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To study the impact of maternal sleep in late pregnancy on birth weight (BW) and leptin and lipid levels in umbilical cord blood.A total of 277 healthy and singleton pregnancy women were recruited for participation in the Shanghai Sleep Birth Cohort Study (SSBC) during their 36-38 weeks of pregnancy, from May 2012 to July 2013. Maternal night sleep time (NST), sleep efficiency (SE), sleep onset latency (SOL) and the percentage of wake after sleep onset (WASO) in NST and midpoint of sleep (MSF) were measured by actigraphy for seven consecutive days. The leptin and lipid levels were determined in cord blood samples collected from the umbilical vein immediately after delivery. Birth information (birth weight, gender, delivery type, etc.) was extracted from medical records. A multivariable linear regression model was applied to examine the effect of maternal sleep in late pregnancy on newborn leptin and lipid levels in umbilical cord blood.A total of 177 women and their infants were included in the analysis. Maternal mean NST was 7.03 ± 1.10 h in late pregnancy, and 48% had a shorter sleep time (NST 7 h). The average maternal SE was 72.54% ± 9.66%. The mean percentage WASO/NST was 21.62% ± 9.98%; the average MSF was about 3:34 (0:53); and the SOL was 46.78 ± 36.00 min. After adjustment for confounders, both maternal NST and SE were found to be significantly associated with triglyceride levels (β = -0.219, p = 0.006; β = -0.224, p = 0.006) in umbilical cord blood; and maternal NST was also observed to have positive association with newborn leptin levels (β = 0.146, p = 0.047). However, we did not find significant association between other maternal sleep parameters in late pregnancy and leptin and lipid levels and birth weight.Short sleep duration and poor sleep quality during late pregnancy were associated with newborn leptin and lipid levels, and efforts on improving maternal sleep during late pregnancy should be advocated for children's health.

Background Sleep disturbances in women occur frequently throughout pregnancy. Previous studies have demonstrated that the increasing incidence of physiological and psychological illness is concurrent with increasing sleep deprivation and poor sleep quality in adults and children. Objectives The Shanghai Sleep Birth Cohort Study (SSBCS) was established to examine the effect of sleep disturbances during the third trimester on emotional regulation of mothers; to assess the effect of maternal sleep during pregnancy on the growth and development of children; and to explore the influence of children's sleep characteristics on physical and social-emotional development. Population The study was conducted in the Renji Hospital in Pudong New District, Shanghai from May 2012 to July 2013. Women and their newborns who met the inclusion criteria and agreed to participate in this study were recruited to the SSBCS. Methods The follow-up visits for children were conducted at the age of 42 days, 3, 6, 9, 12, 18, and 24 months, and 3, 4, and 6 years. Data on demographic factors, physical examination, sleep assessment, developmental and psychiatric assessment, diet records, and biological samples were collected throughout the study. Preliminary results A total of 277 pregnant women were recruited to the study; the response rate was 64.3%. 37.9% of the pregnant women had poor sleep quality and 12.0% suffered from depression. Infant sleep patterns changed during the first year of life, but most sleep characteristics showed little variation from 6 to 12 months. Conclusions The SSBCS is an on-going prospective cohort study with follow-up to 6 years. The detailed data on demographic factors, sleep assessment, physical examinations, neurodevelopmental and psychiatric assessment, diet records, and biological samples make this research platform an important resource for examining the potential effects of sleep characteristics on both maternal and child health.

STUDY OBJECTIVES: To compare the secular trends of sleep/wake patterns in school-aged children in Hong Kong and Shanghai, two major metropolitan cities in China with two different policies that school start time was delayed in Shanghai, but advanced in Hong Kong in 10 years’ time. METHODS: Participants were from two waves of cross-sectional school-based surveys of children aged 6 to 11 years. In Shanghai, 4,339 and 13,795 children participated in the 2005 and 2014 surveys, respectively. In Hong Kong, 6,231 and 4,585 children participated in the 2003 and 2012 surveys, respectively. Parents reported their children’s bedtime and wakeup time, and thus sleep duration, short sleep (≤ 9 hours) and weekend oversleep (difference in sleep duration between weekday and weekend > 2 hours) were determined. RESULTS: Hong Kong children had later bedtime and wakeup time and slept consistently less than their Shanghai counterparts at both survey time points. The shorter sleep duration was particularly marked during weekdays. Over the interval period, weekday sleep duration significantly decreased from 9.2 to 8.9 hours as wakeup time became earlier for Hong Kong children, but increased from 9.4 to 9.6 hours as wakeup time became later for children in Shanghai. Children from both cities slept longer on the weekends. Prevalence of weekend oversleep significantly increased in Hong Kong children, but no interval change was found in Shanghai children. CONCLUSIONS: The findings indicate subcultural differences in sleep/wake patterns in Shanghai and Hong Kong school-aged children. In particular, sleep duration had increased for Shanghai children, but decreased for Hong Kong children over 10 years. The benefits and barriers of delaying school start time for optimizing sleep health in school-aged children should be further explored. CITATION: Wang G, Zhang J, Lam SP, Li SX, Jiang Y, Sun W, Chan NY, Kong APS, Zhang Y, Li S, Li AM, Jiang F, Shen X, Wing YK. Ten-year secular trends in sleep/wake patterns in Shanghai and Hong Kong school-aged children: a tale of two cities. J Clin Sleep Med. 2019;15(10):1495–1502.

Weekday-to-weekend sleep discrepancy is a common phenomenon in school-age children and youths. However, the effects of weekday-to-weekend sleep differences remain unclear. A systematic review that included 72 observational studies was conducted to examine the association of weekday-to-weekend differences in bedtime, rise time, mid-point of sleep and sleep duration with academic performance and health-related outcomes in children and youths. Weekday-to-weekend difference in sleep timing (e.g., bedtime) was associated with poorer academic performance and depressive symptoms in in youths, particularly secondary school students, and a higher risk of substance use as well as overweight/obesity in the overall samples. In addition, weekday-to-weekend difference in sleep duration showed a modest association with poorer academic performance and depressive symptoms in the overall samples, as well as a higher risk of overweight/obesity, particularly in Asian children and youths. Albeit limited evidence, greater sleep differences were related to an increased risk of behavioral problems and suicidality. Findings on the associations between weekday-to-weekend sleep differences and specific cognitive abilities, anxiety, and cardiometabolic risks were limited and inconclusive. Longitudinal and experimental studies utilizing objective sleep measures are recommended to further examine the impacts of weekday-to-weekend sleep differences on mental and physical health, and to gain more insight into the mechanisms underlying their associations.

To examine the mediating effects of socioemotional and behavioral functioning in the association between physical activity and academic achievement in Chinese children.Chinese children (n = 17 318; aged 6-11 years) from the Shanghai Children's Health, Education and Lifestyle Evaluation study in 2014 were the source of data. Children reported the time spent in moderate-to-vigorous physical activities (MVPA) during weekdays and weekends. Parents rated their children's socioemotional and behavioral difficulties. Head teachers rated the academic performance of each student. A mediation analysis with multiple mediators was performed to test the mediation effects of 5 socioemotional and behavioral variables (emotional problems, conduct problems, hyperactivity and inattention, peer relationship, and prosocial behaviors) in the association between MVPA and academic achievement, adjusting for demographic and health-related variables.Results revealed that MVPA was positively associated with academic performance (b = 0.78; SE = .01; P .001). Conduct problems, hyperactivity and inattention, and peer problems showed significant mediating effects in the association between MVPA and academic achievement, with hyperactivity and inattention being the strongest mediator (b = 0.38; SE = 0.04; P .001) accounting for 49% of the total effect.This study provides evidence that MVPA is associated with fewer socioemotional difficulties, which, in turn, is associated with better academic achievement. Promoting physical activity among school-aged children may benefit their overall development.

To examine the prevalence and correlates of nighttime awakenings and to explore the association between sleep and cognitive development in a community sample of infants and toddlers.A total of 590 healthy infants (aged 2-11 months) and 512 toddlers (aged 12-30 months) from 8 provinces of China were assessed for their sleep and cognitive development. Data on sleep duration and nighttime awakenings were collected through the Brief Infant Sleep Questionnaire. Cognitive development was assessed by trained pediatricians using the Bayley Scales of Infant Development.Prevalence of no nighttime awakening, and nighttime awakening(s) for 1×/night, 2×/night, and ≥ 3×/night was 6.8%, 20.2%, 33.2%, and 39.3% in infants, and was 25.8%, 34.6%, 23.8%, and 15.8% in toddlers, respectively. Nighttime awakenings were generally associated with younger age, lower maternal education level, and being currently breastfed. In addition, nighttime awakenings were associated with being boys in toddlers. After controlling for potential confounders, infants with nighttime awakenings for 2×/night were found to have significantly higher Mental Development Index (MDI) score, as compared to those without and those with more frequent nighttime awakenings. However, toddlers with nighttime awakenings for ≥ 3×/night had significantly lower MDI, as compared to those with fewer nighttime awakenings. Total sleep duration was not associated with any developmental indices in both infants and toddlers.Frequent nighttime awakenings are associated with poor cognitive functions in toddlers. Meanwhile, a nonlinear association between nighttime awakenings and cognitive performance was found among infants. The findings provide a developmental context for the effect of sleep on cognitive abilities in young children. Further longitudinal studies and interventional studies on the effects of parent-based sleep-focused intervention on cognitive abilities among young children are warranted.

Physical activity, screen viewing, sleep, and homework among children have been independently linked to health outcomes. However, few studies have assessed the independent associations between time spent in daily activities and children’s physical and mental health. This study describes time spent in four activities among primary school students in Shanghai, and examines the relationship between daily time-use patterns and obesity and mental health. The representative sample consists of 17,318 children aged 6–11 years in Shanghai. Time spent in moderate to vigorous physical activities (MVPA), screen viewing, sleep, and homework was measured by validated questionnaires. Logistic regressions were performed. We also fitted generalized additive models (GAM) and performed two-objective optimization to minimize the probability of poor mental health and obesity. In 2014, 33.7% of children spent ˂1 hour/day on MVPA, 15.6% spent ≥ 2 hours/day on screen viewing, 12.4% spent ˂ 9 hours/day on sleep, and 27.2% spent ≥ 2 hours/day on homework. The optimization results suggest that considering the 24-hour time limit, children face trade-offs when allocating time. A priority should be given to the duration of sleep and MVPA. Screen exposure should be minimized to save more time for sleep and other beneficial activities.

© 2020 European Sleep Research Society Sleep quantity and quality are both important for optimal development and functioning during youth. Yet few studies have examined the effects of insomnia symptoms and objective short sleep duration on memory performance among adolescents and young adults. One-hundred and ninety participants (female: 61.6%) aged from 12 to 24 years completed this study. All participants underwent a clinical interview, a 7-day actigraphic assessment, a battery of self-report questionnaires and cognitive tests to assess working memory and episodic memory. Insomnia symptoms were defined as a score ≥ 9 on the Insomnia Severity Index, and objective short sleep duration was defined as average total sleep time less than 7 hr for those aged 12–17 years, and 6 hr for those aged 18 years and above as assessed by actigraphy. Insomnia symptoms were significantly associated with worse self-perceived memory (p

To explore the association between vitamin D in cord blood or in venous blood and children's sleep-wake patterns at two years of age.Data were from 209 children in a birth cohort, Shanghai Sleep Birth Cohort Study (SSBC). 25-Hydroxyvitamin D (25(OH)D) was assessed in cord blood and venous blood samples at two years of age by electrochemiluminescence immunoassay. Children's sleep-wake patterns were measured with the Brief Infant Sleep Questionnaire (BISQ) and Acti-Watch at two years of age.The prevalence of vitamin D deficiency (defined as50 nmol/L) was 50.4% in cord blood and 28% at two years of age. The cord blood 25(OH)D level was not significantly associated with children's sleep at two years of age. Children with 25(OH)D deficiency at two years old had shorter reported and actigraphic night sleep duration (NSD) and total sleep duration (TSD) than those with normal 25(OH)D concentration. 25(OH)D level at two years old was positively associated with night and total sleep duration (βWe found that not cord blood 25(OH)D level but two-year-old 25(OH)D level was associated with children's sleep-wake patterns at two years of age. These findings suggest more attention should be paid to the assessment of 25(OH)D levels in children with short sleep duration.

Previous studies have suggested that infant rapid weight change can be associated with an increased weight later in life. However, the weight change trajectory in early life over time and which childhood lifestyle behaviors may modify the risk of rapid weight change have not been characterized. Using our ongoing birth cohort study, we have addressed these issues. Nine follow-up time points (birth, 3, 6, 9, 12, 18, 24, 36, and 48 months) were used to calculate the change between two adjacent weight-for-age z-scores (WAZ-change), and then WAZ-change trajectories were defined via group-based trajectory modeling. The solitary, independent and combined effects of WAZ-change trajectories and each lifestyle factor (eating behaviors, physical activity, media exposure time and total sleep duration) on childhood adiposity measures at age 4 years were determined using multivariate regression analysis. Overall, 84 (38%) children had a steady growth trajectory from birth to 4 years, while the other 137 (62%) children had an early infancy rapid growth trajectory, particularly in the first three months. Compared to children with steady growth, children with early infancy rapid growth had a significantly higher body mass index, waist circumference, and subcutaneous fat. Moreover, weight change trajectory and three eating behaviors (i.e. food responsiveness, satiety responsiveness and food fussiness), not only had independent effects, but also combined (synergistic) effects on the majority of adiposity measures. Our results extend the current literature and provide a potentially valuable model to aid clinicians and health professionals in designing early-life interventions targeting specific populations, specific ages and specific lifestyle behaviors to prevent childhood overweight/obesity.

Sleep is known to influence socio-emotional regulation among children and preschoolers, whereas little is known about the association between sleep and social preference during infancy.In the current study, habitual sleep of 49 infants aged around six months old were surveyed by questionnaire, and their social preference was revealed by their preferential gaze in three conditions: (1) a human face paired with an object (ie, a cup), (2) a human face paired with an animal face (ie, a dog), and (3) a dog face paired with a cup.In general, images with richer social information (ie, a human face and dog) attracted infants' gaze significantly more than nonsocial images (ie, cup). Infants with shorter sleep duration (ie,13 h a day) show a significant reduction in their preference toward a human face when paired with a dog than infants with longer sleep duration.Our findings suggest an early positive link between sleep duration and preference towards socially rich stimuli (eg, a human face) during infancy.

Study objectives To examine trajectories of poor sleep quality from late pregnancy to 36 months postpartum, baseline indicators, and association with prospective maternal mood disturbances. Methods A cohort of 262 nonclinical women was followed at late pregnancy, 42 days, 3, 6, 9, 12, 18, 24, and 36 months postpartum. Sleep quality was measured with the Pittsburgh Sleep Quality Index at all time points, and mood disturbances were assessed at late pregnancy and 36 months postpartum. Results The rate of poor sleep quality followed an inverted U-shaped curve. Women reporting poor sleep quality at late pregnancy held a consistently higher risk of poor sleep quality at postpartum points. Three sleep trajectories were distinguished, namely, the stable-low (29.4%), the decreasing-mild (56.5%), and the stable-high (14.1%). Poor sleep quality, depression, and anxiety at baseline were linked to trajectory groups with poorer sleep quality. Adjusting for covariates, the trajectory of the poorer sleep quality group demonstrated increased mood disturbances at 36 months postpartum. Replicating the analyses in women without baseline symptoms of depression and anxiety above clinical cutoffs obtained similar results. Conclusions Women are vulnerable to poor sleep quality from late pregnancy to postpartum years, but follow distinct trajectories. Poor sleep quality, depression, and anxiety at late pregnancy help us to anticipate the sleep trajectories. Trajectories of poor sleep quality indicate increased mood disturbances at 36 months postpartum. A flexible suite of interventions targeting both poor sleep quality and mood disturbances should be implemented and tailored to women in the prenatal and postpartum periods.

Objective. The aim of the present study was to investigate the association between dietary patterns and precocious puberty among Shanghai children.Methods. A cross-sectional study was conducted among Shanghai children by multistage stratified cluster random sampling in June 2014. Diet was assessed using a simplified food frequency questionnaire (FFQ). Height, weight, and Tanner stages of breast development, pubic hair growth, and testicular volume were carefully measured. Exploratory factor analysis was used to identify dietary patterns, and logistic regression analysis was used to assess the association between dietary patterns and precocious puberty.Results. Three distinct dietary patterns, “traditional diet,” “unhealthy diet,” and “protein diet,” were established. Neither the “traditional diet” pattern nor the “protein diet” pattern showed any association with precocious puberty, taking gender, BMI, and adjustment factors into consideration. The “unhealthy diet” pattern was significantly positively associated with precocious puberty in both boys (OR = 1.24, 95% CI = 1.02–1.51) and girls (OR = 1.31, 95% CI = 1.10–1.56). The relationship remained positive only for girls (OR = 1.25, 95% CI = 1.04–1.49) after adjustment for age and BMI but statistically nonsignificant after further adjustment for socioeconomic factors in both boys and girls.Conclusions. Dietary patterns were found to be related to precocious puberty among Shanghai children.

Caesarean section (CS) may increase the risk of asthma and allergic diseases in children, but previous studies could not preclude the potential confounding effect of underlying medical indications for CS. We aim to assess the association between CS itself (without indications) and risks of asthma and allergic rhinitis in children. The 2014 Shanghai Children’s Health, Education and Lifestyle Evaluation was a large population-based survey with cluster random probability sampling in 26 primary schools in Shanghai, China, in 2014. The mode of delivery and child history of asthma and allergic rhinitis were reported by parents. We included 12639 children in our analysis. CS without medical indication was associated with an increased risk of childhood asthma. CS without medical indication and CS for fetal complications were associated with increased risks of childhood allergic rhinitis, respectively. In children fed by exclusive breastfeeding or mixed feeding in the first four months after birth, these risks were not significant. In contrast, in children fed by exclusive formula milk, CS was highly significantly associated with childhood asthma and allergic rhinitis. In conclusion, CS without medical indication was associated with increased risks of both childhood asthma and allergic rhinitis. Breastfeeding in early infancy may attenuate these risks.

Sleep and circadian rhythmicity both play an important role in human’s cognitive functioning, yet the way in which early development of sleep and circadian rhythm affects cognitive processes and social learning in infants remains less understood. We examined the association of sleep and circadian activity rhythm (CAR) with face and emotional information processing in 12-month old infants. Face processing was measured by eye tracking, whereby infants’ scanning patterns and pupil dilations were calculated when they were presented with neutral, pleasant and unpleasant faces. Infants with better sleep quality (i.e., less waking after sleep onset) and lower sleep-wake pattern variability (i.e., higher inter-daily stability) exhibited a higher eyes over mouth fixation ratio (EMR). Infants with longer total sleep time showed larger pupil diameter changes in response to emotional facial expressions, more closely resembling the responses of adults. Our findings suggest the role of sleep and circadian rhythm in waking cognition and have implications for understanding the early development of social learning in young children.

BACKGROUND This was a cross-sectional survey to investigate the relationship of age, parent education, sleep duration, physical activity, and dietary habits with overweight or obesity in school-age children in Shanghai. METHODS The survey gathered information from 13,001 children in grades 1 through 5 (age 6 to 10 years) among 26 elementary schools in 7 districts. Activity level was evaluated using the International Children's Leisure Activities Study Survey Questionnaire (CLASS-C). The definitions of normal, overweight, and obese were adjusted for each age. RESULTS Logistic regression analysis indicated that age, being male, having ≤10 hours of sleep on non-school days, eating ≥1 vegetable/day, or drinking ≥1 sugar-sweetened drink/day increased the risk for a child being overweight or obese compared with having >10 hours of sleep or ≤3 vegetables or ≤3 sugar-sweetened drinks/month (p ≤ .008). Having >2 hours of outdoor activities on non-school days reduced the risk of being overweight or obese compared with ≤2 hours of outdoor activities on non-school days (p

Background Identifying endogenous volatile organic compounds (VOCs) as markers for different cancers currently requires time-consuming procedures and specialized operators. Objective The objective of this study was to develop a rapid and simple method for measuring VOCs at trace levels. Methods A simple vacuum ultraviolet photoionization mass spectrometer (VUV-PIMS) was used to detect trace levels of dimethyl trisulfide (DMTS), dimethyl sulfide (DMS), and 2-butanone, which correspond to volatile biomarker candidates present in the exhaled breath of patients with breast, liver, and lung cancers, respectively. The practicality of measuring endogenous VOCs using VUV-PIMS was confirmed by detecting them in cultured cell lines. Results The abovementioned VOCs were detected with high sensitivity by VUV-PIMS. The limits of detection (LODs) for DMTS, DMS, and 2-butanone were 3.1, 3.9, and 23.2 pptv, respectively, under ambient conditions, which surpass the sensitivity of nearly all other MS-based techniques. Moreover, relatively high concentrations of 2-butanone and DMS were observed in VOCs emitted from the A549 lung cancer cell line and the HepG2 liver cancer cell line, respectively. Conclusions Our results show that VUV-PIMS may serve as a reliable method for real-time measurement of endogenous volatile cancer biomarkers.

Objective To investigate the prevalence of bed-sharing and examine correlates of bed-sharing habits in early adolescents. Methods Participants were 1452 early adolescents from 10 primary schools in Shanghai, China. Children's health status and past history, family environment and parents' attitude towards bed-sharing, and children's sleep arrangements were surveyed. Sleep was assessed by the Children's Sleep Habit Questionnaire. Tanner stage was determined by the endocrinologist. Results The median of age was 10.83 years (range: 9.42–12.92; 95% confidence interval [CI]: 10.79–10.83) and boys accounted for 51.17%. The prevalence of bed-sharing was 16.8%. Positive parental attitude toward bed-sharing (OR: 9.87; 95% CI: 6.57–14.83), asthma (OR: 2.15; 95% CI: 1.16–3.98), smaller residential space (OR: 1.90; 95% CI: 1.17–3.09), extended family (OR: 1.59; 95% CI: 1.16–2.18), and being physically less mature (OR: 2.39; 95% CI: 1.16–4.91) increased the likelihood of bed-sharing. Bed-sharers were more likely to have bedtime resistance (OR: 12.20; 95% CI: 8.59–17.33), sleep anxiety (OR: 3.76; 95% CI: 2.74–5.15), and poor sleep quality (OR: 3.21; 95% CI: 2.28–4.81) compared to non-bed-sharers. Furthermore, bed-sharing was associated with daytime sleepiness (OR: 1.53; 95% CI: 1.10–2.13) but not with sleep duration. Conclusions Bed-sharing is highly prevalent among Chinese early adolescents and is significantly related to sleep quality. Parental positive attitude toward bed-sharing was the most determining factor.

Objectives Obesity is reported to be closely relevant to early sexual development but the relationship between sexual precocity and obesity or central obesity is still inconsistent, especially in boys. We aimed to investigate the relationship between precocious puberty and obesity as well as central obesity. Design A large population-based cross-sectional study using multistage, stratified cluster random sampling. Setting Data from the Shanghai Children’s Health, Education and Lifestyle Evaluation (SCHEDULE) study in June 2014. Participants 17 620 Chinese children aged 6–12 years. Primary and secondary outcome measures Obesity was defined by WHO Child Growth Standards. Central obesity was defined by sex-specific waist-to-height ratio (WHtR) cut-offs (WHtR ≥0.48 for boys, WHtR ≥0.46 for girls). Precocious puberty was identified by Tanner stage of breast, pubic hair and testicle development. A χ 2 test was performed to compare rates. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated to assess the association between precocious puberty and general obesity and central obesity. Probit analysis was used for estimating the median age at entry into Tanner stage 2 or greater for breast, pubic hair and testicle development. Linear regression was utilised to compare the effects of WHtR and body mass index (BMI) on sex development indicators. Results 25.98% and 38.58% of boys with precocious puberty were respectively accompanied by obesity (OR=2.15, 95% CI=1.31 to 3.50) or central obesity (OR=2.10, 95% CI=1.46 to 3.03); meanwhile, 13.86% and 29.42% of girls with precocious puberty were respectively accompanied by obesity (OR=9.00, 95% CI=5.60 to 14.46) or central obesity (OR=5.40, 95% CI=4.10 to 7.12). The median ages of breast, pubic hair and testicle development decreased with BMI increase and median ages of thelarche and testicular development rather than pubarche were earlier in children with central obesity. Conclusions Earlier pubertal development was positively associated with obesity and central obesity in Chinese children.