Showing posts with label sleep. Show all posts
Showing posts with label sleep. Show all posts

Monday, February 23, 2015

Teen Sleep Duration over Two Decades: A Study That May Keep You Awake!

          There are so many studies in our journal and others noting the importance of good sleep hygiene and pointing out the problems that occur when sleep is curtailed in children and adolescents, and yet this week we offer a different longitudinal perspective on sleep studies. 
Keyes et al. (doi: 10.1542/peds.2014-2707) share their analysis of historical shifts in adolescent sleep time over 20 years using national survey data of more than 272,000 teens from 27 years of birth cohorts.  Teens in each cohort were asked if they were getting at least 7 hours of sleep and if the amount of sleep they were getting was adequate or not.  The authors share trends indicating that adolescent sleep has been declining over the last 20 years with girls not doing as well as boys in getting adequate sleep.  There are also lots of misperceptions noted between teens feeling they are getting adequate sleep relative to what they are actually getting especially for underrepresented minorities and teens with lower socioeconomic status. 
If you aren’t talking sleep hygiene with your teen patients, this study is nothing to snore at—and should energize  you to make this more of a priority in your anticipatory guidance discussions during health maintenance visits with adolescents in your practice.  Stay up a few minutes later tonight—and read this study to learn more.

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Monday, December 1, 2014

Uncovering Some Concerning Trends in Infant Bedding Use in the US

By: Lewis First, MD, MS; Editor-in-Chief 

Photo by Janine via Flickr
Since the onset of the “Back to Sleep” campaign for infants in the early 1990s, one would think that the use of dangerous bedding materials in cribs would be much less 20 years later—but how much less?

Shapiro-Mendoza et al. (doi: 10.1542/peds.2014-1793) elected to review almost two decades of data from the National Sleep Position Study and although the use of blankets, pillows and other dangerous bedding materials declined, they were still being used at a prevalence of over 50 percent of those surveyed in this national database as of 2010.

So why is that, and who is not complying with a safe sleep environment for their babies so as to reduce the risk of sudden infant death? The authors reveal some important demographic predictors that will allow us to better educate some populations of parents even more than we are when it comes to making sure bedding is not hazardous for babies.

This is a study that will not put you or parents of infants to sleep. And if the data as presented is not a wake-up call, then read the commentary by safe sleep experts Dr. Rachel Moon and Fern Hauck (doi: 10.1542/peds.2014-3218) also released this week.

You may want to blanket your office (rather than baby’s crib) with copies of these materials with the hope we can do even more to reduce the risk of an unintended unsafe sleeping situation.

Related Reading:

Wednesday, September 10, 2014

Two Studies on Bullying Share New Information on This Tough Topic

By: Lewis First, MD, MS; Editor-in-Chief 

Photo by tamckile via Flickr
There has been much written and studied about bullying and victimization of being bullied, and this week we share two studies that shed even more new light on this important topic.

The first by Bowes et al. (doi:10.1542/peds.2014-0832) discusses the mental health harm incurred when a sibling turns out to be the bully also. The authors ran a longitudinal study of more than 6,900 subjects—all in a community birth cohort in the UK—and then followed those children bullied by their siblings over 12 years. The results are sad ones given the higher frequency of mental health and self-harm issues in children who were bullied by siblings compared to those who were not.

The second study by Wolke et al. (doi:10.1542/peds.2014-1295) looked at sleep problems in those who were bullied by peers. More specifically, the authors collected interview data on children longitudinally to identify bulling and then, several years later, asked about nightmares, night terrors and sleep-walking in those who had been bullied. The findings are eye-opening and should suggest inquiring about sleep behaviors in those who have been bullied—but even more importantly, asking about bullying in those experiencing parasomnias.

Have you found the same findings in either or both of these studies are true for your patients who may be victims of bullying? Share your thoughts on sibling bullying or sleep disorders in those being bullied via a response to this blog, an eLetter at our journal site, or on Facebook or Twitter.

Related Reading:

Monday, July 28, 2014

Wake Up to Two New Studies on Obstructive Sleep Apnea

By: Lewis First, MD, MS; Editor-in-Chief 

Photo by Nnelumba via Flickr
We have published a number of studies over the years on the morbidities associated with obstructive sleep apnea (OSA), but this week we share two new studies that further explore the potential medical complications associated with this disorder.

The first, authored by Rosen et al. (doi: 10.1542/ peds.2013-4223), identifies the prevalence of OSA in children with sickle cell anemia. Given the lower waking oxyhemoglobin saturation associated with OSA, this could be a problem in those whose cells are prone to sickling under hypoxic stress, and this study supports that hypothesis. Have you looked into the role of OSA in your patients with sickle cell disease? If not, you may want to after reading this interesting study.

The other OSA article we are releasing this week looked at anthropometric changes in children during the 7 months following adenotonsillectomy for OSA. The study, performed by Katz et al. (doi: 10.1542/peds.2014-0591) was a randomized controlled trial in which children ages 5 to 9.9 years old either got an early adenotonsillectomy or were monitored with supportive nonoperative care. Changes in weight and growth indices were monitored in each randomized group that involved more than 450 children total.

So what happened? Do you think those with early adenotonsillectomy gained or lost weight compared to those with supportive care? The results you may find difficult to swallow but suggest that an early surgical approach to OSA may not solve the obesity problem and, in fact, may worsen it.

When considering adenotonsillectomy for these patients, you may want to have some good weight monitoring and nutritional counseling ready to go in its aftermath if you want to sustain the gains (but not the weight gains). Read on to learn more.

Related Reading:

Thursday, July 17, 2014

Sleep-Related Deaths: Do Risk Factors Differ by Age?

By: Lewis First, MD, MS; Editor-in-Chief 
Photo by Flickr user Liz

We certainly recognize the importance of counseling families against bed-sharing and to avoid putting objects in the crib in hope of reducing the risk of sudden unexpected infant death (SUID). Yet do some risk factors in sleep environment appear to play a more prevalent role at some ages in infants relative to others when it comes to a SUID occurring?

Colvin et al. (doi: 10.1542/peds.2014-0401) performed a cross-sectional study of sleep-related infant deaths using data obtained from death reports in 24 states during 2004 through 2012. The authors discovered that at different times during infancy, different risk factors play a role in increasing the chance of unexpected death.

For example, bed-sharing is more likely to play a role in a death of an infant in the first three months of life, whereas having an object in the crib or moving from a back to a prone sleep position worsens SUID chances for an older infant (4 months to 1 year).

When it comes to anticipatory guidance on sleep environment for infants, this study will help you further refine instructions to parents to insure that more emphasis is paid to certain risks based on the age of the infant.

Read this study and see if it doesn't help you better educate your families on proper sleep environment for babies.

Related Reading:

Tuesday, July 15, 2014

Covering the Topic of Weighted Blankets & Sleep in Autistic Children

By: Lewis First, MD, MS; Editor-in-Chief 

Photo by Yogendra Joshi via Flickr (cropped)
Sleep problems in children with autism spectrum disorders (ASD) have been identified and well-studied in prior articles published in Pediatrics. Of course, parents have sought solutions to these sleep problems, and one of those solutions readily offered online via the Internet is the use of weighted blankets to allegedly provide a better quality of sleep.

Yet studies on the effectiveness of weighted blankets compared to regular ones have been limited until this week when Gingras et al. (doi: 10.1542/peds.2013-4285) offer us a randomized placebo-controlled phase three trial of weighted blankets in 67 children with ASD between 5 and 16 years of age.

If you are a fan of using weighted blankets to improve sleep in autistic children (and a number of children and parents are), you will find the results of this study surprising and perhaps disappointing.

Are your patients with ASD using weighted blankets? Do they tell you they work? Would you still recommend one after reading this study? Share your thoughts with us via response to this blog, an eLetter or on Facebook and Twitter.

Related Reading: 

Tuesday, June 10, 2014

Classifying Sudden Unexplained Infant Deaths in a Multistate Registry: A New Tool for Prevention Strategies

By: Lewis First, MD, MS

Photo by Janine via Flckr
Given the complexity of classifying a sudden unexpected infant death (SUID), such as one being due to sudden infant death syndrome or accidental sleep-related suffocation, a method of doing such classification in a clear and consistent manner could be quite beneficial—at least those are the thoughts of Shapiro-Mendoza et al. (doi: 10.1542/peds.2014-0180) who have established a system of classifying these death subtypes into groups and further help to identify with their system the highest risk groups that we might be able to intervene and potentially prevent a SUID event.

Just how useful this new system might be is further explained in a commentary associated with this special article by Moon and Byard (doi: 10.1542/peds.2014-0602), who provide historical and international context as well as analysis about the practicality and potential benefits and challenges of Shapiro-Mendoza et al.’s classifications.

If you need an update on just what the various subtypes of SUID are and what we might be able to do about them, then this article and commentary are just what the pediatrician ordered. Read them both and as you do, think about the useful applications of this classification system when it comes to prevention strategies for SUID.

Related Reading:

Tuesday, May 20, 2014

Sleep Duration Patterns and Health-related Quality of Life

By: Lewis First, MD, MS

We certainly are learning more and more about the role of sleep in our overall health and wellbeing, but we may not have realized that different types of sleep patterns may be associated with different health outcomes.

Photo by katrinket via Flickr
Magee et al. (doi: 10.1542/peds. 2013-3806) explored this topic by collecting data on nearly 3,000 Australian children from ages 0-1 to ages 6-7 years as part of the Longitudinal Study of Australian Children. The authors analyzed data on sleep duration collected every two years along with measures of health-related quality of life. Four patterns of sleep were identified—typical, initially short, poor and persistent short sleepers—all with unique findings relative to quality of life.

To examine which pattern is associated with what health outcome, open your eyes to this study and gain even more insight into the role of sleep on child health.

Related Reading:

Monday, April 14, 2014

Two Studies on Media Exposure in Young Children Provide Concerning Results

Photo by normanack via Flickr
The AAP has made media awareness a priority issue for pediatricians and patients and policies to limit media exposure in infants, children and teens have come forth over the past few years in our journal (doi: 10.1542/ peds.2013-2656).

Despite the policies, children seem to be spending more and more time engaged in media usage so this week we are releasing two studies you can share with your patients that might make more of a dent in reducing the amount of television or other media children are often routinely exposed to at home.

The first study by Cespedes et al. (doi: 10.1542/peds.2013-3998) looked at sleep duration differences between infancy and mid-childhood when there was a television in the bedroom as the child got older, as well as whether sleep duration was influenced negatively by the amount of television watched overall. Given the studies we have published on the association of inadequate sleep with general mental and physical health, having sleep duration potentially influenced, or at least associated with, prolonged television exposure and/or television in the bedroom is a message that is well-worth sharing with your patients.

Similarly, a second study by Radesky et al. (doi: 10.1542/peds.2013-2367) looked at parental report of infant behavioral self-regulation and its association with early childhood media exposure. The authors’ study hypothesis was that poor-self regulation would result in parents placing their child in front of television and videos more than those parents who did not perceive their children having self-regulation problems. Again—alerting families that there are better solutions to perceived behavioral issues with their children than simply putting them in front of a television or video screen is also some guidance we might provide to parents in our quest to reduce media exposure in our youngest patients.

Channel your energy into reading these two studies so you can in turn channel your media-reduction messages even more to your patients.

Related Reading:

Thursday, December 5, 2013

Circadian Reset While Resting Under the Stars

Typically, Associate Editor Dr. William V. Raszka offers insight into topics in the news. This week, he turns the reins over to fourth-year medical student Leah Carr, BS, who reflects on recent research on resetting circadian rhythms in nature: 

The internal clocks that govern our sleep-wake cycle are heavily influenced by artificial light exposure. Increasingly exposed to artificial light deep into the evening hours, many have pushed bedtime back, only to still wake up groggy even after eight hours of sleep. For those of us who wish we could be more in tune with a natural sleep cycle, a week outdoors may be all we need to put us back on track.

Photo by Tatiana12 via Flickr
As reported by the BBC (Science & Environment: August 1, 2013), researchers investigating the effect of artificial light on sleep-wake cycles found an association between increased natural light exposure and changes in study participants’ circadian rhythms. Eight participants’ self-selected sleeping patterns were observed after one week in their typically electrically-lit environments and then again following one week of camping in Colorado where the only light came from the sun and a campfire. Melatonin, a hormone closely linked to circadian modulation and sleep onset was measured in participant salivary samples. Generally, melatonin rises just before sleep and decreases through the night until awakening. During the camping portion of the study, participants were exposed, on average, to four times the light exposure experienced in their electrically-lit environment.

While in their typical artificially-lighted environment, melatonin elevations rose two hours before going to sleep, usually at midnight or so, and remained elevated even after awakening, suggesting that they were out of sync with their natural rhythm. However, after one week of camping, melatonin levels rose two hours earlier (around 9-10 pm), with elevations occurring nearer to the time of sunset. Melatonin levels fell early in the morning about the time of participants’ natural awakening and close to sunrise. No significant changes in sleep duration or efficiency occurred when the environment was changed.

While this study is small, it indicates that exposure to artificial light potentially acts as a strong, though easily changed, external cue. If future research solidifies the relationship between natural light, sleep-wake cycles, and melatonin, spending more time outside seems like a great way to tune our biologic clock. 

*This filler excerpt can be found in the December 2013 Pediatrics print journal p. 1080, or online here.

Wednesday, November 6, 2013

Sleep Duration & Food Intake, Appetite-Regulating Hormones & Body-Weight: Are They Related?

We have published a number of studies recently (as have other journals) noting the importance of getting adequate sleep to improve physical and mental health and wellbeing—but how does increased sleep improve physical health—particularly when it comes to reducing the risk of becoming overweight or obese?
Photo by AlexRamos10 via Pixabay

Hart et al. (doi: peds.10.1542/2013-1274) used a cross-over design study for 37 children who over three weeks were told to first sleep as they normally do for a week. The second week they either increased or decreased their time in bed by 1 ½ per night, then did the opposite for the final week of the study. Dietary intake, fasting leptin and ghrelin levels that help regulate appetite and weight were the outcome measures.

The results of this study are not ones that will make you fall asleep—but rather be much more of a wake-up call for taking more careful sleep histories in your patients and then helping them improve their sleep hygiene.