Sleep Problems More Prevalent than Expected in Urban Minority Children Says New Study
Sleep problems among urban minority children, including resistance to
going to bed, shortened sleep duration, and daytime sleepiness are much more common than
previously thought, according to a study conducted by researchers in New York.
The results of the study were presented at the ATS 2011 International Conference in Denver.
“Although studies have shown that children from minority populations take more daytime naps
and have shorter nighttime sleep durations than their non-minority peers, no studies to date have
focused on sleep patterns and objectively measured sleep duration in early school-aged African-
American and Latino children living in urban, economically disadvantaged communities,” said
study author Beverley J. Sheares, MD, associate professor of clinical pediatrics at Columbia
University. “We studied this high-risk population because at age 5 and 6 years, children are
starting school and thus may have less time available for sleep at night or for daytime naps,
thereby reducing the amount of sleep at a time when the effect of shortened sleep on learning,
behavior and health is critically important.
“The results of this study will be of significance to healthcare providers, researchers, parents and
educational professionals, and will have significant public health implications for a highly
vulnerable population of early school-aged children,” she said.
Researchers randomly enrolled 160 parents of healthy 5- and 6-year-old children. Data were
obtained using parental sleep log records and through face-to-face interviews using the
Children’s Sleep Habits Questionnaire (CSHQ), a validated tool commonly used to screen for
childhood sleep problems. CHSQ data were used to identify and characterize the nature of the
sleep disturbances. In addition, researchers were able to obtain data from 30 children who
underwent sleep monitoring at home for five to seven days using actigraphy, an objective
method of continuous, direct-motion monitoring used to measure sleep and awake time. The
monitors were worn 24-hours a day during the monitoring period.
“To our knowledge, neither the CHSQ nor actigraphy has been used extensively in this
population of early school-aged children to examine sleep,” Dr. Sheares noted.
Evaluating the results of the sleep questionnaire, researchers found that 147 of the 160 children,
or 92 percent, had scores indicating the presence of a sleep problem. In addition, parents reported
the following behaviors were the specific sleep problems for their children: parasomnias, a group
of sleep events that includes nightmares, sleepwalking and other events (51 percent); bedtime
resistance (50 percent); shortened sleep duration (50 percent); daytime sleepiness (47 percent);
night waking (41 percent); sleep-onset delay (27 percent); sleep anxiety (19 percent); and sleepdisordered
breathing (11 percent).
All children who completed actigraphy monitoring had shortened sleep duration, with a mean
sleep duration of seven hours 45 minutes per night on average, significantly less than the 10 to
11 hours recommended by the National Sleep Foundation for children in this age group.
“We expected to find behavioral sleep problems in this population, but we did not expect over 90
percent of the children in this community sample to have a behavioral sleep problem as indicated
by the CSHQ,” Dr. Sheares said. “While studies consistently show that 20 percent to 43 percent
of school-aged children experience a range of sleep problems, there is mounting evidence, and
our study supports this, suggesting that children from minority groups have significantly shorter
sleep durations and increased sleep disruptions.”
“Our study also demonstrates the need to use objective measures of sleep in urban populations of
young children,” she said. “While parental reports of children’s sleep behaviors have been
widely used in both clinical practice and in pediatric sleep research, our findings suggest that
parental reports of sleep duration are not reliable because parents in our study consistently
overestimated sleep duration.”
“Although previous studies have shown that parental reports are closely correlated with sleep
schedule variables such as bedtime, wake time and sleep duration, they are less sensitive in
assessing sleep quality variables such as sleep fragmentation as a result of night awakening,” she
explained. “Parents may not have been aware of time spent awake during the night which could
have led to an overestimation of sleep duration.”
Dr. Sheares said future studies will focus on developing intervention programs aimed at
improving children’s sleep disorders.
“The study’s results may have significant implications for this group of children because while
pediatric sleep problems are universal and exist across all cultures, the impact of poor sleep is
magnified in vulnerable children,” she said.
“Inadequate sleep is a major health problem of childhood that often fails to receive attention until
significant health problems are noted, such as inattentiveness, memory loss and impaired
learning,” Dr. Sheares added. “The next step of this research is to carry out and 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.”
“Sleep Problems in Urban Minority Children May Be More Prevalent Than Previously
Recognized” (Session B73, Monday, May 16, 8:15 a.m.-4:30 p.m., Area C, Hall B (Upper
Level), Colorado Convention Center; Abstract 21627)
* Please note that numbers in this release may differ slightly from those in the abstract. Many of
these investigations are ongoing; the release represents the most up-to-date data available at
Sleep Problems In Urban Minority Children May Be More Prevalent Than Previously Recognized
Type: Scientific Abstract
Category: 14.04 – Pediatric Sleep and Control of Breathing (PEDS/SRN)
Authors: B.J. Sheares1, K.B. Dorsey2, C.I. Lamm1, Y. Wei3, M. Kattan1,R.B. Mellins1, D. Evans1; 1Columbia
University College of Physicians and Surgeons – New York, NY/US, 2Yale University – New Haven,
CT/US, 3Columbia University, Joseph L. Mailman School of Public Health – New York, NY/US
RATIONALE: Although studies consistently show that 20-43% of young children experience a range of sleep
problems, there is limited information on the sleep patterns of early school aged children living in low income,
urban, minority communities. Given the numerous exposures that could lead to inadequate sleep in this
vulnerable population, this is an important group to study. We utilized the Children’s Sleep Habits Questionnaire
(CSHQ), a validated screening instrument, to identify children with sleep problems in our population. Sleep
disturbances detected by the CSHQ have been linked to neurobehavioral and other health problems.
Additionally, actigraphy, an objective method of continuous, direct motion monitoring, was used to measure
sleep duration. Our goal was to determine the extent of sleep disorders in a group of 5-6 year old African
American and Latino children living in urban, economically disadvantaged communities. METHODS: Thirtythree
parents with healthy 5-6 year old children were randomly approached in 2 separate pediatric practices. All
parents who were approached for recruitment consented to participate in the study. Data were obtained via
face-to-face interviews using the CSHQ, sleep log records, and home actigraphy monitoring on a subset of the
group. RESULTS: Twenty-seven met eligibility requirements and completed the CSHQ. Twenty-four (89%)
scored greater than or equal to 41 on the CSHQ, indicating the presence of a sleep problem. Ten families
participated in actigraphy monitoring. Nine children yielded complete 7-night monitoring data. All children who
completed actigraphy monitoring had shortened sleep duration. Mean sleep duration was 8 hours/night on
average (SD = 0.81, Range 6.8-9) significantly less than the 10-11 hours recommended by the National Sleep
Foundation for children in this age group. Based on results from the CSHQ, parents of 62% of children reported
parasomnias, bedtime resistance (44%), daytime sleepiness (44%), shortened sleep duration (41%), night
waking (41%), sleep disordered breathing (26%), sleep anxiety (19%), and sleep onset delay (11%).
CONCLUSIONS: The results of this study suggest that sleep problems may be more prevalent than previously
recognized in urban, early school aged, minority children with CSHQ scores for 89% of children indicating the
presence of a sleep disturbance. Shortened sleep duration, parasomnias, bedtime resistance, daytime
sleepiness, sleep fragmentation as indicated by night waking, and sleep disordered breathing are the
predominant sleep problems detected in this study. These findings indicate the need for further study and
interventions that are tailored for use in this high risk population.