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Background: Nocturnal awakening is the most frequent insomnia complaint in the general population. In contrast to a growing knowledge based on adults, little is known about its prevalence, correlated factors, and associations with subjective sleep perception and daytime sleepiness in children. This study was designed to assess the prevalence and the correlate factors of frequent nocturnal awakening (FNA) among Chinese school-aged children. Furthermore, the associations of FNA with subjective sleep perception and daytime sleepiness were examined., Methods: A random sample of 20,505 children aged 5.00 to 11.92 years old (boys: 49.5% vs. girls: 50.5%) participated in a cross-sectional survey, which was conducted in eight cities of China. Parent-administered questionnaires were used to collect information on children's sleep behaviors, sleep perception, and potential influential factors of FNA from six domains. Univariate and multivariate logistic regression models were performed., Results: The prevalence of FNA was 9.8% (10.0% for boys vs. 8.9% for girls) in our sampled children. The prominent FNA-related factors inclued biological health problems, such as overweight/obesity (OR = 1.70), chronic pain during night (OR = 2.47), and chronic respiratory condition (OR = 1.23), poor psychosocial condition, such as poor mental and emotional functioning (OR = 1.34), poor sleep hygiene, such as frequently doing exciting activities before bedtime (OR = 1.24) and bedtime resistance (OR = 1.42), and parents' history of insomnia (OR = 1.31). FNA was associated with subjective poor sleep quality (OR = 1.24), subjective insufficient sleep (OR = 1.21), and daytime sleepiness (OR = 1.35)., Conclusion: FNA was associated with poor sleep and daytime sleepiness. Compared to sleep environment and family susceptibility, chronic health problems, poor psychosocial condition, and poor sleep hygiene had greater impact on FNA, indicating childhood FNA could be partly prevented by health promotion, by psychological intervention, and by improving sleep hygiene routine.

Background: Sufficient sleep during childhood is essential to ensure a transition into a healthy adulthood. However, chronic sleep loss continues to increase worldwide. In this context, it is imperative to make sleep a high-priority and take action to promote sleep health among children. The present series of studies aimed to shed light on sleep patterns, on the longitudinal association of sleep with school performance, and on practical intervention strategy for Chinese school-aged children., Methods and Findings: A serial sleep researches, including a national cross-sectional survey, a prospective cohort study, and a school-based sleep intervention, were conducted in China from November 2005 through December 2009. The national cross-sectional survey was conducted in 8 cities and a random sample of 20,778 children aged 9.0±1.61 years participated in the survey. The five-year prospective cohort study included 612 children aged 6.8±0.31 years. The comparative cross-sectional study (baseline: n = 525, aged 10.80±0.41; post-intervention follow-up: n = 553, aged 10.81±0.33) was undertaken in 6 primary schools in Shanghai. A battery of parent and teacher reported questionnaires were used to collect information on children's sleep behaviors, school performance, and sociodemographic characteristics. The mean sleep duration was 9.35±0.77 hours. The prevalence of daytime sleepiness was 64.4% (sometimes: 37.50%; frequently: 26.94%). Daytime sleepiness was significantly associated with impaired attention, learning motivation, and particularly, academic achievement. By contrast, short sleep duration only related to impaired academic achievement. After delaying school start time 30 minutes and 60 minutes, respectively, sleep duration correspondingly increased by 15.6 minutes and 22.8 minutes, respectively. Moreover, intervention significantly improved the sleep duration and daytime sleepiness., Conclusions: Insufficient sleep and daytime sleepiness commonly existed and positively associated with the impairment of school performance, especially academic achievement, among Chinese school-aged children. The effectiveness of delaying school staring time emphasized the benefits of optimal school schedule regulation to children's sleep health.

Objective: To examine the relationship between sleep and obesity in children 3 to 4 years old in Shanghai, China., Study Design: A total of 1311 Chinese children from 10 kindergarten classes in Shanghai, aged 3 to 4 years, who were participating in the kindergarten entrance health examination in 2000, were included in the study. Body weight and height were measured, and a questionnaire was given to the children's parents about sleep and physical and social characteristics of the children and their family. The main outcome measure was obesity, defined as body mass index (kg/m2) > or = 95th percentile for the children., Results: Compared with children reporting > or = 11 hours of sleep per night, the odds ratio for childhood obesity was 4.76 (95% CI, 1.28-17.69) for children with <9 hours of sleep, and 3.42 (95% CI, 1.12-10.46) for children with 9.0 to 9.4 hours of sleep, after adjustment for age, sex, and other risk factors. Children with caregivers who slept less, who had mothers with higher education, or who co-slept with caregivers had less nighttime sleep than other children., Conclusion: Short sleep duration is positively associated with obesity in preschool children, and short nighttime sleep duration is significantly related to bedtime and co-sleeping with caregivers.

Background: Sleep plays a critical role in normal development and the effects of culture upon sleep are especially important in young children. The purpose of the present paper was to determine the sleep times and the prevalence of sleep problems and co-sleeping in children from Shanghai., Methods: A cross-sectional design incorporating parental self-report was used to investigate the sleep-related habits of 1129 children, 1-23 months of age, randomly selected from the five districts of Shanghai, China., Results: The total sleep time (TST) of Chinese young children was less than that reported in Western populations, and the prevalence of sleep problems (65.97%) was higher than that for Western children. The sleep problems of children were significantly related to perinatal factors and certain behavior problems. The rate of bed sharing did not differ between boys and girls but significantly increased with age from 44.07% in 1-month-olds to 71.51% in 23-month-olds., Conclusions: Sleep problems that cross cultures result from a variety of behavioral and health problems. Nevertheless, it is speculated that reduced TST in Chinese children may be related to factors unique to China, such as co-sleeping and child-rearing practices.

Objective: To assess the age specific sleep time among children 1 month to 5 years of age in Shanghai, China, and to identify the related factors., Methods: A questionnaire survey was conducted among the parents of 3 266 children 1 month to 5 years of age, randomly selected in five urban districts of Shanghai in August and September of 1999 and 2000, with a response rate of 97.83%., Results: The total sleep time among children less than 48 months of age in Shanghai was less than that among children the same age in Western countries. The factors related to children's inadequacy of total time included parental insufficient sleep time, children's difficult temperament parental presence at sleep onset of children, and cosleeping., Conclusions: The total sleep time among children at tender age in Shanghai is on the low side. The main influencing factor of insufficiency of sleep time among children is the family environmental factor, especially parental improper response to children's sleep behaviors.

Objective: The objective was to survey the prevalence of parent-reported ADHD diagnosis and to assess its associations with sleep problems among urban school-aged children in China. Method: A random sample of 20,152 school-aged children participated in a cross-sectional survey in eight cities of China. A parent-administered questionnaire and the Children's Sleep Habits Questionnaire were completed to quantify history of ADHD diagnosis and sleep problems, respectively. Results: Slightly more than 4% of Chinese school-aged children were reported to have a history of ADHD diagnosis. The multivariate regression models revealed that, after controlling for some confounders--such as gender, parents' educational level, family income, family structure, and stimulant medication--there was a higher prevalence of sleep problems, especially parasomnias, sleep-disordered breathing, and daytime sleepiness, in children with a history of ADHD diagnosis. Conclusion: The results emphasized the importance of incorporating screens of sleep problems into the evaluation of ADHD. (Contains 2 tables and 2 figures.)

The prospective associations between homework burdens and adolescent neurobehavioral problems, and whether sleep-durations mediated and sex modified such associations remained unclear. Using Shanghai-Adolescent-Cohort study, 609 middle-school students were recruited and investigations took place at Grade 6, 7 and 9. Information on homework burdens (defined by homework completion-time and self-perceived homework difficulty), bedtime/wake-up-time and neurobehavioral problems was collected. Two patterns of comprehensive homework burdens ('high' vs. 'low') were identified by latent-class-analysis and two distinct neurobehavioral trajectories ('increased-risk' vs. 'low-risk') were formed by latent-class-mixture-modeling. Among the 6th–9th graders, the prevalence-rates of sleep-insufficiency and late-bedtime ranged from 44.0 %–55.0 % and 40.3 %–91.6 %, respectively. High homework burdens were concurrently associated with increased-risks of neurobehavioral problems (IRRs : 1.345–1.688, P < 0.05) at each grade, and such associations were mediated by reduced sleep durations (IRRs for indirect-effects: 1.105–1.251, P < 0.05). High homework burden at the 6th-grade (ORs : 2.014–2.168, P < 0.05) or high long-term (grade 6–9) homework burden (ORs : 1.876–1.925, P < 0.05) significantly predicted increased-risk trajectories of anxiety/depression and total-problems, with stronger associations among girls than among boys. The longitudinal associations between long-term homework burdens and increased-risk trajectories of neurobehavioral problems were mediated by reduced sleep-durations (ORs for indirect-effects: 1.189–1.278, P < 0.05), with stronger mediation-effects among girls. This study was restricted to Shanghai adolescents. High homework burden had both short-term and long-term associations with adolescent neurobehavioral problems, with stronger associations among girls, and sleep-insufficiency may mediate such associations in a sex-specific manner. Approaches targeting appropriate homework-load/difficulty and sleep restoration may help prevent adolescent neurobehavioral problems. [Display omitted] • High homework burden was concurrently related with adolescent behavioral problems. • High homework burden was longitudinally related with adolescent behavioral problems. • Girls were more susceptible to behavioral problems induced by high homework burden. • Adolescent sleep deficiency mediated the link (homework-to-neurobehavioral problems). • The mediation effects of sleep deficiency were stronger among girls than among boys. [ABSTRACT FROM AUTHOR]

Objective: Sleep dysfunction has been speculated to be involved in the pathological mechanism of nocturnal enuresis (NE). However, results obtained from previous studies were conflicting. This study evaluated and compared the sleep patterns and problems between children with and without nocturnal enuresis (NE) across different age and gender groups in a large epidemiological study.Methods: A multi-center, cross-sectional, epidemiological study was carried out in which 21,439 primary school children (10,655 boys and 10,784 girls aged 5.1-12.9 years) and their parents participated. Chinese versions of the Children's Sleep Habits Questionnaire and the General Condition Questionnaire were used to identify nocturnal enuresis, sociodemographic characteristics, sleep patterns, and sleep problems in children. The sleep patterns and problems were compared between children with and without NE while controlling for a number of confounding factors in different age and gender groups.Results: It was observed that children with NE (especially boys aged 11-12 years with severe NE) slept for a shorter period and were more likely to have sleep problems such as bedtime resistance, sleep duration disorder, night awakening, sleep anxiety, sleep-disordered breathing, and daytime sleepiness than those without NE. Girls with NE were more likely to suffer from other types of parasomnias.Conclusion: Children with NE, especially older boys with severe NE, were more sleep compromised than those without NE. Our findings warrant further research on the mechanism of NE and may have clinical implications for the treatment of childhood sleep problems and NE. [ABSTRACT FROM AUTHOR]