 8 using actigraphy, questionnaires and a daily sleep diary. T-tests were used to evaluate efficacy. The study included 94 children with attention-deficit/hyperactivity disorder (mean age 9.0 [sd 2.2] years; 54 [57.4%] boys). Weighted blankets had a significant effect on total sleep time (mean diff. 7.72 min, p = 0.027, Cohen's d = 0.24), sleep efficiency (mean diff. 0.82%, p = 0.038, Cohen's d = 0.23) and wake after sleep onset (mean diff. -2.79 min, p = 0.015, Cohen's d = -0.27), but not on sleep-onset latency (p = 0.432). According to our exploratory subgroup analyses, weighted blankets may be especially beneficial for improving total sleep time in children aged 11-14 years (Cohen's d = 0.53, p = 0.009) and in children with the inattentive attention-deficit/hyperactivity disorder subtype (Cohen's d = 0.58, p = 0.016). Our results suggest that weighted blankets may improve children's sleep and could be used as an alternative to pharmacological sleep interventions.

Child sleep problems, maternal sleep and self-efficacy: Sleep's complicated role in maternal depression.

Depression, poor sleep duration and low self-efficacy are common in mothers of children with sleep problems. However, research rarely extends beyond the postpartum period. This study investigated the multifaceted relationship between child sleep and maternal depression in early motherhood. A confidential survey assessed child sleep problems, maternal sleep duration, parental self-efficacy and depressive symptoms in 477 Australian mothers of children aged 3 months to 5 years. We found no relationship between child age and maternal depression, supporting our decision to look beyond postpartum depression. Robust bootstrapped mediation modelling tested the hypothesis that both maternal sleep duration and parental self-efficacy would mediate child sleep problems as predictors of maternal depression. After controlling for child age, results showed a significant parallel mediation effect, demonstrating that maternal sleep duration and parental self-efficacy both mediate the relationship between child sleep problems on maternal depression. While the total effect of child sleep problems on maternal depression was statistically significant, after partialling out the effects of other variables, child sleep problems no longer predicted maternal depression. Akaike information criterion analyses supported the full model, with both mediators explaining meaningful variance in maternal depression. This study expands our knowledge beyond the postpartum period, and divulges the disparate effects of sleep deprivation and parental self-efficacy on the relationship between child sleep and depression in early motherhood. Maternal sleep duration and self-efficacy are modifiable risk factors of maternal depression, indicating possible efficacious treatments. Parental self-efficacy stands out as a direction for clinical practice and further psychobiological study.

Examining the associations between attention-deficit/hyperactivity disorder, sleep problems, and other mental health conditions in adolescents.

Adolescents with attention-deficit/hyperactivity disorder (ADHD) often experience greater sleep difficulties compared to those without. However, findings are mixed, and other mental health conditions are often overlooked. This study aimed to examine the relationship between sleep problems, ADHD, and other mental health conditions in a sample of adolescents. Data from 373 adolescents aged 10-19 years was used as part of the wider 'Healthy Brain Network' study, which targets children and adolescents experiencing mental health and neurodevelopmental difficulties. Mental health conditions were assessed via a comprehensive assessment. Sleep was measured by self- and parent-report, as well as via up to a month of actigraphy data. Actigraphy data were analysed using mixed-methods modelling, while subjective sleep data were analysed using multiple regression. Subjectively-reported sleep was generally worse in adolescents who had ADHD and other mental health conditions compared to those with ADHD but no other conditions. There were no associations between ADHD status and objective sleep measures or self-reported measures, but a significant association was found between ADHD status and parent-reported sleep difficulties, even when accounting for other conditions. Parent-reported sleep problems were associated not only with ADHD, but also with anxiety, depression, and externalising disorders. The strength of association between ADHD and sleep problems is potentially not as strong as previously thought when considering the role of other mental health conditions. Clinicians should consider the role of other mental health conditions when sleep problems are present, and vice versa. The study also highlights the importance of comprehensive, multi-informant assessment of mental health conditions, including sleep.

Gastrointestinal Manifestations and Their Association with Neurologic and Sleep Problems in Long COVID-19 Minority Patients: A Prospective Follow-Up Study.

BACKGROUND: Long-COVID is a condition post SARS-CoV-2 infection with persistent or recurring symptoms affecting multiple organs, and may involve viral persistence, changes to the microbiome, coagulopathies, and alterations to neuro-immune interactions. These factors can disrupt the Gut-Brain Axis, which is a complex system involving bidirectional communication between the central nervous system and the gastrointestinal (GI) system. As a result of these disruptions, individuals with long-COVID may develop post-infectious functional GI disorders, which can cause a range of symptoms affecting the digestive system. AIM: To understand frequency of GI manifestations of Long-COVID and to determine association with sleep or neurological symptoms in a predominantly minority population. METHODS: We included patients with positive SARS-CoV-2 PCR (n = 747) who were hospitalized from Feb. 2020 to May 2021 at Howard University Hospital and followed between 6 and 12 months from discharge. GI, sleep, and neurological symptoms (via the Montreal Cognitive Assessment (MoCA) scoring system) were assessed using a standardized questionnaire. Linear regression analysis, χ2 and Fisher's exact test were utilized to determine the statistical significance of correlations of GI/Neuro/COVID. RESULTS: The mean age of patients was 58, with 51.6% females and a predominant African American ethnicity (73.6%, n = 550). A total of 108 patients died during their initial hospital stay, with the remaining 639 patients followed-up. Three hundred fifty (350) patients responded to the questionnaire (57 patients died during the follow-up period). Overall, 39 (13.3%) patients reported GI-related symptoms, out of which 19 (6.4%) had persistent symptoms and 20 (6.8%) developed new onset GI symptoms. Nausea and vomiting were the most common 24/39 (61.5%), followed by abdominal pain 7/39 (18%), diarrhea 5/39 (12.8%), and others 3/39 (7.6%). Patients who presented with vomiting during acute SARS-CoV-2 infection were more likely to have Long-COVID GI manifestations (P = 0.023). Use of ACE inhibitors, abnormal lymphocyte count and elevated ferritin are other variables that showed significant associations with Long-COVID GI manifestations (P = 0.03, 0.006 and 0.03, respectively). During follow-up, a total of 28 (9.5%) patients reported difficulty with sleep and 79 (27%) patients had abnormal MoCA assessment. With further analysis, there was a trend between presentation of GI symptoms on admission with abnormal MoCA assessment, and an association between abnormal LFTs and history of liver disease during hospitalization with subsequent sleep problems. Baseline characteristics, clinical comorbidities, other laboratory values, hospital length of stay, mechanical ventilation, medications during hospitalization, re-admission and Flu or COVID-19 vaccination have not shown any association with Long-COVID GI symptoms in our cohort. CONCLUSION: Dyspeptic symptoms were common GI manifestations in the acute and post COVID periods. GI symptoms, abnormal LFTs and a history of liver disease during the acute infectious phase associates with abnormal MoCA and sleep problems during follow-up. Further large population studies are needed to determine if COVID-19 leads to a GI symptoms-associated Long-COVID phenotypes and other symptoms through the Gut-Brain-Axis.

The multiple mediation model of social support and postpartum anxiety symptomatology: the role of resilience, postpartum stress, and sleep problems.

OBJECTIVE: This study aimed to assess the prevalence of postpartum anxiety and the factors influencing it, while also exploring the multiple mediating roles of related factors between social support and postpartum anxiety symptomatology among postpartum women in China. METHODS: Between April and August 2023, we recruited a total of 824 postpartum women through a convenience sampling method. These participants completed a series of general survey questionnaires and were evaluated using the depression anxiety stress scale, perceived social support scale, 10-item Connor-Davidson resilience scale, maternal postpartum stress scale, and Pittsburgh sleep quality index. Additionally, we employed a hierarchical multiple regression model to investigate the relevant factors and mediators of postpartum anxiety symptomatology. A structural equation model was used to examine the mediating role of resilience, postpartum stress, and sleep problems in the relationship between social support and postpartum anxiety symptomatology. RESULTS: Our study found a postpartum anxiety symptomatology prevalence rate of 18.40%. The factors influencing postpartum anxiety symptomatology included age, education of their husband, mastitis, social support, resilience, postpartum stress, and sleep problems. Through a multiple mediation analysis, we found that resilience, postpartum stress, and sleep problems completely mediated the effects of social support on postpartum anxiety symptomatology, with the mediating effect accounting for 83.57% of the total effect. CONCLUSION: The multiple mediation analysis revealed that among postpartum women, the impact of social support on postpartum anxiety symptomatology is channeled through resilience, postpartum stress, and sleep problems. Therefore, enhancing social support, resilience, postpartum stress, and sleep problems might alleviate postpartum anxiety symptomatology.

The mediating role of sleep problems and depressed mood between psychological abuse/neglect and suicidal ideation in adolescent childhood: a multicentred, large sample survey in Western China.

BACKGROUND: Adolescent suicidal ideation are associated with factors including psychological abuse/neglect, sleep problems, and depressed mood, but the systematic effects of these factors on suicidal ideation remain unclear, which is a research gap this work aims to fill. METHODS: A multi-center, the cluster sampling method was employed to collect general demographic data, such as age, gender, the experience of being left behind, and parents' marital status, from 12,192 students across 17 secondary schools in China. The Child Psychological Abuse and Neglect Scale (CPANS), Pittsburgh Sleep Quality Index (PSQI), the Chinese version of the Depressed mood, Anxiety and Stress Scale - 21 Items (DASS-21) and Chinese version of Positive and Negative Suicide Ideation Inventory (PANSI) were utilized. Data were analyzed using t-tests, chi-square tests, correlation analyses, and structural equation modeling mediation analyses. RESULTS: The prevalence of psychological abuse/neglect and adolescent suicidal ideation was 34.8% and 13%, respectively. This mediation analysis suggests that, in the relationship between psychological abuse/neglect and suicidal ideation, sleep problems and depressed mood play both parallel and sequential mediating roles. CONCLUSION: Sleep problems and depressed mood play a mediating role in the development of suicidal ideation in adolescents. Good sleep habits and depressed mood interventions help reduce the risk of suicidal ideation in adolescents who experience psychological neglect/abuse.

Intervention for sleep problems in nursing home residents with dementia: a cluster-randomized study.

OBJECTIVE: To reduce sleep problems in people living with dementia using a multi-component intervention. DESIGN: Cluster-randomized controlled study with two parallel groups and a follow-up of 16 weeks. SETTING: Using external concealed randomization, 24 nursing homes (NH) were allocated either to the intervention group (IG, 12 clusters, 126 participants) or the control group (12 clusters, 116 participants). PARTICIPANTS: Participants were eligible if they had dementia or severe cognitive impairment, at least two sleep problems, and residence of at least two weeks in a NH. INTERVENTION: The 16-week intervention consists of six components: (1) assessment of sleep-promoting activities and environmental factors in NHs, (2) implementation of two "sleep nurses," (3) basic education, (4) advanced education for staff, (5) workshops to develop sleep-promoting concepts, and (6) written information and education materials. The control group (CG) received standard care. MEASUREMENTS: Primary outcome was ≥ two sleep problems after 16 weeks assessed with the Sleep Disorders Inventory (SDI). RESULTS: Twenty-two clusters (IG = 10, CG = 12) with 191 participants completed the study. At baseline, 90% of people living with dementia in the IG and 93% in the CG had at least two sleep problems. After 16 weeks, rates were 59.3% (IG) vs 83.8% (CG), respectively, a difference of -24.5% (95% CI, -46.3% - -2.7%; cluster-adjusted odds ratio 0.281; 95% CI 0.087-0.909). Secondary outcomes showed a significant difference only for SDI scores after eight and 16 weeks. CONCLUSIONS: The MoNoPol-Sleep intervention reduced sleep problems of people living with dementia in NH compared to standard care.

Association between sleep problems and functional disability in community-dwelling older adults.

BACKGROUND: Sleep problems are frequently observed in older adults. They can lead to changes in the individual's physical, occupational, cognitive, and social functioning, compromising the performance of activities of daily living and contributing to the occurrence of functional disability. This study evaluated the association between sleep problems and functional disability in community-dwelling older adults. METHODS: This was a cross-sectional study with data from 10,507 Brazilian community-dwelling older adults participating in the 2013 National Health Survey. The exposure variable was self-reported sleep problems in the last two weeks. The outcome measure was functional disability assessed from self-reported questionnaires, categorized into basic activities of daily living (BADL) and instrumental activities of daily living (IADL), and defined as not being able to perform or having little or a lot of difficulty in at least one of the activities investigated in the domain of interest. RESULTS: Older adults who reported sleep problems had 1.53 (95%CI: 1.34; 1.75) and 1.42 (95%CI: 1.26; 1.59) greater odds of having a disability in BADL and IADL when compared to individuals who reported having no sleep problems. CONCLUSIONS: Older adults with sleep problems were more likely to have a functional disability, both in BADL and IADL. Thus, it is important to implement strategies to screen for sleep problems in older adults in primary health care as a preventive strategy for functional disability.

Childhood lead exposure and sleep problems in adolescents: a longitudinal cohort study.

PURPOSE: Childhood lead exposure is linked to poorer neurobehavioral function in adolescence, but the relationship between lead and adolescent sleep health remains inconsistent. This study aimed to investigate concurrent and longitudinal associations between lead exposure and multiple sleep health domains in adolescents. METHODS: A total of 972 adolescents from China Jintan Child Cohort were included in analyses. The Blood lead levels (BLLs) were assessed in two Waves, at ages 3-5 years (mean 6.50 ± 2.76 µg/dL) and 11-13 years (mean 3.12 ± 1.17 µg/dL). Sleep problems at age 11-13 were parent-reported via the Child Sleep Health Questionnaire (CSHQ) and self-reported by adolescents using the Pittsburgh Sleep Quality Index (PSQI). RESULTS: Both early and later BLLs were associated positively with parental reported sleep problems, including sleep onset delay, night waking, short duration, parasomnias, and disordered breathing. Sex-stratified analyzes showed that most adjusted associations between two-Wave BLLs and sleep outcomes (CSHQ and PSQI) remained statistically significant in males, with a minor increase in the magnitude of these associations. The association between Wave II BLLs and shorter self-reported sleep duration was only statistically significant in female adolescents. Compared to children with consistently low BLLs at both ages, those with persistently high BLLs at both ages had significantly shorter parental-reported sleep duration and worse sleep onset delay. CONCLUSION: Findings suggest that both early and later childhood lead exposures link to more adolescent sleep problems, with recent BLLs showing stronger associations with poor adolescent sleep health reported by their parents.

Anxiety and sleep mediate the effect of food insecurity on depression in single parents in Ghana.

BACKGROUND: Data on the association between food insecurity and depression in single parents in low- and middle-income countries (LMICs) are limited, and no study has reported the serial mediation effects of psychosocial factors in this association. This study examines the extent to which anxiety and sleep serially explain the food insecurity and depression link among single parents in Ghana. METHODS: Data on 627 single parents were obtained through a multi-stage stratified sampling technique. Food insecurity was assessed using the Food and Agriculture Organization Food Insecurity Experience Scale (FIES), and depression was assessed using the Center for Epidemiological Studies Depression Scale (CES-D-10). Multivariable OLS models and bootstrapping serial mediation analyses were performed to evaluate the hypothesized associations. RESULTS: The mean age (SD) was 45.0 (14.7) years; 67.3% females. After full adjustment, food insecurity was significantly associated with increases in anxiety symptoms (ß = 0.61, 95%CI = 0.476 - 0.737), sleep problems (ß = 0.04, 95%CI = 0.02 - 0.07), and depression (ß = 0.24, 95%CI = 0.12 - 0.36). Food insecurity indirectly related to depression via anxiety (ß = 0.35, 95%CI = 0.26-0.44) representing 55.8%, sleep (ß = 0.03, 95%CI = 0.0032-0.0575) suggesting 4.0%, and anxiety→sleep (ß = 0.013, 95%CI = 0.0024-0.0265) yielding 2.0% of the total effect. CONCLUSIONS: Food insecurity was positively associated with depression. This association was partially and serially explained by generalized anxiety and sleep problems. Efforts to address depression among single parents should consider interventions for food insecurity and psychosocial problems, particularly in LMICs.

Cross-lagged panel analysis of the relationship between social networking sites use (SNSU) and sleep problems among university students.

BACKGROUND: Sleep remains a cornerstone for sociopsychological well-being, but it is in decline, especially among today's youth. Simultaneously, engagement with social media is escalating. Research has identified a link between social networking sites use and sleep problems; however, the nature and direction of the relations remain obscure. Therefore, it is imperative to pursue longitudinal research to elucidate this correlation and guide suitable intervention practices. The present study aimed to examine the reciprocal relationship between social networking sites use and sleep problems. METHODS: By adopting a three-stage cross-lagged design across four time points, assessment results from 194 university students were gathered at four-week intervals. RESULTS: The findings indicate that (1) Social networking sites use was significantly greater in females than in males at all four time points, while sleep problems were significantly greater in females than in males at Time 3 and Time 4. (2) Sleep problems at the second time point serve as a positive predictor of subsequent social networking sites use at the third time point. (3) Social networking sites use at the initial time point could marginally significantly predict sleep problems at the fourth time point. CONCLUSIONS: This study elucidates the dynamic relationship between social networking sites use and sleep problems across an academic term, suggesting the need for temporally tailored interventions.

Promoting healthy sleep in 0-2-year-old infants: a study protocol for the development and mixed method evaluation of a sleep health program tailored to Dutch youth healthcare regions.

BACKGROUND: Sleep problems are common among infants and can have a serious impact on the health and wellbeing of both child and parents. To sustainably promote infant sleep on a population level, it is necessary to develop evidence-based programs that can be implemented on a large scale. The Youth Health Care setting, with its focus on prevention, child health promotion and services widely available for parents, can be a suitable setting to do so. Currently however, sleep health promotion in this setting seems to be suboptimal. To promote healthy infant sleep on a population level, programs need to be accessible and comprehensible for all parents, including parents with limited (health) literacy. Therefore, this study aims to develop, implement and evaluate a program called 'Sleep on number 1', that is tailored to Dutch Youth Health Care, to sustainably promote healthy sleep in 0-2-year-old infants. METHODS: The program was developed based on co-creation with parents and Youth Health Care professionals, evidence-based behaviour change theories and sleep health promotion methods. Program effectiveness is investigated with a quasi-experimental study design comparing the program group with the care as usual control group. Participants consist of parents of 0-2-year-old children. Primary outcome is infant sleep quality at the age of 10 weeks and 6, 9, 14 and 24 months, measured with a sleep diary. The primary data analysis focuses on night awakenings at 9 months. Secondary outcomes focus on parental behaviour regarding infant sleep, related behavioural determinants and parental satisfaction with Youth Health Care sleep advice. Program effectiveness is analysed using a linear mixed-model in case of data clustering, and an independent samples T-test or linear regression in case no substantial clustering effects are found. A mixed methods process evaluation is performed with parents and Youth Health Care professionals, assessing program reach, adoption, implementation, maintenance and working mechanisms. DISCUSSION: The 'Sleep on number 1' program is an evidence-based sleep health program for 0-2-year-old children, tailored to Dutch Youth Health Care. If effective, this program has the potential to improve infant sleep on a population level. TRIAL REGISTRATION: ISRCTN, ISRCTN27246394, registered on 10/03/2023. https://www.isrctn.com/ISRCTN27246394 .

Associations between sleep problems and emotional/behavioural difficulties in healthy children and adolescents.

OBJECTIVE: This study aimed to (1) characterise sleep disturbances and emotional/behavioural difficulties among healthy German children and adolescents aged 3 to 13 years, (2) examine the association between parent-reported sleep problems and emotional/behavioural difficulties, (3) point out possible relations between specific kinds of sleep disturbances and different behavioural difficulties. METHODS: Data were collected between 2011 and 2015 within the LIFE Child study in Germany. The sample included 1101 3- to 13-year-old children and adolescents. Information on sleep disturbances-assessed via the Children's Sleep Habits Questionnaire (CSHQ), emotional/behavioural difficulties-assessed via the Strengths and Difficulties Questionnaire (SDQ), and socioeconomic status was provided by participants' parents. Multiple regressions were applied to analyse the associations between general and specific sleep disturbances (independent variables) and emotional/behavioural difficulties (dependent variables). RESULTS: The total CSHQ score was positively associated with the total SDQ score and all SDQ subscales (emotional problems, conduct problems, hyperactivity/inattention, peer relationship problems). Most of the CSHQ subscales were related to SDQ subscale scores, except for a few non-significant relations with hyperactivity/inattention and conduct problems. The CSHQ total score, daytime sleepiness, sleep duration and parasomnias showed the strongest associations with the SDQ total score. CONCLUSION: This study confirms an association between children's and adolescents' sleep habits and psychological health. We were able to demonstrate the association between sleep problems and emotional/behavioural difficulties in a large sample of healthy participants. In particular, we observed a significant relation between parasomnias and hyperactive/inattentive behaviour as well as a significant association between emotional problems and sleep problems, especially daytime sleepiness, sleep anxiety and parasomnias.

Relationship Between Sleep Problems and Memory Impairment Among Nurses.

BACKGROUND: Sleep problems are common among nurses and can lead to various health problems. Further, the relationship between multiple sleep problems and memory impairment in clinical nurses remains unknown. Therefore, in this study, we aimed to explore the relationship between sleep problems and memory impairment among nurses. METHODS: Multistage cluster-stratified random sampling was performed from tertiary hospitals in Shandong, China. Overall, a total of 1833 nurses were included in the final analysis. The Chinese version of the Pittsburgh Sleep Quality Index and prospective and retrospective memory questionnaire were administered to the participants. RESULTS: The sleep quality of the nurses decreased during the normal epidemic prevention and control period compared with that before the epidemic in terms of sleep duration, sleep efficiency, and sleep disturbances. Nurses who reported cumulative or specific sleep problems (e.g., high sleep latency, sleep disturbances, and daytime dysfunction) and those in the "daily disturbances" and "poor sleep quality" groups had a higher risk of memory impairment than the others. CONCLUSION: Sleep problems might be important for memory impairment among nurses. These findings may help identify nurses at considerable risk of memory impairment in clinical practice.

Individual characteristics and environmental factors influencing preschoolers' emotional eating.

Emotional eating, which refers to eating in response to emotional states, is prevalent in early childhood. Executive function (EF) and sleep problems are related to preschoolers' self-regulatory abilities during the day and night and have been reported to be associated with their emotional eating. These associations can be stronger in emotionally stressful situations, such as controlling feeding practices. This study explored the role of preschoolers' EF and sleep problems as child characteristics, as well as maternal feeding practices as environmental factors influencing emotional eating during the preschool period. Participants included 363 Korean mothers with preschoolers aged 3- to 5-years old (190 boys, 173 girls). Mothers reported on their own feeding practices, and preschoolers' EF, sleep problems, and emotional eating. Results indicated that preschoolers' EF was negatively associated with emotional over- and undereating, and this association was stronger when mothers applied more pressure to eat. Maternal monitoring had a similar effect, with emotional overeating exerting a greater impact with low levels of maternal monitoring. Finally, maternal pressure to eat moderated the influence of preschoolers' sleep problems on emotional overeating, with higher pressure to eat predicting a stronger relationship between sleep problems and emotional overeating. These findings suggest that maternal feeding practices, which are relatively modifiable, should be considered an important element in intervention programs aimed at preventing emotional eating in preschool children.