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The Effect of Prebedtime Behaviors on Sleep Duration and Quality in Children: Protocol for a Randomized Crossover
Rosie Jackson1, Chao Gu1, Jillian Haszard2
1Department of Medicine, University of Otago, Dunedin, New Zealand.
Insights
This study investigates how pre-sleep behaviors like screen time, physical activity, and eating affect children's sleep. Objective measures will determine if current sleep guidelines for youth are evidence-based.
Area of Science:
- Pediatric Sleep Science
- Behavioral Sleep Medicine
- Clinical Trial Research
Background:
- Current recommendations for children's pre-sleep routines lack robust evidence.
- Existing guidelines are based on limited, cross-sectional questionnaire data.
- There is a need for objective, experimental data on pre-bedtime behaviors and sleep health.
Purpose of the Study:
- To experimentally determine the impact of specific pre-bedtime behaviors on children's sleep.
- To use objective measures to assess sleep quantity and quality in youth.
- To provide evidence for refining sleep health guidelines for children.
Main Methods:
- A randomized crossover trial involving 72 children (aged 10-14.9 years).
- Four conditions: avoiding all three behaviors, screen use, physical activity, or eating before bed.
- Objective sleep measures (actigraphy, video) and adherence monitoring will be employed.
Main Results:
- Recruitment is ongoing, with results anticipated in late 2026.
- Data analysis will compare sleep outcomes across different pre-bedtime conditions.
- Objective data will be used to establish causal relationships.
Conclusions:
- This trial will provide objective evidence on the relationship between pre-bedtime activities and child sleep.
- Findings will inform the development of more accurate and practical sleep guidelines for children.
- Establishing causal links is crucial for evidence-based sleep health recommendations.
Background:
It is recommended that children should avoid eating dinner, being physically active, or using screens in the hour before bed to ensure good sleep health. However, the evidence base behind these guidelines is weak and limited to cross-sectional studies using questionnaires.
Objective:
The aim of this randomized crossover trial was to use objective measures to experimentally determine whether recommendations to improve sleep by banning electronic media, physical activity, or food intake in the hour before bed, impact sleep quantity and quality in the youth.
Methods:
After a baseline week to assess usual behavior, 72 children (10-14.9 years old) will be randomized to four conditions, which are (1) avoid all 3 behaviors, (2) use screens for at least 30 minutes, (3) be physically active for at least 30 minutes, and (4) eat a large meal, during the hour before bed on days 5 to 7 of weeks 2 to 5. Families can choose which days of the week they undertake the intervention, but they must be the same days for each intervention week. Guidance on how to undertake each intervention will be provided. Interventions will only be undertaken during the school term to avoid known changes in sleep during school holidays. Intervention adherence and shuteye latency (time from getting into bed until attempting sleep) will be measured by wearable and stationary PatrolEyes video cameras (StuntCams). Sleep (total sleep time, sleep onset, and wake after sleep onset) will be measured using actigraphy (baseline, days 5 to 7 of each intervention week). Mixed effects regression models with a random effect for participants will be used to estimate mean differences (95% CI) for conditions 2 to 4 compared with condition 1.
Results:
Recruitment started in March 2024, and is anticipated to finish in April 2025. Following data analysis, we expect that results will be available later in 2026.
Conclusions:
Using objective measures, we will be able to establish if causal relationships exist between prebedtime behaviors and sleep in children. Such information is critical to ensure appropriate and achievable sleep guidelines.
Trial Registration:
Australian New Zealand Clinical Trials Registry ACTRN12624000206527; https://tinyurl.com/3kcjmfnj.
International Registered Report Identifier (Irrid):
DERR1-10.2196/63692.
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