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To examine the association between daily screen time exposure and both sleep patterns (sleep onset, sleep offset, and nighttime, and daily sleep durations) and sleep disturbances among a clinical sample of children with epilepsy.A cross-sectional actigraphic sleep study.A convenience sample of 141 children with epilepsy (1.5-6 years of age) was recruited from an outpatient pediatric neurology clinic of a university-affiliated children's hospital in northern Taiwan. Participating families completed questionnaires and reported children's screen time use, with children wearing an actigraphy monitor for 7 days to assess sleep patterns. Multivariable linear regression analyses were conducted to examine the association of screen time exposure with the child's sleep patterns and sleep disturbance scores.Mean minutes per day of screen time exposure was 89.79 ± 83.94 min, with 62 parents (44.0%) reporting their child having1 hr of screen time daily. Mean daily sleep duration was 9.26 ± 1.01 hr, with 106 children (93.0%) sleeping10 hr in a 24-hr period. In multivariate regression models, daily screen time exposure of1 hour was associated with 23.4-min later sleep onset (b = 0.39, p = .02), 20.4-min later sleep offset (b = 0.34, p = .04), and more severe sleep disturbances (b = 2.42, p = .04).In toddlers and preschool-age children with epilepsy, daily screen time exposure is greater and sleep duration is shorter than the recommended amount, with increased screen time exposure associated with disturbed sleep.Parents need to be informed about the possible adverse impact of screen time exposure on children's sleep and health as well as the importance of limiting screen time exposure to1 hr per day for their toddlers and preschool-age children with epilepsy.

AIMS To examine the association of the timing and consistency of parent bedtime routines with infant night-time sleep duration and variability. DESIGN This was a prospective observational study conducted between November 2012 and November 2016. METHODS Three hundred and twenty healthy 6-month-old infants were recruited from the well-child clinics of a university-affiliated hospital in northern Taiwan. Participating families provided sociodemographic, health and bedtime routine information. Infants wore an actigraph on the ankle for a week. General linear model analysis was performed with the frequency and timing of bedtime routines treated as the primary predictor variables of interest. RESULTS One hundred and ninety-seven (61.6%) parents started the bedtime routine for infants after 9 PM, with 162 (50.6%) not having the exact same bedtime routine every night. In both crude and adjusted analyses, starting a bedtime routine after 9 PM was associated with shorter infant night-time sleep duration (b = -23.55, p

PURPOSE To examine the association between snoring, sleep quality, quantity, and blood pressure in third-trimester normotensive pregnant women. DESIGN This study was a cross-sectional analysis of two cohorts of healthy pregnant women recruited from a prenatal clinic in a medical center in Northern Taiwan. METHODS A total of 322 women reported sociodemographic and health characteristics in a structured interview and wore a wrist actigraph on their nondominant wrist for 7 consecutive days to assess objective sleep patterns. The women's resting blood pressures were measured while seated in the clinic by trained personnel using an electronic sphygmomanometer. FINDINGS One hundred thirty-three (41.3%) women reported snoring. Ninety-three women (28.9%) had

Purpose To describe sleep patterns in young children with epilepsy and to examine levels of agreement between measurements derived from actigraphy and diary recordings. Design Cross-sectional study. Methods Eighty-nine toddlers and preschool-aged children with epilepsy wore an actigraph on their wrists for 7 consecutive days. Parents and caregivers maintained a concurrent sleep diary while the child was wearing the monitor. Levels of agreement between actigraphy and diary recordings were examined using the Bland and Altman method separately for all recording days, weekdays, and weekends. Findings Discrepancies between actigraphy-derived and diary-documented sleep onset, sleep offset, actual sleep at night, wake after sleep onset, and daytime sleep were ±35, ±15, ±82, ±70, and ±29 min, respectively. Differences between actigraphy and diary-derived sleep variables were consistently greater for weekends than for weekdays. Discrepancies between actigraphy and diary-derived actual sleep at night were significantly greater for children who slept alone than for those who co-slept with a parent. Conclusions Our study demonstrates an acceptable agreement between actigraphy and diary recordings for sleep onset, sleep offset, and daytime sleep, but insufficient agreement for actual sleep at night and wake after sleep onset, with parents of children sleeping alone more likely to misestimate child sleep behaviors. Deviation of weekend sleep from weekdays further decreased the accuracy of parental sleep estimates and increased the discrepancies between actigraphy and diary. Clinical relevance Sleep in children with epilepsy assessed using diary recordings alone could be misleading, and actigraphy should be preferred over diaries when resources are available.

Sleep disturbances are one of the most frequent chief complaints brought to the healthcare professionals during routine prenatal care visits. Sleep and mood disturbances are often intertwined, and depression in particular is a leading cause of disability and disease burden worldwide with women more likely to be affected than men. However, limited studies have prospectively investigated the association between sleep disturbances and longitudinal risk of depression in pregnant women, with no studies using actigraphy to objectively estimate daytime and nighttime sleep duration and the extent of sleep disruption.To examine the predictive and longitudinal association of objective actigraphic and subjective sleep disturbances with depressive symptoms in pregnant women.A prospective observational cohort study.204 1st trimester pregnant women recruited from a university-affiliated hospital provided socio-demographic and health information, wore a wrist actigraph for 7 days, and completed Pittsburgh Sleep Quality Index, Center for Epidemiologic Studies - Depression Scale, and Epworth Sleepiness Scale. Identical data collection procedures were implemented again in the 2nd and 3rd trimester, with each data collection scheduled at least 8 weeks apart. We estimated unadjusted and multivariable adjusted odds ratios and 95% confidence intervals to evaluate various types of sleep disturbances at 1st trimester and risk of depression at follow-ups.121 (59.3%) 1st trimester women had a sleep efficiency of85% by actigraphy, and 92 (45.1%) had Pittsburgh Sleep Quality Index global scores5 indicative of poor sleep quality. In multivariable adjusted models, 1st trimester objectively measured sleep efficiency85% was associated with 2.71-, 3.87-, and 5.27-fold increased odds having risk of depression at 2nd trimester, 3rd trimester, and both 2nd and 3rd trimesters, respectively.Healthy pregnant women experience both objective and subjective sleep disturbances during the early trimester, with a substantial proportion of them also having high depressive symptoms throughout the pregnancy. Objectively assessed poor sleep quality in the 1st trimester, but not self-reported characteristics of disturbed sleep, may play a role in the development of both elevated and persistent high depressive symptoms in pregnancy. Future studies using objective sleep measurements and clinical diagnostic interviews are warranted to examine whether an early intervention aiming at improving sleep may help reduce high depressive symptom risk and lower depression rate in women during pregnancy. Tweetable abstract: Objectively assessed poor sleep efficiency in the 1st trimester predicts both elevated and persistent high depressive symptoms in pregnancy.

Aims To examine the sleep characteristics of infants with parentally reported sleep problems, with parentally reported no sleep problems and with parentally reported uncertain sleep conditions. Background Infant sleep problems are recognized as a major health issue worldwide. However, in our daily clinical practices it is not uncommon for parents not to know whether their infant sleep is problematic. Design and Methods A prospective study conducted between 2012 - 2015 where 219 parents completed questionnaires and infants wore an actigraph monitor for 7 days. Multinomial logistic regression models were used to evaluate the actigraphic and parentally reported infant sleep behaviors between the groups. Results Thirty-two (14.61%) parents did not know whether their infant sleep was problematic and 118 (53.88%) parents considered their infant sleep a problem. Compared with infants without sleep problems, infants with uncertain sleep conditions had significantly increased odds of having shortened longest sleep duration according to parental report. A significant association was found for infants without sleep problems compared with those with sleep problems who had significantly more wake after sleep onset as measured by actigraphy, as well as reduced longest sleep duration according to parental report. Conclusion Infants with uncertain sleep conditions have the same problematic sleep behaviors resembling those of children with reported sleep problems. Healthcare professionals should actively disseminate sleep knowledge to help parents interpret infant sleep behaviors and consider possible intervention strategies for improving parental sleep-related knowledge and infant sleep. This article is protected by copyright. All rights reserved.

Daytime sleepiness is a frequent complaint in women during pregnancy. It has also been linked to negative obstetric consequences. Although high prevalence of excessive daytime sleepiness throughout pregnancy is well-documented, neither the causes of persistent daytime sleepiness nor new-onset daytime sleepiness during pregnancy have been investigated. Identifying predictive factors may play an important role in the management of daytime sleepiness in pregnant women and improve prenatal care and maternal-fetal outcomes.To examine first-trimester maternal characteristics associated with the persistence and new-onset daytime sleepiness in pregnant women.A longitudinal, prospective cohort design.One medical center in Taipei, Taiwan and participating women's homes.A total of 204 pregnant women.First-trimester pregnant women recruited from an outpatient obstetric clinic at a medical center provided socio-demographic and health information, wore an actigraphy monitor for 7 days, and completed sleep, mood, and daytime sleepiness questionnaires. Data were collected again when the women were in the second and third trimester.Thirty-one (15.2%) women experienced excessive daytime sleepiness that persisted across all three trimesters. Nulliparous women and women who snored in the first trimester were 2.28 and 2.10 times more at risk of being classified of persistent daytime sleepiness than multiparous women and women who did not snore in the first trimester, respectively. Thirty-one (15.2%) women developed new-onset daytime sleepiness with advancing gestation. Women were more likely to develop new-onset daytime sleepiness if they worked longer hours per week (OR=1.04, p0.001), if they reported snoring (OR=6.75, p0.001), and if they had elevated depressive symptoms in the first trimester of pregnancy (OR=1.09, p=0.01).Snoring in the first trimester is involved in both the persistence and new-onset of daytime sleepiness with elevated depressive symptoms related to new-onset daytime sleepiness in pregnant women. Findings suggest that intervention strategies for alleviating daytime sleepiness in pregnant women should focus on managing snoring and symptoms of depression in early trimesters with special attention to nulliparous and employed women.

We conducted a cross-sectional study to examine sleep in mothers of children with epilepsy and its relation to their children's sleep. A total of 133 dyads of mothers and children with epilepsy aged 1.5-6 years were recruited between 2015 and 2018 from a children's hospital in northern Taiwan. Participating families provided demographic and health information, with children wearing an actigraphy monitor for 7 days and mothers completing sleep and depressive mood questionnaires. We found that 76 (57.1%) of the mothers had poor sleep quality, with 65 (48.9%) mothers having a clinically significant depressive symptom score. Mean actigraphic wake after sleep onset in children was 1.42 (standard deviation = 0.51) hours, with 126 (94.7%) of the children having a clinically significant sleep disturbance score. Multivariate regression analyses showed that higher depressive symptom scores in mothers (β = 0.14; p < .01) and higher sleep disturbance scores in children (β = 0.07; p = .04) were associated with poorer maternal sleep quality, even when maternal demographic characteristics and the child's clinical and epilepsy variables were considered. Findings from our study suggest that sleep disturbances are a shared problem for mothers and their children with epilepsy. Sleep in both mothers and their children with epilepsy should be evaluated in pediatric neurologic practices, with maternal depressive symptoms screened concurrently. Future pediatric epilepsy studies are warranted to examine whether a family-based intervention program would be effective to improve sleep in mother-child dyads and to promote better health and functioning of the entire family.

Study ObjectivesTo evaluate the effect of a clinic-based, behavioral-educational sleep intervention on sleep of children with epilepsy, maternal knowledge about childhood sleep, and maternal sleep quality.MethodsA total of 100 toddlers and preschool-age children with epilepsy (1.5–6 years, 55% boys) and their parents were randomized to receive sleep intervention (n = 50) or usual care with attention (n = 50). Outcomes were assessed at baseline, 3, 6, and 12 months after intervention with the use of objective actigraphy, Children’s Sleep Habits Questionnaire, Parents’ Sleep Knowledge Inventory, and Pittsburgh Sleep Quality Index. Intervention effects were examined using general linear models for repeated measurements to compare the mean change in outcomes from baseline to 12 months post-intervention between the two groups.ResultsSleep intervention resulted in children having greater sleep efficiency by 2.03% compared with the usual care group (95% CI = 0.20% to 3.86%; p = .03). Children in the intervention group also had significantly longer total nighttime sleep as objectively assessed by actigraphy than did those in the usual care group, with an adjusted mean difference of 16.13 minutes (95% CI = 0.24% to 32.03%; p = .04). No intervention effects were observed for maternal knowledge about childhood sleep, and maternal sleep quality.ConclusionSleep intervention provided during routine neurologic visits results in significant, measurable, and sustained benefits in sleep quality and quantity in children with epilepsy. Future trials are warranted to evaluate whether improvements in sleep could impact health-related quality of life or other aspects of functioning in children with epilepsy.Clinical TrialThis trial has been registered at www.clinicaltrials.gov (trial name: Sleep Intervention for Pediatric Epilepsy; registration number: NCT02514291).

The purpose of this descriptive study was to examine the associations of sleep hygiene and actigraphy measures of sleep with self-reported sleep quality in 197 pregnant women in northern Taiwan. Third-trimester pregnant women completed the Sleep Hygiene Practice Scale (SHPS) and the Pittsburgh Sleep Quality Index (PSQI) as well as the Center for Epidemiologic Studies-Depression Scale (CES-D), and wore an actigraph for 7 consecutive days. Student's t-test was used to compare the SHPS scores and means as well as variability of actigraphy sleep variables between poor sleepers (i.e., PSQI global score >5) and good sleepers (i.e., PSQI global score ≤5). Compared to good sleepers, poor sleepers reported significantly worse sleep hygiene, with higher SHPS scores and higher sleep schedule, arousal-related behavior, and sleep environment subscale scores. Poor sleepers had significantly greater intra-individual variability of sleep onset latency, total nighttime sleep, and wake after sleep onset than good sleepers. In stepwise linear regression, older maternal age (p = .01), fewer employment hours per week (p = .01), higher CES-D total score (p

Study objectives To examine maternal knowledge of childhood sleep and its relation to sleep quantity, quality, and variability in a clinic sample of mothers of toddlers and preschool-age children with epilepsy. Methods A total of 112 epileptic children wore a wrist actigraphy to objectively assess daily sleep duration and its variability across 7 days. Mothers completed the Parents' Sleep Knowledge Inventory and Children's Sleep Habits Questionnaire (CSHQ). Multivariate linear regression models were performed to predict CSHQ sleep disturbance scores, daily sleep duration, and daily sleep duration variability in children with epilepsy. Results On average, mothers answered 30.5 per cent of the questions correctly about normal childhood sleep patterns. Only six (5.3%) of the mothers answered half or more of the questions correctly. Mothers more frequently answered "don't know" to questions about dreams, symptoms of sleep-disordered breathing, and adequate amounts of sleep required by children and adolescents. After adjusting for the child's age, gender, bed-sharing, and relevant clinical and epilepsy variables, poorer maternal sleep knowledge was the independent predictor of higher CSHQ sleep disturbance scores and greater intraindividual variability of daily sleep duration in epileptic children (p Conclusions Maternal knowledge about childhood sleep is inadequate and decreased maternal sleep knowledge is associated with poorer and more variable sleep in children with epilepsy. Findings from this study document the need to provide parental education about childhood sleep, particularly emphasizing the recommended sleep duration for children across different developmental stages and addressing the symptoms of sleep disorders commonly comorbid with epilepsy. Trial registration This trial has been registered at www.clinicaltrials.gov (trial name: Sleep Intervention for Pediatric Epilepsy; registration number: NCT02514291).

We designed a cross-sectional study to examine the association between sleep and behavior problems in toddlers and preschool-age children with epilepsy. We found that 71 (78.9%) children slept less than 10 hours in a 24-hour period according to the actigraphy, with 75 (83.3%) children waking for more than an hour during nocturnal sleep. Twenty-five (27.8%) children usually or sometimes had an inconsistent bedtime, and 24 (26.7%) did not sleep the same amount each day. Twenty-nine (32.2%) and 18 (20.0%) children had an internalizing and externalizing problem in clinical range, respectively. Sleep anxiety was significantly (p < .01) associated with increased internalizing and externalizing problems, even after the relevant epilepsy variables were controlled for. Findings from our study suggest that screening of sleep and behavior problems should be part of routine epilepsy care to identify children with problematic sleep and unrecognized sleep disorders and those at risk of behavioral dysfunction.

Adequate physical activity is associated with improved sleep in adults. Such associations, however, vary greatly across studies in pediatric populations, with no studies involving infants found in the literature. This prospective observational study was designed, therefore, to examine the association between physical activity and sleep patterns in infants. A total of 183 healthy infants aged 6 months wore an actigraph for 7 days to measure physical activity and sleep. Parents and caregivers completed a sleep-activity diary over the same period documenting the different types of infant activities. Daily mean time spent in screen-time-or-limited physical activity, including screen-based (e.g., watching television or other electronic devices) and non-screen based activity (e.g., quiet play or restricted infant movement when carried by caregivers or seated in high chairs, swings, or bouncer seats), was 6.68 hr (SD = 1.99), which represented 47.50% of daytime waking hours (SD = 13.73). We found that 65 (35.5%) infants engaged in some screen time during the study, with 10 (5.5%) infants having an average daily screen time >30 min. In our multivariate linear regression model, more hours of screen-time-or-limited physical activity per day were significantly associated with a decrease in total daily 24 hr sleep duration (p < 0.01). Findings from our study suggest that reducing screen-time-or-limited physical activity might be an approach for promoting adequate sleep and lengthening infant daily sleep duration.

To describe sleep patterns in young children with epilepsy and to examine levels of agreement between measurements derived from actigraphy and diary recordings.Cross-sectional study.Eighty-nine toddlers and preschool-aged children with epilepsy wore an actigraph on their wrists for 7 consecutive days. Parents and caregivers maintained a concurrent sleep diary while the child was wearing the monitor. Levels of agreement between actigraphy and diary recordings were examined using the Bland and Altman method separately for all recording days, weekdays, and weekends.Discrepancies between actigraphy-derived and diary-documented sleep onset, sleep offset, actual sleep at night, wake after sleep onset, and daytime sleep were ±35, ±15, ±82, ±70, and ±29 min, respectively. Differences between actigraphy and diary-derived sleep variables were consistently greater for weekends than for weekdays. Discrepancies between actigraphy and diary-derived actual sleep at night were significantly greater for children who slept alone than for those who co-slept with a parent.Our study demonstrates an acceptable agreement between actigraphy and diary recordings for sleep onset, sleep offset, and daytime sleep, but insufficient agreement for actual sleep at night and wake after sleep onset, with parents of children sleeping alone more likely to misestimate child sleep behaviors. Deviation of weekend sleep from weekdays further decreased the accuracy of parental sleep estimates and increased the discrepancies between actigraphy and diary.Sleep in children with epilepsy assessed using diary recordings alone could be misleading, and actigraphy should be preferred over diaries when resources are available.

Background Fatigue is among the most prevalent and distressing symptoms in pregnant and postpartum women. Estimating fatigue severity with a psychometrically sound instrument provides the most fundamental information for understanding women's fatigue experience and assessing the need for intervention to improve maternal and infant health outcomes. Objectives To evaluate the psychometric properties of a Chinese version of the 7-item Lee Fatigue Scale-Short Form (C-LFS-SF) in pregnant and postpartum women. Methods The study was composed of two phases: translation of the scale into Chinese and examination of content validity, and testing to establish the reliability and validity. A convenience sample of 124 women completed health-related questionnaires, kept a fatigue diary and wore a wrist actigraph for 7 days during the third trimester of pregnancy and within three months postpartum. Results The C-LFS-SF showed satisfactory internal consistency (Cronbach's alpha≥.97) and stability over the 7 days at each time point (intraclass correlation coefficient>.87). Exploratory factor analysis showed that 88–94% of the total variance was explained by the one-factor fatigue model. Significant associations among the C-LFS-SF and actigraphic sleep quantity and quality variables supported adequate construct validity. Conclusions The C-LFS-SF has satisfactory psychometric properties and is an easy and promising tool for assessing maternal fatigue during routine prenatal and postpartum care. This scale needs to be further tested in a more diverse population of pregnant and postpartum women, like women with high risk pregnancies or with medical conditions.

We prospectively examined the associations of nighttime and daytime sleep during the third trimester of pregnancy with labor duration and risk of cesarean deliveries in a convenience sample of 120 nulliparous women who completed sleep-related questionnaires and wore wrist actigraphs for up to 7 days. Nap duration and 24-hour sleep duration were inversely associated with labor duration in women with vaginal delivery. Neither actigraphy-derived nor self-reported sleep variables were associated with type of delivery (e.g., vaginal, cesarean). Results showed a beneficial effect of sleep on labor duration and suggest that studies of sleep duration effects on labor and pregnancy outcomes require a consideration of the amount of both daytime and nighttime sleep.

BACKGROUND: Physical activity (PA) is a significant predictor of health outcomes in children with and without chronic conditions. Few researchers have used actigraphy as an objective measure of PA during the child's normal daily routines, and the findings have been inconsistent. It is unclear if asthma can contribute to low PA levels. OBJECTIVES: The aim of this study was to compare daytime PA levels in children with and without asthma and examine the relationships among asthma, PA, body mass index (BMI), and child reports of symptoms. METHODS: Physical activity as measured by actigraphy and self-report symptoms of coughing, wheezing, chest tightness, perceived tiredness, sleepiness, and alertness were obtained in 54 children aged 9-11 years with and without asthma for 7 consecutive days. Activity variables derived from actigraphy included (a) mean daytime activity level; (b) peak daytime activity level; and (c) time duration spent in sedentary, light, moderate, vigorous, and total moderate plus vigorous PA (MVPA). RESULTS: Children with and without asthma did not differ on BMI or activity levels. Children with asthma reported more activity limitations due to breathing problems than children without asthma (p < .01). In multivariate analyses, asthma predicted reduced mean, peak, and total time spent in MVPA level after controlling for gender, BMI, and self-report of symptoms. A significant interaction was found between asthma and BMI on mean, peak, and total time spent in MVPA. DISCUSSION: The association between asthma and PA is complex when the child's BMI is considered. Results suggest that reduced PAs with respect to respiratory symptom severity, childhood obesity, and functional impairment are important areas for future studies.

In this pilot study we examined the relationship between objective and subjective sleep disturbances and depressive symptoms in 22 healthy primiparous postpartum women within 3 months after delivery. We found that none of the women in our study had clinically significant depression scores on the Edinburgh Postnatal Depression Scale; nonetheless, a variable duration of night-time sleep from night to night during the 7-day monitoring period and reported awakening too early were significantly correlated with increased depressive symptoms. Results suggest that first-time mothers who complain of irregular night-time sleep duration and waking up too early should be screened and evaluated for potential postpartum depressive symptoms.

OBJECTIVES To examine the association among nighttime sleep and daytime napping behaviors, depressive symptoms, and perception of fatigue in pregnant women. DESIGN A prospective descriptive study with within-subject design. SETTING A university-affiliated hospital and participants' home environments. PARTICIPANTS Thirty-eight third trimester nulliparous women completed sleep and depressive symptom questionnaires, wore a wrist actigraphy monitor for 7 consecutive days, and kept a concurrent diary reporting naps and rating their level of fatigue using a 0-10 visual analogue scale each morning, midday, afternoon, and evening. A generalized estimating equation regression model was applied to evaluate the time-dependent association. INTERVENTIONS N/A. MEASUREMENTS AND RESULTS Mean duration of total nighttime sleep by actigraphy was 386.3 ± 60.7 min, with 11 (28.9%) women having an average total nighttime sleep 3 days, and only 2 women did not nap over the entire week. Antecedent night sleep duration had a significant inverse association with morning (P = 0.022) and afternoon fatigue (P = 0.009) of the subsequent day. Self-reported naps were significantly associated with midday fatigue (P = 0.003). More depressive symptoms predicted more severe fatigue throughout the day. CONCLUSIONS Results suggest that interventions designed to increase sleep duration and decrease depressive symptoms have the potential to prevent, ameliorate, or reduce fatigue in pregnant women. Depressive symptoms during pregnancy likely share some psychological and behavioral tendencies with fatigue and/or sleep disturbance which may complicate the evaluation of intervention effect.

The purpose of this descriptive study was to examine the associations of sleep hygiene and actigraphy measures of sleep with self-reported sleep quality in 197 pregnant women in northern Taiwan. Third-trimester pregnant women completed the Sleep Hygiene Practice Scale (SHPS) and the Pittsburgh Sleep Quality Index (PSQI) as well as the Center for Epidemiologic Studies-Depression Scale (CES-D), and wore an actigraph for 7 consecutive days. Student's t-test was used to compare the SHPS scores and means as well as variability of actigraphy sleep variables between poor sleepers (i.e., PSQI global score5) and good sleepers (i.e., PSQI global score ≤5). Compared to good sleepers, poor sleepers reported significantly worse sleep hygiene, with higher SHPS scores and higher sleep schedule, arousal-related behavior, and sleep environment subscale scores. Poor sleepers had significantly greater intra-individual variability of sleep onset latency, total nighttime sleep, and wake after sleep onset than good sleepers. In stepwise linear regression, older maternal age (p = .01), fewer employment hours per week (p = .01), higher CES-D total score (p .01), and higher SHPS arousal-related behavior subscale scores (p .01) predicted self-reported global sleep quality. Findings support avoiding physically, physiologically, emotionally, or cognitively arousing activities before bedtime as a target for sleep-hygiene intervention in women during pregnancy.

Background Sleep disturbance, depression, and daytime sleepiness are among the most prevalent symptoms reported by women during pregnancy. However, available data on the association between sleep disturbances and symptoms of depression and daytime sleepiness in pregnant women are sparse and methodological limitations have been acknowledged. The purpose of the study was to examine objective and self-reported sleep disturbances and symptoms of depression and daytime sleepiness in a group of healthy pregnant women. Methods A total of 274 third-trimester pregnant women wore a wrist actigraph continuously for 7 days to assess objective sleep quality and quantity. Self-reported sleep quality was assessed by the Pittsburgh Sleep Quality Index (PSQI), with self-reported poor sleep quality defined as a PSQI score more than 5. The Center for Epidemiologic Studies-Depression Scale (CES-D) and Epworth Sleepiness Scale were used to evaluate symptoms of depression and daytime sleepiness, respectively. Results Sixty-four (23.4%) women were at risk for clinical depression and 69 (25.2%) had daytime sleepiness. Risk of clinically meaningful depressive symptomatology was significantly increased in women with objective total nighttime sleep less than 6 hours (OR 2.53 [95% CI 1.26–5.08]) and self-reported poor sleep quality (OR 3.31 [95% CI 1.74–6.30]), even after multiple adjustment. Neither objective nor self-reported sleep disturbances increased daytime sleepiness in this group of pregnant women. Discussion Both objective nighttime sleep less than 6 hours and self-reported poor sleep quality in healthy third-trimester pregnant women is associated with significant risks for clinical depression. Improving sleep would likely be associated with a reduction in depression symptom severity and an attenuation of the prevalence of depression in pregnant women.

tsai s.-y., thomas k.a., lentz m.j. & barnard k.e. (2011) Light is beneficial for infant circadian entrainment: an actigraphic study. Journal of Advanced Nursing68(6), 1738–1747. Abstract Aim. This article is a report of an exploratory study of the relation between light exposure and circadian rest–activity patterns in infants. Background. Ambient light is a major environmental stimulus for regulation of circadian rhythm of sleep and wake in adults, but few studies have been conducted to examine environmental light exposure in relation to rest–activity circadian rhythm parameters of infants. Methods. An intensive within-subject design was used with a convenience sample of 22 infants (mean postnatal age 49·8 days) who wore a combined light and activity monitoring device for seven consecutive days at home. For each infant, light data (lux) were aggregated over the 7 days into categories of illumination and expressed in mean minutes/day. Circadian light and activity parameters, including mesor, amplitude, acrophase and R2 cosinor fit, were determined using cosinor analysis. Associations between light exposure and circadian rest–activity rhythm parameters were examined using correlation and regression analyses. Data were collected between 2006 and 2007. Results. Infants spent only one-eighth of their daytime hours in an environment with >100 lux light level. There was a relatively large statistically significant relation between the acrophase of light exposure and the acrophase of activity. Increased duration of daily exposure to >100 lux of illumination, and increased amplitude of circadian rhythm of light were associated with stronger circadian patterns of infant activity. Conclusion. Results suggest an association between light and activity patterns and that increasing duration of exposure to moderate light levels may be a simple and economical nursing intervention during the early postnatal weeks.

This research examines subjective and objective report of naps and nighttime sleep in 9- to 11-year-old children with and without asthma.This between subjects study collected prospective self-report diary and objective actigraphy measures of sleep from 27 children with and 27 without asthma during a 7-day/6-night at-home monitoring period.Thirty-two percent of participants reported daytime naps. Nappers were more likely to be children with asthma (12/27 vs. 5/27, p = 0.04) even though the children with asthma did not report being more tired, sleepy, or less alert in the morning. Nappers did not differ from non-nappers on self-report measures of overall sleep quality or number of awakenings but were documented, via objective measures, to have later (clock time: 23:05 vs. 22:21, p = 0.04) and more variable (Levine's Test for Equality of Variances: F = 10.68, p = 0.002) sleep onset times than non-nappers. Sleep offset times did not differ between the nappers vs. non-nappers, therefore, nappers had fewer total minutes of nighttime sleep than did the non-nappers (437 vs. 465, p = 0.04). Later (clock time: 23:01 vs. 22:15, p = 0.01) sleep onset times were also documented in minority vs. Caucasian children.Napping appears a more common behavior than expected especially in children with asthma or of minority ethnicity but the reasons are unclear. Self-report measures may not capture important sleep characteristics that objective measures can identify. Strategies to reduce late and variable bedtimes of all children are needed given our awareness of the negative cognitive, emotional, and behavioral consequences of poor sleep in children.

OBJECTIVES A descriptive pilot study to examine sleep and daytime naps in adolescent girls with chronic musculoskeletal (MSK) pain. METHODS Seventeen girls (14.9 +/- 2.0 years) completed questionnaires on anxiety and depressive symptoms during their clinic visit, and maintained a sleep diary and wore an actigraph for 7 days. Parents completed a daily diary of their teen's medications and approaches used to ease pain. RESULTS Average nighttime sleep was 7.2 hr by actigraphy. All participants had mean sleep efficiency

Sleep disturbances are common in women, especially during pregnancy. Previous studies have confirmed the importance of sleep disturbances as a risk factor of adverse pregnancy outcomes and the need for screening and treatment of inadequate sleep. These reports, however, did not examine health-related quality of life which may be affected by sleep long before adverse clinical consequences are detectable in women during pregnancy.To examine the cross-sectional and longitudinal association between sleep and health-related quality of life in pregnant women.A prospective observational study.A university-affiliated hospital in Taiwan and participants' homes.A total of 164 pregnant women completed questionnaires and wore a wrist actigraphy monitor for 7 days each trimester.Objective sleep was measured by actigraphy, subjective sleep was measured by the Pittsburgh Sleep Quality Index, and health-related quality of life was measured using the SF-12v2 questionnaire across three trimesters. Multiple linear regression analyses were performed to evaluate the cross-sectional and longitudinal associations between sleep and health-related quality of life.Sixty-four (39.0%) women consistently had an average sleep efficiency85% by actigraphy and 40 (24.4%) had a Pittsburgh Sleep Quality Index global score5 in all three trimesters. Cross-sectionally, more actigraphic daytime sleep (p=0.04) and better subjective sleep quality (p0.01) were associated with better physical health-related quality of life in first-trimester pregnant women. Better actigraphic sleep efficiency (p=0.04) and better subjective sleep quality (p0.01) were associated with better mental health-related quality of life in second-trimester pregnant women. Longer actigraphic total nighttime sleep (p0.01) and better subjective sleep quality (p0.01) were associated with better mental health-related quality of life in third-trimester pregnant women. Longitudinally, first-trimester actigraphic total nighttime sleep (p0.05) and subjective sleep quality (p0.01) predicted mental health-related quality of life in the second and third trimester.Sleep disturbances are a highly prevalent and persistent problem in pregnant women. Adequate sleep is essential for women at all pregnancy stages and improving nocturnal sleep quantity and quality in early gestation is of utmost importance for an optimal health-related quality of life later in pregnancy.

We prospectively examined the associations of nighttime and daytime sleep during the third trimester of pregnancy with labor duration and risk of cesarean deliveries in a convenience sample of 120 nulliparous women who completed sleep-related questionnaires and wore wrist actigraphs for up to 7 days. Nap duration and 24-hour sleep duration were inversely associated with labor duration in women with vaginal delivery. Neither actigraphy-derived nor self-reported sleep variables were associated with type of delivery (e.g., vaginal, cesarean). Results showed a beneficial effect of sleep on labor duration and suggest that studies of sleep duration effects on labor and pregnancy outcomes require a consideration of the amount of both daytime and nighttime sleep.

Infant sleep is a challenge among parents and a problem seen frequently in pediatric practice. Actigraphy, an activity-based sleep monitoring system, uses a wristwatch-like device with an accelerometer sensitive to body movements. Activity counts derived from actigraphy serve as the basis for sleep-wake determination. Although it has been concluded that actigraphy is a valid measure of sleep during infancy,1,2 external motion, a common experience for infants (eg, being carried or put in an infant swing), is usually overlooked in studies that use actigraphy to assess infant sleep. In some studies, actigraphy records containing external motion were removed prior to analysis2,3; in others, data involving external motion were included,4,5 with most studies not specifying how such data were analyzed. The objective of this study was to assess the activity count and sleep-wake identification accuracy by actigraphy when an infant doll was exposed to external motion.

Objective: Entrainment to the day—night cycle is critical for infant sleep and social development. Synchronization of infant circadian systems with the social 24-hr day may require maternal activity signals as an entraining cue. This descriptive and exploratory research examines the activity level and circadian pattern in mothers and infants. Method: Twenty-two healthy mothers and their infants (postnatal age 49.8 ± 17.1 days) wore actigraph monitors for seven days. Daytime (06:00—21:59) and nighttime (22:00—05:59) activity levels and circadian parameters of rest—activity patterns (i.e., mesor, amplitude, acrophase, and 24-hr cosinor fit) were calculated. Results: Mothers and infants were significantly more active during the day than at night. The goodness-of-fit index for the model (R2) indicates that circadian rhythm accounted for a mean of 29 ± 10% and 12 ± 8% of the variability in maternal and infant activity, respectively. Acrophase of activity occurred at 15:46 ± 1:07 for the mothers and 15:20 ± 1:21 for the infants. The mean within-dyad correlation of activity counts was r = .46 ± .11, and the within-dyad correlation was associated with the amplitude (r = .66, p < .01) and 24-hr cosinor fit of infant activity (r = .67, p < .01). Conclusions: Our findings suggest maternal rhythms as a possible exogenous influence on shaping an infant’s emerging rhythms and synchronizing them with the external light—dark cycle. Strong pattern synchrony between maternal and infant activity may support infant circadian entrainment and enhance a regular 24-hr sleep—wake schedule during the early postnatal weeks.

Correspondence between infant actigraphy and mother-recorded diary differed significantly when receiver-operator function area under the curve, correlation, and logistic regression were calculated with and without excluding periods of external motion. External motion occurred in 40% of recording time and significantly changed activity count per epoch.