Reducing Sleep Disparities in Minority Children
Condition: Sleep
Study type: Interventional

Summary: 
      Inadequate sleep is a major health problem of childhood that often fails to receive attention
      until significant neurobehavioral and other health problems are noted. Although adequate
      sleep is essential for normal growth and brain development, studies show that children from
      minority and economically disadvantaged families are more likely to experience shorter sleep
      times and more sleep fragmentation compared to their Caucasian and economically advantaged
      counterparts. As a result, they are disproportionately affected by the adverse health and
      quality of life consequences of poor sleep. There are currently no intervention studies to
      the investigators knowledge aimed at addressing sleep disparities by improving sleep duration
      and sleep hygiene in early school-aged children from minority populations. This study seeks
      to close the 'sleep gap' that exists between the sleep duration of minority school-aged
      children and that of their non-minority peers. An interdisciplinary team of researchers and
      clinicians from Columbia University's Pediatric Lung and Sleep Disorders Center, School of
      Public Health, Psychiatry Department, and two outpatient clinic systems affiliated with
      Columbia are collaborating to reduce sleep disparities by improving sleep duration in a group
      of 5-6 year old minority children. The primary goal of this study is to evaluate the efficacy
      of a tailored, interactive, educational and behavioral intervention that utilizes trained
      sleep counselors to assist parents in improving their children's sleep hygiene and reducing
      risk factors for poor sleep, thereby increasing sleep duration over a 12-month period in a
      randomized controlled trial of children identified with sleep problems (Aim 1). The
      investigators will screen 375 parents of 5-6 year old children from 5 primary care clinics to
      identify children with and without sleep problems and enroll 90 of the 375 children screened
      who have sleep problems in a randomized controlled trial of an in-home sleep intervention.
      Using an initial home assessment, baseline actigraphy data, sleep logs recorded by parents,
      and information regarding risk factors for poor sleep collected from each family during
      screening, the investigators will work with intervention parents to develop a personalized
      sleep plan for their children. The investigators will evaluate the effect of the intervention
      on: a) nightly sleep duration; b) neurocognitive function; and c) behavioral disorders.
    

Detailed description: 
      Inclusion Criteria. Eligible families must: (1) have a typically developing healthy child age
      5-6 years old enrolled in school for a minimum of 5 hours per day; (2) have a child who
      screens positive for a sleep problem based on the CSHQ (a score >41); (3) have lived in
      permanent housing within the catchment communities for the study (not in a shelter or other
      temporary housing) for the previous 12 months; (4) have no plans to move out of the area in
      the next 12 months; (5) agree to have research staff come into their homes for a home
      assessment and actigraph fitting every 3 months for 1 year; (6) have telephone access or a
      contact with telephone access; and (7) be fluent in either English or Spanish.

      Exclusion criteria will include the presence of a serious co-morbid condition in the child
      that may impact sleep including: genetic syndromes, neuromuscular disorders, seizure
      disorder, mental retardation, autism, severe learning disabilities, psychiatric disorders,
      and attention-deficit/hyperactivity disorder. The presence of such co-morbid conditions would
      confound the outcome of interest.
    

Intervention name(s): Sleep Counselor Intervention; Sleep Education Control
Intervention type(s): Behavioral; Other
Intervention description(s): Families in the sleep counselor arm of the study will receive 3 scheduled home visits by a trained sleep counselor during the first 3 months following enrollment. Two optional home visits may be scheduled to help families encountering ongoing barriers to improving their child's sleep. The intervention will be provided by trained, bilingual, culturally competent sleep counselors, who will assess home sleep conditions, work with the family to teach them how to improve sleep hygiene and the sleep environment, provide equipment as needed to improve the sleep environment (e.g. nightlight, inflatable bed, window shade, etc.) and guide the family to begin setting goals and making decisions to initiate and sustain behavioral and environmental changes to improve sleep.; The control group will receive a low intensity intervention that provides information about sleep and the benefits of adequate sleep. We will give parents the National Sleep Foundation's handout, "Information about Children's Sleep for Parents and Teachers"
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: Sleep; Children; Disparities; Minority; Urban