Geocultural differences in preschooler sleep profiles and family practices: an analysis of pooled data from 37 countries

Abstract

Study objectives: To examine (1) multidimensional sleep profiles in preschoolers (3-6 years) across geocultural regions and (2) differences in sleep characteristics and family practices between Majority World regions (Pacific Islands, Sub-Saharan Africa, Eastern Europe, Northeast Asia, Southeast Asia, South Asia, the Middle East and North Africa, and Latin America) and the Minority World (the Western world).

Methods: Participants were 3507 preschoolers from 37 countries. Nighttime sleep characteristics and nap duration (accelerometer: n = 1950) and family practices (parental questionnaire) were measured. Mixed models were used to estimate the marginal means of sleep characteristics by region and examine the differences.

Results: Geocultural region explained up to 30% of variance in sleep characteristics. A pattern of short nighttime sleep duration, low sleep efficiency, and long nap duration was observed in Eastern Europe, Northeast Asia, and Southeast Asia. The second pattern, with later sleep midpoints and greater night-to-night sleep variability, was observed in South Asia, the Middle East and North Africa, and Latin America. Compared to the Minority World, less optimal sleep characteristics were observed in several Majority World regions, with medium-to-large effect sizes (∣d∣=0.48-2.35). Several Majority World regions reported more frequent parental smartphone use during bedtime routines (Northeast Asia, Southeast Asia: 0.77-0.99 units) and were more likely to have electronic devices in children's bedroom (Eastern Europe, Latin America, South Asia: OR = 5.97-16.57) and co-sleeping arrangement (Asia, Latin America: OR = 7.05-49.86), compared to the Minority World.

Conclusions: Preschoolers' sleep profiles and related family practices vary across geocultural regions, which should be considered in sleep health promotion initiatives and policies.

Keywords: behavioral sleep; cross-cultural comparison; early childhood; public health.

Graphical Abstract

Figure 1.

Preschooler sleep profiles across geocultural regions. The radar charts depict sleep profiles in preschoolers from the Minority World (A), the Pacific Islands (B), Sub-Saharan Africa (C), Eastern Europe (D), Northeast Asia (E), Southeast Asia (F), South Asia (H), the Middle East and North Africa (I), and Latin America (J). Numbers in the radar charts represent z-scores. The estimated marginal means and z-scores of each sleep characteristic by region are presented in Supplementary Table S3. A z-score close to zero indicates a value near the average across all regions, with positive values indicating above-average and negative values indicating below-average characteristics. Abbreviation: NS, nighttime sleep.

Figure 2.

Family practices across geocultural regions. The bar charts present frequencies for having daily bedtime routines (A), parental smartphone use (B), having electronic device in the child’s bedroom (C), child electronic device use within two hours before bedtime (D), and sleep arrangements (E), along with the median number of co-sleeping family members (F), by geocultural region. The corresponding data is provided in Supplementary Table S4.