Sleep hygiene intervention for youth aged 10 to 18 years with problematic sleep: a before-after pilot study

BMC Pediatrics

Barbara C Galland¹  Andrew R Gray²  Dione Healey³  Evan Tan¹ 

[1] Department of Women’s and Children’s Health, Dunedin School of Medicine, University of Otago, P.O Box 913, Dunedin, 9016, New Zealand;Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand;Department of Psychology, University of Otago, Dunedin, New Zealand

关键词: Accelerometry;    Obesity;    Sleep quality;    Sleep hygiene;    Sleep;   

Others  :  1170597
DOI  :  10.1186/1471-2431-12-189

 received in 2012-06-06, accepted in 2012-12-04,  发布年份 2012

【 摘 要 】

Background

The current study aimed to examine the changes following a sleep hygiene intervention on sleep hygiene practices, sleep quality, and daytime symptoms in youth.

Methods

Participants aged 10–18 years with self-identified sleep problems completed our age-appropriate F.E.R.R.E.T (an acronym for the categories of Food, Emotions, Routine, Restrict, Environment and Timing) sleep hygiene programme; each category has three simple rules to encourage good sleep. Participants (and parents as appropriate) completed the Adolescent Sleep Hygiene Scale (ASHS), Pittsburgh Sleep Quality Index (PSQI), Sleep Disturbance Scale for Children (SDSC), Pediatric Daytime Sleepiness Scale (PDSS), and wore Actical® monitors twice before (1 and 2 weeks) and three times after (6, 12 and 20 weeks) the intervention. Anthropometric data were collected two weeks before and 20 weeks post-intervention.

Results

Thirty-three youths (mean age 12.9 years; M/F = 0.8) enrolled, and retention was 100%. ASHS scores significantly improved (p = 0.005) from a baseline mean (SD) of 4.70 (0.41) to 4.95 (0.31) post-intervention, as did PSQI scores [7.47 (2.43) to 4.47 (2.37); p < 0.001] and SDSC scores [53.4 (9.0) to 39.2 (9.2); p < 0.001]. PDSS scores improved from a baseline of 16.5 (6.0) to 11.3 (6.0) post- intervention (p < 0.001). BMI z-scores with a baseline of 0.79 (1.18) decreased significantly (p = 0.001) post-intervention to 0.66 (1.19). Despite these improvements, sleep duration as estimated by Actical accelerometry did not change. There was however a significant decrease in daytime sedentary/light energy expenditure.

Conclusions

Our findings suggest the F.E.R.R.E.T sleep hygiene education programme might be effective in improving sleep in children and adolescents. However because this was a before and after study and a pilot study with several limitations, the findings need to be addressed with caution, and would need to be replicated within a randomised controlled trial to prove efficacy.

Trial registration

Australian New Zealand Clinical Trials Registry: ACTRN12612000649819

【 授权许可】

   
2012 Tan et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

【 参考文献 】

• [1]National Sleep Foundation: Sleep in America Poll. 2006. http://www.sleepfoundation.org/article/sleep-america-polls/2006-teens-and-sleep webcite.
• [2]Carskadon MA: Patterns of sleep and sleepiness in adolescents. Pediatrician 1990, 17:5-12.
• [3]Mercer PW, Merritt SL, Cowell JM: Differences in reported sleep need among adolescents. J Adolesc Health 1998, 23:259-263.
• [4]Galland BC, Taylor BJ, Elder DE, Herbison P: Normal sleep patterns in infants and children: A systematic review of observational studies. Sleep Med Rev 2012, 16:213-222.
• [5]Wolfson AR, Carskadon MA: Sleep schedules and daytime functioning in adolescents. Child Dev 1998, 69:875-877.
• [6]Gibson E, Powles ACP, Thabane L, O’Brien S, Molnar DS, Trajanovic N, Ogilvie R, Shapiro C, Yan M, Chilcott-Tanser L: ‘Sleepiness” is serious in adolescence: two surveys of 3235 Canadian students. BMC Public Health 2006, 6:116. BioMed Central Full Text
• [7]Pagel JF, Forister N, Kwiatkowki C: Adolescent sleep disturbance and school performance: the confounding variable of socioeconomics. J Clin Sleep Med 2007, 3:9-23.
• [8]Carskadon MA, Acebo C, Richardson GS, Tate BA, Seifer R: An approach to studying circadian rhythms of adolescent humans. J Biol Rhythms 1997, 12:278-289.
• [9]Mindell JA, Owens JA, Carskadon MA: Developmental features of sleep. Child Adolesc Psychiatr Clin N Am 1999, 8:695-725.
• [10]Beebe DW, Lewin D, Zeller M, McCabe M, MacLeod K, Daniels SR, Amin R: Sleep in overweight adolescents: shorter sleep, poorer sleep quality, sleepiness, and sleep-disordered breathing. J Pediatr Psychol 2007, 32:69-79.
• [11]Roberts RE, Ramsay Roberts C, Ger Chen I: Impact of insomnia on future functioning of adolescents. J Psychosom Res 2002, 53:561-569.
• [12]Ohayon MM, Roberts RE, Zulley J, Smirne S, Priest RG: Prevalence and patterns of problematic sleep among older adolescents. J Can Acad Child Adolesc Psychiatry 2000, 39:1549-1556.
• [13]Wahistrom K: Changing times: findings from the first longitudinal study of later high school start times. NASSP Bulletin 2002, 86:3-21.
• [14]Drapeau C, Hamel-Habert I, Robillard R, Selmaoui B, Filipini D, Carrier J: Challenging sleep in aging: the effects of 200 mg of caffeine during the evening in young and middle-aged moderate caffeine consumers. J Sleep Res 2006, 15:133-141.
• [15]Pollak CP, Bright D: Caffeine consumption and weekly sleep patterns in us seventh-, eighth-, and ninth-graders. Pediatrics 2003, 111:42-46.
• [16]Zimmerman FJ: Children’s media use and sleep problems: issues and unanswered questions. http://www.kff.org/entmedia/7674.cfm webcite.
• [17]Higuchi S, Motohashi Y, Liu Y, Ahara M, Kaneko Y: Effects of VDT tasks with a bright display at night on melatonin, core temperature, heart rate, and sleepiness. J Appl Physiol 2003, 94:1773-1776.
• [18]Calamaro CJ, Mason TBA, Ratcliffe SJ: Adolescents living the 24/7 lifestyle: effects of caffeine and technology on sleep duration and daytime functioning. Pediatrics 2009, 123:e1005-e1010.
• [19]Lebourgeois MK, Giannotti F, Cortesi F, Wolfson A, Harsh J: Sleep hygiene and sleep quality in Italian and American adolescents. Ann N Y Acad Sci 2004, 1021:352-354.
• [20]Brown FC, Buboltz WC Jr, Soper B: Development and evaluation of the Sleep treatment and education program for students (STEPS). J Am Coll Health 2006, 54:231-237.
• [21]Gallasch J, Gradisar M: Relationships between sleep knowledge, sleep practice and sleep quality. Sleep Biol Rhythms 2007, 5:63-73.
• [22]Taheri S: The link between short sleep duration and obesity: we should recommend more sleep to prevent obesity. Arch Dis Child 2006, 91:881-884.
• [23]Moseley L, Gradisar M: Evaluation of a school-based intervention for adolescent sleep problems. Sleep 2009, 32:334-341.
• [24]Bootzin RR, Stevens SJ: Adolescents, substance abuse, and the treatment of insomnia and daytime sleepiness. Clin Psychol Rev 2005, 25:629-644.
• [25]Spruyt K, Molfese DL, Gozal D: Sleep duration, sleep regularity, body weight, and metabolic homeostasis in school-aged children. Pediatrics 2011, 127:e345-e352.
• [26]Tan E: Sleep and the potential of sleep hygiene for weight management in youth. PhD thesis. Dunedin, New Zealand: University of Otago; 2011.
• [27]Lindseth A, Norberg A: A phenomenological hermeneutical method for researching lived experience. Scand J Caring Sci 2004, 18:145-153.
• [28]LeBourgeois MK, Giannotti F, Cortesi F, Wolfson AR, Harsh J: The relationship between reported sleep quality and sleep hygiene in Italian and American adolescents. Pediatrics 2005, 115(Suppl):257-265.
• [29]Lewandowski AS, Toliver-Sokol M, Palermo TM: Evidence-based review of subjective pediatric sleep measures. J Pediatr Psychol 2010, 36:780-793.
• [30]Buysse DJ, Reynolds CF, Monk TH, Berman SR, Kupfer DJ: The Pittsburgh sleep quality index: a new instrument for psychiatric practice and research. Psychiatry Res 1989, 28:193-213.
• [31]Bruni O, Ottaviano S, Guidetti V, Romoli M, Innocenzi M, Cortesi F, Giannotti F: The sleep disturbance scale for children (SDSC). Construction and validation of an instrument to evaluate sleep disturbances in childhood and adolescence. J Sleep Res 1996, 5:251-261.
• [32]Blunden SL, Chervin RD: Sleep problems are associated with poor outcomes in remedial teaching programmes: a preliminary study. J Paediatr Child Health 2008, 44:237-242.
• [33]Blunden S, Lushington K, Lorenzen B, Ooi T, Fung F, Kennedy D: Are sleep problems under-recognised in general practice? Arch Dis Child 2004, 89:708-712.
• [34]Drake C, Nickel C, Burduvali E, Roth T, Jefferson C, Pietro B: The pediatric daytime sleepiness scale (PDSS): sleep habits and school outcomes in middle-school children. Sleep 2003, 26:455-458.
• [35]Pfeiffer KA, McIver KL, Dowda M, Almeida MJCA, Pate RR: Validation and calibration of the actical accelerometer in preschool children. Med Sci Sports Exerc 2006, 38:152-157.
• [36]Puyau MR, Adolph AL, Vohra FA, Zakeri I, Butte NF: Prediction of activity energy expenditure using accelerometers in children. Med Sci Sports Exerc 2004, 36:1625-1631.
• [37]Heil DP: Predicting activity energy expenditure using the actical activity monitor. Res Q Exerc Sport 2006, 77:64-80.
• [38]Weiss AR, Johnson NL, Berger NA, Redline S: Validity of activity-based devices to estimate sleep. J Clin Sleep Med 2010, 6:336-342.
• [39]Yang CM, Huang YS, Song YC: Clinical utility of the chinese version of the pediatric daytime sleepiness scale in children with obstructive sleep apnea syndrome and narcolepsy. Psychiatry Clin Neurosci 2010, 64:134-140.
• [40]Brown FC, Buboltz WC Jr, Soper B: Relationship of sleep hygiene awareness, sleep hygiene practices, and sleep quality in university students. Behav Med 2002, 28:33-38.
• [41]Hiscock H, Wake M: Randomised controlled trial of behavioural infant sleep intervention to improve infant sleep and maternal mood. BMJ 2002, 324:1062-1068.
• [42]Mindell JA, Telofski LS, Wiegand B, Kurtz ES: A nightly bedtime routine: Impact on sleep in young children and maternal mood. Sleep 2009, 32:599-606.
• [43]Lund HG, Reider BD, Whiting AB, Prichard JR: Sleep patterns and predictors of disturbed sleep in a large population of college students. J Adolesc Health 2010, 46:124-132.
• [44]Maganti R, Hausman N, Koehn M, Sandok E, Glurich I, Mukesh BN: Excessive daytime sleepiness and sleep complaints among children with epilepsy. Epilepsy Behav 2006, 8:272-277.
• [45]Economos CD, Hyatt RR, Goldberg JP, Must A, Naumova EN, Collins JJ, Nelson ME: A community intervention reduces BMI z-score in children: Shape up Somerville first year results. Obesity 2007, 15:1325-1336.
• [46]Nowicka P, Hoglund P, Pietrobelli A, Lissau I, Flodmark CE: Family weight school treatment: 1-year results in obese adolescents. Int J Pediatr Obes 2008, 3:141-147.
• [47]Spiegel K, Tasali E, Penev P, Van Cauter E: Sleep curtailment in healthy young men is associated with decreased leptin levels, elevated ghrelin levels, and increased hunger and appetite. Ann Intern Med 2004, 141:846-850.
• [48]Taheri S, Lin L, Austin D, Young T, Mignot E: Short sleep duration is associated with reduced leptin, elevated ghrelin, and increased body mass index. PLoS Med 2004, 1:e62.
• [49]Ulukavak CT, Kokturk OO, Bukan NN, Bilgihan AA: Leptin and ghrelin levels in patients with obstructive sleep apnea syndrome. Respiration 2005, 72:395-401.
• [50]Nedeltcheva AV, Kilkus JM, Imperial J, Schoeller DA, Penev PD: Insufficient sleep undermines dietary efforts to reduce adiposity. Ann Intern Med 2010, 153:435-441.
• [51]Cizza G, Marincola P, Mattingly M, Williams L, Mitler M, Skarulis M, Csako G: Treatment of obesity with extension of sleep duration: a randomized, prospective, controlled trial. Clin Trials 2010, 7:274-285.