Introduction
Methods
Study design
Measures
Description | |
---|---|
Bedtime resistance | This category assesses if the child falls asleep in his/her own bed, if he/she has a regular bedtime, if he/she needs a parent in the room, struggles at bedtime, or is afraid of sleeping alone |
Sleep onset delay | Is defined as a delay of 20 min or more |
Sleep duration | Assesses if the sleep duration is adequate and whether the child sleeps the same amount each day |
Sleep anxiety | Does the child need a parent in the room, is he/she afraid of sleeping alone or in the dark, does he/she have trouble sleeping away from home? |
Night wakening | Most healthy young children wake up during the night but usually resume sleep without parental awareness or intervention. Referred children are more likely to have difficulty falling back to sleep and require more parental interventions. Questions include frequency of night wakenings and switching to another person’s bed [28] |
Parasomnias | Sleep disorders due to central nervous system arousal, leading to motor or autonomic activation [2]. Assesses bedwetting, talking during sleep, sleepwalking, bruxism, night terrors, and restlessness |
Sleep-disordered breathing | This category includes primary snoring, upper airway resistance syndrome, obstructive hypoventilation, and obstructive sleep apnea. It is most prevalent in children 2–6 years old (due to adenotonsillar hypertrophy), in adolescents (related to obesity), and during the first year of life (anatomic and neurologic problems) [28] |
Daytime sleepiness | This category includes questions regarding waking up in the morning (with help from others, time to alertness, difficulties getting up, and negative mood) and sleepiness during the day (falling asleep watching TV or riding in a car) |
Statistical analysis
Results
Demographics
Children’s sleep habits questionnaire
CSHQ score | All | 2–6 years | 7–10 years | 10–14 years | ||||
---|---|---|---|---|---|---|---|---|
Mean (95% CI) |
N
| Mean (95% CI) |
N
| Mean (95% CI) |
N
| Mean (95% CI) |
N
| |
Total score | 40.50 (40.21–40.80) | 1,282 | 40.83 (40.21–41.44) | 283 | 40.57 (40.09–41.04) | 554 | 40.16 (39.66–40.65) | 412 |
Subscale item | ||||||||
Bedtime resistanceb
| 6.68 (6.61–6.76) | 1,375 | 6.83 (6.64–7.02) | 305 | 6.74 (6.62–6.86) | 583 | 6.48 (6.38–6.59) | 452 |
Sleep onset delaya
| 1.30 (1.27–1.33) | 1,507 | 1.12 (1.08–1.16) | 323 | 1.29 (1.24–1.33) | 632 | 1.43 (1.37–1.49) | 507 |
Sleep durationa
| 3.50 (3.45–3.55) | 1,430 | 3.39 (3.30–3.48) | 310 | 3.49 (3.42–3.57) | 606 | 3.57 (3.48–3.66) | 478 |
Sleep anxietyb
| 4.86 (4.79–4.93) | 1,359 | 5.10 (4.94–5.26) | 300 | 4.96 (4.84–5.07) | 580 | 4.56 (4.46–4.67) | 445 |
Night wakeningb
| 3.62 (3.56–3.67) | 1,368 | 3.91 (3.76–4.05) | 304 | 3.59 (3.50–3.67) | 583 | 3.44 (3.37–3.52) | 443 |
Parasomniasb
| 8.57 (8.48–8.66) | 1,355 | 8.89 (8.68–9.09) | 301 | 8.64 (8.50–8.78) | 584 | 8.23 (8.10–8.36) | 437 |
Sleep-disordered breathingb
| 3.30 (3.26–3.33) | 1,318 | 3.40 (3.30–3.49) | 293 | 3.29 (3.24–3.35) | 567 | 3.24 (3.19–3.29) | 422 |
Daytime sleepinessa
| 11.16 (11.02–11.30) | 1,424 | 10.89 (10.63–11.15) | 308 | 11.02 (10.80–11.24) | 606 | 11.52 (11.27–11.77) | 471 |
CSHQ score | Problem sleepersa
| Non-problem sleepers | ||
---|---|---|---|---|
Mean (95% CI) |
N
| Mean (95% CI) |
N
| |
Total score* | 44.72 (44.01–45.43) | 265 | 39.25 (38.95–39.54) | 888 |
Subscale item | ||||
Bedtime resistance* | 8.81 (8.29–9.34) | 85 | 6.54 (6.48–6.61) | 1,290 |
Sleep onset delay* | 2.11 (1.94–2.28) | 83 | 1.25 (1.22–1.28) | 1,424 |
Sleep duration* | 4.88 (4.56–5.20) | 78 | 3.42 (3.37–3.46) | 1,352 |
Sleep anxiety* | 7.07 (6.72–7.42) | 90 | 4.70 (4.64–4.77) | 1,269 |
Night wakening* | 5.74 (5.30–6.18) | 44 | 3.55 (3.50–3.60) | 1,324 |
Parasomnias* | 10.85 (10.42–11.28) | 93 | 8.40 (8.32–8.49) | 1,262 |
Sleep-disordered breathing* | 5.08 (4.40–5.75) | 13 | 3.28 (3.24–3.31) | 1,305 |
Daytime sleepiness* | 13.77 (13.20–14.34) | 112 | 10.94 (10.80–11.07) | 1,312 |
Sleep self-report
Correlation children’s sleep habits questionnaire and sleep self-report
Item | SSR mean (95% CI) | CSHQ mean (95% CI) |
r
a
|
p
|
---|---|---|---|---|
Child falls asleep within 20 min | 2.11 (1.99–2.23) | 1.39 (1.28–1.49) | 0.42 | <.001 |
Child is afraid of sleeping alone | 1.16 (1.09–1.23) | 1.12 (1.06–1.18) | 0.35 | <.001 |
Child is afraid of sleeping in the dark | 1.35 (1.26–1.45) | 1.30 (1.20–1.41) | 0.24 | .005 |
Difficulty getting out of bed in the morning | 2.12 (2.01–2.24) | 1.58 (1.47–1.68) | 0.21 | .01 |
Child sleeps too little | 1.54 (1.44–1.64) | 1.29 (1.21–1.36) | 0.16 | NS |
Child falls asleep in parent's or sibling's bed | 1.33 (1.23–1.43) | 1.12 (1.06–1.18) | 0.16 | .05 |
Child moves to someone else's bed | 1.21 (1.14–1.28) | 1.06 (1.02–1.10) | 0.15 | .04 |
Child goes to bed at same time | 1.67 (1.57–1.77) | 1.06 (1.02–1.11) | 0.15 | NS |
Child seems tired | 1.56 (1.47–1.66) | 1.30 (1.22–1.39) | 0.06 | NS |
Child awakes once during night | 1.59 (1.49–1.69) | 1.35 (1.25–1.44) | 0.07 | NS |
Child struggles at bedtime | 1.34 (1.25–1.42) | 1.13 (1.05–1.20) | 0.05 | NS |
Cultural comparison
CSHQ score | Netherlands | USAa
| Netherlands | Chinaa
| ||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
Age 7.53 ± 1.98 years (range, 4–11) | Age 7.56 years (range, 4.8–11) | Age 10.07 ± 1.78 years (range, 7–13.7) | Age 11 years (range, 7–13) | |||||||||
Mean | SD |
N
| Mean | SD |
N
| Mean | SD |
N
| Mean | SD |
N
| |
Total scoreb,c
| 40.67 | 5.50 | 926 | 38.71 | 5.51 | 357 | 40.27 | 5.30 | 815 | 42.11 | 7.43 | 292 |
Subscale item | ||||||||||||
Bedtime resistanceb,c
| 6.71 | 1.45 | 987 | 7.01 | 1.80 | 393 | 6.60 | 1.29 | 878 | 7.92 | 2.49 | 292 |
Sleep onset delayc
| 1.27 | 0.55 | 1,071 | 1.26 | 0.54 | 415 | 1.36 | 0.64 | 973 | 1.28 | 0.60 | 292 |
Sleep durationc
| 3.49 | 0.93 | 1,020 | 3.44 | 0.98 | 408 | 3.54 | 0.97 | 925 | 4.21 | 1.53 | 292 |
Sleep anxietyc,d
| 4.97 | 1.38 | 979 | 4.86 | 1.43 | 387 | 4.74 | 1.25 | 868 | 5.58 | 1.98 | 292 |
Night wakeningb,c
| 3.65 | 1.06 | 988 | 3.49 | 0.88 | 388 | 3.47 | 0.84 | 869 | 3.85 | 1.27 | 292 |
Parasomniasb
| 8.67 | 1.73 | 985 | 8.14 | 1.31 | 382 | 8.40 | 1.54 | 864 | 8.46 | 2.06 | 292 |
Sleep-disordered breathingc
| 3.32 | 0.70 | 953 | 3.28 | 0.67 | 391 | 3.24 | 0.55 | 836 | 3.34 | 0.97 | 292 |
Daytime sleepinessb,c
| 11.06 | 2.65 | 1,019 | 9.72 | 2.89 | 387 | 11.27 | 2.83 | 915 | 10.22 | 3.10 | 292 |