Abstract
BACKGROUND: This study compared multilevel factors associated with sleep duration and bedtime regularity in children with and without neurological and developmental disorders (NDD) using a nationally representative sample. METHODS: We combined data from the 2016-2017, 2018-2019, and 2020-2021 United States National Survey of Children's Health (NSCH), including 86,014 children aged 9-17 years. Parent-reported outcomes included adequate sleep duration (yes/no) and bedtime regularity (yes/no). We assessed the relationship between twenty independent individual, social, and environmental variables on the sleep outcomes. We used random survival forest decision trees to identify the five most predictive variables [in terms of variable importance (VIMP)]. Regression analyses were then used to assess directionality and independent associations. RESULTS: A greater proportion of children with NDDs versus those who are typically developing (TD) had parent reports of not achieving adequate sleep duration (34.0% versus 30.9%, respectively) and bedtime regularity (18.8% versus 13.7%, respectively). For adequate sleep, achieving bedtime regularity, having more family meals together and older age emerged as the most important independent variables for both TD children and those with NDDs. For bedtime regularity, achieving adequate sleep, and having more family meals together were the most proximal independent variables for NDD and TD children. CONCLUSION: Increasing the frequency of family meals and addressing both sleep duration and bedtime regularity may serve as key modifiable intervention targets to improve sleep health in children, including those with NDDs.