Original Article Bed-sharing and related factors in early adolescents Yanrui Jiang a,b,1 , Wenjuan Chen a,b,1 , Karen Spruyt a,b , Wanqi Sun a,b , Yan Wang a,b , Shenghui Li b,c , Xiaoming Shen b,c , Guanghai Wang a , Fan Jiang a,b, * a Department of Developmental and Behavioral Pediatrics, Shanghai Children’s Medical Center, School of Medicine, Shanghai Jiaotong University, Shanghai, China b Ministry of Education-Shanghai Key Laboratory of Children’s Environmental Health, Shanghai, China c Shanghai Institute for Pediatric Research, Xinhua Hospital Affiliated with Shanghai Jiao Tong University School of Medicine, Shanghai, China ARTICLE INFO Article history: Received 22 May 2015 Received in revised form 31 July 2015 Accepted 2 August 2015 Available online 1 December 2015 Keywords: Bed-sharing Adolescent Sleep habit Co-sleeping Epidemiology A B ST R AC T Objective: To investigate the prevalence of bed-sharing and examine correlates of bed-sharing habits in early adolescents. Methods: Participants were 1452 early adolescents from 10 primary schools in Shanghai, China. Chil- dren’s health status and past history, family environment and parents’ attitude towards bed-sharing, and children’s sleep arrangements were surveyed. Sleep was assessed by the Children’s Sleep Habit Ques- tionnaire. Tanner stage was determined by the endocrinologist. Results: The median of age was 10.83 years (range: 9.42–12.92; 95% confidence interval [CI]: 10.79– 10.83) and boys accounted for 51.17%. The prevalence of bed-sharing was 16.8%. Positive parental attitude toward bed-sharing (OR: 9.87; 95% CI: 6.57–14.83), asthma (OR: 2.15; 95% CI: 1.16–3.98), smaller resi- dential space (OR: 1.90; 95% CI: 1.17–3.09), extended family (OR: 1.59; 95% CI: 1.16–2.18), and being physically less mature (OR: 2.39; 95% CI: 1.16–4.91) increased the likelihood of bed-sharing. Bed- sharers were more likely to have bedtime resistance (OR: 12.20; 95% CI: 8.59–17.33), sleep anxiety (OR: 3.76; 95% CI: 2.74–5.15), and poor sleep quality (OR: 3.21; 95% CI: 2.28–4.81) compared to non-bed- sharers. Furthermore, bed-sharing was associated with daytime sleepiness (OR: 1.53; 95% CI: 1.10–2.13) but not with sleep duration. Conclusions: Bed-sharing is highly prevalent among Chinese early adolescents and is significantly related to sleep quality. Parental positive attitude toward bed-sharing was the most determining factor. © 2015 Elsevier B.V. All rights reserved. 1. Introduction ‘Co-sleeping’ is an umbrella term that generally is considered to include the practices of bed sharing with a caretaker(s) or other family members, proximate sleeping arrangements, and room sharing during sleep. A large-scale cross-cultural survey involving 17 coun- tries found that the incidence of co-sleeping in the first 3 years of life was highest in India (72.6%) and lowest in the United Kingdom (5.0%) [1]. In general, more than half of the families reported this practice in Asian countries as compared to rates lower than 10% in European countries [1]. In addition to the differences between coun- tries, significant racial and ethnic differences in co-sleeping were found even within the same country [2]. As a result, professionals need to recognize the cultural environment in which children sleep, and be knowledgeable about how the cultural beliefs and values of both families and professionals may interact with the charac- teristics of each child [3]. Bed-sharing involves children and parent(s) sharing the same bed during the night. Mainly parental attitudes and motivations have been thought to influence whether or not a child sleeps with parents [4]. Parents commonly choose their children’s sleep arrangements on the basis of cultural beliefs or values, and professional advice [3]. However, across cultures much controversy exists regarding the potential benefits and risks associated with bed-sharing [5–8]. For instance, in Western countries children’s development of indepen- dence and individualism is cardinal, and thus especially the hazards of bed-sharing might be stressed. As a result, bed-sharing is less likely to be considered appropriate or desirable [2,9,10]. However, in Asian countries, childrearing practices emphasize the develop- ment of interdependence and family closeness; therefore bed- sharing has been generally accepted by parents [11,12]. Epidemiologic studies confirm these cultural practices. Bed-sharing may predominantly be thought of as a child-care practice limited to infancy in some cultures. Yet studies involving school-age children have shown that bed-sharing is still common beyond infancy: 12.4% of Saudi Arabian school-age children [13] and, * Corresponding author. Department of Developmental and Behavioral Pediatrics, Shanghai Children’s Medical Center, School of Medicine, Shanghai Jiaotong University, 1678 Dongfang Road, Shanghai 200127, China. Tel.: +86 21 38626012; fax: +86 21 58706129. E-mail address: fanjiang@shsmu.edu.cn (F. Jiang). 1 These authors contributed equally to this paper. http://dx.doi.org/10.1016/j.sleep.2015.08.022 1389-9457/© 2015 Elsevier B.V. All rights reserved. Sleep Medicine 17 (2016) 75–80 Contents lists available at ScienceDirect Sleep Medicine journal homepage: www.elsevier.com/locate/sleep