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The objective of this narrative review paper is to discuss about sleep duration needed across the lifespan. Sleep duration varies widely across the lifespan and shows an inverse relationship with age. Sleep duration recommendations issued by public health authorities are important for surveillance and help to inform the population of interventions, policies, and healthy sleep behaviors. However, the ideal amount of sleep required each night can vary between different individuals due to genetic factors and other reasons, and it is important to adapt our recommendations on a case-by-case basis. Sleep duration recommendations (public health approach) are well suited to provide guidance at the population-level standpoint, while advice at the individual level (eg, in clinic) should be individualized to the reality of each person. A generally valid assumption is that individuals obtain the right amount of sleep if they wake up feeling well rested and perform well during the day. Beyond sleep quantity, other important sleep characteristics should be considered such as sleep quality and sleep timing (bedtime and wake-up time). In conclusion, the important inter-individual variability in sleep needs across the life cycle implies that there is no “magic number” for the ideal duration of sleep. However, it is important to continue to promote sleep health for all. Sleep is not a waste of time and should receive the same level of attention as nutrition and exercise in the package for good health.
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Nature and Science of Sleep 2018:10 421–430
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Sleeping hours: what is the ideal number and how
does age impact this?
Jean-Philippe Chaput1–4
Caroline Dutil1,3
Hugues Sampasa-Kanyinga1,4
1Healthy Active Living and Obesity
Research Group, Children’s Hospital
of Eastern Ontario Research Institute,
Ottawa, ON, Canada; 2Department
of Pediatrics, University of Ottawa,
Ottawa, ON, Canada; 3School of
Human Kinetics, University of Ottawa,
Ottawa, ON, Canada; 4School of
Epidemiology and Public Health,
University of Ottawa, Ottawa, ON,
Abstract: The objective of this narrative review paper is to discuss about sleep duration needed
across the lifespan. Sleep duration varies widely across the lifespan and shows an inverse
relationship with age. Sleep duration recommendations issued by public health authorities
are important for surveillance and help to inform the population of interventions, policies,
and healthy sleep behaviors. However, the ideal amount of sleep required each night can vary
between different individuals due to genetic factors and other reasons, and it is important to
adapt our recommendations on a case-by-case basis. Sleep duration recommendations (public
health approach) are well suited to provide guidance at the population-level standpoint, while
advice at the individual level (eg, in clinic) should be individualized to the reality of each person.
A generally valid assumption is that individuals obtain the right amount of sleep if they wake
up feeling well rested and perform well during the day. Beyond sleep quantity, other important
sleep characteristics should be considered such as sleep quality and sleep timing (bedtime and
wake-up time). In conclusion, the important inter-individual variability in sleep needs across the
life cycle implies that there is no “magic number” for the ideal duration of sleep. However, it
is important to continue to promote sleep health for all. Sleep is not a waste of time and should
receive the same level of attention as nutrition and exercise in the package for good health.
Keywords: sleep, recommendations, guidelines, population heath, public health, life cycle
Sleep is increasingly recognized as a critical component of healthy development and
overall health.1–3 Healthy sleep comprises many dimensions, including adequate dura-
tion, good quality, appropriate timing, and the absence of sleep disorders.4,5 Not getting
enough sleep at night is generally associated with daytime sleepiness, daytime fatigue,
depressed mood, poor daytime functioning, and other health and safety problems.6–9
Chronic insufficient sleep has become a concern in many countries, given its associa-
tion with morbidity and mortality.10,11 For example, habitual short sleep duration has
been associated with adverse health outcomes including obesity,12 type 2 diabetes,13
hypertension,14 cardiovascular disease,15 depression,16 and all-cause mortality.17 Inter-
est in finding ways to improve sleep patterns of individuals at the population-level
standpoint is growing, and experts recommend that sleep should be considered more
seriously by public health bodies, ie, given as much attention and resources as nutri-
tion and physical activity.18–20
Guidelines on the recommended amount of sleep needed for optimal health exist;
they are a vital tool for surveillance, they help inform policies, they can provide a
starting point for intervention strategies, and they educate the general public about
Correspondence: Jean-Philippe Chaput
Healthy Active Living and Obesity
Research Group, Children’s Hospital
of Eastern Ontario Research Institute,
401 Smyth Road, Ottawa, ON K1H 8L1,
Tel +1 613 737 7600 (ext 3683)
Journal name: Nature and Science of Sleep
Article Designation: Review
Year: 2018
Volume: 10
Running head verso: Chaput et al
Running head recto: Sleep duration across the lifespan
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Chaput et al
healthy sleep behaviors. However, sleep needs may vary from
one person to another at any given age across the lifespan.
Additionally, some age groups and populations are more
likely to report insufficient sleep duration and may be at
greater risk for detrimental health outcomes.5,6,11 The objec-
tive of this narrative review article is to discuss whether or
not an ideal amount of sleep exists for optimal health and
how it is impacted by age.
Insufcient sleep across the lifespan
Insufficient sleep has become widespread over the last
decades, especially among adolescents.11,21 Both physi-
ological factors and exogenous exposures come into play in
explaining insufficient sleep in this age group. Sleep curtail-
ment is often attributed to extrinsic factors, such as artificial
light, caffeine use, lack of physical activity, no bedtime rules
in the household, and the increased availability of informa-
tion and communication technologies.22–25 In adolescence,
insufficient sleep has also been attributed to intrinsic factors
such as pubertal hormonal changes, which is associated with
a shift toward an evening chronotype26 that may also lead to
an asynchrony between the biological clock, characterized by
a phase delay, and the social clock.27 In adolescents, this bio-
logical phase delay combined with the social clock, for which
the main synchronizer is the fixed and early school start time,
contributes to the observed sleep deficits in this population.27
The conflict between intrinsic and extrinsic factors, biological
time and social time, has been indicated to be greater during
adolescence than at any other point in our lives.28
Despite some overlap between factors that could explain
insufficient sleep among adolescents and adults, such as
exposure to artificial light at night, lack of physical activity,
caffeine consumption, and poor sleep hygiene, other factors
that could specifically be related to insufficient sleep among
adults may include but not be limited to work demands,
social commitments, health and/or affective problems, and
family dynamics (eg, working mothers and children with
full agendas).10
In the elderly, sleep patterns and distribution undergoes
significant quantitative and qualitative changes. Older adults
tend to have a harder time falling asleep and more trouble
staying asleep. This period of life is often accompanied by
a circadian shift to a morning chronotype, as opposed to the
evening chronotype change during adolescence, that results
in early bedtime and risetime.29 Research suggests that the
need for sleep may not change with age, but it is the abil-
ity to get the needed sleep that decreases with age.10 This
decreased ability to sleep in older adults is often secondary to
their comorbidities and related medications (polypharmacy)
rather than normal aging processes per se.30–32 Furthermore,
the increased frequency of sleep-related disorders in the
elderly population contribute to much of the sleep deficien-
cies observed in this population.33–36 Inadequate sleep in
the elderly could also be related to other factors, such as
life changes (eg, retirement, physical inactivity, decreased
social interactions), age-related changes in metabolism, and
environmental changes (eg, placement in a nursing home).37
A systematic review and meta-analysis reported that
in the elderly population both short and long sleep are
independently associated with increased risk of cardiovas-
cular-related and cancer-related mortality.38 Additionally,
adjustments for health conditions in the studies examining
the association between sleep duration and mortality risks
did not attenuate the strength of the association between long
sleep and increased risk of mortality, which suggests that the
mechanisms in these associations may differ between long
sleep and short sleep duration.38 One possible explanation for
this association, between long sleep duration and increased
risk of non-communicable diseases related mortality, may be
related to the increased prevalence of sleep fragmentation in
this population.38,39 While older adults may report long sleep
duration, other sleep characteristics, namely sleep archi-
tecture and quality, are altered by sleep fragmentation. As
the relationship between long sleep duration and increased
risk of cardiovascular-related and cancer-related mortality
is unique to the elderly population, the causality should be
further investigated.
Normative sleep duration values across
the lifespan
Sleep–wake regulation and sleep states evolve very rapidly
during the first year of life.40 For example, newborns (0–3
months) do not have an established circadian rhythm and
therefore their sleep is distributed across the full 24-hour
day. 41 At 10–12 weeks, the circadian rhythm emerges and
sleep becomes more nocturnal between ages 4 and 12
months.42 Children continue to take daytime naps between 1
and 4 years of age, and night wakings are common.43 Daytime
naps typically stop by the age of 5 years and overnight sleep
duration gradually declines throughout childhood, in part
due to a shift to later bedtimes and unchanged wake times.43
Sleep patterns are explained by a complex interplay
between genetic, behavioral, environmental, and social fac-
tors. Examples of factors that can determine sleep duration
include daycare/school schedules, parenting practices, cul-
tural preferences, family routines, and individual differences
in genetic makeup. Despite inter-individual differences in
sleep duration, international normative data exist to show the
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Sleep duration across the lifespan
normal distribution of sleep duration for different age groups.
However, it is important to keep in mind that normative
reference values by no means indicate anything about what
the ideal or optimal sleep duration should be, ie, the amount
of sleep associated with health benefits. Nevertheless, they
tell us about what is normal (or not) in the population and
provide a valuable yardstick for practitioners and educators
when dealing with sleep-related issues.
A meta-analysis by Galland et al44 examined the scientific
literature with regards to normal sleep patterns in infants and
children aged 0–12 years. The review included 69,542 partici-
pants from 18 countries and subjective measures were used
to determine sleep duration (sleep diary or questionnaire).
They calculated mean reference values and ranges (±1.96
SD) for sleep duration of 12.7 h/day (9.0–13.3) for infants
(<2 years), 11.9 h/day (9.9–13.8) for toddlers/preschoolers
(ages 2–5 years), and 9.2 h/day (7.6–10.8) for children (6–12
years). Normative sleep duration data across age categories
are shown in Figure 1. A strong inverse relationship with age
was evident from these data, with the fastest rate of decline
observed over the first 6 months of life (10.5 min/month
decline in sleep duration). The review also highlighted that
Asians had significantly shorter sleep (1 hour less over the
0–12-year range) compared to Caucasians or other ethnic
groups. Overall, these reference values should be considered
as global norms because the authors combined different
countries and cultures.
Galland et al45 also reported in 2018 normative sleep dura-
tion values for children aged 3–18 years as measured with
actigraphy (objective assessment of sleep duration). Their
meta-analysis included 79 articles and involved children from
17 countries. As shown in Figure 2, pooled mean estimates
for overnight sleep duration declined from 9.68 hours (3–5
years age band) to 8.98 hours (6–8 years age band), 8.85 hours
(9–11 years age band), 8.05 hours (12–14 years age band),
and 7.4 hours (15–18 years age band). These normative sleep
duration values may aid in the interpretation of actigraphy
measures from nighttime recordings in the pediatric popula-
tion for any given age.
A meta-analysis of objectively assessed sleep from child-
hood to adulthood was also published by Ohayon et al46 in
2004 to determine normative sleep values across the lifespan.
A total of 65 studies representing 3,577 healthy individu-
als aged 5–102 years were included. Polysomnography or
actigraphy was used to assess sleep duration in the included
studies. They observed that total sleep time significantly
12.9 12.6 12.9 12.6
9.7 9.4 9.3 9.3 9.1 98.9
0–2 m
Sleep duration (hours/day)
1–2 y 2–3 y 4–5 y
6 y7 y8 y9 y 10 y11 y 12 y3 m6 m9 m 12 m
Figure 1 Normal self-reported sleep durations in children aged 0–12 years.
Note: The mean reference values are from a meta-analysis of 34 studies from 18 countries.44
Abbreviations: m, months; y, years.
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Chaput et al
decreased with age in adults, while it was the case in children
and adolescents only in studies performed on school days.
This pattern suggests that, in children and adolescents, the
decrease in total sleep time is not related to maturation but
to other factors such as earlier school start times.
In summary, normative sleep duration values are helpful
in providing information on what constitutes the norm for
a given age and what is considered outside the norm. These
reference values are impacted by the method used to deter-
mine sleep duration (objective vs subjective assessment)
and provide norms at the population-level standpoint. Many
factors can determine sleep duration at the individual level.
Although international normative data provide information
about the normal distribution of sleep duration in the popula-
tion, they do not identify the duration associated with health
benefits. For example, having a sleep duration that fits with
the average of the population is by no means indicative of
either a good or a bad sleep amount. Optimal sleep duration,
or the amount of sleep associated with favorable outcomes,
is what is used for public health recommendations and is
discussed in the next section.
Recommended amount of sleep across
the lifespan
In 2015, the National Sleep Foundation in the US released
their updated sleep duration recommendations to make scien-
tifically sound and practical recommendations for daily sleep
duration across the lifespan.47 The same year, the American
Academy of Sleep Medicine and the Sleep Research Society
released a consensus recommendation for the amount of
sleep needed to promote optimal health in adults.48 The year
after, they released their recommended amount of sleep for
pediatric populations.49 Both sleep guidelines issued by the
US used a similar developmental approach to deliver their
sleep duration recommendations, which included a consensus
and a voting process with a multidisciplinary expert panel.
The sleep duration recommendations can be found in Table 1.
Many organizations around the world have their own sleep
duration recommendations, and the aim of this article is not
to review the different sleep duration guidelines. Overall, they
are all very similar, and often reference the recommendations
from the US. In Canada, robust and evidence-informed sleep
guidelines became available in 2016.50,51 The sleep recom-
mendations in Canada for children of all ages, also known
as the 24-hour guidelines, are integrated with physical
activity and sedentary behavior recommendations to cover
the entire 24-hour period (sleep/wake period). This allows
to put more emphasis on the overall “cocktail” of behaviors
for a healthier 24-hour day, rather than isolating individual
behaviors. This integrated approach to health, with a focus
on the interrelationships among sleep, sedentary behavior,
and physical activity, is an important advancement in public
8.98 8.85
3–5 6–8 9–11 12–14 15–18
Sleep duration (hours/night)
Age (Years)
Figure 2 Normal actigraphy-determined sleep duration values in children aged 3–18 years.
Note: The mean reference values are from a meta-analysis of 79 studies from 17 countries.45
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Sleep duration across the lifespan
health messaging. It emphasizes that all of these behaviors
matter equally, and balancing all three is required for favor-
able health outcomes.
The Canadian 24-hour guidelines were the impetus for
the development of similar guidelines in Australia,52 New
Zealand,53 and the initiation of similar global guidelines by
the World Health Organization. Similar integrated 24-hour
guidelines for adults and older adults are currently being
developed in Canada to cover the entire lifespan. The sleep
duration recommendations contained within the 24-hour
movement guidelines can be found in Table 1.
Although sleep duration recommendations are based on
the best available evidence and expert consensus, they are still
largely reliant on observational studies using self-reported
sleep duration. More longitudinal studies and sleep restric-
tion/extension experiments are needed to better quantify
the upper and lower limits of healthy sleep duration, and
the shape of the dose–response curve with a wide range of
health outcomes. Current sleep duration recommendations
also suggest that a generalized optimum exists for the entire
population; however, it is unlikely to be the case and this opti-
mum can vary depending on the health outcome examined.54
There is also inter-individual variability in sleep needs in that
sleeping shorter or longer than the recommended amount
may not necessarily result in adverse effects on health. For
example, genetic differences between individuals can explain
some of the variability in sleep needs. However, intention-
ally restricting sleep over a prolonged period of time (ie,
chronic sleep deprivation) is not a good idea and can impact
health and safety.47 Thus, although sleep recommendations
are a good tool for public health surveillance, they need to
be adapted on a case-by-case basis in clinic (not a one-size-
fits-all recommendation).
Sleep duration recommendations have ranges, or zones
of optimal sleep, suggesting that the relationship between
sleep duration and adverse health outcomes is U-shaped,
with both extremities, sleep durations that are too short or
too long, associated with negative effects on health.47–51
There is a large body of evidence providing biological
plausibility for short sleep as causally related to a wide
range of adverse health outcomes; however, the role of long
sleep is less clear. Aside from the elderly population, long
sleep is generally associated with other health problems
(eg, depression, chronic pain, low socioeconomic status)
that can confound the associations.55,56 Reverse causation
and residual confounding are thus better mechanisms to
explain the associations between long sleep and adverse
health outcomes.55,56 This may explain why the American
Academy of Sleep Medicine and the Sleep Research Soci-
ety recommends a threshold value for adults (7 hours per
night) rather than a range (eg, 7–9 hours per night) (Table
1). However, excessive long sleep duration may be infor-
mative as it can be indicative of poor sleep efficiency (ie,
spending a lot of time in bed but of low quality).
Table 1 Sleep duration recommendations in the US and Canada
National sleep foundation
24-hour movement guidelines
Age group Recommendation Age group Recommendation Age group Recommendation
(0–3 months)
14–17 hours Newborns
(0–3 months)
Not included Newborns
(0–3 months)
14–17 hours
(4–11 months)
12–15 hours Infants
(4–11 months)
12–16 hours Infants
(4–11 months)
12–16 hours
(1–2 years)
11–14 hours Toddlers
(1–2 years)
11–14 hours Toddlers
(1–2 years)
11–14 hours
(3–5 years)
10–13 hour Preschoolers
(3–5 years)
10–13 hours Preschoolers
(3–4 years)
10–13 hours
(6–13 years)
9–11 hours Children
(6–12 years)
9–12 hours Children
(5–13 years)
9–11 hours
(14–17 years)
8–10 hours Teenagers
(13–17 years)
8–10 hours Teenagers
(14–17 years)
8–10 hours
Young adults
(18–25 years)
7–9 hours Adults
(18–60 years)
7 hours Adults
(18–64 years)
In development
(26–64 years)
7–9 hours Older adults
(65 years)
In development
Older adults
(65 years)
7–8 hours
Note: Papers describing the sleep duration recommendations can be found elsewhere.47–51
Abbreviations: AASM, American Academy of Sleep Medicine; SRS, Sleep Research Society.
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Chaput et al
Self-reported sleep duration is typically used in popula-
tion health surveillance studies, because it provides several
advantages (eg, inexpensive, not invasive, and logistically
easy to administer to a large sample of individuals). How-
ever, the concession is that sleep duration recommenda-
tions are then largely based on self-reported data. It is
well-known that self-reported sleep duration overestimates
actual sleep duration.57 Thus, it would be misleading to
use an objective measure of sleep duration to report the
prevalence of short sleepers in a given sample; this would
result in an overestimation of true short sleepers. The grow-
ing popularity of actigraphy and wearable technologies for
health behavior tracking in epidemiology is nevertheless
desirable for providing better sleep estimates and more pre-
cise associations with health outcomes.58,59 Sleep duration
recommendations are also likely to evolve over time, as
more objective measures of sleep are used in future studies.
For example, an individual self-reporting 7 hours of sleep
per night may actually get 6 hours if assessed objectively
with actigraphy, as it can better account for total sleep by
accurately measuring sleep onset and episodes of night
wakings.60 Thus, using reliable tools for tracking sleep
duration over time is important, and one must keep in mind
that the overall sleep duration pattern is more critical to
long-term health than one snapshot in time (ie, chronic
effect vs acute effect of insufficient sleep on health).
Consumers have also become increasingly interested in
using fitness trackers and smartphone applications to assess
their sleep. These devices provide information on sleep
duration and even sleep quality from in-built accelerometry
but the mechanisms and algorithms are propriotery.61–64 The
growing body of evidence on consumer sleep tracking devices
against polysomnography/actigraphy shows that they tend to
underestimate sleep disruptions and overestimate sleep dura-
tion and sleep efficiency in healthy individuals.61–64 Although
consumer sleep tracking devices are changing the landscape
of sleep health and have important advantages, more research
is needed to better determine their utility and reduce current
Population statistics in Canada indicate that 16% of
preschoolers sleep less than recommended, while 20% of
children and one-third of teenagers, adults, and older adults
report less-than-recommended sleep durations for optimal
health.65–67 These nationally representative surveys use sub-
jective data and are thus comparable to the sleep duration
guidelines. As shown in Figure 3, the average sleep duration
of Canadians by age group is situated at the lower border of
the sleep duration recommendations. On average, a large
7.12 7.24
Recommended sleep duration range Average sleep duration duration of Canadians
Newborns Infants Toddlers Preschoolers School-aged
Teenagers Aduts Older adults
Sleep duration (hours/night)
Age group
Figure 3 Sleep duration estimates of Canadians (dashed line) compared with the sleep duration recommendation ranges (solid lines).
Notes: Sleep duration estimates for the Canadian population have been recently published.65–67 However, they are not available for newborns, infants, or toddlers. Canadians
sleeping less than recommended for optimal health is estimated at 16% for preschoolers, 20% for school-aged children, 30% for teenagers, 32% for adults, and 31% for
older adults.
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Sleep duration across the lifespan
proportion of Canadians meet the sleep duration recom-
mendations (eg, two-third of teenagers and adults); however,
a large number of individuals fail to meet the guidelines
(eg, one-third of teenagers and adults). If we dig deeper,
we realize that the teenage group has shown the greatest
rate of decline in sleep duration in past decades, especially
on school days.11 Knowing the age groups more likely to
experience insufficient sleep is critical to help inform the
development of interventions aimed at improving sleep (eg,
having school start times not earlier than 8:30 am for high-
school students).68–70
Ideal amount of sleep: fact or ction?
As discussed in this article, there is no magic number
for all in terms of the ideal sleep amount to obtain each
night. Sleep duration recommendations are meant for
public health guidance, but need to be individualized to
each patient in the clinic. Sleep needs are determined by
a complex set of factors, including our genetic makeup,
environmental and behavioral factors. For example, high-
performance athletes need more sleep to perform at high
level and recover from their intense physical training. Sleep
needs in children and adolescents can also be driven by
their maturation stage, independent of their chronological
age.46 This means that changes in sleep patterns may happen
earlier (at a younger age) for some or at an older age for
others. Objectively, our current evidence of sleep need is
based on circadian, homeostatic, and ultradian processes
of sleep regulation and sleep need.
The notion of “optimal sleep” is complex and
poorly understood.71 The definitions of optimal sleep
also vary in the literature. It is very often defined as the
amount recommended by public health authorities. It has
also been defined as the daily amount of sleep that allows
an individual to be fully awake (ie, not sleepy), and able
to sustain normal levels of performance during the day.72
Others have also defined it as the amount of sleep required
to feel refreshed in the morning.73 The notion of a new
definition to optimal sleep based on performance is of
growing interest in the literature. For example, sleep exten-
sion interventions have been shown to improve athletic
However, as discussed in this article and by other sleep
experts,76 there is no magic number for optimal sleep, and
sleep is influenced by inter- and intra-individual factors.
Similarly, in a context of sleep deprivation, individual dif-
ferences in sleep homeostatic and circadian rhythm contri-
butions to neurobehavioral impairments have been elegantly
documented by Van Dongen.77–79
Optimal sleep should be conceptualized as the amount of
sleep needed to optimize outcomes (eg, performance, cogni-
tive function, mental health, physical health, quality of life,
etc). This implies that there might be many dose–response
curves that may differ in shape between outcomes.54 Typically,
the peaks of each health outcome should fall somewhere
within the recommended sleep duration range. However, the
exact amount of sleep to get each night for optimizing all
relevant health outcomes is not straightforward or ubiquitous
as the optimal amount for one outcome may not be the same
for another outcome (eg, 9 hours of sleep per night could be
the ideal for athletic performance, while 7 hours could be
the best for academic achievement). Also, determining the
causal effects of sleep need on health is not an easy task and
requires experiments (eg, interventional study designs with
improved vs reduced sleep, both acutely and chronically
applied, and then assessing outcomes on physiology, well-
being, health, and behavior).
Although the present article focused on sleep duration,
many other dimensions of sleep are important beyond get-
ting a sufficient amount each night. These include aspects
of sleep quality such as sleep efficiency (ie, proportion of
the time in bed actually asleep), sleep timing (ie, bedtime/
wake-up times), sleep architecture (ie, sleep stages), sleep
consistency (ie, day-to-day variability in sleep duration),
sleep consolidation (ie, organization of sleep across the
night), and sleep satisfaction. For example, the National Sleep
Foundation recently released evidence-informed sleep quality
recommendations for individuals across the lifespan.80 These
included sleep continuity variables such as sleep latency,
number of awakenings >5 minutes, wake after sleep onset,
and sleep efficiency. Along the same lines, monophasic sleep
(ie, sleeping once per day, typically at night) is considered the
norm in our society but other sleep patterns (eg, biphasic or
polyphasic) are also observed depending on the preference
of each person or culture. Napping is increasingly seen as a
public health tool and countermeasure for sleep deprivation
in terms of reducing accidents and cardiovascular events and
improving working performance.81
In summary, there is no magic number or ideal amount of
sleep to get each night that could apply broadly to all. The
optimal amount of sleep should be individualized, as it
depends on many factors. However, it is a fair assumption to
say that the optimal amount of sleep, for most people, should
be within the age-appropriate sleep duration recommended
ranges. Future studies should try to better inform contem-
porary sleep duration recommendations by examining dose–
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Chaput et al
response curves with a wide range of health outcomes. In the
meantime, promoting the importance of a good night’s sleep
should be a priority given its influence on other behaviors and
the well-known adverse consequences of insufficient sleep.82
Important sleep hygiene tips include removing screens from
the bedroom, exercising regularly during the day, and having
a consistent and relaxing bedtime routine.
Jean-Philippe Chaput is a Research Scientist funded by the
Children’s Hospital of Eastern Ontario Research Institute
(ON, Canada).
The authors report no conflicts of interest in this work.
1. Chaput JP, Gray CE, Poitras VJ, et al. Systematic review of the
relationships between sleep duration and health indicators in school-
aged children and youth. Appl Physiol Nutr Metab. 2016;41(6 Suppl
2. Chaput JP, Gray CE, Poitras VJ, et al. Systematic review of the relation-
ships between sleep duration and health indicators in the early years
(0–4 years). BMC Public Health. 2017;17(Suppl 5):855.
3. St-Onge MP, Grandner MA, Brown D, et al. Sleep duration and
quality: impact on lifestyle behaviors and cardiometabolic health: a
scientific statement from the American Heart Association. Circulation.
4. Buysse DJ. Sleep health: can we define it? Does it matter? Sleep.
5. Gruber R, Car rey N, Weiss SK, et al. Position statement on pediatric sleep
for psychiatrists. J Can Acad Child Adolesc Psychiatry. 2014;23(3):
6. Owens J. Adolescent Sleep Working Group; Committee on Adolescence.
Insufficient sleep in adolescents and young adults: an update on causes
and consequences. Pediatrics. 2014;134(3):e921–e932.
7. Wolfson AR, Carskadon MA. Sleep schedules and daytime functioning
in adolescents. Child Dev. 1998;69(4):875–887.
8. Shochat T, Cohen-Zion M, Tzischinsky O. Functional consequences of
inadequate sleep in adolescents: a systematic review. Sleep Med Rev.
9. Roehrs T, Zorick F, Sicklesteel J, Wittig R, Roth T. Excessive day-
time sleepiness associated with insufficient sleep. Sleep. 1983;6(4):
10. Institute of Medicine (US) Committee on Sleep Medicine and Research;
Colten HR, Altevogt BM, editors. Sleep Disorders and Sleep Depriva-
tion: An Unmet Public Health Problem. Washington, DC: The National
Academies Press; 2006.
11. Matricciani L, Olds T, Petkov J. In search of lost sleep: secular trends
in the sleep time of school-aged children and adolescents. Sleep Med
Rev. 2012;16(3):203–211.
12. Wu Y, Zhai L, Zhang D. Sleep duration and obesity among adults: a meta-
analysis of prospective studies. Sleep Med. 2014;15(12):1456–1462.
13. Shan Z, Ma H, Xie M, et al. Sleep duration and risk of type 2 diabetes:
a meta-analysis of prospective studies. Diabetes Care. 2015;38(3):
14. Wang Y, Mei H, Jiang YR, et al. Relationship between duration of
sleep and hypertension in adults: a meta-analysis. J Clin Sleep Med.
15. Wang D, Li W, Cui X, et al. Sleep duration and risk of coronary heart
disease: A systematic review and meta-analysis of prospective cohort
studies. Int J Cardiol. 2016;219:231–239.
16. Zhai L, Zhang H, Zhang D. Sleep duration and depression among
adults: a meta-analysis of prospective studies. Depress Anxiety.
17. Shen X, Wu Y, Zhang D. Nighttime sleep duration, 24-hour sleep dura-
tion and risk of all-cause mortality among adults: a meta-analysis of
prospective cohort studies. Sci Rep. 2016;6:21480.
18. Barnes CM, Drake CL. Prioritizing sleep health: public health policy
recommendations. Perspect Psychol Sci. 2015;10(6):733–737.
19. Chaput JP, Dutil C. Lack of sleep as a contributor to obesity in adoles-
cents: impacts on eating and activity behaviors. Int J Behav Nutr Phys
Act. 2016;13(1):103.
20. Chaput JP, Carson V, Gray CE, Tremblay MS. Importance of all move-
ment behaviors in a 24 hour period for overall health. Int J Environ Res
Public Health. 2014;11(12):12575–12581.
21. Chaput JP, Janssen I. Sleep duration estimates of Canadian children
and adolescents. J Sleep Res. 2016;25(5):541–548.
22. Bartel KA, Gradisar M, Williamson P. Protective and risk fac-
tors for adolescent sleep: a meta-analytic review. Sleep Med Rev.
23. Chaput JP, Tremblay MS, Katzmarzyk PT, et al. Sleep patterns and
sugar-sweetened beverage consumption among children from around
the world. Public Health Nutr. 2018;21(13):2385–2393.
24. Sampasa-Kanyinga H, Hamilton HA, Chaput JP. Sleep duration and
consumption of sugar-sweetened beverages and energy drinks among
adolescents. Nutrition. 2018;48:77–81.
25. Sampasa-Kanyinga H, Hamilton HA, Chaput JP. Use of social media
is associated with short sleep duration in a dose-response manner in
students aged 11 to 20 years. Acta Paediatr. 2018;107(4):694–700.
26. Carskadon MA, Vieira C, Acebo C. Association between puberty and
delayed phase preference. Sleep. 1993;16(3):258–262.
27. Kelley P, Lockley SW, Foster RG, Kelley J. Synchronizing education
to adolescent biology: ‘let teens sleep, start school later’. Learn Media
Technol. 2015;40(2):210–226.
28. Adan A, Archer SN, Hidalgo MP, di Milia L, Natale V, Randler
C. Circadian typology: a comprehensive review. Chronobiol Int.
29. Edwards BA, O’Driscoll DM, Ali A, Jordan AS, Trinder J, Malhotra A.
Aging and sleep: physiology and pathophysiology. Semin Respir Crit
Care Med. 2010;31(5):618–633.
30. Foley DJ, Monjan AA, Brown SL, Simonsick EM, Wallace RB, Blazer
DG. Sleep complaints among elderly persons: an epidemiologic study
of three communities. Sleep. 1995;18(6):425–432.
31. Foley D, Ancoli-Israel S, Britz P, Walsh J. Sleep disturbances and chronic
disease in older adults: results of the 2003 National Sleep Foundation
Sleep in America Survey. J Psychosom Res. 2004;56(5):497–502.
32. Vitiello MV, Moe KE, Prinz PN. Sleep complaints cosegregate with
illness in older adults. J Psychosom Res. 2002;53(1):555–559.
33. Ancoli-Israel S, Kripke DF, Klauber MR, Mason WJ, Fell R, Kaplan
O. Periodic limb movements in sleep in community-dwelling elderly.
Sleep. 1991;14(6):496–500.
34. Bailes S, Baltzan M, Alapin I, Fichten CS, Libman E. Diagnostic indi-
cators of sleep apnea in older women and men: a prospective study. J
Psychosom Res. 2005;59(6):365–373.
35. Young T, Palta M, Dempsey J, Skatrud J, Weber S, Badr S. The occur-
rence of sleep-disordered breathing among middle-aged adults. N Engl
J Med. 1993;328(17):1230–1235.
36. Ancoli-Israel S, Ayalon L. Diagnosis and treatment of sleep disorders
in older adults. Am J Geriatr Psychiatry. 2006;14(2):95–103.
37. Neikrug AB, Ancoli-Israel S. Sleep disorders in the older adult – a
mini-review. Gerontology. 2010;56(2):181–189.
38. Grandner MA, Drummond SP. Who are the long sleepers? Towards an
understanding of the mortality relationship. Sleep Med Rev. 2007;11(5):
39. Edwards BA, O’Driscoll DM, Ali A, Jordan AS, Trinder J, Malhotra A.
Aging and sleep: physiology and pathophysiology. Semin Respir Crit
Care Med. 2010;31(5):618–633.
40. Mclaughlin Crabtree V, Williams NA. Normal sleep in children and
adolescents. Child Adolesc Psychiatr Clin N Am. 2009;18(4):799–811.
Nature and Science of Sleep downloaded from by on 27-Nov-2018
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Sleep duration across the lifespan
41. Davis KF, Parker KP, Montgomery GL. Sleep in infants and young
children: Part one: normal sleep. J Pediatr Health Care. 2004;18(2):
42. Sheldon SH, Sateia MJ, Carskadon MA. Sleep in infants and children.
In: Lee-Chiong TL, Sateia MJ, Carskadon MA, editors. Sleep Medicine.
Philadelphia, PA: Hanley and Belfus Inc; 2002:99–103.
43. Iglowstein I, Jenni OG, Molinari L, Largo RH. Sleep duration from
infancy to adolescence: reference values and generational trends.
Pediatrics. 2003;111(2):302–307.
44. Galland BC, Taylor BJ, Elder DE, Herbison P. Normal sleep patterns
in infants and children: a systematic review of observational studies.
Sleep Med Rev. 2012;16(3):213–222.
45. Galland BC, Short MA, Terrill P, et al. Establishing normal values for
pediatric nighttime sleep measured by actigraphy: a systematic review
and meta-analysis. Sleep. 2018;41(4).
46. Ohayon MM, Carskadon MA, Guilleminault C, Vitiello MV. Meta-
analysis of quantitative sleep parameters from childhood to old age
in healthy individuals: developing normative sleep values across the
human lifespan. Sleep. 2004;27(7):1255–1273.
47. Hirshkowitz M, Whiton K, Albert SM, et al. National Sleep Foundation’s
updated sleep duration recommendations: final report. Sleep Health.
48. Consensus Conference Panel, Watson NF, Badr MS, et al. Joint
consensus statement of the American Academy of Sleep Medi-
cine and Sleep Research Society on the recommended amount
of sleep for a healthy adult: methodology and discussion. Sleep.
49. Paruthi S, Brooks LJ, D’Ambrosio C, et al. Recommended amount
of sleep for pediatric populations: a consensus statement of the
American Academy of Sleep Medicine. J Clin Sleep Med. 2016;12(6):
50. Tremblay MS, Carson V, Chaput JP. Canadian 24-hour movement
guidelines for children and youth: an integration of physical activity,
sedentary behaviour, and sleep. Appl Physiol Nutr Metab. 2016;41(6
Suppl 3):S311–327.
51. Tremblay MS, Chaput JP, Adamo KB, et al. Canadian 24-hour move-
ment guidelines for the early years (0–4 years): an integration of
physical activity, sedentary behaviour, and sleep. BMC Public Health.
2017;17(Suppl 5):874.
52. Okely AD, Ghersi D, Hesketh KD, et al. A collaborative approach to
adopting/adapting guidelines – The Australian 24-Hour Movement
Guidelines for the early years (Birth to 5 years): an integration of
physical activity, sedentary behavior, and sleep. BMC Public Health.
2017;17(Suppl 5):869.
53. New Zealand Ministry of Health. Sit Less, Move More, Sleep Well: Active
Play Guidelines for Under-Fives. Wellington: New Zealand, Ministry
of Health; 2017.
54. Matricciani L, Blunden S, Rigney G, Williams MT, Olds TS. Children’s
sleep needs: is there sufficient evidence to recommend optimal sleep
for children? Sleep. 2013;36(4):527–534.
55. Stamatakis KA, Punjabi NM. Long sleep duration: a risk to health or
a marker of risk? Sleep Med Rev. 2007;11(5):337–339.
56. Knutson KL, Turek FW. The U-shaped association between
sleep and health: the 2 peaks do not mean the same thing. Sleep.
57. Girschik J, Fritschi L, Heyworth J, Waters F. Validation of self-reported
sleep against actigraphy. J Epidemiol. 2012;22(5):462–468.
58. Meltzer LJ, Montgomery-Downs HE, Insana SP, Walsh CM. Use of
actigraphy for assessment in pediatric sleep research. Sleep Med Rev.
59. Sadeh A. The role and validity of actigraphy in sleep medicine: an
update. Sleep Med Rev. 2011;15(4):259–267.
60. Cespedes EM, Hu FB, Redline S, et al. Comparison of self-reported
sleep duration with actigraphy: results from the hispanic community
health study/study of Latinos Sueño Ancillary Study. Am J Epidemiol.
61. Lorenz CP, Williams AJ. Sleep apps: what role do they play in clinical
medicine? Curr Opin Pulm Med. 2017;23(6):512–516.
62. Mansukhani MP, Kolla BP. Apps and fitness trackers that measure sleep:
Are they useful? Cleve Clin J Med. 2017;84(6):451–456.
63. Kolla BP, Mansukhani S, Mansukhani MP. Consumer sleep tracking
devices: a review of mechanisms, validity and utility. Expert Rev Med
Devices. 2016;13(5):497–506.
64. Ko PR, Kientz JA, Choe EK, Kay M, Landis CA, Watson NF. Con-
sumer sleep technologies: a review of the landscape. J Clin Sleep Med.
65. Chaput JP, Colley RC, Aubert S, et al. Proportion of preschool-aged
children meeting the Canadian 24-Hour Movement Guidelines and
associations with adiposity: results from the Canadian Health Measures
Survey. BMC Public Health. 2017;17(Suppl 5):829.
66. Michaud I, Chaput JP. Are Canadian children and adolescents sleep
deprived? Public Health. 2016;141:126–129.
67. Chaput JP, Wong SL, Michaud I. Duration and quality of sleep among
Canadians aged 18 to 79. Health Rep. 2017;28(9):28–33.
68. Adolescent Sleep Working Group. Committee on Adolescence; Coun-
cil on School Health. School start times for adolescents. Pediatrics.
69. Minges KE, Redeker NS. Delayed school start times and adolescent
sleep: A systematic review of the experimental evidence. Sleep Med
Rev. 2016;28:86–95.
70. Hafner M, Stepanek M, Troxel WM. The economic implications of later
school start times in the United States. Sleep Health. 2017;3(6):451–457.
71. Matricciani L, Bin YS, Lallukka T, et al. Past, present, and future: trends
in sleep duration and implications for public health. Sleep Health.
72. Ferrara M, De Gennaro L. How much sleep do we need? Sleep Med
Rev. 2001;5(2):155–179.
73. Engle-Friedman M, Palencar V, Riela S. Sleep and effort in adolescent
athletes. J Child Health Care. 2010;14(2):131–141.
74. Bonnar D, Bartel K, Kakoschke N, Lang C. Sleep interventions designed
to improve athletic performance and recovery: a systematic review of
current approaches. Sports Med. 2018;48(3):683–703.
75. Mah CD, Mah KE, Kezirian EJ, Dement WC. The effects of sleep
extension on the athletic performance of collegiate basketball players.
Sleep. 2011;34(7):943–950.
76. Horne J. Sleepiness as a need for sleep: when is enough, enough?
Neurosci Biobehav Rev. 2010;34(1):108–118.
77. Van Dongen HP, Bender AM, Dinges DF. Systematic individual dif-
ferences in sleep homeostatic and circadian rhythm contributions to
neurobehavioral impairment during sleep deprivation. Accid Anal Prev.
78. Van Dongen HP, Caldwell JA, Caldwell JL. Individual differences in
cognitive vulnerability to fatigue in the laboratory and in the workplace.
Prog Brain Res. 2011;190:145–153.
79. Van Dongen HP, Belenky G. Individual differences in vulnerability to
sleep loss in the work environment. Ind Health. 2009;47(5):518–526.
80. Ohayon M, Wickwire EM, Hirshkowitz M, et al. National Sleep Foun-
dation’s sleep quality recommendations: first report. Sleep Health.
81. Faraut B, Andrillon T, Vecchierini MF, Leger D. Napping: a public
health issue. From epidemiological to laboratory studies. Sleep Med
Rev. 2017;35:85–100.
82. Chaput JP. The integration of pediatric sleep health into public health
in Canada. Sleep Med. Epub 2018 Jun 30.
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... Sleep is an essential component of athletic performance and overall well-being (Chaput, Dutil, & Sampasa-Kanyinga, 2018). A comprehensive research has consistently emphasized the fundamental significance of sleep for various essential brain functions, including the working of nerve cells (neurons) and cognitive functions (Joiner, 2018;Ramar et al., 2021). ...
... An unusual aspect found in this research was the increase in total sleep time but decrease in overall sleep health of student athletes in USA (Chandler et al., 2021). Rise in the hours of total sleep has always been associated with positive sleep health (Chaput et al., 2018). However, this was not the case during Covid-19 lockdown as stated in this study (Chandler et al., 2021). ...
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The emergence of the Covid-19 has led to the implementation of widespread lockdown, significantly impacting athletes’ sleep routine. Therefore, determining the association between Covid-19 lockdown and sleep health among athletic population was primary objective of this systematic review. Through a comprehensive review of existing literature, a collection of 5,128 article titles and corresponding abstracts were obtained. Finally, after the completion of additional screening and quality assessment procedure, only 13 studies met the necessary quality criteria and were deemed eligible for the final analysis. Among the included studies, a majority of the studies (69%) revealed a negative impact of Covid-19 lockdown on sleep health among athletes, whereas 23% reported a positive impact. Additionally, a minority of the studies (7%) indicated no significant impact. Hence, the collective findings from the reviewed studies indicate a likelihood of Covid-19 lockdown having a detrimental effect on the sleep health of athletes.
... Sleep plays a major role in human life and health, as it is important for brain functions and development. However, the amount of sleep required varies due to normal demographic and biological variations, and not all individuals require the standard eight hours of sleep [1]. Sleep can be affected by various disorders that cause changes in sleeping hours, which may lead to psychological disorders such as depression and negatively affect academic performance [2]. ...
... Few studies are available to compare our results on GC. To our knowledge, our findings are consistent with current literature on the topic, despite the relationship between sleep duration and GC is elsewhere described through a U-shaped curve that we do not observe [44]. U-shaped results have been also described for non-neoplastic conditions such as metabolic syndrome [45] and amyloid-beta burden [46]. ...
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The association between sleep and stress and cancer is underinvestigated. We evaluated these factors in association with gastric cancer (GC). Five case-control studies from the Stomach Cancer Pooling (StoP) Project were included. We calculated the odds ratios (ORs) and the corresponding 95% confidence intervals (CIs) for sleep duration and stress level in association with GC through multiple logistic regression models adjusted for several lifestyle factors. The analysis included 1293 cases and 4439 controls, 215 cardia and 919 noncardia GC, and 353 diffuse and 619 intestinal types. Sleep duration of ≥9 h was associated with GC (OR =1.57, 95% CI = 1.23–2.00) compared to 8 h. This was confirmed when stratifying by subsite (noncardia OR = 1.59, 95% CI = 1.22–2.08, and cardia OR = 1.63, 95% CI = 0.97–2.72) and histological type (diffuse OR = 1.65, 95% CI = 1.14–2.40 and intestinal OR = 1.24, 95% CI = 0.91–1.67). Stress was associated with GC (OR = 1.33, 95% CI = 1.18–1.50, continuous). This relationship was selectively related to noncardia GC (OR = 1.28, 95% 1.12–1.46, continuous). The risk of diffuse (OR = 1.32, 95% CI = 1.11–1.58) and intestinal type (OR = 1.23, 95% CI = 1.07–1.42) were higher when stress was reported. Results for the association between increasing level of stress and GC were heterogeneous by smoking and socioeconomic status (p for heterogeneity = 0.02 and <0.001, respectively). In conclusion, long sleep duration (≥9 h) was associated with GC and its subtype categories. Stress linearly increased the risk of GC and was related to noncardia GC.
... 28 Children of different ages require different optimal sleep durations. 29 However, shorter sleep in children could be the result of increased screen time around bedtime and collectively may be associated with higher levels of adiposity, poor growth and emotional dysregulation. 30 The sleep duration of children less than 2 years of age in the GUSTO cohort was significantly associated with body length; shorter sleep duration was also associated with higher body mass index and shorter body length for those at 3 months of age. ...
Introduction: Early childhood is a critical period for growth and development. Adopting healthy lifestyle behaviours during this period forms the foundation for future well-being and offers the best protection against non-communicable diseases. Singapore studies have shown that many young children are not achieving the recommendations on physical activity, sedentary behaviour and sleep. A workgroup was set up to develop recommendations for caregivers of infants, toddlers and preschoolers (aged <7 years) on how to integrate beneficial activities within a daily 24-hour period for optimal development and metabolic health. Method: The Grading of Recommendations Assessment, Development and Evaluation (GRADE)-ADOLOPMENT approach was employed for adoption, adaption or de novo development of recommendations. International and national guidelines were used as references, and an update of the literature reviews up to September 2021 was conducted through an electronic search of PubMed, Embase and Cochrane Central Register of Controlled Trials (CENTRAL) databases. Results: Four consensus statements were developed for each age group: infants, toddlers and preschoolers. The statements focus on achieving good metabolic health through regular physical activity, limiting sedentary behaviour, achieving adequate sleep and positive eating habits. The 13th consensus statement recognises that integration of these activities within a 24-hour period can help obtain the best results. Conclusion: This set of recommendations guides and encourages caregivers of Singapore infants, toddlers and preschoolers to adopt beneficial lifestyle activities within each 24-hour period.
... As a basic part of a person's daily routine, sleep is fundamental to individual's whole life cycle health (Buysse, 2014;Grandner, 2020). The American National Sleep Foundation has recommended a 7to 9-h sleep duration for adults (Chaput et al., 2018), and referring to this criteria, sleep duration less than 7 h is regarded as short sleep status. Nevertheless, there were scarcely 50% of adults in the US reported a habitual sleep time falling within the recommended sleeping hour (Covassin and Singh, 2016), and this trend was also found in other developed countries (Bin et al., 2012). ...
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Background: Short sleep is more common in the modern society. Recreational physical activity (RPA) like exercise brings both mental and physiological benefits to depression; paradoxically, lack of sleep is harmful. Evidence on the association between RPA and depression in the short sleep population is limited. Methods: Participants with short sleep condition from the National health and Nutrition Examination Surveys (NHANES 2007-2018) were included in the present study. Short sleep condition was defined as ≤ 7 h per night. Sleep duration and RPA status were self-reported in NHANES by the Physical Activity Questionnaire using a 7-day recall method. Multivariable logistic regression was applied to evaluate the association between RPA and depression. Additionally, the non-linear relationship between RPA and depression was evaluated using the threshold effect analysis and restricted cubic spline. Results: This cross-sectional study comprised 6,846 adults' data, and the weighted participants were 52,501,159. The weighted prevalence of depression was higher in females, which took up 65.85% of all depression patients. In fully adjusted models, sufficient volume of RPA was associated with lower depression risks, with OR (95% CI) =0.678 (0.520, 0.883). Further analysis revealed a U-shaped association between RPA and incident depression, and the inflection point was 640 MET-minutes/week. When RPA <640 MET-minutes/week, increased RPA was associated with lower risk of incident depression, with OR (95% CI) = 0.891 (0.834, 0.953). When RPA ≥ 640 MET-minutes/week, the benefits of RPA seemed to be not significant, with OR (95% CI) = 0.999 (0.990, 1.009). Conclusion: Our findings observed associations between RPA condition and incident depression in the short sleep population. Moderate RPA was beneficial to maintain mental health and associated with lower incidence of depression for short sleepers, but excessive RPA might increase the risk of depression. For general short sleepers, keeping the RPA volume approximately 640 MET-minutes/week was beneficial to lower risks of depression. Gender difference should be considered as an important factor for further studies to examine these relationships and explore mechanisms.
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Gangguan Tidur merupakan suatu kumpulan kondisi yang dicirikan dengan gangguan dalam jumlah, kualitas atau waktu tidur pada seorang individu. Seorang lansia akan membutuhkan waktu lebih lama untuk masuk tidur (berbaring lama di tempat tidur sebelum tertidur) dan mempunyai lebih sedikit atau lebih pendek waktu tidur nyenyaknya. Tujuan penelitian ini adalah diketahuinya prevalensi dan faktor-faktor yang mempengaruhi gangguan tidur. Penelitian ini adalah penelitian deskriptif analitik dengan pendekatan Cross-Sectional. Pengambilan sampel dilakukan dengan menggunakan teknik consecutive sampling. Instrumen yang digunakan adalah Pittsburgh Sleep Quality Index (PSQI). Analisis dilakukan dengan chi-square. Berdasarkan uji chi-square diketahui terdapat korelasi antara status merokok (p=0,034, OR=1,974, 95%CI=1,048±3,721) dan tingkat kecemasan (p=0,013, OR=0,482, 95%CI=0,270±0,859) dengan kejadian Gangguan Tidur. Penelitian tidak dapat membuktikan adanya korelasi antara jenis kelamin, usia, tingkat pendidikan, status pekerjaan, penghasilan perbulan, konsumsi kopi, konsumsi alkohol, tekanan darah, indeks massa tubuh, gula darah puasa, kolesterol dan asam urat dengan kejadian Gangguan Tidur.
Physical inactivity is a significant global health risk, contributing to one-third of all deaths worldwide. The World Health Organization (WHO) has identified inadequate physical activity as the fourth leading risk factor for mortality. Large-scale data analyses by the WHO indicate that nearly one-third of the global population does not engage in sufficient physical activity, with even greater disparities among genders and young people. Insufficient physical activity among children and adolescents poses potential health risks for their current and future well-being. To monitor physical activity, international guidelines were established by organizations like the American College of Sports Medicine and the WHO. Germany adopted the WHO recommendations, and population-based studies like DEGS, KiGGS, and MoMo were conducted to assess adherence to these guidelines. These studies incorporated the use of physical activity questionnaires and, more recently, accelerometers to obtain continuous and objective data on activity intensity. Accelerometers have become popular for monitoring physical activity, and their sales have increased significantly over the years. ActiGraph accelerometers were utilized in various global epidemiological studies, including KiGGS and MoMo, to ensure comparability. However, using accelerometers requires careful consideration of technical decisions to derive accurate metrics. Researchers must account for factors such as device type, wearing position, recording parameters, study design, and data preprocessing. This dissertation aimed to address key questions concerning accelerometer use in large epidemiological studies: (1) how to make technical decisions, (2) which methodological aspects to apply, (3) the implications of different evaluation methods, (4) how accelerometer data compare to questionnaire data, and (5) differences in physical activity patterns between weekdays and weekends. The work encompassed five scientific articles. The "Consensus Article" reflects the expert consensus on accelerometer studies and emphasizes the importance of thorough familiarization with validation studies and documenting technical decisions. The "Study Protocol" presents the methodological aspects of the MoMo study's accelerometer measurements. The "Methods Article" investigates the impact of evaluation factors on quantifying physical activity with accelerometers. The "Comparison Article" compares self-reported and accelerometer-measured physical activity in children and adolescents, revealing low adherence to WHO recommendations. Finally, the "Typical Day" article analyzes accelerometer data to understand differences in physical activity between school and weekend days. The findings underscore the critical need to address physical inactivity in children and adolescents. More precise measurements and international collaboration are necessary to develop effective interventions. Technical advancements, shorter epoch lengths, and improved data pooling methods are crucial for comprehensive and accurate reporting. In this context, CAPA can serve as a platform for bringing together experts from various disciplines to refine data acquisition methods and provide a realistic picture of physical behavior. Failure to address this global issue could lead to severe consequences in public health.
Decreased quality and duration of sleep can impact both physical and mental health in addition to quality of life, well-being, quality of social relationships, productivity, and performance. With insomnia as a leading sleep disorder among menopausal-aged women, identifying low-cost and low-risk interventions is important for maintaining physical and mental health. One promising intervention is cognitive behavioral therapy for insomnia (CBT-I). The objective of this review was to describe the effectiveness of CBT-I in decreasing insomnia symptoms in menopausal-aged women. Electronic databases were searched using terms encompassing insomnia, CBT-I, and menopausal age. Seven articles met the inclusion criteria of using a CBT-I strategy in women of menopausal or post-menopausal age and measuring at least one sleep-related outcome. Studies primarily used sleep restriction, stimulus control, and sleep hygiene education techniques. Interventions were delivered in both face-to-face and telehealth formats. Across studies, insomnia symptoms and sleep quality improved with moderate to large effect sizes and clinically significant changes were achieved in most studies. Quality of life and mental health were improved in studies measuring those outcomes. Effectiveness did not appear to vary between delivery methods. Based on this review, we can state that CBT-I is a practical and effective intervention for menopausal-aged women experiencing insomnia, providing clinically meaningful reductions in insomnia symptoms and improvements in sleep quality, quality of life, and mental health. Future research would benefit from more detailed analyses of the different techniques and dosing. Additionally, new technology, including sleep trackers and personalized care using AI-driven programming, should be investigated.
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Background: New Canadian 24-Hour Movement Guidelines for the Early Years have been released in 2017. According to the guidelines, within a 24-h period, preschoolers should accumulate at least 180 min of physical activity (of which at least 60 min is moderate-to-vigorous physical activity), engage in no more than 1 h of screen time, and obtain between 10 and 13 h of sleep. This study examined the proportions of preschool-aged (3 to 4 years) Canadian children who met these new guidelines and different recommendations within the guidelines, and the associations with adiposity indicators. Methods: Participants were 803 children (mean age: 3.5 years) from cycles 2-4 of the Canadian Health Measures Survey (CHMS), a nationally representative cross-sectional sample of Canadians. Physical activity was accelerometer-derived, and screen time and sleep duration were parent-reported. Participants were classified as meeting the overall 24-Hour Movement Guidelines if they met all three specific time recommendations for physical activity, screen time, and sleep. The adiposity indicators in this study were body mass index (BMI) z-scores and BMI status (World Health Organization Growth Standards). Results: A total of 12.7% of preschool-aged children met the overall 24-Hour Movement Guidelines, and 3.3% met none of the three recommendations. A high proportion of children met the sleep duration (83.9%) and physical activity (61.8%) recommendations, while 24.4% met the screen time recommendation. No associations were found between meeting individual or combined recommendations and adiposity. Conclusions: Very few preschool-aged children in Canada (~13%) met all three recommendations contained within the 24-Hour Movement Guidelines. None of the combinations of recommendations were associated with adiposity in this sample. Future work should focus on identifying innovative ways to reduce screen time in this population, and should examine the associations of guideline adherence with health indicators other than adiposity.
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Background: The objective of this systematic review was to examine for the first time the associations between sleep duration and a broad range of health indicators in children aged 0 to 4 years. Methods: Electronic databases were searched with no limits on date or study design. Included studies (published in English or French) were peer-reviewed and met the a priori determined population (apparently healthy children aged 1 month to 4.99 years), intervention/exposure/comparator (various sleep durations), and outcome criteria (adiposity, emotional regulation, cognitive development, motor development, growth, cardiometabolic health, sedentary behaviour, physical activity, quality of life/well-being, and risks/injuries). The quality of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework. Due to high levels of heterogeneity across studies, narrative syntheses were employed. Results: A total of 69 articles/studies (62 unique samples) met inclusion criteria. Data across studies included 148,524 unique participants from 23 countries. The study designs were randomized trials (n = 3), non-randomized interventions (n = 1), longitudinal studies (n = 16), cross-sectional studies (n = 42), or longitudinal studies that also reported cross-sectional analyses (n = 7). Sleep duration was assessed by parental report in 70% of studies (n = 48) and was measured objectively (or both objectively and subjectively) in 30% of studies (n = 21). Overall, shorter sleep duration was associated with higher adiposity (20/31 studies), poorer emotional regulation (13/25 studies), impaired growth (2/2 studies), more screen time (5/5 studies), and higher risk of injuries (2/3 studies). The evidence related to cognitive development, motor development, physical activity, and quality of life/well-being was less clear, with no indicator showing consistent associations. No studies examined the association between sleep duration and cardiometabolic biomarkers in children aged 0 to 4 years. The quality of evidence ranged from "very low" to "high" across study designs and health indicators. Conclusions: Despite important limitations in the available evidence, longer sleep duration was generally associated with better body composition, emotional regulation, and growth in children aged 0 to 4 years. Shorter sleep duration was also associated with longer screen time use and more injuries. Better-quality studies with stronger research designs that can provide information on dose-response relationships are needed to inform contemporary sleep duration recommendations.
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Background: In 2017, the Australian Government funded the update of the National Physical Activity Recommendations for Children 0-5 years, with the intention that they be an integration of movement behaviours across the 24-h period. The benefit for Australia was that it could leverage research in Canada in the development of their 24-h guidelines for the early years. Concurrently, the Grading of Recommendations Assessment, Development and Evaluation (GRADE) working group published a model to produce guidelines based on adoption, adaption and/or de novo development using the GRADE evidence-to-decision framework. Referred to as the GRADE-ADOLOPMENT approach, it allows guideline developers to follow a structured and transparent process in a more efficient manner, potentially avoiding the need to unnecessarily repeat costly tasks such as conducting systematic reviews. The purpose of this paper is to outline the process and outcomes for adapting the Canadian 24-Hour Movement Guidelines for the Early Years to develop the Australian 24-Hour Movement Guidelines for the Early Years guided by the GRADE-ADOLOPMENT framework. Methods: The development process was guided by the GRADE-ADOLOPMENT approach. A Leadership Group and Consensus Panel were formed and existing credible guidelines identified. The draft Canadian 24-h integrated movement guidelines for the early years best met the criteria established by the Panel. These were evaluated based on the evidence in the GRADE tables, summaries of findings tables and draft recommendations from the Canadian Draft Guidelines. Updates to each of the Canadian systematic reviews were conducted and the Consensus Panel reviewed the evidence for each behaviour separately and made a decision to adopt or adapt the Canadian recommendations for each behaviour or create de novo recommendations. An online survey was then conducted (n = 302) along with five focus groups (n = 30) and five key informant interviews (n = 5) to obtain feedback from stakeholders on the draft guidelines. Results: Based on the evidence from the Canadian systematic reviews and the updated systematic reviews in Australia, the Consensus Panel agreed to adopt the Canadian recommendations and, apart from some minor changes to the wording of good practice statements, keep the wording of the guidelines, preamble and title of the Canadian Guidelines. The Australian Guidelines provide evidence-informed recommendations for a healthy day (24-h), integrating physical activity, sedentary behaviour (including limits to screen time), and sleep for infants (<1 year), toddlers (1-2 years) and preschoolers (3-5 years). Conclusions: To our knowledge, this is only the second time the GRADE-ADOLOPMENT approach has been used. Following this approach, the judgments of the Australian Consensus Panel did not differ sufficiently to change the directions and strength of the recommendations and as such, the Canadian recommendations were adopted with very minor alterations. This allowed the Guidelines to be developed much faster and at lower cost. As such, we would recommend the GRADE-ADOLOPMENT approach, especially if a credible set of guidelines, with all supporting materials and developed using a transparent process, is available. Other countries may consider using this approach when developing and/or revising national movement guidelines.
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Abstract Background The Canadian Society for Exercise Physiology convened representatives of national organizations, research experts, methodologists, stakeholders, and end-users who followed rigorous and transparent guideline development procedures to create the Canadian 24-Hour Movement Guidelines for the Early Years (0–4 years): An Integration of Physical Activity, Sedentary Behaviour, and Sleep. These novel guidelines for children of the early years embrace the natural and intuitive integration of movement behaviours across the whole day (24-h period). Methods The development process was guided by the Appraisal of Guidelines for Research and Evaluation (AGREE) II instrument. Four systematic reviews (physical activity, sedentary behaviour, sleep, combined behaviours) examining the relationships within and among movement behaviours and several health indicators were completed and interpreted by a Guideline Development Panel. The systematic reviews that were conducted to inform the development of the guidelines, and the framework that was applied to develop the recommendations, followed the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology. Complementary compositional analyses were performed using data from the Canadian Health Measures Survey to examine the relationships between movement behaviours and indicators of adiposity. A review of the evidence on the cost effectiveness and resource use associated with the implementation of the proposed guidelines was also undertaken. A stakeholder survey (n = 546), 10 key informant interviews, and 14 focus groups (n = 92 participants) were completed to gather feedback on draft guidelines and their dissemination. Results The guidelines provide evidence-informed recommendations as to the combinations of light-, moderate- and vigorous-intensity physical activity, sedentary behaviours, and sleep that infants (
The concept of sleep health is gaining momentum globally. Rather than “medicalizing” sleep with a focus on sleep disorders and their treatment, there is growing interest in sleep health promotion for all and on the prevention of sleep problems. In Canada, sleep health is increasingly becoming part of a holistic vision of health and provides a metric for health promotion efforts. One of the outcomes of this evolving understanding of sleep health in Canada has been the release of the world's first integrated 24-hour movement guidelines for the pediatric population in 2016. These were the first systematic review-informed sleep guidelines in Canada, and provided important benchmarks for surveillance. They also integrated sleep health with other lifestyle behaviors by putting the emphasis on the full 24-hour period rather than nocturnal sleep duration. Among the possible solutions to counter the adverse effects of insufficient sleep, public health policies are crucial to help prioritizing sleep health in children. The future of pediatric sleep health in Canada is bright, and we need to align our efforts and continue to push for this important topic in the public health arena. It is expected that this action will result in the prioritization of sleep health by the public health community in Canada so that it becomes an equal counterpart to the attention and resources given to other lifestyle behaviors such as healthy nutrition and sufficient amounts of physical activity.
Objective To examine the relationships between objectively measured sleep patterns (sleep duration, sleep efficiency and bedtime) and sugar-sweetened beverage (SSB) consumption (regular soft drinks, energy drinks, sports drinks and fruit juice) among children from all inhabited continents of the world. Design Multinational, cross-sectional study. Setting The International Study of Childhood Obesity, Lifestyle and the Environment (ISCOLE). Subjects Children ( n 5873) 9–11 years of age. Results Sleep duration was 12 min per night shorter in children who reported consuming regular soft drinks ‘at least once a day’ compared with those who reported consuming ‘never’ or ‘less than once a week’. Children were more likely to sleep the recommended 9–11 h/night if they reported lower regular soft drink consumption or higher sports drinks consumption. Children who reported consuming energy drinks ‘once a week or more’ reported a 25-min earlier bedtime than those who reported never consuming energy drinks. Children who reported consuming sports drinks ‘2–4 d a week or more’ also reported a 25-min earlier bedtime compared with those who reported never consuming sports drinks. The associations between sleep efficiency and SSB consumption were not significant. Similar associations between sleep patterns and SSB consumption were observed across all twelve study sites. Conclusions Shorter sleep duration was associated with higher intake of regular soft drinks, while earlier bedtimes were associated with lower intake of regular soft drinks and higher intake of energy drinks and sports drinks in this international study of children. Future work is needed to establish causality and to investigate underlying mechanisms.
Background Despite the widespread use of actigraphy in pediatric sleep studies, there are currently no age-related normative data. Objectives To systematically review the literature, calculate pooled mean estimates of actigraphy-derived pediatric nighttime sleep variables and to examine the magnitude of change with age. Methods A systematic search was performed across eight databases of studies that included at least one actigraphy sleep variable from healthy children aged 0–18 years. Data suitable for meta-analysis were confined to ages 3–18 years with seven actigraphy variables analyzed using random effects meta-analysis and meta-regression performed using age as a covariate. Results In total, 1334 articles did not meet inclusion criteria; 87 had data suitable for review and 79 were suitable for meta-analysis. Pooled mean estimates for overnight sleep duration declined from 9.68 hours (3–5 years age band) to 8.98, 8.85, 8.05, and 7.4 for age bands 6–8, 9–11, 12–14, and 15–18 years, respectively. For continuous data, the best-fit (R² = 0.74) equation for hours over the 0–18 years age range was 9.02 − 1.04 × [(age/10)^2 − 0.83]. There was a significant curvilinear association between both sleep onset and offset with age (p < .001). Sleep latency was stable at 19.4 min per night. There were significant differences among the older age groups between weekday and weekend/nonschool days (18 studies). Total sleep time in 15–18 years old was 56 min longer, and sleep onset and offset almost 1 and 2 hours later, respectively, on weekend or nonschool days. Conclusion These normative values have potential application to assist the interpretation of actigraphy measures from nighttime recordings across the pediatric age range, and aid future research.
Aim: This study examined the association between social media and sleep duration among Canadian students aged 11-20. Methods: Data from 5242 students were obtained from the 2015 Ontario Student Drug Use and Health Survey, a province-wide, school-based survey that has been conducted every two years since 1977. We measured the respondents' sleep duration against the recommended ranges of 9-11 h per night at 11-13 years of age, 8-10 h at 14-17 and 7-9 h per night for those aged 18 years or more. Results: Overall, 36.4% of students met or exceeded the recommended sleep duration and 63.6% slept less than recommended, with 73.4% of students reporting that they used social media for at least one hour per day. After adjusting for various covariates, the use of social media was associated with greater odds of short sleep duration in a dose-response manner (p for linear trend <0.001). Odds ratios ranged from 1.82 for social media use of at least one hour per day to 2.98 for at least five hours per day. Conclusion: Greater use of social media was associated with shorter sleep duration in a dose-response fashion among Canadian students aged 11-20.
This article provides recent estimates of the duration and quality of sleep of Canadian adults and of the percentage who adhere to sleep duration guidelines (7 to 9 hours per night at ages 18 to 64, and 7 to 8 hours per night at age 65 or older). The study is based on 10,976 respondents aged 18 to 79 from the 2007-to-2013 Canadian Health Measures Survey, a nationally representative, cross-sectional survey. Sleep duration and quality were self-reported. Mean sleep duration was 7.12 hours per night at ages 18 to 64 and 7.24 hours per night at ages 65 to 79. An estimated 65% of 18- to 64-year-olds and 54% of seniors slept the recommended number of hours per night. However, short sleep duration and poor sleep quality were relatively common. About a third slept fewer hours than recommended. At ages 18 to 64, an estimated 43% of men and 55% of women reported trouble going to sleep or staying asleep "sometimes/most of the time/all of the time" the corresponding percentages at ages 65 to 79 were 40% and 59%.
Objective: To examine the relationship between sleep duration and consumption of sugar sweetened beverages (SSBs) and energy drinks (EDs) among adolescents. Methods: Data on 9,473 adolescents aged 11-20 years were obtained from the 2015 cycle of the Ontario Student Drug Use and Health Survey, a province-wide and cross-sectional school based survey of students in middle and high school. Respondents self-reported their sleep duration and consumption of SSBs and EDs. Those who did not meet the age-appropriate sleep duration recommendation were considered short sleepers. Results: Overall, 81.4% and 12.0% of respondents reported that they had at least one SSBs and EDs in the past week, respectively. Males were more likely than females to consume SSBs and EDs. High school students were more likely than those in middle school to report drinking EDs. After adjusting for multiple covariates, results from logistic regression analyses indicated that short sleep duration was associated with greater odds of SSB consumption in middle school students (odd ratio (OR) = 1.64, 95% confidence interval (CI) = 1.18-2.11), but not those in high school (OR = 1.06, 95% CI = 0.86-1.31). Short sleep duration was associated with greater odds of ED consumption in both middle (OR = 1.60, 95% CI = 1.10-2.34) and high school (OR = 1.78, 95% CI = 1.38-2.30) students. Conclusion: Short sleep duration was associated with consumption of EDs in middle and high school students and with SSBs in middle school students only. Future studies are needed to establish causality and to determine whether improving sleep patterns can reduce the consumption of SSBs and EDs among adolescents.