Bedtime Routines and Children's Health
Condition: Myopia; Dental Caries; Sleep; Asthenopia
MeSH terms: Dental Caries; Myopia; Asthenopia
Study type: Interventional

Summary: 
      In Taiwan, the prevalence of sleep problems, myopia, and dental caries in school-age children
      is high. Little is known regarding the implementation of oral and vision health outcomes
      around bedtime. A bedtime routine intervention was conducted to improve children's oral,
      vision and sleep health.
    

Detailed description: 
      Background: In Taiwan, the prevalence of sleep problems, myopia, and dental caries in
      school-age children is high. Recent studies show that there are some linkages between sleep,
      myopia, and dental caries; however, most of the studies were observational studies and lack
      of interventional studies. In addition, little is known regarding the implementation of oral
      and vision health outcomes around bedtime. Establishing beneficial bedtime routines is
      recommended for improving health-related outcomes. Brush-Book-Bed (BBB), a bedtime routine
      program proposed by the American Academy of Pediatrics, has been widely applied in Western
      countries as a bedtime guideline. Therefore, in current research, researchers will apply the
      concept of BBB into practice with primary caregivers with the hope to improve sleep, dental
      health, and vision health outcomes.

      Purpose: To compare the effectiveness of a BBB intervention group to control groups in
      school-age children.

      Method: This study is a pilot interventional study. A total of 200 first graders will be
      allocated to either the intervention group or the control group. Inclusion criteria include
      (1) sleep duration less than 9 hours or more than 11 hours (2) average bedtime later than
      9:30 p.m. Exclusion criteria include (1) intellectual disability prior to pre-school age
      diagnosed by physicians (2) special education students (3) less than 15 school day per month
      (4) medications used that influence sleep (5) congenital eye diseases (6) dental emergencies.
      Individual permuted block randomization will be used for the assignment. Intervention
      includes bedtime brushing, limited sugar consumption around bedtime, reading books instead of
      using screen devices before bed, setting a regular bedtime, turning off the light, and
      reaching a 9 to 11-hour sleep duration. Researchers will send interactive reminder messages
      periodically to maintain participants' compliance. Sleep questionnaires include CSHQ,
      modified Bedtime Routine Questionnaires, a sleep diary, Pediatric Daytime Sleepiness Scale,
      Questionnaire, Epworth Sleepiness Scale, and The Pittsburgh Sleep Quality Index. Oral hygiene
      evaluation includes salivary pH value and salivary flow rate. The near vision test and
      refractive error are evaluated as myopia measurements. Asthenopia pictures and critical
      flicker fusion frequency are used to measure subjective eye fatigue. Moreover, a
      self-administered questionnaire related to sleep, oral hygiene, and vision health is also
      measured. Intervention Feasibility will be asked with open-ended questionnaires immediately
      after the intervention. Data analyses will be conducted using SPSS Statistics 22.0. The
      findings of this pilot study will provide the basis for developing a tailored bedtime routine
      for Taiwanese children. which can be applied in further interventional studies. In addition,
      outcome indicators can act as proxies, early detection if potential risks of sleep problems,
      and vision or oral diseases.

      Estimated Result: School-age children who receive BBB intervention will have significantly
      better health-related outcomes than those without after the intervention, the third and sixth
      months post-intervention.
    

Intervention name(s): Bedtime routine; Control
Intervention type(s): Behavioral; Behavioral
Intervention description(s): a regular routine conducted around bedtime includes brush, book reading and regular bedtime; a healthy control checklist
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: An bedtime routine interventional group and a healthy lifestyle control group
Masking: Double (Participant, Care Provider)
Primary purpose: Prevention
Keywords: Myopia; dental caries; bedtime routine; sleep