Screens and Sleep Health-It's Almost Bedtime, Time to Put Your Phone Away.

This Viewpoint discusses the National Sleep Foundation consensus panel's recommendations for screen-based media use and sleep health among children and teenagers.

Childhood sleep is prospectively associated with adolescent alcohol and marijuana use.

INTRODUCTION: Prior studies have examined the cross-sectional relationship between adolescent sleep and substance use; however, fewer have explored the long-term connections between childhood sleep and adolescent substance use. METHODS: This study investigated both cross-sectional associations during adolescence and prospective associations between childhood weeknight sleep and later alcohol and marijuana use in the Future of Families and Child Wellbeing Study, a diverse national birth cohort of urban children from 20 cities with populations greater than 200,000. Parents reported their child's bedtime at ages 3, 5, and 9 and their child's sleep duration at ages 5 and 9. RESULTS: At age 15, adolescents self-reported their bedtime, sleep duration, and alcohol and marijuana use (n = 1514). Logistic regression analyses for each substance use outcome at age 15 were adjusted for sex, age at time of assessment, race/ethnicity, income-relative-to-poverty threshold, family structure, and caregiver education level. At age 15, later bedtime (AOR=1.39; 95 % CI=1.22, 1.57) and shorter sleep duration (AOR=1.28; 95 % CI=1.14, 1.43) were associated with greater odds of consuming a full drink of alcohol more than once, and later bedtime was associated with greater odds of trying marijuana (AOR=1.35; 95 % CI=1.20, 1.51). Unexpectedly, later bedtimes at age 3 were associated with lower odds of drinking alcohol by age 15 (AOR=0.74; 95 % CI=0.59, 0.92). In contrast, later bedtimes at age 9 were associated with greater odds of drinking alcohol (AOR=1.45; 95 % CI=1.11, 1.90). Additionally, later bedtime at age 5 (AOR=1.26; 95 % CI=1.01, 1.58) and shorter sleep duration at age 9 (AOR=1.19; 95 % CI=1.04, 1.36) were associated with greater odds of trying marijuana. CONCLUSION: Taken together, these associations support the importance of protecting childhood sleep habits to reduce the likelihood of substance use starting as early as mid-adolescence. IMPLICATIONS AND CONTRIBUTION: In this longitudinal cohort study, adolescents were more likely to have consumed alcohol or tried marijuana by age 15 if they had later bedtimes and shorter sleep duration during childhood and adolescence. Protecting sleep health throughout childhood may reduce the likelihood of substance use during early adolescence.

The impact of screen use on sleep health across the lifespan: A National Sleep Foundation consensus statement.

OBJECTIVE: To achieve consensus on whether screen-based digital media (1) in general, (2) via prebedtime content, and (3) via prebedtime light impairs sleep health in (a) childhood, (b) adolescence, and (c) adulthood. Furthermore, to address whether employing behavioral strategies and interventions may reduce the potential negative effects of screens on sleep health. METHODS: The National Sleep Foundation convened a 16-person multidisciplinary expert panel ("Panel"). Panelists met virtually 5 times throughout 2023, during which they followed a modified Delphi RAND/UCLA Appropriateness Method to reach consensus. RESULTS: The Panel conducted a literature review starting with 2209 articles, narrowed down to 522 relevant empirical articles and 52 relevant review articles. The search was refined to include 35 experimental/intervention studies that examined whether there was a causal link between screen-based digital media and sleep. In addition, panelists reviewed 5 recent relevant systematic review articles. After reviewing the summarized current literature, panelists voted on 10 candidate statements about whether screen use impairs sleep health. The Panel met virtually to discuss the results of the first round of votes, which was then followed by a second round of voting, ultimately achieving consensus on 5 out of the 10 statements. CONCLUSIONS: The Panel achieved consensus that (1) in general, screen use impairs sleep health among children and adolescents, (2) the content of screen use before sleep impairs sleep health of children and adolescents, and (3) behavioral strategies and interventions may attenuate the negative effects of screen use on sleep health.

Actigraphic sleep dimensions and associations with academic functioning among adolescents.

STUDY OBJECTIVES: There is mixed evidence regarding associations of sleep duration with academic functioning in adolescents and a lack of research on other sleep dimensions, particularly using objective sleep measures. We examined associations of multiple actigraphic sleep dimensions with academic functioning among adolescents. METHODS: Data were from the sleep sub-study of the age 15 wave of the Future of Families and Child Wellbeing Study (n = 774-782; 52% female), a national, diverse sample of teens. Adolescents wore wrist-actigraphs for ~1 week and completed a survey reporting academic performance and school-related behavioral problems. Regression models assessed whether average sleep duration, timing, maintenance efficiency, and SD-variability were associated with self-reported academic functioning in cross-sectional analyses adjusted for demographic characteristics, depressive symptoms, and anxious symptoms. RESULTS: Later sleep timing (hours) and greater sleep variability (SD-hours) were associated with poorer academic outcomes, including sleep onset variability with higher odds of receiving a D or lower (OR = 1.29), sleep onset (ß = -.07), sleep offset (ß = -.08), and sleep duration variability (ß = -.08) with fewer A grades, sleep offset with lower GPA (ß = -.07), sleep offset (OR = 1.11), sleep duration variability (OR = 1.31), and sleep onset variability (OR = 1.42) with higher odds of being suspended or expelled in the past 2 years, and sleep duration variability with greater trouble at school (ß = .13). Sleep duration, sleep maintenance efficiency, and sleep regularity index were not associated with academic functioning. CONCLUSIONS: Later sleep timing and greater sleep variability are risk factors for certain academic problems among adolescents. Promoting sufficient, regular sleep timing across the week may improve adolescent academic functioning.

Perceived childhood neighborhood safety and sleep health during childhood and adulthood among a cohort of African American women.

OBJECTIVE: To investigate associations between perceived childhood neighborhood safety and sleep over the life course. METHODS: Among a cohort of 1693 Black/African American women aged 23-35 years at enrollment (2010-2012), participants recalled neighborhood safety (safe vs. unsafe) when they were 5, 10, and 15 years old. Participants' mothers/caregivers and participants reported sleep-related health behaviors at age 5. We used ordinal logistic regression to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for sleep-related health behaviors (i.e., rarely/never or sometimes vs. mostly/always going to bed by 8:00 p.m., bed in a quiet room, bed in a dimly lit or unlit room), separately. Adulthood sleep duration and insomnia symptoms were reported at enrollment and over three follow-up periods. We applied generalized estimating equations to log binomial regression models to estimate relative risks (RR) for adulthood sleep characteristics. RESULTS AND CONCLUSIONS: Four percent of participants reported an unsafe neighborhood at age 5 years, only, and 12% reported an unsafe neighborhood at all ages. Participants in perceived unsafe vs. safe neighborhoods at age 5 had higher odds of poor sleep-related health behaviors (e.g., rarely/never or sometimes going to bed in a quiet room: OR = 1.73 [1.27-2.35]). Participants in perceived unsafe vs. safe neighborhoods throughout childhood had higher risk of short sleep (RR = 1.10 [1.02-1.18]) and insomnia symptoms (RR = 1.07 [1.00-1.15]) during adulthood after adjustment for life course socioeconomic characteristics and adulthood health behaviors and characteristics. Perceived unsafe childhood neighborhood was associated with poorer sleep over the life course and may serve as an early intervention target.

Impact of School Start Time Delays and Learning Modality on Sleep Timing and Duration During COVID-19.

OBJECTIVES: To assess the impact of a school start time (SST) delay on adolescent sleep health during the COVID-19 pandemic, and whether there were differences by learning modality. METHODS: Data were collected from a longitudinal study evaluating sleep, education, and health among high school students in Georgia in 2020. Paired t-tests and multivariable linear regression analyses were conducted to examine changes in sleep duration and timing among 9th grade students (n = 134) and their association with the learning modality (remote vs. in-person learner). RESULTS: Students' school day wake times were 1.5 hours later, school night sleep duration was 1.2 hours longer, and social jetlag was 0.9 hours shorter after the school start time delay (all P < .05). The learning modality was a significant predictor of changes in sleep timing but was not associated with changes in sleep duration. CONCLUSIONS: Delayed school start time was associated with positive changes in adolescent sleep health during the COVID-19 pandemic. Sleep timing was affected by the learning modality, however in-person and virtual students had similar gains in sleep duration. Learning modality may be more beneficial for adolescents with early school start times to promote healthier sleep habits.

Sleep Characteristics are Associated with Risk of Treated Diabetes Among Postmenopausal Women.

OBJECTIVE: The purpose of this study was to determine whether sleep characteristics are associated with incidence of treated diabetes in postmenopausal individuals. METHODS: Postmenopausal participants ages 50-79 years reported sleep duration, sleep-disordered breathing, or insomnia at baseline and again in a subsample 3 years later. The primary outcome was self-reported new diagnosis of diabetes treated with oral drugs or insulin at any time after baseline. Multivariable Cox proportional hazards models were used. RESULTS: In 135,964 participants followed for 18.1 (± 6.3) years, there was a nonlinear association between sleep duration and risk of treated diabetes. Participants sleeping ≤5 hours at baseline had a 21% increased risk of diabetes compared with those sleeping 7 hours (adjusted hazard ratio [aHR] 1.21; 95% confidence interval [CI], 1.00-1.47). Those who slept for ≥9 hours had a nonsignificant 6% increased risk of diabetes compared with those sleeping 7 hours (aHR 1.06; 95% CI, 0.97-1.16). Participants whose sleep duration had decreased at 3 years had a 9% (aHR 1.09; 95% CI, 1.02-1.16) higher risk of diabetes than participants with unchanged sleep duration. Participants who reported increased sleep duration at 3 years had a risk of diabetes (HR 1.01; 95% CI, 0.95-1.08) similar to those with no sleep duration change. Participants at high risk of sleep-disordered breathing at baseline had a 31% higher risk of diabetes than those without (aHR 1.31; 95% CI, 1.26-1.37). No association was found between self-reported insomnia score and diabetes risk. CONCLUSIONS: Sleep-disordered breathing and short or long sleep duration were associated with higher diabetes risk in a postmenopausal population.

Interactive Screen-Based Activities Predict Worse Actigraphic Sleep Health That Night Among Adolescents.

PURPOSE: To determine the micro-longitudinal effects of duration and timing of screen-based activities on sleep within and between adolescents. METHODS: Daily survey and actigraphy data from the age 15 wave of the Future of Families and Child Wellbeing Study were analyzed using multilevel modeling. Four hundred seventy five adolescents provided three or more days of valid daily survey and nighttime sleep data. RESULTS: Within-person results showed that on days when adolescents played video games more than their daytime average ± SE (1.3 ± 1.2 hours), sleep onset (6 ± 2 minutes, p < .01) and midpoint (4 ± 2 minutes, p < .02) were delayed for each additional hour of gaming. Between-person results showed that for each hour adolescents used screens to communicate with friends across the day, sleep onset was later (11 ± 3 minutes, p < .01), sleep midpoint was later (8 ± 3 minutes, p < .01), and sleep duration was shorter (-5 ± 2 minutes, p < .03). Adolescents who used screens to communicate with friends or play video games in the hour before bed had later sleep onset (30 ± 14 minutes, p < .03) and midpoint (25 ± 13 minutes, p < .05). DISCUSSION: Among adolescents, passive screen usage such as browsing the Internet or watching videos may not affect sleep timing or duration, but limiting interactive screen-based activities could protect adolescent sleep health and well-being.

The Association of Sleep Duration with Grade Point Averages and Absences Among 9th Graders in Georgia, USA.

This study aimed to examine the association between sleep measures (self-reported sleep duration and weekend catch-up sleep) and grade point average (GPA) and absences among 9th grade students from two racially and economically diverse high schools in a semi-rural county of north-central Georgia. Linear and Poisson regression models estimated the association between sleep measures and GPA and absences (separately), respectively. Analyses adjusted for gender, race/ethnicity, free/reduced-price school lunch status, and parental education. Sleep duration was significantly associated with both GPA and absences, such that for every one additional hour of sleep, GPA increased by 0.8 percentage points (b=0.8, 95% CI:0.1,1.5) while the number of absences was lower by 6% (b=-0.05; OR=0.94, 95% CI:0.91,0.98). Weekend catch-up sleep was also significantly and positively associated with absences (b=0.04; OR=1.04, 95% CI; 1.02, 1.07). Increasing sleep may be a strategy to improve GPA and reduce absences among teenagers. Future research should identify effective measures to lengthen sleep.

Microbiome engineering optimized by Antarctic microbiota to support a plant host under water deficit.

Climate change challenges modern agriculture to develop alternative and eco-friendly solutions to alleviate abiotic and/or biotic stresses. The use of soil microbiomes from extreme environments opens new avenues to discover novel microorganisms and microbial functions to protect plants. In this study we confirm the ability of a bioinoculant, generated by natural engineering, to promote host development under water stress. Microbiome engineering was mediated through three factors i) Antarctic soil donation, ii) water deficit and iii) multigenerational tomato host selection. We revealed that tomato plants growing in soils supplemented with Antarctic microbiota were tolerant to water deficit stress after 10 generations. A clear increase in tomato seedling tolerance against water deficit stress was observed in all soils over generations of Host Mediated Microbiome Engineering, being Fildes mixture the most representatives, which was evidenced by an increased survival time, plant stress index, biomass accumulation, and decreased leaf proline content. Microbial community analysis using 16s rRNA gene amplicon sequencing data suggested a microbiome restructuring that could be associated with increased tolerance of water deficit. Additionally, the results showed a significant increase in the relative abundance of Candidatus Nitrosocosmicus and Bacillus spp. which could be key taxa associated with the observed tolerance improvement. We proposed that in situ microbiota engineering through the evolution of three factors (long-standing extreme climate adaption and host and stress selection) could represent a promising strategy for novel generation of microbial inoculants.

Tapping the rhizosphere metabolites for the prebiotic control of soil-borne bacterial wilt disease.

Prebiotics are compounds that selectively stimulate the growth and activity of beneficial microorganisms. The use of prebiotics is a well-established strategy for managing human gut health. This concept can also be extended to plants where plant rhizosphere microbiomes can improve the nutrient acquisition and disease resistance. However, we lack effective strategies for choosing metabolites to elicit the desired impacts on plant health. In this study, we target the rhizosphere of tomato (Solanum lycopersicum) suffering from wilt disease (caused by Ralstonia solanacearum) as source for potential prebiotic metabolites. We identify metabolites (ribose, lactic acid, xylose, mannose, maltose, gluconolactone, and ribitol) exclusively used by soil commensal bacteria (not positively correlated with R. solanacearum) but not efficiently used by the pathogen in vitro. Metabolites application in the soil with 1 µmol g-1 soil effectively protects tomato and other Solanaceae crops, pepper (Capsicum annuum) and eggplant (Solanum melongena), from pathogen invasion. After adding prebiotics, the rhizosphere soil microbiome exhibits enrichment of pathways related to carbon metabolism and autotoxin degradation, which were driven by commensal microbes. Collectively, we propose a novel pathway for mining metabolites from the rhizosphere soil and their use as prebiotics to help control soil-borne bacterial wilt diseases.

Actigraphic Sleep Variability is Associated With Lower Positive Mood in Adolescents.

PURPOSE: Poor sleep health is associated with lower positive mood in adolescents, and more variable sleep is associated with more negative mood. There is a lack of research on the associations between sleep variability and positive mood in adolescents. We investigated whether several types of sleep variability, measured with actigraphy, were associated with positive mood reported on a daily diary in adolescents. METHODS: Data were collected from a substudy of the Year 15 wave of the Future of Families and Child Wellbeing Study (n = 580; 53% female, mean age ± standard deviation [SD] = 15.4 ± 0.5 years, range 14.7-17.7). Adolescents wore an actigraphy device (M ± SD = 5.6 ± 1.4 nights per adolescent, range: 3-10) and completed daily diaries (M ± SD = 5.5 ± 1.4 days per adolescent, range: 3-9) for ∼1 week, where they rated their levels of happiness and excitement during that day from 0 (not at all) to 4 (extremely). Happiness and excitement were averaged into "positive mood." Separate linear regression models assessed whether actigraphy-measured variability of sleep duration, onset, and offset (residual individual standard deviation, riSD), sleep regularity index, social jetlag, and free night catch-up sleep were associated with average positive mood per person. Analyses adjusted for age, birth sex, race/ethnicity, household income, and the primary caregiver's education level. RESULTS: Greater variability in sleep duration (p = .011, ß = -0.11) and lower sleep regularity index (p = .034, ß = 0.09) were associated with lower ratings of positive mood. There were no other significant associations (p ≥ .10). DISCUSSION: Variable and irregular sleep are associated with lower levels of positive mood in adolescence, which may increase the risk of poor emotional health in adulthood.

Biochar enhancement of nitrification processes varies with soil conditions.

Application of inorganic nitrogen (N) fertilizers in agriculture can increase emissions of nitrous oxide, a potent greenhouse gas, leaching of nitrate (NO3-), a groundwater contaminant hazardous to human health, and soil acidification. Soil amendment with biochar potentially mitigates these losses and undesirable outcomes. However, there have been considerable inconsistencies in reported impacts, likely owing to variable physiochemical characteristics of the biochar materials and/or the soil environment. This study methodically evaluated the impact of biochar soil incorporation on N transformation and underlying microbial processes using soils with varying biochar types, soil texture, soil moisture, and manure compost co- amendments. Laboratory incubations were conducted to monitor the fate of urea fertilizer N spiked in biochar amended and unamended soils by assaying soil ammonium (NH4+), nitrite (NO2-), and NO3- concentrations, pH, and abundances of soil nitrifiers; ammonia oxidizing bacteria and archaea (AOB and AOA) and Nitrospira with the capacity to perform complete ammonia oxidation (comammox). Soil moisture was a critical factor affecting N transformation processes, more so than biochar, but biochar did result in significantly different concentrations of N species in response to urea application. Biochar enhanced nitrification, more significantly in drier conditions and in sandy soil. Biochar offered some buffering potential in the neutral-alkaline, unsaturated soils, preventing >1 unit drop in pH compared to unamended soils. Co-application of biochar with manure composts enhanced nitrification slightly, which was evidenced by higher abundances of some soil nitrifiers at 4 weeks, although increases in nitrification rates were not statistically significant. Soil nitrifier populations tended to increase in response to a pinewood biochar, but trends differed for saturated soil, in soils of differing textures, or when different biochar materials were evaluated. Thus, when evaluating implications of biochar on the fate of mineral N fertilizer, soil moisture and other environment conditions should be considered.

The potential of biochar as a microbial carrier for agricultural and environmental applications.

Biochar can be an effective carrier for microbial inoculants because of its favourable properties promoting microbial life. In this review, we assess the effectiveness of biochar as a microbial carrier for agricultural and environmental applications. Biochar is enriched with organic carbon, contains nitrogen, phosphorus, and potassium as nutrients, and has a high porosity and moisture-holding capacity. The large number of active hydroxyl, carboxyl, sulfonic acid group, amino, imino, and acylamino hydroxyl and carboxyl functional groups are effective for microbial cell adhesion and proliferation. The use of biochar as a carrier of microbial inoculum has been shown to enhance the persistence, survival and colonization of inoculated microbes in soil and plant roots, which play a crucial role in soil biochemical processes, nutrient and carbon cycling, and soil contamination remediation. Moreover, biochar-based microbial inoculants including probiotics effectively promote plant growth and remediate soil contaminated with organic pollutants. These findings suggest that biochar can serve as a promising substitute for non-renewable substrates, such as peat, to formulate and deliver microbial inoculants. The future research directions in relation to improving the carrier material performance and expanding the potential applications of this emerging biochar-based microbial immobilization technology have been proposed.

Why so slangry (sleepy and angry)? Shorter sleep duration and lower sleep efficiency predict worse next-day mood in adolescents.

PURPOSE: The goal of this study was to evaluate the relationships of actigraphic nighttime sleep duration and quality with next-day mood among urban adolescents using a micro-longitudinal design. METHODS: A subsample (N = 525) of participants from the Fragile Families & Child Wellbeing Study (mean age: 15.4 years; 53% female; 42% Black non-Hispanic, 24% Hispanic/Latino, 19% White non-Hispanic) in the United States between 2014 and 2016 concurrently wore a wrist actigraphic sleep monitor and rated their daily mood in electronic diaries for about 1 week. Multilevel models tested the within-person temporal associations of nightly sleep duration and sleep maintenance efficiency with next-day reports of happiness, anger, and loneliness. The models also tested the between-person associations of sleep variables and mood. Models adjusted for sociodemographic and household characteristics, weekend, and school year. RESULTS: After nights when adolescents obtained longer sleep duration than their usual, they reported lower ratings of anger (B = -.03, p < .01) the next day. After nights when adolescents had higher sleep maintenance efficiency than their usual, they reported higher ratings of happiness (B = .02, p < .01) the next day. Adolescents who had longer average sleep duration reported lower ratings of anger (B = -.08, p < .01) and loneliness (B = -.08, p < .01) compared to others. There was no within-person association of sleep duration or efficiency with loneliness. Sleep duration was not associated with happiness between adolescents, and sleep maintenance efficiency was not associated with any mood measure between adolescents. CONCLUSIONS: Improvements to nightly sleep may help increase happiness and decrease anger the following day in adolescents. Promoting sleep health is recommended to improve mood.

Resource-dependent biodiversity and potential multi-trophic interactions determine belowground functional trait stability.

BACKGROUND: For achieving long-term sustainability of intensive agricultural practices, it is pivotal to understand belowground functional stability as belowground organisms play essential roles in soil biogeochemical cycling. It is commonly believed that resource availability is critical for controlling the soil biodiversity and belowground organism interactions that ultimately lead to the stabilization or collapse of terrestrial ecosystem functions, but evidence to support this belief is still limited. Here, we leveraged field experiments from the Chinese National Ecosystem Research Network (CERN) and two microcosm experiments mimicking high and low resource conditions to explore how resource availability mediates soil biodiversity and potential multi-trophic interactions to control functional trait stability. RESULTS: We found that agricultural practice-induced higher resource availability increased potential cross-trophic interactions over 316% in fields, which in turn had a greater effect on functional trait stability, while low resource availability made the stability more dependent on the potential within trophic interactions and soil biodiversity. This large-scale pattern was confirmed by fine-scale microcosm systems, showing that microcosms with sufficient nutrient supply increase the proportion of potential cross-trophic interactions, which were positively associated with functional stability. Resource-driven belowground biodiversity and multi-trophic interactions ultimately feedback to the stability of plant biomass. CONCLUSIONS: Our results indicated the importance of potential multi-trophic interactions in supporting belowground functional trait stability, especially when nutrients are sufficient, and also suggested the ecological benefits of fertilization programs in modern agricultural intensification. Video Abstract.

Deciphering the mechanism of fungal pathogen-induced disease-suppressive soil.

One model of a disease-suppressive soil predicts that the confrontation of plant with a phytopathogen can lead to the recruitment and accumulation of beneficial microorganisms. However, more information needs to be deciphered regarding which beneficial microbes become enriched, and how the disease suppression is achieved. Here, we conditioned soil by continuously growing eight generations of cucumber inoculated with Fusarium oxysporum f.sp. cucumerinum in a split-root system. Disease incidence was found to decrease gradually upon pathogen infection accompanied with higher quantity of reactive oxygen species (ROS mainly OH• ) in roots and accumulation of Bacillus and Sphingomonas. These key microbes were proven to protect the cucumber from pathogen infection by inducing high ROS level in the roots through enrichment of pathways, including a two-component system, a bacterial secretion system, and flagellar assembly revealed by metagenomics sequencing. Untargeted metabolomics analysis combined with in vitro application assays suggested that threonic acid and lysine were pivotal to recruit Bacillus and Sphingomonas. Collectively, our study deciphered a 'cry for help' case, wherein cucumber releases particular compounds to enrich beneficial microbes that raise the ROS level of host to prevent pathogen attack. More importantly, this may be one of the fundamental mechanisms underpinning disease-suppressive soil formation.

Pediatric sleep: current knowledge, gaps, and opportunities for the future.

This White Paper addresses the current gaps in knowledge, as well as opportunities for future studies in pediatric sleep. The Sleep Research Society's Pipeline Development Committee assembled a panel of experts tasked to provide information to those interested in learning more about the field of pediatric sleep, including trainees. We cover the scope of pediatric sleep, including epidemiological studies and the development of sleep and circadian rhythms in early childhood and adolescence. Additionally, we discuss current knowledge of insufficient sleep and circadian disruption, addressing the neuropsychological impact (affective functioning) and cardiometabolic consequences. A significant portion of this White Paper explores pediatric sleep disorders (including circadian rhythm disorders, insomnia, restless leg and periodic limb movement disorder, narcolepsy, and sleep apnea), as well as sleep and neurodevelopment disorders (e.g. autism and attention deficit hyperactivity disorder). Finally, we end with a discussion on sleep and public health policy. Although we have made strides in our knowledge of pediatric sleep, it is imperative that we address the gaps to the best of our knowledge and the pitfalls of our methodologies. For example, more work needs to be done to assess pediatric sleep using objective methodologies (i.e. actigraphy and polysomnography), to explore sleep disparities, to improve accessibility to evidence-based treatments, and to identify potential risks and protective markers of disorders in children. Expanding trainee exposure to pediatric sleep and elucidating future directions for study will significantly improve the future of the field.