Search

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., Competing Interests: Declaration of conflicts of interest The authors have declared no conflicts of interest., (Copyright © 2024 National Sleep Foundation. Published by Elsevier Inc. All rights reserved.)

Objective: A diurnal variation in urine output has been described in humans, whereby it is lowest at night. Fluid balance hormones such as vasopressin and aldosterone as well as urine output have a diurnal variation. Although the diurnal variation of vasopressin results in part from a circadian rhythm, the variation in aldosterone has until recently been reported to be due to the sleep/wake cycle. The present study used a specialized protocol to explore whether aldosterone has an underlying circadian rhythm., Methods: Ten healthy participants (average age 23.1) were enrolled in the 57.3-hour protocol that included an 8-hour baseline sleep episode, 40 hours in constant routine conditions (wakefulness, food and fluid intake, posture, and dim light), and a 9.3-hour recovery sleep. Blood samples for aldosterone were taken every 4 hours. Cosinor analysis was performed on the constant routine data to test the effect of the sleep/wake cycle on overall aldosterone secretion., Results: There was a significant circadian rhythm during the 40-hour constant routine, independent of sleep, with aldosterone higher at the end of the biological night and lower at the end of the biological day. When analyzing data from the entire 57.3-hour protocol and controlling for this circadian rhythm, aldosterone concentration was significantly higher during the recovery night following the 40-hour sleep deprivation compared to the night spent awake., Conclusion: We found a significant endogenous circadian rhythm in the secretion of aldosterone, independent of sleep. In addition, as shown previously, there was a significant effect of the sleep/wake cycle on aldosterone secretion., Competing Interests: Declaration of conflicts of interest Drs. Scheuermaier and Duffy report no conflicts of interest. Dr. Chang reports grants from Kunasan, Inc, and personal fees and nonfinancial support from the University of Miami, both unrelated to this work., (Copyright © 2024 National Sleep Foundation. Published by Elsevier Inc. All rights reserved.)

Objectives: Short sleep duration is associated with poor physical health in college students. Few studies examine the effects of sleep extension on physical health in this population, who are susceptible to sleep loss. We examined health effects of a 1-week, 1-hour nightly sleep extension in college students., Methods: Twelve healthy undergraduate college students (83% female; age 20.2 ± 1.5years) completed a study consisting of sleeping typically for 1week ("Habitual"), then extending sleep by ≥1 hour/night during the second week ("Extension"). Sleep and physical activity actigraphy were collected throughout. Following each week, participants completed cardiometabolic assessments including a meal response and provided a urine sample for markers of hydration., Results: In Extension compared to Habitual, average sleep duration increased (mean change±SEM, +42.6 ± 15.1 minutes; p = .005), while subjective sleepiness (-1.8 ± 0.8 units; p = .040), systolic blood pressure (-6.6 ± 2.8 mmHg; p = .037), postprandial glucose area under the curve (-26.5 ± 10.2 mg/dL × h; p = .025) and time to baseline (-83.0 ± 46.4 minutes; p = .031) after the meal response, sedentary time (-44.3 ± 15.7 minutes; p = .018), and percentage of wake in moderate-to-vigorous activity (-0.89% ± 0.35%; p = .030) decreased. Participants who increased average sleep duration by ≥20 minutes (n = 9) were better hydrated according to urine osmolality (-187.0 ± 68.4 mOsm/kg; p = .026) and specific gravity (-0.01 ± 0.002 g/mL; p = .012) and had reduced odds of dehydration according to urine osmolality (≥800 mOsm/kg; -67%; OR=0.03; p = .035)., Conclusions: This pilot study's findings suggest that sleep extension may improve cardiometabolic functioning and hydration, and alter sedentary behavior and physical activity, in college students. Sleep extension may be employed to improve multiple aspects of health in this sleep-deprived population., Competing Interests: Declaration of conflicts of interest None of the authors have conflicts of interests related to the material presented. Outside of the current work, DA is supported by the Prevention and Methodology Training Program (T32 DA017629) with funding from the National Institute on Drug Abuse. A-MC has received a grant to the Pennsylvania State University from Kunasan and honoraria/travel support for lectures from University of Miami., (Copyright © 2024 National Sleep Foundation. Published by Elsevier Inc. All rights reserved.)

Objectives: For optimal health and well-being the sleep episode and the circadian timing system should be properly aligned. We evaluated the effectiveness of different dynamic light and sleep/wake shift schedules for rapid circadian entrainment following an 8-hour advance of sleep., Methods: Forty-three healthy participants completed an 8-day inpatient protocol in which the 8-hour sleep episode was advanced by 8 hours. Participants were assigned to one of five conditions: (1) dim ambient WHITE light and GRADUAL shift in which the sleep episode was incrementally advanced over 5days; (2) dim GREEN, short-wavelength (∼504 nm) polychromatic light and GRADUAL shift; (3) dim WHITE light and SLAM shift, including an abrupt 8-hour advance on day 3 following an extended 32-hour wake episode; (4) GREEN light and SLAM shift; or (5) COMBINED (higher illuminance WHITE plus GREEN) light and modified SLAM shift with 2 short naps scheduled on the day prior to the abrupt advance. Phase shifts of the plasma dim light melatonin onset and sleep measures were compared to examine effects of protocol condition., Results: After 5days, the COMBINED light/modified SLAM shift condition showed larger phase advances of dim light melatonin onset (4.02 ± 1.13 hours) compared to the other 4 conditions (range 1.50 ± 0.96-2.83 ± 2.23 hours; p < .05) and resulted in increased REM sleep duration and fewer sleep disruptions., Conclusions: Consideration of the type of shift and the illuminance and wavelength of light may assist in designing lighting countermeasures to sleep and circadian disruption, which has implications for jetlag, shiftwork, and circadian rhythm sleep disorders., Competing Interests: Declaration of conflicts of interest A-MC has no conflicts of interest to disclose for this work. Outside of the work presented here, A-MC has received a grant to the Pennsylvania State University from Kunasan, Inc., and honoraria/travel support for lectures from the University of Miami. CA has no conflicts of interest for this work, but in the interest of full disclosure: CA has received a research award/prize from Sanofi-Aventis; contract research support from VicRoads, Rio Tinto Coal Australia, National Transport Commission, Tontine/Pacific Brands, and AAA Foundation; industry funding through ARC Linkage scheme with Seeing Machines and Cogstate Ltd; and lecturing fees from Brown Medical School/Rhode Island Hospital, Ausmed, Healthmed and TEVA Pharmaceuticals; and reimbursements for conference travel expenses from Philips Healthcare. In addition, she has served as a consultant to the Rail, Bus and Tram Union, the Transport Accident Commission (TAC), the National Transportation Committee (NTC), VicRoads, and Melius Consulting. She has also served as an expert witness and/or consultant in relation to fatigue and drowsy driving, and was a Theme Leader in the Cooperative Research Centre for Alertness, Safety and Productivity. SWC has received research funds from Versalux and Delos, and consulted for Beacon Lighting, Versalux, and Dyson. DAR has no conflicts of interest to disclose. JMR has no conflicts of interest to disclose. SWL reports commercial interests from the last 3 years (2020-2023). His interests are reviewed and managed by Brigham and Women's Hospital and Partners HealthCare in accordance with their conflict-of-interest policies. SWL has received consulting fees from Hintsa Performance AG, Stantec and View Inc, and has consulting contracts with Absolute Rest, Akili Interactive, Apex 2100 Ltd, Ashurst Risk Advisory, Consumer Sleep Solutions, KBR Wyle Services, Light Cognitive; Lighting Science Group Corporation/HealthE; Mental Workout/Timeshifter. He has received honoraria and travel or accommodation expenses from Bloxhub, Clifton College, Danish Centre for Lighting, and University of Toronto; and travel or accommodation expenses (no honoraria) from Wiley; and royalties from Oxford University Press and Monash University. He holds equity in iSleep pty. He has received an unrestricted equipment gift and investigator-initiated grant from F. Lux Software LLC, and a Clinical Research Support Agreement and Clinical Trial Agreement with Vanda Pharmaceuticals Inc. He is an unpaid Board Member of the Midwest Lighting Institute (non-profit). He is part-time adjunct professor at the University of Surrey, UK. He holds several pending (US20190366032; US20210162164 US20220151552) and one awarded (USD943612) patents. He has served as a paid expert in legal proceedings related to light, sleep and health. CAC serves as the incumbent of an endowed professorship provided to Harvard Medical School by Cephalon, Inc. and reports institutional support for a Quality Improvement Initiative from Delta Airlines and Puget Sound Pilots; education support to Harvard Medical School Division of Sleep Medicine and support to Brigham and Women’s Hospital from: Jazz Pharmaceuticals PLC, Inc, Philips Respironics, Inc., Optum, and ResMed, Inc.; research support to Brigham and Women’s Hospital from Axome Therapeutics, Inc., Dayzz Ltd., Peter Brown and Margaret Hamburg, Regeneron Pharmaceuticals, Sanofi SA, Casey Feldman Foundation, Summus, Inc., Takeda Pharmaceutical Co., LTD, Abbaszadeh Foundation, CDC Foundation; educational funding to the Sleep and Health Education Program of the Harvard Medical School Division of Sleep Medicine from ResMed, Inc., Teva Pharmaceuticals Industries, Ltd., and Vanda Pharmaceuticals; personal royalty payments on sales of the Actiwatch-2 and Actiwatch-Spectrum devices from Philips Respironics, Inc; personal consulting fees from Axsome, Inc., Bryte Foundation, With Deep, Inc. and Vanda Pharmaceuticals; honoraria from the Associated Professional Sleep Societies, LLC for the Thomas Roth Lecture of Excellence at SLEEP 2022, from the Massachusetts Medical Society for a New England Journal of Medicine Perspective article, from the National Council for Mental Wellbeing, from the National Sleep Foundation for serving as chair of the Sleep Timing and Variability Consensus Panel, for lecture fees from Teva Pharma Australia PTY Ltd. and Emory University, and for serving as an advisory board member for the Institute of Digital Media and Child Development, the Klarman Family Foundation, and the UK Biotechnology and Biological Sciences Research Council. Dr. Czeisler has received personal fees for serving as an expert witness on a number of civil matters, criminal matters, and arbitration cases, including those involving the following commercial and government entities: Amtrak; Bombardier, Inc.; C&J Energy Services; Dallas Police Association; Delta Airlines/Comair; Enterprise Rent-A-Car; FedEx; Greyhound Lines, Inc./Motor Coach Industries/FirstGroup America; PAR Electrical Contractors, Inc.; Puget Sound Pilots; and the San Francisco Sheriff’s Department; Schlumberger Technology Corp.; Union Pacific Railroad; United Parcel Service; and Vanda Pharmaceuticals. Dr. Czeisler has received travel support from the Stanley Ho Medical Development Foundation for travel to Macao and Hong Kong; equity interest in Vanda Pharmaceuticals, With Deep, Inc, and Signos, Inc.; and institutional educational gifts to Brigham and Women’s Hospital from Johnson & Johnson, Mary Ann and Stanley Snider via Combined Jewish Philanthropies, Alexandra Drane, DR Capital, Harmony Biosciences, LLC, San Francisco Bar Pilots, Whoop, Inc., Harmony Biosciences LLC, Eisai Co., LTD, Idorsia Pharmaceuticals LTD, Sleep Number Corp., Apnimed, Inc., Avadel Pharmaceuticals, Bryte Foundation, f.lux Software, LLC, and the Stuart F. and Diana L. Quan Charitable Fund. Dr Czeisler's interests were reviewed and are managed by the Brigham and Women's Hospital and Mass General Brigham in accordance with their conflict-of interest policies., (Copyright © 2024. Published by Elsevier Inc.)

Goal and Aims: Commonly used actigraphy algorithms are designed to operate within a known in-bed interval. However, in free-living scenarios this interval is often unknown. We trained and evaluated a sleep/wake classifier that operates on actigraphy over ∼24-hour intervals, without knowledge of in-bed timing., Focus Technology: Actigraphy counts from ActiWatch Spectrum devices., Reference Technology: Sleep staging derived from polysomnography, supplemented by observation of wakefulness outside of the staged interval. Classifications from the Oakley actigraphy algorithm were additionally used as performance reference., Sample: Adults, sleeping in either a home or laboratory environment., Design: Machine learning was used to train and evaluate a sleep/wake classifier in a supervised learning paradigm. The classifier is a temporal convolutional network, a form of deep neural network., Core Analytics: Performance was evaluated across ∼24 hours, and additionally restricted to only in-bed intervals, both in terms of epoch-by-epoch performance, and the discrepancy of summary statistics within the intervals., Additional Analytics and Exploratory Analyses: Performance of the trained model applied to the Multi-Ethnic Study of Atherosclerosis dataset., Core Outcomes: Over ∼24 hours, the temporal convolutional network classifier produced the same or better performance as the Oakley classifier on all measures tested. When restricting analysis to the in-bed interval, the temporal convolutional network remained favorable on several metrics., Important Supplemental Outcomes: Performance decreased on the Multi-Ethnic Study of Atherosclerosis dataset, especially when restricting analysis to the in-bed interval., Core Conclusion: A classifier using data labeled over ∼24-hour intervals allows for the continuous classification of sleep/wake without knowledge of in-bed intervals. Further development should focus on improving generalization performance., Competing Interests: Declaration of conflicts of interest DMR was employed by Proactive Life, Inc. at the time of the initial submission of the manuscript. At the point of revision, he was instead employed by Pennsylvania State University. DG is employed by Proactive Life, Inc., a for-profit company. Related to monitoring sleep, Proactive Life has two patents issued: Sleep Stimulation and Monitoring (US patent 10524661), Cyclical Behavior Modification (US Patent 8468115), four patents pending: Sleep Tracking Method and Device (16/950,987), Valence State Memory Association (16/504,285), Systems, Methods, and Apparatus for Monitoring Sleep (PCT/US21/59978), and two design patents pending: Holder for a Mobile Phone (29/796,124), Stands for Mobile Telephones (WIPO111054). Outside of the current work (last 4 years), Orfeu M. Buxton received honoraria/travel support for lectures/consulting from Boston University, Boston College, Tufts School of Dental Medicine, New York University, University of Miami, University of Utah, University of South Florida, University of Arion, Eric Angle Society for Orthodontists, and Allstate, consulting fees from SleepNumber, and receives an honorarium for his role as the Editor in Chief of Sleep Health (sleephealthjournal.org)., (Copyright © 2023 National Sleep Foundation. Published by Elsevier Inc. All rights reserved.)

Background: Secondhand smoke exposure has been cross-sectionally associated with worse sleep health outcomes in children and shorter sleep duration in adolescents., Objectives: We assessed longitudinal and cross-sectional associations between secondhand smoke (SHS) exposure and shorter sleep duration in children from the Fragile Families and Child Wellbeing Study, a longitudinal birth cohort. We additionally examined whether associations would persist after controlling for potential confounders., Participants: Mothers (n = 4898) were recruited using a stratified random sample of large United States cities and oversampling for nonmarital births., Measurements: Mothers were asked about whether they smoked during pregnancy, whether their child spent time with someone who is smoking, and their child's weekday sleep duration. Sociodemographic factors, asthma diagnosis, and bedtime routines were assessed as potential confounders. Data collected at ages 3, 5, and 9 years were analyzed using multivariable regression models (N = 1912; 51.6% boys)., Results: SHS exposure at age 3 predicted 15.0 fewer minutes at age 5 (P = .001) and 12.3 fewer minutes at age 9 (P = .003). SHS exposure at age 9 was cross-sectionally associated with 14.4 fewer minutes of sleep duration at age 9 (P = .002). Findings persisted after controlling for potential confounders., Conclusion: These results provide associational support for the hypothesis that SHS exposure may have long-term consequences for childhood sleep duration. Future studies should investigate the relationship between SHS exposure and shorter sleep duration using objective measurements of serum cotinine and sleep actigraphy and by exploring potential mechanisms., (Copyright © 2021 National Sleep Foundation. Published by Elsevier Inc. All rights reserved.)

Background: Cross-sectional studies have found that individuals with posttraumatic stress disorder (PTSD) exhibit deficits in autonomic functioning. While PTSD rates are twice as high in women compared to men, sex differences in autonomic functioning are relatively unknown among trauma-exposed populations. The current study used a prospective design to examine sex differences in posttraumatic autonomic functioning., Methods: 192 participants were recruited from emergency departments following trauma exposure ( Mean age = 35.88, 68.2% female). Skin conductance was measured in the emergency department; fear conditioning was completed two weeks later and included measures of blood pressure (BP), heart rate (HR), and high frequency heart rate variability (HF-HRV). PTSD symptoms were assessed 8 weeks after trauma., Results: 2-week systolic BP was significantly higher in men, while 2-week HR was significantly higher in women, and a sex by PTSD interaction suggested that women who developed PTSD demonstrated the highest HR levels. Two-week HF-HRV was significantly lower in women, and a sex by PTSD interaction suggested that women with PTSD demonstrated the lowest HF-HRV levels. Skin conductance response in the emergency department was associated with 2-week HR and HF-HRV only among women who developed PTSD., Conclusions: Our results indicate that there are notable sex differences in autonomic functioning among trauma-exposed individuals. Differences in sympathetic biomarkers (BP and HR) may have implications for cardiovascular disease risk given that sympathetic arousal is a mechanism implicated in this risk among PTSD populations. Future research examining differential pathways between PTSD and cardiovascular risk among men versus women is warranted., Competing Interests: In the last three years GDS has received research funding from the NSF, NIH and LifeBell AI, and unrestricted donations from AliveCor, Amazon Research, the Center for Discovery, the Gordon and Betty Moore Foundation, MathWorks, Microsoft Research, the Gates Foundation, Google, One Mind Foundation, and Samsung Research. GDS has financial interest in AliveCor and receives unrestricted funding from the company. He is also the CTO of MindChild Medical and CSO of LifeBell AI and has ownership in both companies. These relationships are unconnected to the current work. In the past three years, LTG has served on the Scientific Advisory Board of Sage Bionetworks, for which she received a small honorarium. SLR reports grants from NIH during the conduct of the study; personal fees from SOBP (Society of Biological Psychiatry) paid role as secretary, other from Oxford University Press royalties, other from APP (American Psychiatric Publishing Inc.) royalties, other from VA (Veterans Administration) per diem for oversight committee, and other from Community Psychiatry paid board service, including equity outside the submitted work; and Leadership roles on Board or Council for SOBP, ADAA (Anxiety and Depression Association of America), and NNDC (National Network of Depression Centers). SS has received funding from the Florida Medical Malpractice Joint Underwriter's Association Dr. Alvin E. Smith Safety of Healthcare Services Grant; Allergan Foundation; the NIH/NIA-funded Jacksonville Aging Studies Center (JAX-ASCENT; R33AG05654); and the Substance Abuse and Mental Health Services Administration (1H79TI083101-01); and the Florida Blue Foundation. CWJ reports no direct conflicts related to this paper. He has been an investigator on studies funded by Hologic Inc, Janssen, AstraZeneca, and Vapotherm, for which his department has received research funding. JJ receives consulting payments from Janssen Pharmaceuticals. Over the past three years, DAP has received consulting fees from Albright Stonebridge Group, BlackThorn Therapeutics, Boehringer Ingelheim, Compass Pathway, Concert Pharmaceuticals, Engrail Therapeutics, Neurocrine Biosciences, Otsuka Pharmaceuticals, and Takeda Pharmaceuticals as well as one honorarium from Alkermes. In addition, he has received stock options from BlackThorn Therapeutics, and research support from National Institute of Mental Health, Dana Foundation, Brain and Behavior Research Foundation, and Millennium Pharmaceuticals. No funding from these entities was used to support the current work, and all views expressed are solely those of the authors. JME reports support from the National Institutes of Health (NIH) through Grant Numbers R01HD079076 & R03HD094577, Eunice Kennedy Shriver National Institute of Child Health & Human Development, and National Center for Medical Rehabilitation Research. He also reports funding from the New South Wales Health Spinal Cord Injury Research Grants Program and consulting fees (<$15,000 per annum) from Orofacial Therapeutics, LLC. In the past 3 years, RCK was a consultant for Datastat, Inc., Holmusk, RallyPoint Networks, Inc., and Sage Pharmaceuticals. He has stock options in Mirah, PYM, and Roga Sciences. KJR has received consulting income from Alkermes, research support from NIH, Genomind and Brainsway, and he is on scientific advisory boards for Janssen and Verily, all of which is unrelated to the present work. All other authors have no conflicts of interest to disclose., (© 2021 The Authors.)

Objectives: Ethnoracial disparities in sleep health across the lifecourse, may underlie other disparities in health and well-being among adults in the United States (U.S.). We evaluated if socioenvironmental stressors, which likely differ by the race/ethnicity of college students, may contribute to sleep disparities in this demographic group., Design/measurements: National Health Interview Survey data pooled from 2004 to 2017 were used to test the hypothesis that ethnoracial disparities in sleep exist among college students residing in dormitories in the U.S., Setting: Nationally representative survey data., Participants: A total of 2,119 college students residing in dormitories (71% White, 16% Black/African-American, 7% Hispanic/Latino, and 6% Asian) participated in the study., Results: The prevalence of short sleep duration was higher among Black/African-Americans than among White students, but not among Hispanics/Latinos and Asians, after adjusting for age, gender, and region of residence. In fully adjusted models, Black/African-Americans, although no longer statistically significant after adjustments, were more likely to report short sleep duration compared with White students (adjusted prevalence ratio; [aPR] = 1.30, 95% confidence interval [CI]: 0.98-1.71). The prevalence of separate insomnia symptoms did not differ by ethnoracial group in adjusted models. Only Asian students had a higher prevalence (aPR = 1.40, 95% CI: 1.12-1.75) of nonrestorative sleep than White students., Conclusion: Black/African-American but not Hispanic/Latino or Asian college students were more likely to report short sleep duration than Whites. Insomnia symptoms did not differ between groups, while Asians experienced more nonrestorative sleep. Future studies should investigate the socioenvironmental causes of disparities using longitudinal designs, larger sample sizes, better socioeconomic status (SES) indicators, and objective sleep measures., (Published by Elsevier Inc.)

Objectives: Sleep is a major lifestyle factor that may change dramatically when students begin college. Sleep duration has been shown to influence cardiometabolic health. We investigated the feasibility of sleep extension in college students to increase actigraphically measured sleep duration and the association of sleep extension with daytime sleepiness and blood pressure., Design: This was a within-participant experimental study., Setting: The study setting was 14-day at-home study and 3 in-lab visits., Participants: The participants included in this study were healthy undergraduate students (n=53; mean age 20.5 ± 1.1 years; 70% female)., Intervention: Participants maintained a habitual sleep schedule during week 1 and then were instructed to extend their sleep duration by at least 1 hour per night for week 2., Measurements: Sleep measures included wrist actigraphy and daytime sleepiness assessed by the Epworth Sleepiness Scale (ESS) and by daily diary. Cardiovascular measures included blood pressure (BP) and heart rate (HR). ESS, BP and HR were measured during lab visits on days 7 and 14. Multilevel modeling was used to test the effects of extension on sleep duration, daytime sleepiness, BP and HR., Results: Participants increased sleep duration during week 2 by 43.0 ± 6.2 standard error minutes per night, compared with week 1 (p<.001). Furthermore, 41 of 53 participants (77%) increased their sleep duration by >15 minutes per night (p<.001). Participants reported less daytime sleepiness on weekly ESS (p<.05) and daily log ratings (p<.001) after sleep extension; and systolic BP was significantly reduced by 7.0 ± 3.0 mmHg (p<.05)., Conclusion: This study demonstrates that substantive sleep extension is feasible in college students and can positively impact their sleep and cardiovascular health., (Copyright © 2019 National Sleep Foundation. Published by Elsevier Inc. All rights reserved.)

Objectives: High school start times are a key contributor to insufficient sleep. This study investigated associations of high school start times with bedtime, wake time, and time in bed among urban teenagers., Design: Daily-diary study nested within the prospective Fragile Families and Child Wellbeing Study., Setting: Twenty US cities., Participants: Four hundred thirteen teenagers who completed ≥1 daily diary report on a school day., Measurements: Participating teens were asked to complete daily diaries for 7 consecutive days. School-day daily diaries (3.8±1.6 entries per person) were used in analyses (N=1555 school days). High school start time, the main predictor, was categorized as 7:00-7:29 am (15%), 7:30-7:59 am (22%), 8:00-8:29 am (35%), and 8:30 am or later (28%). Multilevel modeling examined the associations of school start times with bedtime, wake time, and time in bed. Models adjusted for age, sex, race/ethnicity, household income, caregiver's education, and school type., Results: Teens with the earliest high school start times (7:00-7:29 am) obtained 46 minutes less time in bed on average compared with teens with high school start times at 8:30 am or later (P<.001). Teens exhibited a dose-response relationship between earlier school start times and shorter time in bed, primarily due to earlier wake times (P<.05). Start times after 8:30 am were associated with increased time in bed, extending morning sleep by 27-57 minutes (P<.05) when compared with teens with earlier school start times., Conclusion: Later school start times are associated with later wake times in our large, diverse sample. Teens starting school at 8:30 am or later are the only group with an average time in bed permitting 8 hours of sleep, the minimum recommended by expert consensus for health and well-being., (Copyright © 2017 National Sleep Foundation. Published by Elsevier Inc. All rights reserved.)

Study Objectives: The overall objective of the 2014 National Sleep Foundation Sleep in America Poll "Sleep in the Modern Family" was to obtain a current picture of sleep in families with at least 1 school-aged child., Design: Cross-sectional poll., Setting: Internet-based interview., Participants: Nationally representative Internet panel of US households with a child 6-17 years., Measurements and Results: Primary measures included parental perception of the importance of sleep, parental and child sleep quality, child sleep duration and habits, technology in bedroom, and family rules. Parents/guardians (n= 1103; mean age, 42; 54% female) completed the survey. Although the majority of parents endorsed the importance of sleep, 90% of children obtain less sleep than recommended. Significant predictors of age-adjusted sufficient sleep duration (estimated conservatively as ≥9 hours for ages 6-11 years and ≥8 hours for ages 12-17 years) included parent education, regular enforcement of rules about caffeine, and whether children left technology on in their bedroom overnight. Significant predictors of excellent sleep quality included whether a bedtime was always enforced and whether children left technology on overnight., Conclusions: Children generally have better age-appropriate sleep in the presence of household rules and regular sleep-wake routines. Sufficient sleep quantity and adequate sleep quality were protected by well-established rules of sleep hygiene (limited caffeine and regular bedtime). In contrast, sleep deficiency was more likely to be present when parents and children had electronic devices on in the bedroom after bedtime. Public health intervention goals for sleep health might focus on reducing the encroachment of technology and media into time for sleep and supporting well-known sleep hygiene principles.