Results from the DHA-Oxford-Learning-and-Behaviour study (DOLAB) on the benefits of DHA supplementation for childrens' sleep. 



 



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Fatty acids and sleep in UK children: subjective and pilot objective sleep results from the DOLAB study – a randomized controlled trial.



(http://onlinelibrary.wiley.com/enhanced/doi/10.1111/jsr.12135/

Burton, Jennifer R.

Montgomery, Paul

Richardson, Alex J.

Sewell, Richard P.

Spreckelsen, Thees F.

English

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Omega-3 DHA and sleep in UK children:Results from the DOLAB study.Montgomery P., Burton JR., Sewell RP., Spreckelsen TF., and Richardson AJ.Centre of Evidence Based Intervention, University of Oxford, United KingdomIntroductionGood sleep quality and duration are essential for children’slearning and behaviour.Past researchFatty acid (LC-PUFA) metabolites play a role in sleepregulation and fatty acid supplementation may reduce anxietyeffects of sleep deprivation.However, little is known about the effect of the LC-PUFADHA Omega-3 on sleep in children.Research Question•Does supplementation with DHA Omega-3 change the qual-ity, duration and timing of children’s sleep.MethodsThe DHA Oxford Learning and Behaviour Study (Dolab) isa randomized, double-blind, placebo-controlled trial.ParticipantsChildren aged 7-9 from mainstream schools, underperformingin literacy skills according to nationally standardised assess-ments (KS1) were invited. NHS ethics as well as parentalconsent and child assent was obtained.Children invited from 74 Oxfordshire (UK) schools:n = 1376Parents did not consent (n=701)Parent consent:n=675Did not meet inclusion criteria (n=313):BAS Reading≤33% (n =236 );Eating Fish ≥ 2x week (n= 50)Already taking Omega-3 (n=9);Sibling in study (n=8); Capsule refusal (n=5);Moderate Learning Difficulty (n=3);Medication (n=2)Randomization sampleAssessment of Subjective Sleep (CSHQ)n=362Actigraphy subsamplen=43(randomly selected)Actigraph not worn (n=2)Baseline(Active n=180, Placebo n=182)Actigraphy Baseline(Active n=19, Placebo n=24)Actigraph not worn (n=9)Postintervention(Active n=179, Placebo n=180)Children moved out of area (n=3)Actigraphy Postintervention(Active n=15, Placebo n=19)InterventionSupplementation with DHA (600mg/day for 16 weeks) with acontrol group receiving a soy/corn oil placebo.Outcomes1. Subjective sleep: Measured using the Child SleepHealth Questionnaire, with eight sub-scales and one totalsleep disturbance score.2.Objective sleep: Children in a subsample (15%) wereassessed using an actigraph during five consecutive nightsat baseline and follow-up.(More details in separate box Actigraphy).Improvements in Objective Sleep (Actigraphy)Following Supplementation with DHA Omega-3Change in Amount ofSleep and Wakefulness at night654min 639min497min 543min157min 96minTotal Sleep DurationChange:−16minAsleepChange:+46minAwakeChange:−61min0100200300400500600700800Baseline PostinterventionActiveMinutes Sleep Minutes AwakeGraphs by treatment640min 611min500min 488min140min 123minTotal Sleep DurationChange:−29minAsleepChange:−12minAwakeChange:−17min0100200300400500600700800Baseline PostinterventionPlaceboMinutes Sleep Minutes AwakeGraphs by treatmentMeans Pre−/Post−InterventionTotal Minutes of Sleep & Wakefulness per NightOn average, children who received DHA during the 16-weekintervention, compared to those who did not:• Spent 44min less awake during an average night.•Got 58min more sleep per night.Change in Sleep Efficiency & Number ofNight-wakings9% efficiency gain1%Sig. difference: p<.052approx. 10 wakings less−3.5Sig. difference: p<.013−10−50510Change Mean Number of Wakings10%5%0−10%−5%Sleep Efficiency − Change in RatioSleep Efficiency (ratio) Number of Wake EpisodesActive (n=19) Placebo (n=24)Change Pre−/Post−Intervention (Mean ± 1 SE)Sleep Efficency and Number of Wake−episodesIn addition, children in the intervention group, compared tothe placebo group:•Gained 8% sleep efficiency (sleep during time in bed).•Had 7 fewer wake episodes per night, (brief wakings).Supplementation, Subjective Sleep (CSHQ) and Clinical RelevanceChange in Subjective Sleep (CSHQ)following Supplementationp<.318 p<.478 p<.469 p<.245 p<.849 p<.196 p<.816 p<.898 p<.495.50−.5−1−1.5Mean Change ScorePre−/Post−Intervention (Mean 1 SE)Bedtime ResistanceSleep Onset DelaySleep DurationSleep AnxietyNight wakingsParasomniasSleep Disturbed BreathingDaytime SleepinessTotal Sleep disturbanceActive (n=180) Placebo (n=182)Whole Sample (n=362)Change Scores for CSHQThe Child Health Questionaire (CSHQ) measures subjectivesleep quality.A “Total Sleep Disturbance” score >41 is used to diagnoseclinical sleep problems.No significant improvements in parents’ perceptions of sleepwere found across the subscales of the CSHQ.Improvements in a Clinical Subgroup ofchildren with sleep problemsp<.526 p<.871 p<.129 p<.366 p<.668 p<.039 p<.817 p<.753 p<.05.5−.5−1.5−2.5−3.5Mean Change ScorePre−/Post−Intervention (Mean 1 SE)Bedtime ResistanceSleep Onset DelaySleep DurationSleep AnxietyNight wakingsParasomniasSleep Disturbed BreathingDaytime SleepinessTotal Sleep disturbanceActive (n=94) Placebo (n=94)Change Scores for Caseness Sample CSHQ>41(n=188)CSHQ Clinical Subgroup − Effects of SupplementationA post-hoc analysis of children with clinical sleep problemsshows some improvements.Total Sleep Disturbance: Children had significantlylower scores if they received the DHA supplement.Parasomnia: Parents of children in the active group men-tioned fewer parasomnias (e.g. sleepwalking).Acknowledgements:Funding was provided by DSM Nutritional Products, who also provided the product (DHA-S) and placebo.Thanks also goes to the Waterloo Foundation who supported Dr Richardson’s work in this area of research.Actigraphy: How to measuresleep objectively?MicroMini-Motionlogger R©, Ambulatory Monitoring Inc.What is anActigraph?Actigraphs are small,watch-sized movementsensors, worn on thewrist or ankle (see pic-ture).How do Actigraphswork?Actigraphy assesses sleepby measuring movementduring time in bed.A sensor logs thefrequency and patternof movement, whichallows the detection ofbasic sleep-wake pat-terns.How well does Actigraphy measure sleep?Actigraphy sleep measures correlate with the best measuresof sleep from clinical polysomnography to about 80%.ConclusionsResults:The analyses of subjective and objective sleep as secondaryoutcomes of the Dolab Study suggest that:• DHA supplementation improves the qualityof child sleep.Children taking DHA had less wake episodes per nightand received on average 58mins more sleep.After supplementation children and gained 8% sleepefficiency.Relevance:Post-hoc analyses suggest that with regard to subjectivesleep:•Children with clinical sleep problems mightparticularly benefit from DHA supplementa-tion.Future Research:These exploratory analyses give good grounds for futureresearch into LC-PUFA as a cheap and safe treatment forsleep problems.•Future studies should focus on children withpoor sleep outcomes as these might benefitmost.Please do not reproduce or cite without permission of the authors, c©2013.

Omega-3 DHA and Sleep in UK Children: Results From the DOLAB Study

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Omega-3 DHA and sleep in UK children:
Results from the DOLAB study.
Montgomery P., Burton JR., Sewell RP., Spreckelsen TF., and Richardson AJ.
Centre of Evidence Based Intervention, University of Oxford, United Kingdom
Introduction
Good sleep quality and duration are essential for children’s
learning and behaviour.
Past research
Fatty acid (LC-PUFA) metabolites play a role in sleep
regulation and fatty acid supplementation may reduce anxiety
effects of sleep deprivation.
However, little is known about the effect of the LC-PUFA
DHA Omega-3 on sleep in children.
Research Question
•Does supplementation with DHA Omega-3 change the qual-
ity, duration and timing of children’s sleep.
Methods
The DHA Oxford Learning and Behaviour Study (Dolab) is
a randomized, double-blind, placebo-controlled trial.
Participants
Children aged 7-9 from mainstream schools, underperforming
in literacy skills according to nationally standardised assess-
ments (KS1) were invited. NHS ethics as well as parental
consent and child assent was obtained.
Children invited from 74 Oxfordshire (UK) schools:
n = 1376
Parents did not consent (n=701)
Parent consent:
n=675
Did not meet inclusion criteria (n=313):
BAS Reading≤33% (n =236 );
Eating Fish ≥ 2x week (n= 50)
Already taking Omega-3 (n=9);
Sibling in study (n=8); Capsule refusal (n=5);
Moderate Learning Difficulty (n=3);
Medication (n=2)
Randomization sample
Assessment of Subjective Sleep (CSHQ)
n=362
Actigraphy subsample
n=43
(randomly selected)
Actigraph not worn (n=2)
Baseline
(Active n=180, Placebo n=182)
Actigraphy Baseline
(Active n=19, Placebo n=24)
Actigraph not worn (n=9)
Postintervention
(Active n=179, Placebo n=180)
Children moved out of area (n=3)
Actigraphy Postintervention
(Active n=15, Placebo n=19)
Intervention
Supplementation with DHA (600mg/day for 16 weeks) with a
control group receiving a soy/corn oil placebo.
Outcomes
1. Subjective sleep: Measured using the Child Sleep
Health Questionnaire, with eight sub-scales and one total
sleep disturbance score.
2.Objective sleep: Children in a subsample (15%) were
assessed using an actigraph during five consecutive nights
at baseline and follow-up.
(More details in separate box Actigraphy).
Improvements in Objective Sleep (Actigraphy)
Following Supplementation with DHA Omega-3
Change in Amount of
Sleep and Wakefulness at night
654min 639min
497min 543min
157min 96min
Total Sleep Duration
Change:
−16min
Asleep
Change:
+46min
Awake
Change:
−61min
0
10
0
20
0
30
0
40
0
50
0
60
0
70
0
80
0
Baseline Postintervention
Active
Minutes Sleep Minutes Awake
Graphs by treatment
640min 611min
500min 488min
140min 123min
Total Sleep Duration
Change:
−29min
Asleep
Change:
−12min
Awake
Change:
−17min
0
10
0
20
0
30
0
40
0
50
0
60
0
70
0
80
0
Baseline Postintervention
Placebo
Minutes Sleep Minutes Awake
Graphs by treatment
Means Pre−/Post−Intervention
Total Minutes of Sleep & Wakefulness per Night
On average, children who received DHA during the 16-week
intervention, compared to those who did not:
• Spent 44min less awake during an average night.
•Got 58min more sleep per night.
Change in Sleep Efficiency & Number of
Night-wakings
9% efficiency gain
1%
Sig. difference: p<.052
approx. 10 wakings less
−3.5
Sig. difference: p<.013
−
10
−
5
0
5
10
Ch
an
ge
 M
ea
n 
Nu
m
be
r o
f W
ak
in
gs10
%
5%
0
−
10
%
−
5%
Sl
ee
p 
Ef
fic
ie
nc
y 
− 
Ch
an
ge
 in
 R
at
io
Sleep Efficiency (ratio) Number of Wake Episodes
Active (n=19) Placebo (n=24)
Change Pre−/Post−Intervention (Mean ± 1 SE)
Sleep Efficency and Number of Wake−episodes
In addition, children in the intervention group, compared to
the placebo group:
•Gained 8% sleep efficiency (sleep during time in bed).
•Had 7 fewer wake episodes per night, (brief wakings).
Supplementation, Subjective Sleep (CSHQ) and Clinical Relevance
Change in Subjective Sleep (CSHQ)
following Supplementation
p<.318 p<.478 p<.469 p<.245 p<.849 p<.196 p<.816 p<.898 p<.495
.
5
0
−
.
5
−
1
−
1.
5
M
ea
n 
Ch
an
ge
 S
co
re
Pr
e−
/P
os
t−
In
te
rv
en
tio
n 
(M
ea
n 1
 S
E)
Bed
time
 Res
istan
ce
Slee
p On
set D
elay
Slee
p Du
ratio
n
Slee
p An
xiety
Nigh
t wa
king
s
Para
som
nias
Slee
p Dis
turbe
d Br
eath
ing
Day
time
 Slee
pine
ss
Tota
l Sle
ep d
istur
banc
e
Active (n=180) Placebo (n=182)
Whole Sample (n=362)
Change Scores for CSHQ
The Child Health Questionaire (CSHQ) measures subjective
sleep quality.
A “Total Sleep Disturbance” score >41 is used to diagnose
clinical sleep problems.
No significant improvements in parents’ perceptions of sleep
were found across the subscales of the CSHQ.
Improvements in a Clinical Subgroup of
children with sleep problems
p<.526 p<.871 p<.129 p<.366 p<.668 p<.039 p<.817 p<.753 p<.05.5
−
.
5
−
1.
5
−
2.
5
−
3.
5
M
ea
n 
Ch
an
ge
 S
co
re
Pr
e−
/P
os
t−
In
te
rv
en
tio
n 
(M
ea
n 1
 S
E)
Bed
time
 Res
istan
ce
Slee
p On
set D
elay
Slee
p Du
ratio
n
Slee
p An
xiety
Nigh
t wa
king
s
Para
som
nias
Slee
p Dis
turbe
d Br
eath
ing
Day
time
 Slee
pine
ss
Tota
l Sle
ep d
istur
banc
e
Active (n=94) Placebo (n=94)
Change Scores for Caseness Sample CSHQ>41(n=188)
CSHQ Clinical Subgroup − Effects of Supplementation
A post-hoc analysis of children with clinical sleep problems
shows some improvements.
Total Sleep Disturbance: Children had significantly
lower scores if they received the DHA supplement.
Parasomnia: Parents of children in the active group men-
tioned fewer parasomnias (e.g. sleepwalking).
Acknowledgements:
Funding was provided by DSM Nutritional Products, who also provided the product (DHA-S) and placebo.
Thanks also goes to the Waterloo Foundation who supported Dr Richardson’s work in this area of research.
Actigraphy: How to measure
sleep objectively?
MicroMini-Motionlogger R©, Ambulatory Monitoring Inc.
What is an
Actigraph?
Actigraphs are small,
watch-sized movement
sensors, worn on the
wrist or ankle (see pic-
ture).
How do Actigraphs
work?
Actigraphy assesses sleep
by measuring movement
during time in bed.
A sensor logs the
frequency and pattern
of movement, which
allows the detection of
basic sleep-wake pat-
terns.
How well does Actigraphy measure sleep?
Actigraphy sleep measures correlate with the best measures
of sleep from clinical polysomnography to about 80%.
Conclusions
Results:
The analyses of subjective and objective sleep as secondary
outcomes of the Dolab Study suggest that:
• DHA supplementation improves the quality
of child sleep.
Children taking DHA had less wake episodes per night
and received on average 58mins more sleep.
After supplementation children and gained 8% sleep
efficiency.
Relevance:
Post-hoc analyses suggest that with regard to subjective
sleep:
•Children with clinical sleep problems might
particularly benefit from DHA supplementa-
tion.
Future Research:
These exploratory analyses give good grounds for future
research into LC-PUFA as a cheap and safe treatment for
sleep problems.
•Future studies should focus on children with
poor sleep outcomes as these might benefit
most.
Please do not reproduce or cite without permission of the authors, c©2013.


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Omega-3 DHA and Sleep in UK Children: Results From the DOLAB Study

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