# Presentation: 672025

## Sleepless in America: Inadequate Sleep and Relationships to Health and Well-being of our Nation’s Children

***Arlene Smaldone, DNSc, CPNP, CDE***
***Judy C. Honig, DrNP, RN, EdD, CPNP***
***Mary W. Byrne, PhD, MPH, FAAN***
***Columbia University School of Nursing, NY, NY***

## Sleep

**An “invisible” phenomenon**
**Fails to get attention unless interferes with child’s behavior, mood or performance**
**The “forgotten country”**
**Requirements vary by age and developmental stage**
**Needs may be underestimated especially during adolescence**
**Relationships between sleep and chronic health conditions not well understood**

## Purpose

**Describe the prevalence and characteristics of ****inadequate sleep**** as perceived by parents of school-age and adolescent children as part of the 2003 National Survey of Children’s Health**
**Survey question**
**“****During the past week, on how many nights did your child get enough sleep for a child his/her age?”**

## Methods

**Data source**
**68,418 parental respondents of children 6-17 years**
**Variables**
**Enough sleep <7 nights = inadequate sleep**
**Stratified by age**
**School age children **
**Adolescents**

## Multi-domain conceptual approach

**Family**

**  ****Environment**

**Child**

## Variables

**Child Level**
**Demographics**
**Gender**
**Race/ethnicity**
**Health status**
**Co morbid conditions**
**Reported child behaviors**
**Physical activity**
**Television/video time**

## Variables

**Family Level**
**Education**
**Income**
**Parental physical and emotional health**
**Family life**
**Family structure**
**Family conflict**
**Environment Level**
**School life**
**Safety concerns **

## Statistical analysis

**SUDAAN 9.0.0**
**Population weights to extrapolate findings from sample to national population estimates**
**Bivariate analyses**
**Multivariate logistic regression**
**Models controlled for demographic characteristics, child health, school and activities, and family life variables **

## Results: Prevalence of Inadequate Sleep

**2003 National Survey of Children’s Health**

**P<0.001 for**** ****trend**

## Inadequate Sleep and Associated Factors

**Findings common to school age children and adolescents**
**Child level**
**Race/ethnicity**
**Health status**
**Family level**
**Family level of education**
**Family income**
**Family conflict**
**Environment level**
**Safety concerns**
**Multivariate analyses**

## Inadequate Sleep and Associated Factors: Child level

|  |    School age |  |    Adolescent |  |
| --- | --- | --- | --- | --- |
|  | OR | (95% CI) | OR | (95% CI) |
| *Race/ethnicity
   Non Hispanic black
   Hispanic
   Other or mixed race | 
1.02
0.80
0.69 | 
(0.83-1.25)
(0.66-0.97)
(0.53-0.90) | 
0.73
0.71
0.77 | 
(0.60-0.89)
(0.59-0.86)
(0.60-0.99) |

***Reference group: Non Hispanic white **

## Inadequate Sleep and Associated Factors: Child level

|  |    School age |  |    Adolescent |  |
| --- | --- | --- | --- | --- |
|  | OR | (95% CI) | OR | (95% CI) |
| Health Status:
*Depressive symptoms  
   Sometimes
   Usually/always
**Physical activity
   0 days/week
   1-5 days/week | 

1.38
1.67

1.10
1.43 | 

(1.17-1.63)
(1.32-2.12)

(0.85-1.42)
(1.28-1.60) | 

1.56
1.43

1.16
1.33 | 

(1.36-1.79)
(1.17-1.75)

(1.00-1.35)
(1.19-1.49) |

**  *****Reference group: Never have depressive symptoms**
****Reference group: Physical activity 6-7 days/week**** **

## Inadequate Sleep and Associated Factors: Family level

|  |    School age |  |    Adolescent |  |
| --- | --- | --- | --- | --- |
|  | OR | 95% CI | OR | 95% CI |
| *Level of education
   High school graduate
**Family income level
   <100% FPL
   100-199% FPL
   200-399% FPL | 
0.81

0.68
0.77
0.91 | 
(0.70-0.94)

(0.52-0.88)
(0.64-0.91)
(0.80-1.03) | 
0.68

0.49
0.79
0.89 | 
(0.60-0.77)

(0.38-0.64)
(0.67-0.93)
(0.80-0.99) |

**  *****Reference group: More than high school**
****Reference group: Income ****≥400% FPL**

## Inadequate Sleep and Associated Factors: Family level

|  |    School age |  |    Adolescent |  |
| --- | --- | --- | --- | --- |
|  | OR | (95% CI) | OR | (95% CI) |
| Family conflict
*Argue heatedly, shout  
    Rare
    Sometimes - always
**Hitting/throwing
    Occasionally | 

1.17
1.28

1.40 | 

(1.01-1.35)
(1.10-1.49)

(1.16-1.70) | 

1.10
1.24

1.16 | 

(0.96-1.25)
(1.08-1.42)

(1.00-1.35) |

**  *****Reference group: Never argues heatedly/shouts**
****Reference group: Never hits/throws things**

## Inadequate Sleep and Associated Factors: Environment 

|  |    School age |  |    Adolescent |  |
| --- | --- | --- | --- | --- |
|  | OR | (95% CI) | OR | (95% CI) |
| *Safety concern
   Usually safe | 
1.23 | 
(1.09-1.38) | 
1.35 | 
(1.22-1.49) |

***Reference group: Always safe at home, school, neighborhood **

## Inadequate Sleep and Associated Factors in School age children Family   Environment 

|  |    School age |  |
| --- | --- | --- |
|  | OR | (95% CI) |
| *Father’s general health
   Fair/poor
**Problems at school
   Parents contacted | 
1.41

1.16 | 
(1.06-1.88)

(1.02-1.32) |

**  *****Reference group: Excellent health **
****Reference group: Never contacted regarding problems at school**

## Inadequate Sleep and Associated Factors in Adolescents Child Family 

|  |    Adolescent |  |
| --- | --- | --- |
|  | OR | (95% CI) |
| *Health status
   Atopic condition
   Frequent or severe headache
**Parental emotional health
   Mother
      Very good, good
   Father
      Very good, good
      Fair, poor | 
1.17
1.27

1.20

1.18
1.41 | 
(1.06-1.29)
(1.05-1.53)

(1.03-1.39)

(1.02-1.36)
(1.04-1.92) |

**  *****Reference group: Not having the condition**
****Reference group: Excellent emotional health**

## Inadequate Sleep and Associated Factors in Adolescents  Child Family 

|  |    School age |  |
| --- | --- | --- |
|  | OR | (95% CI) |
| Family stress
   *Child harder to care for
      Sometimes
  **Parental anger with child
      Sometimes
      Usually, always | 

1.24

1.15
1.61 | 

(1.10-1.39)

(1.02-1.30)
(1.16-2.23) |

**  *****Reference group: Never harder to care for **
****Reference group: Never angry with child**

## Implications

**32% of parents reported that their child experienced ****≥1 night of inadequate sleep during the previous week**
**Consistent with reports of epidemiological studies**
**These children experienced health-related deficits associated with child, family and environmental factors**
**Ethno cultural and socioeconomic differences**
**Non Hispanic white children **
**higher income **
**more education**

## Implications

**Association with co-morbidities**
**Depressive symptoms in both groups**
**Atopic conditions and headache in adolescent group**
**No associations with Attention Deficit Hyperactive Disorder**
**Association with family and social factors**
**Family conflict – both age groups**
**Parental emotional health, “difficult child,” parental anger – adolescent group**
**Not feeling safe at home, school or community **

##           Implications

**Sleep health **
**Important component of wellness in children**
**Assessment of children’s sleep should be a fundamental aspect of clinical prevention**
**Future surveys should explore sleep in greater detail**