| Sleep is a basic activity of brain in early development, which plays critical role in many aspects including body growth, immunity functioning, energy recovery, memory consolidation, and emotional and cognitive functioning. Sleep disturbances (including irregular sleep patterns and insufficient sleep) can not only have tremendous and detrimental impact on physical and psychological health of the children and their family, but also greatly increase healthcare burden. Sleep disturbances frequently occur in childhood, and are considered as global public health issues. As transition of traditional medical model to bio-socio-psychological model, introduce of translational medicine, and the establishment of sleep psychology, childhood sleep disturbances have become new focus of multidisciplinary, interdisciplinary, crosss-cultural and international-collaborative research.Sleep disturbances are more critical in Chinese children than their Western counterparts. Preschool age is the key period of rapid physical and psychological development, but also a period in which many sleep disturbances start to appear and frequently occur. Therefore, sleep disturbances in Chinese preschool children warrant special attention.This study is one of the achievements under the State-Spondsored Joint PhD Students Program, and mainly includes three parts. Study 1 conducted a survey to parents of 1,632 Chinese preschool children aged 3-6 years recruited from 10 cities across China with the Children’s Sleep Habits Questionnaire (CSHQ), and the Strengths and Difficulties Questionnaire (SDQ), to explore characteristics and influencing factors of sleep arrangements, sleep patterns and sleep disturbances in Chinese preschool children from a macroscopic level, and in particular of the relationship between sleep disturbances and emotional/behavioral problems. Study 2 conducted a semi-structure interview to 18 parents in Shanghai who concern and worry about sleep in their preschool children, through qualitatively coding analysis, to explore the type and manifestation of sleep disturbances and potential influencing factors in Chinese preschool children, and examine parental satisfaction with sleep in the children and parental distress and concern in managing the children’s sleep. From the perspective of translational medicine, using case study method with non-concurrent multiple baselines across participants design, study 3 preliminarily evaluate the efficacy and feasibility of behavioral interventions for sleep disturbances in Chinese preschool children.The study 1 demonstrated:The incidence rate of cosleeping in Chinese preschool children was 88.6%, and that of bed-sharing was as high as 72.3%. The incidence rate of cosleeping in children of different ages was higher 75%, but significantly lower in older children. The children with boys, lower age, being the only child, lower annual family income extensive family, non-strict parenting style, and higher inconsistency of inter-parental attitudes had significant higher risk of cosleeping.The average daily bedtime was 21:39 (SD=0:A2), wake time was 7:38 (SD=0:42), nighttime sleep duration was 9:34 (SD=0:44), daytime sleep duration was 1:32 (SD=0:44), total sleep duration was 11:06 (SD=1:00), and the prevalence of daily insufficient nighttime sleep (<10 h) and insufficient total sleep (<11 h) was 62.6% and 39.9%, respectively. There were significant ethnic and age differences in some aspects of sleep patterns and insufficient sleep. The children with the minority ethnic, higher age, extensive family, and shorter studying duration within 3 h before bedtime had significant higher risk of daily insufficient total sleep. The children with the only child, higher father education level, lower annual household income had significant higher risk of daily insufficient nighttime sleep. Sleep patterns, insufficient sleep and influencing factors present some differences between weekdays and weekends.Overall sleep disturbances in Chinese preschool children are relatively severe, with the CSHQ total score of 49.32 (SD=7.04) higher than the clinical cut-off of 41. Gender differences in sleep resistance, sleep anxiety, and sleep disordered breathing were significant, with more severe in boys. Ethnic differences in parasomnia, sleep disordered breathing, and overall sleep disturbances were significant, with more severe in the minority. Interaction effect of gender and ethnic on the difference in sleep anxiety was significant, with more severe in the minority of boys rather than girls. Age differences in overall and all specific sleep disturbances (except for sleep onset delay and daytime sleepiness) were significant. The prevalence of overall sleep disturbances was 88.6%, with sleep resistances (59.9%), sleep anxiety (49.4%) and daytime sleepiness (21.4%) occurring most frequently, and significant gender, ethnic and age differences in prevalence of several domains of sleep disturbances. The children with higher mother education level, non-strict parenting style, higher inconsistency of inter-parental attitudes, cosleeping, and longer electronics using time with 3 h before bedtime had significantly higher risk of overall sleep disturbances.Positive correlations were significant among most domains of sleep disturbances and emotional/behavioral problems in Chinese preschool children, that is to say, sleep disturbances were more severe as increased emotional/behavioral problems and lower level of prosocial behavior. When adjusted for multiple factors, emotional symptoms, conduct problems, hyperactivity and prosocial behavior could significantly predict the overall sleep disturbances.The study 2 demonstrated:Sleep disturbances in Chinese preschool children as reported by parents in clinical setting were mainly grouped into 4 themes:bedtime problems, in-sleep problems, daytime sleepiness, and irregular sleep-wake patterns; their potential influencing factors were mainly grouped into 4 themes:sleep hygiene factors, physical factors, psychobehavioral factors, and family factors. Parents demonstrated upper middle level of satisfaction with the children’s sleep, and lower middle level of distress and concern in managing the children’s sleep.The study 3 demonstrated:The children had more regular sleep/wake patterns, shorter sleep latency, less frequent night wakings, longer nighttime sleep duration, and felt more rested after sleep in the intervention period than in the baseline. After the intervention, Overall and several specific sleep disturbances in the children decreased remarkably; parents reported increased satisfaction with the children’s sleep and decreased concern and distress in managing the children’s sleep. In addition, parents indicated high acceptability and satisfaction with the intervention.The main conclusions of this study include:In Chinese preschool children, co-sleeping is the predominant sleep arrangement, and irregular sleep patterns, insufficient sleep and sleep disturbances are very severe and prevalent. Multiple socio-demographic, family, and environmental factors can influence their sleep arrangements, sleep patterns and sleep disturbances. Of note, sleep disturbances in Chinese preschool children are closely associated with emotional/behavioral problems, with the later serving as significant predictors. Clinical assessment of their sleep disturbances and potential influencing factors should consider parental complaints and perception. Furthermore, behavioral intervention would be an efficacious and feasible way to decrease sleep disturbances, and promote sleep health in Chinese preschool children.This study has important implications for future study, policy making, and education and clinical practice regarding sleep heath in Chinese preschool children. |
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