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We tested the relationship of objectively measured sleep quantity and quality with positive characteristics of the child. Sleep duration, sleep latency and sleep efficiency were measured by an actigraph for an average of seven (range = 3–14) consecutive nights in 291 8-year-old children (standard deviation = 0.3 years). Children’s optimism, self-esteem and social competence were rated by parents and/or teachers. Sleep duration showed a non-linear, reverse J-shaped relationship with optimism (P = 0.02), such that children with sleep duration in the middle of the distribution scored higher in optimism compared with children who slept relatively little. Shorter sleep latency was related to higher optimism (P = 0.01). The associations remained when adjusting for child’s age, sex, body mass index, and parental level of education and optimism. In conclusion, sufficient sleep quantity and good sleep quality are related to children’s positive characteristics. Our findings may inform why sleep quantity and quality and positive characteristics are associated with wellbeing in children.
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- Materials and methods
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Insufficient sleep quantity and poor sleep quality, defined as short sleep duration, long sleep latency and low sleep efficiency, are common among adults as well as children. In industrialized countries, the average sleep duration among adults (Bonnet and Arand, 1995; Rajaratnam and Arendt, 2000; Iglowstein et al., 2003) has decreased substantially during the past few decades, and complaints about poor sleep quality are frequent (Heath et al., 1998; Sateia et al., 2000). Estimates are that between 20 and 40% of children suffer from poor sleep (Fricke-Oerkermann et al., 2007; Liu et al., 2005; Smaldone et al., 2007), with half of them having persistent problems over time (Fricke-Oerkermann et al., 2007).
Epidemiological evidence in adults shows that both short and/or long sleep duration and poor sleep quality relate to a wide spectrum of detrimental physical health consequences, such as obesity (Gangwisch et al., 2005; Hasler et al., 2004; Patel and Hu, 2008; Vioque et al., 2000), type 2 diabetes (Ayas et al., 2003b; Gangwisch et al., 2007; Knutson et al., 2006; Yaggi et al., 2006), hypertension (Gangwisch et al., 2006), coronary heart disease (Ayas et al., 2003a) and even premature death (Ferrie et al., 2007; Heslop et al., 2002; Hublin et al., 2007; Kojima et al., 2000; Kripke et al., 2002; Tamakoshi and Ohno, 2004). Insufficient sleep quantity is also associated with poor health in children and adolescents. Children with shorter sleep duration are more likely to be obese (Patel and Hu, 2008; for meta analyses, see Cappuccio et al., 2008; Chen et al., 2008), and prospective studies show that short sleep duration predicts a higher body mass index (BMI) later in childhood (Reilly et al., 2005) and in adolescence (Snell et al., 2007). Furthermore, poor sleep in children is associated with poorer cognitive performance (Meijer et al., 2000; Randazzo et al., 1998; Sadeh et al., 2002; Touchette et al., 2007), and with depression, anxiety, conduct problems and hyperactivity (Aronen et al., 2000; Cohen-Zion and Ancoli-Israel, 2004; El-Sheikh et al., 2007; Gregory and O’Connor, 2002; Gregory et al., 2004; Ivanenko et al., 2006).
Relative to the wealth of studies focusing on the negative consequences of poor sleep, much less is known about the beneficial consequences of sufficient sleep quantity and good sleep quality. There is evidence that adults who get adequate sleep report more optimism and satisfaction with life compared with adults who sleep less than 6 h a night (National Sleep Foundation, 2002). Experimentally induced sleep deprivation in adults results in a gradual reduction in optimism and sociability, suggesting that the association between sufficient sleep and these positive characteristics may be causal (Haack and Mullington, 2005). In adolescents, longer sleep duration predicts prospectively higher self-esteem (Fredriksen et al., 2004). We are not aware of any studies focusing on associations between sufficient sleep quantity, good sleep quality and positive characteristics in young children.
Accordingly, we examined if children’s objectively measured sleep quantity and quality are associated with their level of optimism rated by parents, and with their level of self-esteem and social competence rated by parents and teachers. We focused on optimism, self-esteem and social competence, as a wealth of evidence suggests that these are important characteristics promoting good physical and mental health in children and/or in adults (Aspinwall and Taylor, 1992; Ben-Zur, 2003; Bromberger and Matthews, 1996; Burt et al., 2008; Carvajal et al., 1998; Chang and Mackenzie, 1998; Matthews et al., 2004; McGee and Williams, 2000; O’Donnell et al., 2008; Orth et al., 2008; Räikkönen et al., 1999; Reitzes and Mutran, 2006; Roberts et al., 1998; Scheier and Carver, 2003; Stamatakis et al., 2004; Trzesniewski et al., 2006). Indeed, more optimistic/less pessimistic children and/or adolescents show lower ambulatory blood pressure (Räikkönen and Matthews, 2008), and they report more positive and less negative effects, depression, hopelessness, suicidal ideation and substance abuse (Ben-Zur, 2003; Carvajal et al., 1998; Roberts et al., 1998). Parents report that their more optimistic children have less internalizing and externalizing behaviour problems (Lemola et al., 2010). Children and/or adolescents with higher self-esteem show better self-, parent- and teacher-rated psychological adjustment, better self-reported school adjustment, higher grade levels, less self-reported delinquency and health-compromising behaviour, and better objective and subjective health later in life (Aspinwall and Taylor, 1992; Donnellan et al., 2005; McGee and Williams, 2000; Orth et al., 2008; Trzesniewski et al., 2006). Higher social competence in children relates to better peer-reported social acceptance, less parent- and teacher-reported problem behaviour, higher grade levels, and predicts a lower risk to develop psychopathology later in life (Burt et al., 2008; Chen et al., 2000; Rubin et al., 1998). We hypothesized that children whose sleep duration is sufficient (not short or long in duration), and who have shorter sleep latency and higher sleep efficiency would be more optimistic and less pessimistic, and would have higher self-esteem and social competence, relative to their same-aged peers with compromised sleep quantity and quality.
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On average the children slept for 8.4 h (SD = 40 min), their average sleep latency was 19 min (SD = 11 min), and they were asleep on average for 84.0% (SD = 5.9%) of the time they spent in bed. Sleep duration correlated significantly with sleep efficiency (r = 0.80) and sleep latency (r = −0.19), and sleep latency correlated with sleep efficiency (r = −0.48; all P-values < 0.001). In Table 1, means and standard deviations for sleep duration, sleep latency and sleep efficiency are displayed separately for girls and boys. In comparison to boys, girls slept on average longer (P = 0.001), their sleep latency was marginally shorter (P = 0.06) and their sleep efficiency higher (P = 0.01).
Table 1. Characteristics of the sample
| ||Girls N = 150||Boys N = 141||P|
|Mean N||(SD) (%)||Mean N||(SD) (%)|
| Age (years)||8.1||(0.3)||8.2||(0.3)||0.096|
| Weight (kg)||28.3||(5.2)||29.4||(7.5)||0.160|
| Height (cm)||130.4||(5.3)||131.8||(5.9)||0.033|
| BMI (kg m−2)||16.6||(2.2)||16.9||(4.2)||0.945|
| Maternal age (years)||39.1||(4.4)||38.4||(4.5)||0.195|
| Paternal age (years)||41.1||(5.1)||40.9||(6.4)||0.819|
| Highest education in the family|
| High-school diploma||16||(10.7)||23||(16.3)||0.158|
| Vocational education||48||(32.0)||31||(22.0)|| |
| Some college||24||(16.0)||20||(14.2)|| |
| Degree beyond college||62||(41.3)||67||(47.5)|| |
|PLOT-Scales (mother- and father ratings averaged):|
| Total optimism||27.2||(2.2)||26.6||(2.6)||0.016|
| Optimism subscale||12.3||(1.7)||11.9||(1.9)||0.032|
| Pessimism subscale||5.1||(1.1)||5.2||(1.1)||0.332|
|Self-esteem (mother, father and teacher ratings averaged)||50.0||(4.3)||47.6||(5.2)||<0.001|
|Social competence (mother, father and teacher ratings averaged)||46.7||(4.9)||43.1||(5.9)||<0.001|
|Sleep quantity and quality:|
| Sleep duration (h)||8.5||(0.6)||8.3||(0.7)||0.001|
| Sleep latency (min)||18.1||(9.8)||20.2||(11.4)||0.064|
| Sleep efficiency (%)||84.9||(6.0)||83.2||(5.7)||0.013|
Table 1 also presents, for girls and boys separately, the means and standard deviations for parent-rated total optimism score, and optimism and pessimism subscale scores, as well as parent- and teacher-rated self-esteem and social competence scores. On average, the girls were rated as more optimistic (P-values < 0.03) and higher in self-esteem and social competence than were the boys (both P-values < 0.001); girls and boys did not differ in pessimism (P = 0.20).
Sleep quantity, quality and positive characteristics
Table 2 shows that sleep duration had a non-linear relationship with parent-rated optimism (total optimism score: R2 change = 2.0%, P = 0.02; optimism subscale score: R2 change = 2.7%, P = 0.005). Children in the middle of the distribution of sleep duration were rated as more optimistic (Fig. 1) than children in the shorter or longer ends of the distribution of sleep duration. Categorical analyses of sleep duration revealed that children whose sleep duration was between the 10th and 90th percentiles of the distribution were more optimistic (total optimism score: R2 change = 2.3%, P = 0.01; optimism subscale score: R2 change = 2.6%, P = 0.009) than children whose sleep duration was short (below 10th percentile); average (10th–90th percentiles) and long sleepers (above 90th percentile) did not differ significantly from each other (P-values > 0.16).
Table 2. Associations of sleep quantity and quality with parent-rated optimism, and parent- and teacher-rated self-esteem, and social competence of the child
|Sleep quantity and quality||Total optimism||Optimism subscale||Pessimism subscale||Self-esteem||Social competence|
| Linear effect||0.08||0.161||0.08||0.206||−0.06||0.309||0.04||0.515||0.06||0.309|
| Non-linear effect||−0.15||0.015||−0.17||0.005||0.04||0.469||−0.05||0.373||−0.10||0.096|
| Average (7.7–9.3 h) versus|
| Short (≤7.6 h)||−0.15||0.014||−0.16||0.009||0.07||0.291||−0.05||0.444||−0.07||0.239|
| Long (≥9.4 h)||0.04||0.537||0.00||0.977||−0.09||0.166||−0.02||0.720||−0.04||0.478|
| Linear effect||−0.15||0.010||−0.13||0.024||0.12||0.044||−0.11||0.060||0.04||0.515|
| Short-average (<32 min) versus|
| Long (>32 min)||−0.08||0.179||−0.05||0.356||0.08||0.162||−0.12||0.026||−0.03||0.620|
| Linear effect||0.07||0.265||0.07||0.226||−0.03||0.603||−0.01||0.892||−0.01||0.809|
| Average-high (>77.4%) versus|
| Low (<77.4%)||−0.05||0.443||−0.09||0.131||−0.04||0.523||0.01||0.905||0.01||0.823|
Figure 1. Non-linear relationship between sleep duration and parent-rated dispositional optimism (total score) of the child. Linear regression equation: y = 0.4b + 23.8; non-linear regression equation: y = −0.6b2 + 9.8b– 16.0.
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Table 2 also shows that sleep latency and parent-rated optimism (total optimism score: R2 change = 2.3%, P = 0.01; optimism subscale score: R2 change = 1.7%, P = 0.02) and pessimism (R2 change = 1.4%, P = 0.04), and combined parent- and teacher-rated self-esteem (R2 change = 1.1%, approaching statistical significance, P = 0.06) were linearly related. The shorter the sleep latency, the higher was the child’s optimism and self-esteem, and the lower the child’s pessimism. Analyses of sleep latency as a dichotomous variable revealed no significant differences between children with short to average and long sleep latency in optimism and social competence, while there was a difference in self-esteem: the children with a short to average sleep latency were higher in parent- and teacher-rated self-esteem (R2 change = 1.5%, P = 0.03). All the significant associations listed above were adjusted for child’s age, sex, BMI and highest education in the family. The significant associations between sleep and child optimism remained also when further controlling for maternal and paternal optimism (all P-values < 0.05).
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We examined if sufficient sleep quantity and good sleep quality are associated with optimism, self-esteem and social competence in children. In accordance with our hypothesis, we found a non-linear relationship between sleep duration and optimism. The relation resembled a reverse J-shaped curve, such that children whose sleep duration was in the middle of the distribution scored higher on optimism compared with children who slept relatively little. Further, children with shorter sleep latency scored higher on optimism and tended to have higher scores on self-esteem. The associations remained when adjusting for child’s age, sex, BMI and parental level of education, factors that may increase risk for less optimal sleep patterns and/or for lower scores on positive characteristics. Additionally, the association of sleep with optimism did not change when the parent ratings of their own optimism were controlled.
Our findings in the 8-year-old children are consistent with the previous epidemiological and experimental studies in adults (Haack and Mullington, 2005; National Sleep Foundation, 2002). The findings are, however, not in line with those by Fredriksen et al. (2004) who showed that adolescents who report sleeping longer scored higher on self-esteem. There are methodological differences in the measurement of sleep duration, however, between the current and the Fredriksen et al. (2004) study that may explain the differences. While the present study relied on actigraphy measurement of sleep, participants of the Fredriksen et al. (2004) study reported their sleep duration on a survey questionnaire. It is also worth noting that adolescence is a period when the biological need for sleep is altered (e.g. Iglowstein et al., 2003). Therefore, our findings in prepubertal children do not necessarily apply to adolescents.
Data in adults and adolescents show that optimism and self-esteem are predictors of good physical and mental health. For instance, optimistic adults have lower ambulatory blood pressure levels (Räikkönen et al., 1999), and are less likely to develop signs of subclinical cardiovascular disease (Matthews et al., 2004) and to suffer from symptoms of depression (Bromberger and Matthews, 1996). The associations between optimism and physical and mental health in children and/or adolescents are in line with the findings in adults, with respect to ambulatory blood pressure levels, positive and negative affect, depression, hopelessness, suicidal ideation, substance abuse, and internalizing and externalizing behaviour problems (Ben-Zur, 2003; Carvajal et al., 1998; Lemola et al., 2010; Räikkönen and Matthews, 2008; Roberts et al., 1998). Higher self-esteem, in turn, is associated in adults, for instance, with better physical fitness (Reitzes and Mutran, 2006), lower stress-induced cardiovascular and inflammatory responses (O’Donnell et al., 2008), and lower risk of all-cause mortality (Stamatakis et al., 2004). Also, the findings relating self-esteem with mental and physical health in children and/or adolescents are in line with the findings in adults, with respect to psychological adjustment, health compromising and delinquent behaviour, and health symptoms (Aspinwall and Taylor, 1992; Donnellan et al., 2005; McGee and Williams, 2000; Orth et al., 2008; Trzesniewski et al., 2006). Thus, our findings showing a relation between an optimal sleep pattern and positive characteristics in children may inform why positive characteristics are associated with better physical and mental health.
The associations between the children’s sleep duration and latency with optimism and/or self-esteem were modest in effect size. In interpreting the effect sizes, one should, however, keep in mind that we examined a generally healthy population of young children. The effect sizes are comparable to, for instance, the size of the relation of sleep duration with BMI reported in some epidemiological studies in children. While it is well acknowledged that short sleep duration poses a risk for obesity in children/adolescents (Cappuccio et al., 2008; Chen et al., 2008), in some large-scale epidemiological studies the size of the cross-sectional association between sleep duration and BMI has been modest (Eisenmann et al., 2006; Snell et al., 2007) – comparable or even smaller than the effect sizes we report for the relation of sleep with optimism and self-esteem in this study. It should also be kept in mind that we cannot draw causal inferences from the cross-sectional findings of this study. Hence, it is possible that good sleep and positive characteristics are reciprocally related. In other words, good sleep, by promoting better physical and mental wellbeing, may result in a more positive psychological profile. Equally, it may be true that positive psychological characteristics, by promoting better physical and mental wellbeing, result in quantitatively and qualitatively better sleep. Further, the associations may also be determined by a common, but yet unknown, underlying factor, such as genetic variants for sleep–wake cycles. Thus, the underlying physical, genetic or psychological mechanisms linking sleep and positive characteristics have yet to be identified.
Apart from the cross-sectional study design and lack of data on the underlying mechanisms, a further limitation of our study relates to the generalizability of the findings; sleep pattern changes with age and pubertal maturation (Iglowstein et al., 2003). Thus, our findings cannot be generalized to much younger or older age groups. Further, our sample was predominantly Caucasian, and none of the children suffered from severe physical or mental health problems. Thus, our findings may not either generalize to samples with different ethnic backgrounds or with greater variance in health. Also, nearly half of the sample had rather well-educated parents with degrees beyond college. While we did not observe associations between parental level of education and sleep patterns, our findings may not generalize to less affluent populations.
Further, whereas sleep duration and sleep efficiency in children, measured with the chosen actigraph brand, have shown high agreement with polysomnography (with agreement rate of 87.3, sensitivity of 93.9 and specificity of 59.0 with a medium activity threshold; Hyde et al., 2007), concerns have been raised about the reliability of sleep latency in children (Sitnick et al., 2008), which is highly dependent on the reliability of the bedtime reported in a sleep log. However, very rarely have sleep logs and event marker data been compared to assess the reliability of the reported bedtime. We were able to do this in our study, and found very high correspondence between the sleep log completed by the parents and the event markers in the actigraph data. Still, it has to be kept in mind that results involving sleep latency should be interpreted cautiously.
Although the actigraphy measurement may lack the accuracy provided by polysomnography in measuring sleep quantity and quality in young children (Ohayon et al., 2004), actigraphy has the benefit of being ecologically valid as children sleep in their own beds over many consecutive nights (Acebo and LeBourgeois, 2006). A further strength to our study is that we did not rely on a single informant in measuring the children’s positive characteristics, as both mothers and fathers rated their children’s optimism, and mothers, fathers and teachers rated the children’s self-esteem and social competence.
In summary, we found associations between objectively measured sleep patterns and positive psychological characteristics in young children. Our results show that sufficient sleep quantity and good sleep quality are related to higher levels of optimism, and good sleep quality is related to higher levels of self-esteem. Thus, our results may inform why sleep quantity and quality and positive characteristics are associated with wellbeing in children.