Sleep Education: A Narrative Review on Barriers and Opportunities to Grow a Diverse Sleep Team.

The increased recognition of sleep-wake disorders and their effects, along with the anticipated shortage of sleep medicine specialists, heralds a concomitant need to have more health care providers with dedicated training in the evaluation and management of sleep disorders across the life span. A narrative review of published literature on sleep education was conducted and identified factors related to diversity within the sleep team, barriers to implementation of sleep education, and strides in sleep education. Implementation of novel sleep education strategies will require creative navigation of barriers such as allocation of curricular time, availability of teaching faculty, and funding to train more members of the sleep team. Deliberate coordination within and across health professions programs, with efforts to share resources and leverage technology, will be instrumental to guide the next phase of growth in sleep education.

"I'm not sure if it works": School nurses' experiences of sleep-promoting work in Sweden.

OBJECTIVES: Lack of sleep is a common problem in children and adolescents of school age (students), and it is a health aspect that affects the ability to assimilate into the school's education and thereby falls within the school nurses promoting work. This study aimed to describe school nurses' experiences of sleep-promoting work. METHOD: Data were collected by n = 61 school nurses' written narratives of their sleep-promotion work. Data were analyzed using qualitative content analysis. RESULTS: The results describe school nurses' experiences of sleep-promoting work in three main categories: (1) Informing and providing knowledge is the primary task. School nurses do it systematically, through dialogs with an individual student, with several students simultaneously, or with parents. (2) Benefits take place when the needs of the student guide the work. Through curiosity about the personal story, the keys to sleep-promoting work can be found, appropriate strategies can be given, and the student can be guided further if needed. (3) Barriers challenge the outcome of the work. The school nurses experience these barriers in the form of unmotivated students, unsupportive parents, and lack of prerequisites, which make the school nurses unsure of their performance. CONCLUSIONS: School nurses experience a significant benefit in their sleep-promoting work when the needs of the student guide the sleep-promoting information, strategies, and follow-ups. To avoid feeling insecure in sleep-promoting work, school nurses need updates on the state of knowledge and evidence-based tools. Further research on sleep-promoting work at school is necessary.

Barriers and enablers to screening, management and referral of sleep disorders in patients attending cardiac rehabilitation: A qualitative descriptive study.

AIMS: To examine healthcare professional's knowledge about assessment and management of sleep disorders for cardiac patients and to describe the barriers to screening and management in cardiac rehabilitation settings. DESIGN: A qualitative descriptive study. Data were collected via semi-structured interviews. METHODS: In March 2022, a total of seven focus groups and two interviews were conducted with healthcare professionals who currently work in cardiac rehabilitation settings. Participants included 17 healthcare professionals who had undertaken cardiac rehabilitation training within the past 5 years. The study adheres to the consolidated criteria for reporting qualitative research guidelines. An inductive thematic analysis approach was utilized. RESULTS: Six themes and 20 sub-themes were identified. Non-validated approaches to identify sleep disorders (such as asking questions) were often used in preference to validated instruments. However, participants reported positive attitudes regarding screening tools provided they did not adversely affect the therapeutic relationship with patients and benefit to patients could be demonstrated. Participants indicated minimal training in sleep issues, and limited knowledge of professional guidelines and recommended that more patient educational materials are needed. CONCLUSION: Introduction of screening for sleep disorders in cardiac rehabilitation settings requires consideration of resources, the therapeutic relationship with patients and the demonstrated clinical benefit of extra screening. Awareness and familiarity of professional guidelines may improve confidence for nurses in the management of sleep disorders for patients with cardiac illness. IMPACTS: The findings from this study address healthcare professionals' concerns regarding introduction of screening for sleep disorders for patients with cardiovascular disease. The results indicate concern for therapeutic relationships and patient management and have implications for nursing in settings such as cardiac rehabilitation and post-cardiac event counselling. REPORTING METHOD: Adherence to COREQ guidelines was maintained. PATIENT OR PUBLIC CONTRIBUTION: No Patient or Public Contribution as this study explored health professionals' experiences only.

School-Based Sleep Education Program for Children: A Cluster Randomized Controlled Trial.

Insufficient sleep contributes negatively to child developmental processes and neurocognitive abilities, which argues the need for implementing interventions to promote sleep health in children. In this study, we evaluated the effectiveness of a multimodal and multilevel school-based sleep education program in primary school children using a cluster randomized controlled design. Twelve schools were randomly assigned to either the sleep education or nonactive control groups. The sleep education group included a town hall seminar, small class teaching, leaflets, brochures, and a painting competition for children. Parents and teachers were invited to participate in a one-off sleep health workshop. Parental/caregiver-reported questionnaires were collected at baseline and 1-month follow-up. A total of 3769 children were included in the final analysis. There were no significant improvements observed in the sleep-wake patterns, daytime functioning, and insomnia symptoms between the two groups at follow-up, whereas the intervention group had significantly improved parental sleep knowledge than the controls (paternal: adjusted mean difference: 0.95 [95% confidence interval (CI): 0.18 to 1.71]; maternal: adjusted mean difference: 0.87 [95% CI: 0.17 to 1.57]). In addition, children receiving the intervention had a lower persistence rate of excessive beverage intake (adjusted odds ratio: 0.49 [95% CI: 0.33 to 0.73]), and experienced greater reductions in conduct problems (adjusted mean difference: 0.12 [95% CI: 0.01 to 0.24]) compared with the controls at 1-month of follow-up. Moreover, a marginally significant reduction for emotional problems in the intervention group was also observed (adjusted mean difference: 0.16 [95% CI: -0.00 to 0.32]). These findings demonstrated that school-based sleep education was effective in enhancing parental sleep knowledge and improving behavioral outcomes in children, but not sufficient in altering the children's sleep-wake patterns and sleep problems.

Disseminating sleep education to graduate psychology programs online: a knowledge translation study to improve the management of insomnia.

STUDY OBJECTIVES: Despite the negative impact of poor sleep on mental health, evidence-based insomnia management guidelines have not been translated into routine mental healthcare. Here, we evaluate a state-wide knowledge translation effort to disseminate sleep and insomnia education to graduate psychology programs online using the RE-AIM (reach, effectiveness, adoption, implementation, and maintenance) evaluation framework. METHODS: Using a non-randomized waitlist control design, graduate psychology students attended a validated 6-hour online sleep education workshop delivered live as part of their graduate psychology program in Victoria, Australia. Sleep knowledge, attitudes, and practice assessments were conducted pre- and post-program, with long-term feedback collected at 12 months. RESULTS: Seven out of ten graduate psychology programs adopted the workshop (adoption rate = 70%). The workshop reached 313 graduate students, with a research participation rate of 81%. The workshop was effective at improving students' sleep knowledge and self-efficacy to manage sleep disturbances using cognitive behavioral therapy for insomnia (CBT-I), compared to the waitlist control with medium-to-large effect sizes (all p < .001). Implementation feedback was positive, with 96% of students rating the workshop as very good-to-excellent. Twelve-month maintenance data demonstrated that 83% of students had used the sleep knowledge/skills learned in the workshop in their clinical practice. However, more practical training is required to achieve CBT-I competency. CONCLUSIONS: Online sleep education workshops can be scaled to deliver cost-effective foundational sleep training to graduate psychology students. This workshop will accelerate the translation of insomnia management guidelines into psychology practice to improve sleep and mental health outcomes nationwide.

Examining changes in knowledge and practice in nurse practitioners after an online educational module on obstructive sleep apnea.

AIMS: The purpose of this study is to investigate primary care nurse practitioner (NP) knowledge and knowledge retention on obstructive sleep apnea (OSA) screening after an educational in-service. BACKGROUND: The prevalence of OSA is high and continues to rise amid the obesity epidemic. Approximately 75-90 % of individuals with moderate to severe OSA remain undiagnosed. Continuing education of OSA risk factors among primary care providers may increase screening rates, leading to early diagnosis and treatment. METHODS: An educational module was presented to NPs (n = 30) during a mandatory NP in-service at two sets of outpatient clinics. Knowledge was assessed with a pre-test and post-test survey consisting of 23 items. A 25-item follow-up test was administered five weeks after to assess knowledge retention. RESULTS: An increase in total knowledge scores was demonstrated between the pre-test and post-test with a decrease in knowledge observed at follow-up. Follow-up test total mean scores remained above pre-test levels, indicating potential long-term learning. CONCLUSIONS: While learning was demonstrated, NPs acknowledged continued barriers to screening for OSA such as time and having no OSA screening tool available in the electronic medical record (EMR).

A scoping review of sleep education and training for nurses.

BACKGROUND: Shift work and resulting sleep impairment among nurses can increase their risk for poor health outcomes, occupational injuries, and errors due to sleep deficiencies. While sleep education and training for nurses has been recommended as part of a larger fatigue risk management system, little is known about training programs designed specifically for nurses. OBJECTIVE: Investigate the literature for current sleep education or training programs specifically for shift working nurses, with intent to assess training content, delivery characteristics, and outcome measures. DESIGN: A scoping review conducted October 2020 through September 2021. METHODS: The bibliographic databases Cumulative Index of Nursing and Allied Health (CINAHL), Scopus, PubMed, and NIOSHTIC-2 were searched using words such as "nurse," "sleep hygiene," "shift work," and "education". Studies were included if they: 1) were original research; 2) discussed sleep education, training, or sleep hygiene interventions; 3) included a study population of nurses engaging in shift work; 4) focused on sleep as a primary study measure; 5) were written in English language; and 6) were published in 2000 or later. RESULTS: Search results included 17,237 articles. After duplicates were removed, 14,620 articles were screened. Nine articles were found to meet established criteria. All studies included sleep hygiene content in the training programs, with five studies adding psychological and/or behavior change motivation training to support change in nurse sleep habits. Three studies added specific training for nurses and for managers. Delivery modes included in-person training of various lengths and frequency, mobile phone application with daily engagement, an online self-guided presentation, and daily reading material coupled with audio training. Pittsburgh Sleep Quality Index and Epworth Sleepiness Scale were the outcome measures most frequently used. Although studies demonstrated improved sleep measures, most were pilot studies testing feasibility. CONCLUSION: Although there is a paucity of studies focused on sleep education and training for shift working nurses, we found the inclusion of sleep hygiene content was the only common characteristic of all nine studies. The variability in training content, delivery methods, and outcome measures suggests further research is needed on what constitutes effective sleep education and training for nurses.

Equivalent Improvements in Sleep Duration and Sleep Quality Regardless of Program Delivery Modality: The SLeep Education for Everyone Program (SLEEP).

Sleep issues are pervasive, and treatment can be difficult to access, if available at all. The purpose of this study was to test whether the delivery modality (online vs. in person) of the SLeep Education for Everyone Program (SLEEP) influenced programmatic outcomes. A total of 60 participants completed the study, 28 in the online group and 32 in the in-person group. Across all participants, SLEEP improved sleep duration, sleep quality, and sleep hygiene behaviors (p < 0.001 for all). When comparing delivery modality, sleep duration and quality improved similarly between groups; however, sleep hygiene behaviors improved more in the in-person group (p = 0.033). Sleep hygiene scores did not correlate with sleep duration or quality after the program. Based on these findings, SLEEP appears to be equally effective in improving sleep duration and quality when delivered online or in person. These findings suggest that SLEEP can be delivered based on the organization's and participant's resources, needs, and preferred style of interaction.

A low-threshold sleep intervention for improving sleep quality and well-being.

Background: Approximately one-third of the healthy population suffer from sleep problems, but only a small proportion of those affected receive professional help. Therefore, there is an urgent need for easily accessible, affordable, and efficacious sleep interventions. Objective: A randomized controlled study was conducted to investigate the efficacy of a low-threshold sleep intervention consisting of either (i) sleep data feedback plus sleep education or (ii) sleep data feedback alone in comparison with (iii) no intervention. Material and methods: A total of 100 employees of the University of Salzburg (age: 39.51 ± 11.43 years, range: 22-62 years) were randomly assigned to one of the three groups. During the 2-week study period, objective sleep parameters were assessed via actigraphy. In addition, an online questionnaire and a daily digital diary were used to record subjective sleep parameters, work-related factors, as well as mood and well-being. After 1 week, a personal appointment was conducted with participants of both experimental group 1 (EG1) and experimental group 2 (EG2). While the EG2 only received feedback about their sleep data from week 1, the EG1 additionally received a 45-min sleep education intervention containing sleep hygiene rules and recommendations regarding stimulus control. A waiting-list control group (CG) did not receive any feedback until the end of the study. Results: Results indicate positive effects on sleep and well-being following sleep monitoring over the course of 2 weeks and minimal intervention with a single in-person appointment including sleep data feedback. Improvements are seen in sleep quality, mood, vitality, and actigraphy-measured sleep efficiency (SE; EG1), as well as in well-being and sleep onset latency (SOL) in EG2. The inactive CG did not improve in any parameter. Conclusion: Results suggest small and beneficial effects on sleep and well-being in people being continuously monitored and receiving (actigraphy-based) sleep feedback when paired with a single-time personal intervention.

Assessment of sleep knowledge among medical and dental students in a Nigerian tertiary institution: a cross-sectional study.

PURPOSE: Sleep medicine is a rapidly growing field of Medicine globally. However, studies are lacking on the knowledge of Nigerian medical and dental students on sleep and the different types of sleep disorders. Thus, we assessed the knowledge, interest and awareness of Nigerian medical and dental students about sleep medicine. We also determined the factors associated with sleep knowledge among the medical and dental students. METHODS: We conducted this cross-sectional study from June to September 2021, among medical students at the Obafemi Awolowo University, Ile-Ife, Nigeria. The students' knowledge of sleep was assessed with the Assessment of Sleep Knowledge in Medical Education (ASKME) survey. The participants were classified as having low or high scores based on the proportion who gave a correct answer to 60% of the questions. RESULTS: Among the 488 students who completed the questionnaire, there was a male preponderance (55%). About three-quarters of the respondents (376, 77%) had a low sleep knowledge score. Age, year of study, and awareness about sleep medicine were the predictors of sleep knowledge. CONCLUSION: A significant proportion of the medical students had poor sleep knowledge scores. There is a need to incorporate teaching sleep medicine in the curriculum of medical students early in their training.

Comparing Perceived Sleep Quality, Practices, and Behaviors of Male and Female Elite Rugby Union Athletes with the Use of Sleep Questionnaires.

Objective To evaluate the differences in subjective sleep quality, quantity, and behaviors among male and female elite rugby union athletes through two common sleep questionnaires. Materials and Methods A sample of 38 male and 27 female elite rugby union athletes filled out the Athlete Sleep Behavior Questionnaire (ASBQ) and the Pittsburgh Sleep Quality Index (PSQI). Global scores and individual items for each questionnaire were compared to assess differences between sexes. Results Male athletes reported significantly longer sleep duration (7 h 50 m ± 50 m versus 7h 12 m ± 58 m respectively; p ≤ 0.01; d = 0.70) and higher habitual sleep efficiency (88% versus 83% respectively; p < 0.05; d = 0.54) when compared with female athletes. Individual items of the ASBQ revealed significant differences between male and female athletes for five questions. Male athletes displayed higher instances of taking stimulants before training or competition and consuming alcohol within 4 hours of going to bed. Conversely, female athletes expressed greater thought or worry while in bed and a higher instance of training late at night. Discussion Male athletes displayed better self-reported sleep quality and quantity than female athletes; however, the present study highlighted that male and female elite rugby union athletes face specific challenges that differ. It appears that the differences observed between male and female elite rugby union athletes may be due to differing levels of professionalism or differences in training or competition schedules.

Infant Safe Sleep Knowledge, Attitudes, and Behaviors by Physicians at an Academic Children's Hospital.

Sudden unexpected infant death (SUID) is the leading cause of death for infants. Physician advice on safe sleep is an important source of information for families. We sought to evaluate the safe sleep knowledge, attitudes, and behaviors of physicians by distributing a cross-sectional survey at a freestanding children's hospital. The survey included demographics, knowledge items, attitudinal assessment, and frequency of providing safe sleep guidance. Multivariable linear regression and logistic regression were used to evaluate associations between variables. 398 physicians were surveyed with 124 responses (31%). Females, those who received safe sleep training, and those who see infants in daily practice had higher knowledge scores. Physicians with higher knowledge scores had more positive attitudes toward safe sleep and provided safe sleep education to patients more often. Our study underlies the importance of education and repeated exposure in forming positive attitudes toward safe sleep recommendations and leads to increased provision of safe sleep guidance.

Hospital-based inpatient quality improvement initiatives on safe infant sleep: Systematic review and narrative synthesis.

This review aimed to better understand the application of Quality Improvement (QI) processes to increase adherence to safe infant sleep recommendations in inpatient hospital settings. Following Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) 2020 guidelines, we searched MEDLINE/PubMed, CINAHL, and PsycINFO for articles published between 1992 and 2021 describing safe infant sleep QI processes in inpatient settings. Data were extracted from eligible articles based on the hospital setting, intervention target, and QI elements in addition to QI improvement efforts. Article quality was assessed using Standards for Quality Improvement Reporting Excellence (SQUIRE) criteria. The initial search yielded 331 articles; 27 met eligibility criteria for data extraction. QI was conducted in pediatric, maternity, and neonatal intensive care units, or a combination. The most often targeted practices were supine position and no objects in crib, followed by parent teaching, sleep location, flat surface, and appropriate bundling. Change approaches fit four broad categories: staff education, parent education, policy, and unit environment changes. All articles reported at least partial success in increasing adherence, and the "lessons learned" can assist hospital teams in tailoring their own safe sleep QI process.

A REDCap-based model for online interventional research: Parent sleep education in autism.

INTRODUCTION: The use of online platforms for pediatric healthcare research is timely, given the current pandemic. These platforms facilitate trial efficiency integration including electronic consent, randomization, collection of patient/family survey data, delivery of an intervention, and basic data analysis. METHODS: We created an online digital platform for a multicenter study that delivered an intervention for sleep disorders to parents of children with autism spectrum disorder (ASD). An advisory parent group provided input. Participants were randomized to receive either a sleep education pamphlet only or the sleep education pamphlet plus three quick-tips sheets and two videos that reinforced the material in the pamphlet (multimedia materials). Three measures - Family Inventory of Sleep Habits (FISH), Children's Sleep Habits Questionnaire modified for ASD (CSHQ-ASD), and Parenting Sense of Competence (PSOC) - were completed before and after 12 weeks of sleep education. RESULTS: Enrollment exceeded recruitment goals. Trial efficiency was improved, especially in data entry and automatic notification of participants related to survey completion. Most families commented favorably on the study. While study measures did not improve with treatment in either group (pamphlet or multimedia materials), parents reporting an improvement of ≥3 points in the FISH score showed a significantly improved change in the total CSHQ (P = 0.038). CONCLUSION: Our study demonstrates the feasibility of using online research delivery platforms to support studies in ASD, and more broadly, pediatric clinical and translational research. Online platforms may increase participant inclusion in enrollment and increase convenience and safety for participants and study personnel.

A community-based sleep educational intervention for children with autism spectrum disorder.

BACKGROUND: Sleep problems are common in children with autism spectrum disorder (ASD). Sleep education, effective in improving sleep in ASD, may be difficult to access. We determined if community-based pediatric therapists could successfully deliver sleep educational interventions to caregivers of children with ASD. METHODS: A seven-week feasibility study was conducted consisting of 10 children and caregivers. This feasibility study informed the development of a 16-week preliminary effectiveness study, which consisted of 33 children and caregivers. Children, ages 2-12 years, with a clinical diagnosis of autism and caregiver-reported sleep onset delay of 30 min were included. Community therapists underwent comprehensive training in sleep education and then met with caregiver participants to provide sleep education to each family. Semi-structured qualitative interviews were conducted with all families who completed study procedures.In the feasibility and preliminary effectiveness studies, child participants wore an actigraphy watch (at baseline and after sleep education) and caregivers completed the Child Sleep Habits Questionnaire and Family Inventory of Sleep Habits at baseline and after sleep education; the Child Behavior Checklist was also completed by caregivers in the preliminary effectiveness study. RESULTS: Educator fidelity to the manualized curriculum was maintained. Caregivers showed appropriate understanding, comfort, and implementation of the curriculum. Qualitative and quantitative measures, including caregiver surveys and actigraphy, showed improvements in child sleep and behavior. CONCLUSIONS: Community-based therapists can successfully deliver sleep education to families of children with ASD, which has favorable implications for improving access to care in this population.

Time lost: Factors influencing advanced practice provider's prioritization of sleep.

BACKGROUND: Prescribing patient care providers regularly experience insufficient sleep, putting them at increased risk of committing occupational injuries, accidents, and errors and developing chronic health conditions. OBJECTIVE: Identify antecedents to short sleep (≤6-hours sleep in 24-hour period) in the understudied population of hospital-based Advanced Practice Providers (APPs). METHODS: Using an ethnographic research design, data included APP and key stakeholder interviews, hospital observations, and relevant documents. Interview data were analyzed using modified constant comparative method. RESULTS: Nine APPs were interviewed, revealing four themes: Social/Family Obligations and Value of Connectivity, Community Value of Sleep, Organizational Value of Sleep, and Individual Biology and How the Body Values Sleep. APP decisions to prioritize sleep are based on an interplay of societal, professional, organizational, and personal values. Triangulated data verified results, except regarding how APP sleep deficit can lead to mood disturbances and the lack sleep consideration in patient care error reporting. CONCLUSIONS: Findings demonstrate the importance of consistency in messaging, action, and policy when promoting occupational sleep health among healthcare workers. Implications include instituting worker sleep education, leadership modeling healthy sleep habits, and inclusion of sleep in root cause analyses. Additional consideration includes evaluating the influence of nursing culture on nurse practitioners' sleep habits.

Update on school-based sleep education programs: how far have we come and what has Australia contributed to the field?

OBJECTIVE: School-based sleep education programs help to promote sleep health information to many children and adolescents. The aim of this systematic review was to identify and describe school-based sleep education programs, to update previous reviews and identify recent advances and improvements in this field worldwide. METHODS: Four electronic databases were searched. Eligibility criteria included children aged 5-18 years, sleep education intervention conducted in a school setting, and at least one pre-post-measure of a sleep variable. RESULTS: A total of 32 articles met eligibility criteria with Australian sleep researchers constituting âˆ¼ one quarter of these studies. Studies dated from 2007 to 2020 with sample sizes ranging from 9 to 3713 students. The majority of participants were high school students and predominantly female. Education programs generally took 4-6 weeks and content was consistent across studies. Overall, exposure to sleep education increased sleep knowledge, however changes in sleep behaviour variables and secondary outcome variables (eg, mental health; cognitive function; sleep hygiene practices) presented varied results. Studies conducted since 2015 were more likely to be randomised controlled trials and to include more interactive, online designs utilising innovative content such as mindfulness. CONCLUSIONS: An exponential growth in school sleep education programs was identified since 2016. Future studies should consider utilising objective sleep measures, longer-term follow-ups, innovative delivery methods, and stronger attempts at implementing a knowledge-to-action approach for more sustainable programs.

Sleep interventions and glucose metabolism: systematic review and meta-analysis.

OBJECTIVE: Sleep disturbances (insufficient or poor sleep quality) have been linked to abnormal glucose metabolism. This systematic review and meta-analysis aimed to explore the effects of behavioral and pharmacological sleep interventions on glucose metabolism. METHODS: Medline and Embase were used for systematic search. Studies reporting behavioral or pharmacological interventions in population with sleep disturbances, with measured outcomes of glucose metabolism and sleep parameters were selected. RESULTS: Twenty two studies were eligible for review (eight were conducted in people with type 2 diabetes). Studies were grouped into three types of intervention: sleep extension (n = 6), sleep education or cognitive behavioral therapy for insomnia (CBT-I, n = 6) and pharmacological interventions (n = 10). CBT-I and sleep education resulted in significantly improved self-reported sleep quality (Pittsburgh Sleep Quality Index, mean difference, MD, -1.31, 95% confidence interval (CI) -1.83, -0.80), non-significant reduction in hemoglobin A1c level (MD -0.35%, 95% CI -0.84, 0.13), and non-significant reduction in fasting glucose levels (MD -4.76 mg/dL, 95% CI -14.19, 4.67). Other studies were not eligible for meta-analysis due to heterogeneity of interventions or outcomes. Sleep extension was able to increase sleep duration by varying degrees in short sleepers, and five of six studies demonstrated relationships between the intervention and measures of insulin resistance. A majority of pharmacological intervention studies showed improved sleep but the effects on glucose metabolism were mixed. CONCLUSIONS: Available sleep interventions were effective in improving sleep but the effects on glucose metabolism were inconclusive. Larger randomized studies with consistent outcome measurements are needed to demonstrate this potential causal relationship.

Sleep health practices and sleep knowledge among healthcare professionals in Dutch paediatric rehabilitation.

BACKGROUND: Sleep disorders are highly prevalent in children with neurodisabilities, yet they seem under-recognized in paediatric rehabilitation settings. The aim of this study was to assess among two groups of healthcare professionals (HCPs) working in paediatric rehabilitation: (1) sleep health practices and (2) knowledge about sleep physiology, sleep disorders and sleep hygiene. METHODS: We performed a cross-sectional sleep survey among medical and non-medical HCPs and the general population. Participants (30 rehabilitation physicians [RPs], 54 allied health professionals [AHPs] and 63 controls) received an anonymous 30-item survey consisting of three domains: (1) general information, (2) application of sleep health practices and (3) sleep knowledge. RESULTS: RPs address sleep issues more frequently in clinical practice than AHPs. Sleep interventions mostly consist of giving advice about healthy sleep practices and are given by the majority of HCPs. While RPs demonstrated the highest scores on all knowledge domains, total sleep knowledge scores did not exceed 50% correct across groups, with AHPs and controls showing equal scores. Sleep hygiene rules closest to bedtime and related to the sleep environment were best known, whereas those related to daytime practices were rarely mentioned across all groups. A small minority of HCPs (RPs 20%; AHPs 15%) believed to possess sufficient sleep knowledge to address sleep in clinical practice. No association was found between self-perceived knowledge and sleep knowledge scores among HCPs. CONCLUSIONS: Sleep should become a standard item for review during routine health assessments in paediatric rehabilitation settings. HCPs' limited exposure to sleep education may result in feelings of incompetence and inadequate sleep knowledge levels, affecting their sleep health practices. Appropriate sleep training programs should be implemented to empower HCPs with knowledge, skills and confidence, needed to recognize and treat sleep disorders in children with neurodisabilities, as well as to be able to guide parents.

The challenges of adolescent sleep.

Sleep is vital for our physical, emotional and cognitive health. However, adolescents face many challenges where their sleep is concerned. This is reflected in their sleep patterns including the timing of their sleep and how much sleep they achieve on a regular basis: their sleep is characteristically delayed and short. Notably, insufficient sleep is associated with impairments in adolescent functioning. Endogenous and exogenous factors are known to affect sleep at this age. Alterations in the bioregulation of sleep, comprising the circadian timing system and the sleep/wake homeostatic system, represent the intrinsic mechanisms at work. Compounding this, environmental, psychosocial and lifestyle factors may contribute to shortened sleep. This review discusses the amount of sleep gained by adolescents and its implications, the challenges to adolescent sleep and the interventions introduced in an effort to prioritize sleep health in this important developmental period.