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Research ArticleSleep Habits of Elementary and Middle SchoolChildren in South Texas
Salim Surani,1,2 Sean Hesselbacher,3,4 Saherish Surani,2 Sreevidya Sadasiva,2
Zoya Surani,2 Sara S. Surani,5 Amina Khimani,6 and Shyam Subramanian7
1Texas A&M University, Corpus Christi, TX 78405, USA2Pulmonary Associates, Corpus Christi, TX 78336, USA3Sentara Healthcare, Virginia Beach, VA 23454, USA4Eastern Virginia Medical School, Norfolk, VA 23507, USA5Harvard University, Boston, MA 02138, USA6University of California, Berkeley, CA 94720, USA7Mercy Health, Cincinnati, OH 45202, USA
Correspondence should be addressed to Salim Surani; [email protected]
Received 23 August 2015; Revised 16 November 2015; Accepted 17 November 2015
Academic Editor: Marco Zucconi
Copyright 2015 Salim Surani et al. This is an open access article distributed under the Creative Commons Attribution License,which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Background. Sleep difficulties, including insufficient sleep and inadequate sleep hygiene, have been prevalent among children.Sleep deprivation can lead to poor grades, sleepiness, and moodiness. We undertook this study to assess the prevalence of sleepabnormalities among elementary andmiddle school students in SouthTexas andhow the groups comparewith one another.Method.After approval from the appropriate school district for a sleep education program, a baseline survey was taken of elementary andmiddle school students, using the Childrens Sleep Habit Questionnaire-Sleep Self-Report Form, which assessed the domains ofbedtime resistance, sleep onset delay, sleep anxiety, sleep duration, night awakening, and daytime sleepiness. Results. The surveywas completed by 499 elementary and 1008 middle school children. Trouble sleeping was reported by 43% in elementary school,compared with 29% of middle school children. Fifty percent of middle school children did not like sleeping, compared with 26% inelementary school. Bedtime resistance, sleep onset delay, and nighttime awakening were more common among elementary schoolstudents. Daytime sleepiness was more common among themiddle school children when compared to elementary school children.Conclusions. Sleep abnormalities are present in elementary school children with changes in sleep habits into middle school.
Insufficient sleep syndrome occurs when an individualpersistently fails to obtain the amount of sleep required tomaintain normal levels of alertness and wakefulness. Theindividual is chronically sleep deprived as a result of failureto achieve necessary sleep time due to reduced time inbed. Inadequate sleep hygiene is characterized by sleep andwake difficulties resulting from daily living activities that areinconsistent with the maintenance of good-quality sleep andnormal daytime alertness . These problems are commonamong adolescents and children .
The Centers for Disease Control currently recommend 9-10 hours of sleep nightly in teenagers and 10+ hours in schoolage children ; the National Sleep Foundation ScientificAdvisory Council similarly recommends 911 hours forschool age children and 810 hours for teenagers . Only15% of teens slept 8.5 hours or more on school nights and 70% have a bedtime of 10 PM or later. Common reasonsgiven for delayed sleep included homework, hanging outwith friends, television, stress, and part-time jobs . Arecently published yearly cross-sectional survey of adoles-cents revealed that the percentage of teens achieving7 hoursof sleep nightly decreases each year from ages 12 through 18
Hindawi Publishing CorporationSleep DisordersVolume 2015, Article ID 179103, 9 pageshttp://dx.doi.org/10.1155/2015/179103
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and has shown an overall decline over the past 20 years .Teens aremore inclined to have irregular sleep patterns acrosstheweek and tend to stay up late and sleep in late onweekends. Irregular sleep patterns are detrimental to the biologicalclock and affect sleep quality. Sleep deprivation can adverselyaffect academics, behaviors, and overall health [3, 4, 6, 11, 12].
Approximately, 90% of parents feel that their children aregetting adequate sleep. Conversely, 60% of the adolescentsreported difficulty getting out of bed in the morning andmajority of them required their parents to wake them upfor school [11, 13, 14]. These conflicting reports highlightdiscrepancies in the ways parents and children view theadequacy of the childrens sleep.
We undertook this study to assess the prevalence of sleep-related problems among school children in South Texas,including inadequate sleep hygiene and insufficient sleep, andto ascertain some of the differences in sleep habits betweenchildren of elementary and middle school ages. The majorityof the sleep related studies that have been conducted inUnited States of America and Europe have been on Cau-casian population. Very little research has been done amongUS Hispanic population. Based on the demographic andprevalent risk factors as diabetes, obesity, low socioeconomicfactors, high incidence of obstructive sleep apnea, and loweducational status points toward sleep habit . This isthe first attempt to get the epidemiological information asit relates to sleep among children in South Texas. 65% ofthe population in the region is of Hispanic ethnicity, withlow percentage of professionals, and only 21% of them arecollege graduates. There are 38,938 students enrolled in thisschool district; of those 78.9% are of Hispanic ethnicity .Enrollment in the middle schools is larger than that of theelementary schools as several feeder elementary schools feedinto one middle school; therefore, data were collected from1 middle school and 2 elementary schools. We attemptedto approximate the overall population demographics in thegroups chosen to answer the questionnaires: the ethniccomposition of the middle school is similar to that of theschool district as a whole. Elementary school #1 has a higherHispanic population, lower proportion of Caucasians, andlower socioeconomic status than the composition of theschool district; the inverse is true of elementary school #2.Weaimed to compare these groups based on self-reported sleephabits, which can often be different from the perception of theparents.
Participantswere elementary (4th and 5th grades) andmiddle(6th through 8th grades) school students taking part ina school-sponsored sleep education program. Permissionwas obtained from the Corpus Christi Independent SchoolDistrict prior to embarking on the broader sleep educationprogram. All elementary and middle schools in the schooldistrict were offered participation in the sleep educationprogram; 2 elementary and 1 middle schools were chosento participate in the first wave of education, with the base-line data reported here being collected from these schools.The schools were felt, by consensus of the investigators,
to represent the overall school district as closely as possi-ble. All participants completed the Childrens Sleep HabitsQuestionnaire-Sleep Self Report Form (CSHQ-SSRF). TheCSHQ is a validated tool, assessing students in the domainsof bedtime resistance, sleep onset delay, sleep anxiety, sleepduration, night awakening, anddaytime sleepiness, which hasdemonstrated good internal consistency in both communityand clinical samples . The CSHQ-SSRH is a 26-itemsurvey, which is designed to assess sleep domains similar tothe CSHQ, completed by the student (rather than parent orcaregiver) [18, 19]. The items are grouped into six blocks,with each addressing an aspect of sleep quality/quantity, andare answered based on a 3-point scale. The points systemdesignates usually (57 times/week), sometimes (24times/week), and rarely (0-1 times/week); a higher scoreindicates more abnormal sleep . The sum of the scoresfor the whole questionnaire (questions 2 through 26) hasa possible maximum score of 73 and a minimum score of23. All completed questionnaires were accepted for analysis;incomplete questionnaires were excluded.
2.1. Statistics. Statistical analysis was performed using RStatistical Software (Foundation for Statistical Computing,Vienna, Austria). The proportion of responses to the ques-tionnaire was calculated to determine baseline sleep habitsand problems. The mean scores were calculated for eachquestion and the overall questionnaire. -test was performedon the mean scores of each group of questions (exceptgroup 2 which is a single question) to detect the differencesbetween the groups. As shown in Figure 1, the distributionof total questionnaire scores for each group of students wasnormally distributed; the same was assumed to hold truefor groups of multiple questions. Because the responses tosingle questions were categorical data, the proportion ofresponses to each questionwas compared between the groupsusing contingency tables. A value of
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Table 1: Demographic characteristics of the students.
School Elementary #1 Elementary #2 MiddleEthnicity
Hispanic 68.5% 47.4% 67.3%Caucasian 24.4% 39.8% 23.6%African American 5.8% 2% 6%Asian/Pacific Islander 1.3% 10.1% 2.9%Native American 0% 0.6% 0.2%
Risk factorsEconomically disadvantaged 58.7% 29.4% 36.8%At risk 42.3% 18.3% 30%Limited English proficient 1.9% 3.8% 0.1%
Teacher experience (mean years) 16.8 17.6 15.8
40 50 6030Overall scores of the sleep questionnaire
Mean = 44.09
35 40 45 50 55 6030Overall scores of the sleep questionnaire
Mean = 44.18
Figure 1: Distribution of the total questionnaire