Engineering a mobile platform to promote sleep in the pediatric primary care setting

Jonathan A Mitchell, Knashawn H Morales, Ariel A Williamson, Nicholas Huffnagle, Casey Eck, Abigail Jawahar, Lionola Juste, Alexander G Fiks, Babette S Zemel, David F Dinges, Jonathan A Mitchell, Knashawn H Morales, Ariel A Williamson, Nicholas Huffnagle, Casey Eck, Abigail Jawahar, Lionola Juste, Alexander G Fiks, Babette S Zemel, David F Dinges

Abstract

Study objectives: Pediatricians lack tools to support families at home for the promotion of childhood sleep. We are using the Multiphase Optimization Strategy (MOST) framework to guide the development of a mobile health platform for childhood sleep promotion. The objective of this study is to demonstrate feasibility of a mobile health platform towards treating children with insufficient sleep.

Methods: Children aged 10-12 years were enrolled (Study #1: N = 30; Study #2: N = 43). Participants wore a sleep tracker to measure sleep duration. Data were retrieved by a mobile health platform, programmed to send introductory messages during run-in (2 weeks) and goal achievement messages during intervention (7 weeks) periods. In study #1, participants were randomized to control, gain-framed incentive or loss-framed incentive arms. In study #2, participants were randomized to control, loss-framed incentive, normative feedback or loss-framed incentive plus normative feedback arms.

Results: In study #1, 1514 nights of data were captured (69%) and sleep duration during the intervention was higher by an average of 21 (95% CI: -8, 51) and 34 (95% CI: 7, 61) minutes per night for the gain-framed and loss-framed arms, respectively, compared to controls. In study #2, 2,689 nights of data were captured (81%), with no major differences in average sleep duration between the control and the loss-framed or normative feedback arms.

Conclusions: We have developed and deployed a mobile health platform that can capture sleep data and remotely communicate with families. Promising candidate intervention components will be further investigated under the optimization phase of the MOST framework.

Clinical trials: Both studies included in this manuscript were registered at clinicaltrials.gov:-Study #1: NCT03263338-Study #2: NCT03426644.

Keywords: children; intervention; pediatrics; sleep.

© The Author(s) 2021. Published by Oxford University Press on behalf of Sleep Research Society.

Figures

Figure 1.
Figure 1.
Consort diagrams for study #1 (A) and study #2 (B). W2H, Way to Health platform; Q, questionnaire; V1, study visit number 1; V2, study visit number 2; TIB, time in bed; LF, loss-framed incentive; NFB, normative feedback; Qual, qualitative data collection.
Figure 2.
Figure 2.
Average nights of sleep data acquired in each study, by study week, with 95% confidence intervals. (A) Average acquirement for study #1 (left) and study #2 (right). (B) Difference in average nights acquired by study arm, for study #1 (left) and study #2 (right). (C) control arm; GF, gain-framed arm; LF, loss-framed arm; and NF, normative feedback arm. Panel C. Difference in average nights acquired by sex for study #1 (left) and study #2 (right). (D) Difference in average nights acquired by race for study #1 (left) and study #2 (right). Due to the small number of participants, the Asian race category is not presented. (E) Difference in average nights acquired by household income for study #1 (left) and study #2 (right).
Figure 3.
Figure 3.
Changes in nighttime sleep duration for study #1. The left column presents averages and 95% confidence intervals for sleep duration (hours per night) by study arm and study week. The column on the right presents the difference in sleep duration and the probability of sleeping ≥9 hours per night by study week and study arms, relative to the control arm.
Figure 4.
Figure 4.
Changes in nighttime sleep duration for study #2. The left column presents averages and 95% confidence intervals for sleep duration (hours per school night) by study arm and study week. The column on the right presents the difference in school night sleep duration and the probability of sleeping ≥9 hours per school night by study week and study arms, relative to the control arm.

References

    1. Keyes KM, et al. . The great sleep recession: changes in sleep duration among US adolescents, 1991-2012. Pediatrics. 2015;135(3):460–468.
    1. Matricciani LA, et al. . Never enough sleep: a brief history of sleep recommendations for children. Pediatrics. 2012;129(3):548–556.
    1. Matricciani L, et al. . 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.
    1. Wheaton AG, et al. . Short sleep duration among middle school and high school students - United States, 2015. MMWR Morb Mortal Wkly Rep. 2018;67(3):85–90.
    1. Wheaton AG, et al. . Sleep duration and injury-related risk behaviors among high school students–United States, 2007-2013. MMWR Morb Mortal Wkly Rep. 2016;65(13):337–341.
    1. Nahmod NG, et al. . Later high school start times associated with longer actigraphic sleep duration in adolescents. Sleep. 2019;42(2). doi:10.1093/sleep/zsy212.
    1. Wheaton AG, et al. . School start times, sleep, behavioral, health, and academic outcomes: a review of the literature. J Sch Health. 2016;86(5):363–381.
    1. Owens JA, et al. . A quasi-experimental study of the impact of school start time changes on adolescent sleep. Sleep Health. 2017;3(6):437–443.
    1. Owens JA, et al. . Impact of delaying school start time on adolescent sleep, mood, and behavior. Arch Pediatr Adolesc Med. 2010;164(7):608–614.
    1. Dunster GP, et al. . Sleepmore in Seattle: later school start times are associated with more sleep and better performance in high school students. Sci Adv. 2018;4(12):eaau6200.
    1. Widome R, et al. . Association of delaying school start time with sleep duration, timing, and quality among adolescents. JAMA Pediatr. 2020;174(7):697–704.
    1. Adolescent Sleep Working Group; Committee on Adolescence; Council on School Health. School start times for adolescents. Pediatrics. 2014;134(3):642–649.
    1. Hiscock H, et al. . Impact of a behavioral sleep intervention on new school entrants’ social emotional functioning and sleep: a translational randomized trial. Behav Sleep Med. 2019;17(6):698–712.
    1. Blunden S, et al. . Lessons learned from sleep education in schools: a review of dos and don’ts. J Clin Sleep Med. 2015;11(6):671–680.
    1. Wing YK, et al. . A school-based sleep education program for adolescents: a cluster randomized trial. Pediatrics. 2015;135(3):e635–e643.
    1. Kira G, et al. . Sleep education improves the sleep duration of adolescents: a randomized controlled pilot study. J Clin Sleep Med. 2014;10(7):787–792.
    1. Cassoff J, et al. . School-based sleep promotion programs: effectiveness, feasibility and insights for future research. Sleep Med Rev. 2013;17(3):207–214.
    1. Blunden SL, et al. . Are sleep education programs successful? The case for improved and consistent research efforts. Sleep Med Rev. 2012;16(4):355–370.
    1. Moseley L, et al. . Evaluation of a school-based intervention for adolescent sleep problems. Sleep. 2009;32(3):334–341.
    1. Honaker SM, et al. . Sleep in pediatric primary care: a review of the literature. Sleep Med Rev. 2016;25:31–39.
    1. Owens JA, et al. . Parental knowledge of healthy sleep in young children: results of a primary care clinic survey. J Dev Behav Pediatr. 2011;32(6):447–453.
    1. Faruqui F, et al. . Sleep disorders in children: a national assessment of primary care pediatrician practices and perceptions. Pediatrics. 2011;128(3):539–546.
    1. Collins LM. Optimization of Behavioral, Biobehavioral, and Biomedical Interventions. Vol 1. Switzerland: Springer International Publishing; 2018.
    1. Patel MS, et al. . Framing financial incentives to increase physical activity among overweight and obese adults. Ann Intern Med. 2016;165(8):600.
    1. Wong CA, et al. . Effect of financial incentives on glucose monitoring adherence and glycemic control among adolescents and young adults with type 1 diabetes: a randomized clinical trial. JAMA Pediatr. 2017;171(12):1176–1183.
    1. Tversky A, et al. . The framing of decisions and the psychology of choice. Science. 1981;211(4481):453–458.
    1. Patel MS, et al. . Individual versus team-based financial incentives to increase physical activity: a randomized, controlled trial. J Gen Intern Med. 2016;31(7):746–754.
    1. Carskadon MA. Sleep in adolescents: the perfect storm. Pediatr Clin North Am. 2011;58(3):637–647.
    1. Asch DA, et al. . On the way to health. LDI Issue Brief. 2012;17(9):1–4.
    1. Asch DA, et al. . Automated hovering in health care–watching over the 5000 hours. N Engl J Med. 2012;367(1):1–3.
    1. Lee XK, et al. . Validation of a consumer sleep wearable device with actigraphy and polysomnography in adolescents across sleep opportunity manipulations. J Clin Sleep Med. 2019;15(9):1337–1346.
    1. Stevens J. Behavioral economics strategies for promoting adherence to sleep interventions. Sleep Med Rev. 2015;23:20–27.
    1. Bradley EH, et al. . Qualitative data analysis for health services research: developing taxonomy, themes, and theory. Health Serv Res. 2007;42(4):1758–1772.
    1. Matricciani L, et al. . Children’s sleep and health: a meta-review. Sleep Med Rev. 2019;46:136–150.
    1. Gruber R, et al. . Impact of sleep extension and restriction on children’s emotional lability and impulsivity. Pediatrics. 2012;130(5):e1155–e1161.
    1. Hart CN, et al. . Development of a behavioral sleep intervention as a novel approach for pediatric obesity in school-aged children. Sleep Med Clin. 2016;11(4):515–523.
    1. Perfect MM, et al. . The development of a clinically relevant sleep modification protocol for youth with type 1 diabetes. Clin Pract Pediatr Psychol. 2016;4(2):227–240.
    1. Van Dyk TR, et al. . Feasibility and emotional impact of experimentally extending sleep in short-sleeping adolescents. Sleep. 2017;40(9). doi:10.1093/sleep/zsx123
    1. Bandura A. Self-efficacy: toward a unifying theory of behavioral change. Psychol Rev. 1977;84(2):191–215.
    1. Pyper E, et al. . Do parents’ support behaviours predict whether or not their children get sufficient sleep? A cross-sectional study. BMC Public Health. 2017;17(1):432.
    1. Huf SW, et al. . Association of medicaid healthy behavior incentive programs with smoking cessation, weight loss, and annual preventive health visits. JAMA Netw Open. 2018;1(8):e186185.
    1. Raber I, et al. . Health insurance and mobile health devices: opportunities and concerns. JAMA. 2019;321(18):1767–1768.
    1. Quante M, et al. . A qualitative assessment of the acceptability of smartphone applications for improving sleep behaviors in low-income and minority adolescents. Behav Sleep Med. 2019;17(5):573–585.
    1. Matthews KA, et al. . Sleep in healthy Black and White adolescents. Pediatrics. 2014;133(5):e1189–e1196.
    1. Guglielmo D, et al. . Racial/ethnic sleep disparities in US school-aged children and adolescents: a review of the literature. Sleep Health. 2018;4(1):68–80.
    1. Mitchell JA, et al. . Changes in sleep duration and timing during the middle-to-high school transition. J Adolesc Health. 2020;67(6):829–836.
    1. Hakim M, et al. . Comparison of the Fitbit(R) charge and polysomnography for measuring sleep quality in children with sleep disordered breathing. Minerva Pediatr. 2018. doi:10.23736/0026-4946.18.05333-1
    1. Meltzer LJ, et al. . Direct comparison of two new actigraphs and polysomnography in children and adolescents. Sleep. 2012;35(1):159–166.

Source: PubMed

Patrocinadores y Colaboradores

Condiciones médicas

Intervenciones de drogas

3
Suscribir