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  • Co sleeping is defined as sharing

    2018-11-09

    Co-sleeping is defined as sharing of the Madecassoside bed and the room by some other person in addition to the index person [31]. We found that room sharing was more common among rural children as compared to urban counterparts. In addition, the number of persons sharing the bedroom was higher in the rural area. This could be influenced by the availability of the space in the house as well as the cultural practices. National Family Health Survey-III showed that overcrowding was more common in rural areas as compared to urban areas in India. In addition to the available space, cultural factors could have also played a role in co-sleeping. Available literature also suggests that co-sleeping is more common among Asian Madecassoside as compared to western. One Indian study reported co-sleeping among 93% children in the age group of 3–10 years [4]. Another study from Singapore has shown the prevalence of co-sleeping among 73% children in age groups of 2–19 years and 81% in 2–6 years [12,13]. In Japan, the reported prevalence of co-sleeping was 87% [10]. The only exception to this is the China where co-sleeping was found to be less prevalent (37%) among school children with further reduction in prevalence with increasing age [11,14]. However, even in China, it was still higher than most of the Western countries. This is an important issue in view of known adverse health consequences of co-sleeping as reported in some of the studies e.g., nocturnal enuresis, parasomnia, sleep apnea, bedtime resistance, daytime sleepiness [14,32]. However, contradictory literature is also available which suggest that children who co-sleep have lesser prevalence of sleep-starts and nightmares [12]. This needs to be addressed in future studies. Parents from the rural background reported that their children were sleeping lesser than desired duration in this study. It was observed despite the fact that the rural children spent a longer time in sleep as compared to the urban children and the “need for more sleep” was more prevalent among urban children. To best of our knowledge, this fact has never been examined before and it may be related to the cultural effect on sleep practices [33]. Our clinical experience suggests that people in the rural areas go to bed soon after the sunset to wake up just before the dawn. Thus, they spend around 10–12h in bed in addition to the 1–2h of siesta. This could be one reason that the parents from the rural areas felt that their children had required more sleep. During past few years, India has witnessed a major lifestyle and cultural change with availability of electricity and television in many of the rural areas. It is possible that these factors might have curtailed the total time spent in sleep among rural children, resulting in parent\'s perception that their children required more sleep. This could also be the reason that interaction of gender, domicile and school type did not find any difference in the total sleep time. However, these issues need to be further verified through a large scale research. One surprising finding of this study was the absence of effect of gender on the pre-sleep behaviors; sleep schedules, co-sleeping and parent\'s perception of sleep. Though we could not find any comparative literature, one of the earlier studies had failed to find the effect of gender on co-sleeping, a finding that was confirmed in present study [14]. Like any other study, this study also had some limitations. First, this was a questionnaire-based study and we have conflicting literature regarding the validity of measurement of sleep patterns using questionnaires. While some studies suggest that questionnaires provide authentic information, others contradict substitution [34]. However, it must be remembered that CSHQ is a validated questionnaire and has been used in a number of studies across the globe, as already mentioned. Moreover, gathering objective data is a bit difficult in such a large population. Hence, we relied on gathering the information through questionnaire. Second, the parents provided the information rather than the child himself. This is important because parents have been reported to overestimate their children\'s sleep [35]. Third, size of the urban and rural groups was dissimilar. However, distribution of normality of data has been checked. Fourth, we did not enquire for socio-economic status. Fifth, gender difference might have been influenced by the age and could be present only among adolescents.