Commentary: Broadening the Reach: Multidimensional Sleep Health and Cultural Diversity in Pediatric Sleep Research
Year: 2024
Type: editorial
Abstract: The concept of “multidimensional sleep health” as a holistic approach to understanding sleep and wellbeing is increasingly being recognized and utilized. The pediatric multidimensional sleep health framework defines six dimensions of sleep health: sleep-related Behaviors (e.g. screen use before bed, caffeine intake), sleep Satisfaction/quality (e.g. how pleased a child feels with their night of sleep), daytime Alertness/sleepiness, sleep Timing (e.g., bed and wake times), sleep Efficiency (e.g., sleep continuity), and sleep Duration (B-SATED) (Meltzer & Paisley, 2023; Meltzer et al., 2021). Multidimensional sleep health considers individual, family, and sociocultural factors that both promote and inhibit sleep and values subjective assessment of sleep. Mitchel et al. (2023) take a unique approach to the concept of multidimensional sleep health by considering two categories of sleep, sleep disturbance and sleep-related impairment, using latent variable mixture modeling (LVMM) to identify sleep profiles in a sample of predominantly Hispanic/Latin elementary school-aged children (Mitchel et al., 2023). Based on children’s self-report of their sleep during the academic year, three profiles arose: (1) “Average Sleep Disturbance and Impairment,” (2) “Elevated Sleep Disturbance and Average Sleep Impairment,” and (3) “Elevated Sleep Disturbance and Impairment” (Mitchel et al., 2023). Youth with elevations in both sleep disturbance and impairment had the poorest self- and teacher-reported mood and behavior at baseline, with worsening scores 6 months later (Mitchel et al., 2023). However, while those with sleep disturbance but not impairment had elevated mood and behavioral problems at baseline compared to those with no sleep disturbance or impairment, their functioning improved at 6-month follow-up. This is an interesting finding given that prior research has longitudinally associated sleep disturbance with elevated depression and anxiety (Gregory & Sadeh, 2016). Mitchel et al. do not explicitly claim to measure multidimensional sleep health. However, the measures with which they assess sleep disturbance and sleep impairment are the same as measures commonly used to evaluate two aspects of multidimensional sleep health: sleep satisfaction/quality and daytime alertness/sleepiness (Meltzer & Paisley, 2023, Mitchel et al., 2023). Therefore, the Mitchel et al. sleep disturbance scores also measure sleep satisfaction/quality, and the sleep impairment scores likewise represent daytime alertness/sleepiness. In the future, we can potentially synthesize the existing literature base by examining what aspects of multidimensional sleep health may have been assessed previously. This would entail a systematic review or meta-analysis of pediatric sleep and psychology research that examines sleep scoring methodology across papers to (1) ascertain if measures are consistent with B-SATED criteria even if multidimensional sleep health was not an original focus, and (2) assess how the results of studies analyzed in the first objective compare with regards to the same sleep health criteria. As the field moves toward considering multidimensional sleep health, this work will allow for greater, more consistent evaluation and synthesis across studies. Additionally, Mitchel et al. used self-report measures, which are advantageous for assessing sleep quality and sleepiness, subjective criteria judged by the child themselves, but future research could also consider including parent report and objective measure to address other multidimensional sleep health criteria. Further, Mitchel et al.’s use of LVMM with just these two aspects of multidimensional sleep health suggests that more unique profiles may emerge upon examining additional sleep health domains (Mitchel et al., 2023). Given that the sleep profiles identified by Mitchel et al. were differentially associated with emotional and behavioral health, it is possible that different combinations of strengths and weaknesses in sleep health may relate to varying aspects of wellness (Mitchel et al., 2023). Thus, future research employing LVMM on additional aspects of multidimensional sleep health is recommended to identify those that may be at risk or protected from emotional and behavioral health impairment, and who may benefit most from targeted and tiered intervention. Utilizing sleep health profiles to develop and test differential interventions to improve sleep health may be a novel next step to address emotional and behavioral health in school-age children. Notably, participants in the Mitchel et al. study who identified as Hispanic/Latinx ethnicity were more likely to be in the Elevated Sleep Disturbance and Average Sleep Impairment category (Mitchel et al., 2023). This finding appears to be consistent prior literature showing that children from historically minoritized backgrounds have more sleep difficulties, particularly shorter duration and sleep quality, but similar daytime sleepiness compared to white, non-Hispanic US children (Guglielmo et al., 2018; Ordway et al., 2023; Smith et al., 2019). Environmental disturbances, microaggressions, discrimination, acculturation, and systemic racism have all been suggested as causes for sleep health disparities (Billings et al., 2021; Roncoroni et al., 2022). However, Mitchel et al. posit that the elevations on the sleep disturbance scale may be related to differences in sleep routines and expectations common in Hispanic culture rather than true sleep problems (Mitchel et al., 2023). Unfortunately, very little is known regarding cultural differences in pediatric sleep health: to date, only a single study interviewed Hispanic parents about their practices and beliefs about their children’s sleep (Gray et al., 2022; Roncoroni et al., 2022). Results from majority white, non-Hispanic populations are not only less generalizable but also overlook those with the greatest need. A significant strength of the Mitchel et al. manuscript is the ethnically diverse, majority Hispanic study population (Mitchel et al., 2023). Their findings overall redouble the call for more ethnically and racially diverse populations in future research to inform culturally sensitive evidence-based intervention development. Healthy sleep is essential for the wellbeing of school-age children, yet, over a fifth of school-age children, particularly youth of color, experience sleep difficulties (Lewien et al., 2021; Matricciani et al., 2019). Mitchel et al. demonstrate that not only do distinct profiles of sleep disturbance and impairment emerge in school-age children, these profiles are associated with emotional and behavioral health in an ethnically diverse population (Mitchel et al., 2023). This is of particular concern at a time when both sleep disturbances and mental health symptoms in school-age children have risen dramatically during and following the coronavirus disease 2019 pandemic (Racine et al., 2021; Sharma et al., 2021; Stearns et al., 2022). Further research is needed to expand profiles to include additional aspects of multidimensional sleep health. This work may be used to develop tiered and targeted interventions to improve sleep health and mental health in school-age children. Furthermore, there is a critical need for more studies in diverse populations to make such interventions culturally sensitive in order to diminish prevalent sleep disparity. None declared.
Source: Journal of Pediatric Psychology
Authors: Jordan A Davidson, Stacey L Simon
Language: English
Topic: Sleep and related disorders
Subfield: Experimental and Cognitive Psychology
Field: Psychology
Domain: Social Sciences
Open Access status: bronze
OpenAlex ID: W4390858276