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Sleep characteristics of young children in Japan: internet study and comparison with other Asian countries

Kohyama J, Mindell JA, Sadeh A

Pediatr Int, 2011 Oct;53(5):649-655.
PMID: 21199167 DOI: 10.1111/j.1442-200X.2010.03318.x

BACKGROUND: A recent international Internet-based study of young children (birth to 36 months) found that total sleep duration in Japan was the shortest among 17 countries/regions. The present study compared features of children's sleep in Japan relative to those in other Asian countries/regions.
METHODS: Parents of 872 infants and toddlers in Japan (48.6% boys), and parents of 20 455 infants and toddlers in 11 other Asian countries/regions (48.1% boys; China, Hong Kong, India, Indonesia, Korea, Malaysia, Philippines, Singapore, Taiwan, Thailand, and Vietnam) completed an Internet-based expanded version of the Brief Infant Sleep Questionnaire.
RESULTS: Young children in Japan exhibited significantly fewer nocturnal wakings and shorter daytime sleep in comparison with other Asian countries/regions. Although the former finding was apparent in all age groups, the reduced duration of daytime sleep in Japan was not present until after 3 months of age. Interestingly, sleep problems were reported by significantly fewer parents in Japan compared with those in other Asian countries/regions, although parents in Japan reported significantly more difficulty at bedtime.
CONCLUSIONS: The short sleep duration of young children in Japan is largely due to a relatively short duration of daytime sleep. Significant differences in sleep characteristics in Japan relative to other Asian regions were found primarily after 3 months of age. Future studies should further explore the underlying causes and the potential impacts of these sleep differences.
Cross-cultural differences in the sleep of preschool children

Mindell JA, Sadeh A, Kwon R, Goh DY

Sleep Med, 2013 Dec;14(12):1283-9.
PMID: 24269649 DOI: 10.1016/j.sleep.2013.09.002

The aim of our study was to characterize cross-cultural sleep patterns and sleep problems in a large sample of preschool children ages 3-6years in multiple predominantly Asian (P-A) and predominantly Caucasian (P-C) countries/regions.
Fulltext Cross-cultural comparison of maternal sleep

Mindell JA, Sadeh A, Kwon R, Goh DY

Sleep, 2013 Nov;36(11):1699-706.
PMID: 24179304 DOI: 10.5665/sleep.3132

BACKGROUND:
To characterize cross-cultural sleep patterns and sleep problems in a large sample of mothers of children (ages birth to 6 years) in multiple predominantly Asian and predominantly Caucasian countries.

METHODS:
Mothers of 10,085 young children (predominantly Asian countries/regions: China, Hong Kong, India, Korea, Japan, Malaysia, Philippines, Singapore, Thailand; predominantly Caucasian countries: Australia, Canada, New Zealand, United Kingdom, United States) completed an internet-based expanded version of the Pittsburgh Sleep Quality Index.

RESULTS:
Mothers in predominantly Asian countries/regions had later bedtimes, decreased number and duration of night wakings, more nighttime sleep, and more total sleep than mothers from predominantly Caucasian countries, P < 0.001. More than half (54.7%) of mothers reported having poor sleep, ranging from 50.9% of mothers in Malaysia to 77.8% of mothers in Japan. Sleep disturbance symptoms were quite common, especially symptoms related to insomnia, and were more likely to be reported by mothers in predominantly Caucasian countries. However, psychosocial factors, including having children of a younger age, being unemployed, and having a lower education level were the best predictors of poor sleep, whereas culture was not a significant predictor.

CONCLUSIONS:
Overall, mothers in predominantly Asian countries/regions reported later bedtimes but sleeping better and longer than mothers from predominantly Caucasian countries, which is dissimilar to cross-cultural findings of young children. Psychosocial factors were found to be the best predictors of poor sleep, irrespective of culture. Further studies are needed to understand the impact of these findings.

KEYWORDS:
Sleep; adult; cross-cultural; maternal; mother
Parental behaviors and sleep outcomes in infants and toddlers: a cross-cultural comparison

Mindell JA, Sadeh A, Kohyama J, How TH

Sleep Med, 2010 Apr;11(4):393-9.
PMID: 20223706 DOI: 10.1016/j.sleep.2009.11.011

BACKGROUND: To assess the prevalence of parental behaviors and other factors of sleep ecology and to analyze their relationships with sleep outcomes in a large sample of children ages birth to 36months in multiple countries/regions.
METHODS: Parents of 29,287 infants and toddlers (48% boys; Australia, Canada, China, Hong Kong, India, Indonesia, Korea, Japan, Malaysia, New Zealand, Philippines, Singapore, Taiwan, Thailand, United Kingdom, United States, and Vietnam) completed an internet-based expanded version of the Brief Infant Sleep Questionnaire.
RESULTS: Overall, there is a high level of parental involvement in sleep onset and sleep maintenance for young children, with significant differences in parenting behaviors across cultural groups. For predominantly-Caucasian, the most common behavior occurring at bedtime is falling asleep independently in own crib/bed (57%), compared to just 4% of those children living in predominantly-Asian regions. Parental behaviors and sleep ecology, including parental presence at sleep onset, bedtime, and bedtime routine, significantly explain a portion of the variance in sleep patterns. Overall, parental behaviors are more highly predictive of nighttime sleep outcomes in predominantly-Caucasian regions. Finally, parental involvement in sleep onset mediates the relationship between cosleeping and sleep outcomes.
CONCLUSIONS: Overall, the best predictors of nighttime sleep are related to parental behaviors at bedtime and during the night. Furthermore, sleep disruption and decreased total sleep associated with bed sharing and room sharing are mediated by parental presence at bedtime. These findings provide additional support for addressing parental behaviors in behavioral interventions for infant and toddler sleep problems.
Fulltext Bedtime routines for young children: a dose-dependent association with sleep outcomes

Mindell JA, Li AM, Sadeh A, Kwon R, Goh DY

Sleep, 2015 May;38(5):717-22.
PMID: 25325483 DOI: 10.5665/sleep.4662

Establishment of a consistent bedtime routine (the activities that occur right before lights out) is often recommended as part of healthy sleep habits. However, no studies have investigated the dose-dependent association of a bedtime routine with sleep outcomes, especially in young children for whom they are particularly recommended. Thus, the aim of this study was to examine the associations of a consistent bedtime routine with sleep outcomes in young children (ages 0 through 5 y) in a large global sample and assess whether there is a dose-dependent relationship between the frequency of a bedtime routine both concurrently and retrospectively with sleep outcomes.
Effect of current breastfeeding on sleep patterns in infants from Asia-Pacific region

Ramamurthy MB, Sekartini R, Ruangdaraganon N, Huynh DH, Sadeh A, Mindell JA

J Paediatr Child Health, 2012 Aug;48(8):669-74.
PMID: 22616943 DOI: 10.1111/j.1440-1754.2012.02453.x

AIM:
The aim of this study was to assess the relationship between breastfeeding and sleep patterns in infants from Asia-Pacific region.

METHODS:
Parents of 10 321 infants (0-11 months) from Australia, China, Hong Kong, India, Indonesia, Korea, Japan, Malaysia, New Zealand, the Philippines, Singapore, Taiwan, Thailand and Vietnam completed an expanded version of the Brief Infant Sleep Questionnaire.

RESULTS:
Overall, 4714 (45.72%) were currently being breastfed; 61.3% of those between 0 and 5 months and 36.6% of those between 6 and 11 months. Currently breastfed infants, when compared with not currently breastfed infants, had a significant increase in the number and duration of night-time wakings and less consolidated sleep. Interestingly, currently breastfed infants less than 6 months also showed longer duration of daytime sleep and obtained more sleep overall. Of note, of those who were currently breastfed, those infants who were nursed back to sleep during night, woke up more often at night (2.41 vs. 1.67 times) and had shorter continuous night-time sleep period (5.58 vs. 6.88 h; P < 0.001). There was no significant difference between breastfeeding and non-breastfeeding infants in the number of night wakings, when the nursing to sleep variable was controlled for in the analysis of variance.

CONCLUSION:
Breastfeeding is associated with reduced sleep consolidation in infants. This relationship, however, may be moderated by parenting practices of nursing to sleep and back to sleep during the night. Thus, parents of infants with night waking problems should be encouraged to limit the association between nursing and falling to sleep, to improve sleep while maintaining breastfeeding.
Cross-cultural differences in infant and toddler sleep

Mindell JA, Sadeh A, Wiegand B, How TH, Goh DY

Sleep Med, 2010 Mar;11(3):274-80.
PMID: 20138578 DOI: 10.1016/j.sleep.2009.04.012

BACKGROUND:
To characterize cross-cultural sleep patterns and sleep problems in a large sample of children ages birth to 36 months in multiple predominantly-Asian (P-A) and predominantly-Caucasian (P-C) countries.

METHODS:
Parents of 29,287 infants and toddlers (predominantly-Asian countries/regions: China, Hong Kong, India, Indonesia, Korea, Japan, Malaysia, Philippines, Singapore, Taiwan, Thailand, Vietnam; predominantly-Caucasian countries: Australia, Canada, New Zealand, United Kingdom, United States) completed an internet-based expanded version of the Brief Infant Sleep Questionnaire.

RESULTS:
Overall, children from P-A countries had significantly later bedtimes, shorter total sleep times, increased parental perception of sleep problems, and were more likely to both bed-share and room-share than children from P-C countries, p
Sleep education in medical school curriculum: a glimpse across countries

Mindell JA, Bartle A, Wahab NA, Ahn Y, Ramamurthy MB, Huong HT, et al.

Sleep Med, 2011 Oct;12(9):928-31.
PMID: 21924951 DOI: 10.1016/j.sleep.2011.07.001

The objective of this study was to assess the prevalence of education about sleep and sleep disorders in medical school education and to identify barriers to providing such education.