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Ono M, Ando H, Daikoku T, Fujiwara T, Mieda M, Mizumoto Y, Iizuka T, Kagami K, Hosono T, Nomura S, Toyoda N, Sekizuka-Kagami N, Maida Y, Kuji N, Nishi H, Fujiwara H. The Circadian Clock, Nutritional Signals and Reproduction: A Close Relationship. Int J Mol Sci 2023; 24:ijms24021545. [PMID: 36675058 PMCID: PMC9865912 DOI: 10.3390/ijms24021545] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 01/08/2023] [Accepted: 01/09/2023] [Indexed: 01/15/2023] Open
Abstract
The circadian rhythm, which is necessary for reproduction, is controlled by clock genes. In the mouse uterus, the oscillation of the circadian clock gene has been observed. The transcription of the core clock gene period (Per) and cryptochrome (Cry) is activated by the heterodimer of the transcription factor circadian locomotor output cycles kaput (Clock) and brain and muscle Arnt-like protein-1 (Bmal1). By binding to E-box sequences in the promoters of Per1/2 and Cry1/2 genes, the CLOCK-BMAL1 heterodimer promotes the transcription of these genes. Per1/2 and Cry1/2 form a complex with the Clock/Bmal1 heterodimer and inactivate its transcriptional activities. Endometrial BMAL1 expression levels are lower in human recurrent-miscarriage sufferers. Additionally, it was shown that the presence of BMAL1-depleted decidual cells prevents trophoblast invasion, highlighting the importance of the endometrial clock throughout pregnancy. It is widely known that hormone synthesis is disturbed and sterility develops in Bmal1-deficient mice. Recently, we discovered that animals with uterus-specific Bmal1 loss also had poor placental development, and these mice also had intrauterine fetal death. Furthermore, it was shown that time-restricted feeding controlled the uterine clock's circadian rhythm. The uterine clock system may be a possibility for pregnancy complications, according to these results. We summarize the most recent research on the close connection between the circadian clock and reproduction in this review.
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Affiliation(s)
- Masanori Ono
- Department of Obstetrics and Gynecology, Tokyo Medical University, Tokyo 160-0023, Japan
- Department of Obstetrics and Gynecology, Graduate School of Medical Sciences, Kanazawa University, Kanazawa 920-8641, Japan
- Correspondence: ; Tel.: +81-3-3342-6111
| | - Hitoshi Ando
- Department of Cellular and Molecular Function Analysis, Graduate School of Medical Sciences, Kanazawa University, Kanazawa 920-8641, Japan
| | - Takiko Daikoku
- Institute for Experimental Animals, Advanced Science Research Center, Graduate School of Medical Sciences, Kanazawa University, Kanazawa 920-8641, Japan
| | - Tomoko Fujiwara
- Department of Social Work and Life Design, Kyoto Notre Dame University, Kyoto 606-0848, Japan
| | - Michihiro Mieda
- Department of Integrative Neurophysiology, Graduate School of Medical Sciences, Kanazawa University, Kanazawa 920-8641, Japan
| | - Yasunari Mizumoto
- Department of Obstetrics and Gynecology, Graduate School of Medical Sciences, Kanazawa University, Kanazawa 920-8641, Japan
| | - Takashi Iizuka
- Department of Obstetrics and Gynecology, Graduate School of Medical Sciences, Kanazawa University, Kanazawa 920-8641, Japan
| | - Kyosuke Kagami
- Department of Obstetrics and Gynecology, Graduate School of Medical Sciences, Kanazawa University, Kanazawa 920-8641, Japan
| | - Takashi Hosono
- Department of Obstetrics and Gynecology, Graduate School of Medical Sciences, Kanazawa University, Kanazawa 920-8641, Japan
| | - Satoshi Nomura
- Department of Obstetrics and Gynecology, Graduate School of Medical Sciences, Kanazawa University, Kanazawa 920-8641, Japan
| | - Natsumi Toyoda
- Department of Obstetrics and Gynecology, Graduate School of Medical Sciences, Kanazawa University, Kanazawa 920-8641, Japan
- Institute for Experimental Animals, Advanced Science Research Center, Graduate School of Medical Sciences, Kanazawa University, Kanazawa 920-8641, Japan
| | - Naomi Sekizuka-Kagami
- Department of Nursing, College of Medical, Pharmaceutical, and Health Sciences, Kanazawa University, Kanazawa 920-8641, Japan
| | - Yoshiko Maida
- Department of Nursing, College of Medical, Pharmaceutical, and Health Sciences, Kanazawa University, Kanazawa 920-8641, Japan
| | - Naoaki Kuji
- Department of Obstetrics and Gynecology, Tokyo Medical University, Tokyo 160-0023, Japan
| | - Hirotaka Nishi
- Department of Obstetrics and Gynecology, Tokyo Medical University, Tokyo 160-0023, Japan
| | - Hiroshi Fujiwara
- Department of Obstetrics and Gynecology, Graduate School of Medical Sciences, Kanazawa University, Kanazawa 920-8641, Japan
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Lenehan SM, Fogarty L, O’Connor C, Mathieson S, Boylan GB. The Architecture of Early Childhood Sleep Over the First Two Years. Matern Child Health J 2023; 27:226-250. [PMID: 36586054 PMCID: PMC9925493 DOI: 10.1007/s10995-022-03545-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/09/2022] [Indexed: 01/01/2023]
Abstract
INTRODUCTION The architecture and function of sleep during infancy and early childhood has not been fully described in the scientific literature. The impact of early sleep disruption on cognitive and physical development is also under-studied. The aim of this review was to investigate early childhood sleep development over the first two years and its association with neurodevelopment. METHODS This review was conducted according to the 2009 PRISMA guidelines. Four databases (OVID Medline, Pubmed, CINAHL, and Web of Science) were searched according to predefined search terms. RESULTS Ninety-three studies with approximately 90,000 subjects from demographically diverse backgrounds were included in this review. Sleep is the predominant state at birth. There is an increase in NREM and a decrease in REM sleep during the first two years. Changes in sleep architecture occur in tandem with development. There are more studies exploring sleep and early infancy compared to mid and late infancy and early childhood. DISCUSSION Sleep is critical for memory, learning, and socio-emotional development. Future longitudinal studies in infants and young children should focus on sleep architecture at each month of life to establish the emergence of key characteristics, especially from 7-24 months of age, during periods of rapid neurodevelopmental progress.
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Affiliation(s)
| | - Leanna Fogarty
- INFANT Research Centre, University College Cork, Cork, Ireland
| | - Cathal O’Connor
- INFANT Research Centre, University College Cork, Cork, Ireland
| | - Sean Mathieson
- INFANT Research Centre, University College Cork, Cork, Ireland
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Gossé LK, Wiesemann F, Elwell CE, Jones EJH. Habitual night waking associates with dynamics of waking cortical theta power in infancy. Dev Psychobiol 2022; 64:e22344. [PMID: 36426793 PMCID: PMC9828365 DOI: 10.1002/dev.22344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Revised: 07/27/2022] [Accepted: 09/21/2022] [Indexed: 11/23/2022]
Abstract
The implications of the substantial individual differences in infant sleep for early brain development remain unclear. Here, we examined whether night sleep quality relates to daytime brain activity, operationalized through measures of EEG theta power and its dynamic modulation, which have been previously linked to later cognitive development. For this longitudinal study, 76 typically developing infants were studied (age: 4-14 months, 166 individual study visits) over the course of 6 months with one, two, three, or four lab visits. Habitual sleep was measured with a 7-day sleep diary and actigraphy, and the Brief Infant Sleep Questionnaire. Twenty-channel EEG was recorded while infants watched multiple rounds of videos of women singing nursery rhymes; oscillatory power in the theta band was extracted. Key metrics were average theta across stimuli and the slope of change in theta within the first novel movie. Both objective and subjective sleep assessment methods showed a relationship between more night waking and higher overall theta power and reduced dynamic modulation of theta over the course of the novel video stimuli. These results may indicate altered learning and consolidation in infants with more disrupted night sleep, which may have implications for cognitive development.
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Affiliation(s)
- Louisa K. Gossé
- Centre for Brain and Cognitive Development, BirkbeckUniversity of LondonLondonUK
| | - Frank Wiesemann
- Research & DevelopmentProcter & GambleSchwalbach am TaunusGermany
| | - Clare E. Elwell
- Department of Medical Physics and Biomedical Engineering, Biomedical Optics Research LaboratoryUniversity College LondonLondonUK
| | - Emily J. H. Jones
- Centre for Brain and Cognitive Development, BirkbeckUniversity of LondonLondonUK
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Wang G, Chen J, Zhang K, Tang S, Wang G. The mediating role of gaze patterns in the association of child sleep disturbances and core symptoms of autism spectrum disorder. Autism Res 2022; 15:1719-1731. [PMID: 35521660 DOI: 10.1002/aur.2737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 04/20/2022] [Indexed: 11/05/2022]
Abstract
Children with autism spectrum disorder (ASD) are at high risk for sleep disturbances, but the mechanism underlying the association between sleep disturbances and ASD core symptoms is largely unknown. This study examined the relationship between sleep disturbances and ASD core symptoms, and the mediating role of gaze patterns during the facial emotion recognition (FER) task. The study included 57 children with ASD and 59 age- and intelligence-matched typically developing (TD) controls aged 3-7 years. Parents reported their children's sleep disturbances and ASD core symptoms using the Children's Sleep Habits Questionnaire (CSHQ) and Social Communication Questionnaire (SCQ). Children's gaze patterns during the FER task were recorded by an eye tracking method. We found (1) ASD children had more severe sleep disturbances than TD children; (2) ASD children had atypical gaze patterns and poor FER task performance as determined by lower accuracy and longer reaction time; (3) sleep disturbances were significantly associated with ASD core symptoms of social interaction, communication, and restricted, repetitive and stereotyped patterns of behavior; and (4) atypical gaze patterns partially mediated the association between sleep disturbances and ASD core symptoms. These findings suggest the need for more comprehensive clinical interventions and more effective sleep interventions to improve ASD core symptoms. LAY SUMMARY: Sleep disturbances are very common in children with autism spectrum disorder (ASD). The current study found that sleep disturbances were significantly associated with ASD core symptoms, and gaze patterns during facial emotion recognition task could partially mediate this relationship.
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Affiliation(s)
- Guangshuai Wang
- School of Computer Science, Wuhan University, Wuhan, Hubei, China.,National Engineering Research Center for Multimedia Software,Wuhan University, Wuhan, Hubei, China.,National Engineering Research Center for E-Learning, Central China Normal University, Wuhan, Hubei, China
| | - Jingying Chen
- National Engineering Research Center for E-Learning, Central China Normal University, Wuhan, Hubei, China
| | - Kun Zhang
- National Engineering Research Center for E-Learning, Central China Normal University, Wuhan, Hubei, China
| | - Suyun Tang
- School of Education, Guangzhou University, Guangzhou, Guangdong, China
| | - Guanghai Wang
- Pediatric Translational Medicine Institution, Department of Developmental and Behavioral Pediatrics, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
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Mäkelä TE, Kylliäinen A, Saarenpää-Heikkilä O, Paavonen EJ, Paunio T, Leppänen JM, Peltola MJ. Signaled night awakening and its association with social information processing and socio-emotional development across the first two years. Sleep 2021; 44:zsab179. [PMID: 34270777 PMCID: PMC8664598 DOI: 10.1093/sleep/zsab179] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 06/14/2021] [Indexed: 11/30/2022] Open
Abstract
STUDY OBJECTIVES Night awakening is common in infancy, and some infants continue to have signaled night awakenings throughout early childhood. However, the influence of signaled night awakening on children's social development is less explored. In the present study, longitudinal associations between signaled night awakening, social information processing, and socio-emotional development were measured within the CHILD-SLEEP birth cohort in two groups formed based on parent-reported night awakenings. METHODS At 8 months, there were 77 infants in the waking group (≥3 awakenings) and 69 infants in the nonwaking group (≤1 awakening). At 8 and 24 months, social information processing was measured as children's attention to neutral and emotional faces, and at 24 months, parent-reported socio-emotional behavior was measured with the Brief Infant-Toddler Social and Emotional Assessment (BITSEA) questionnaire. RESULTS The two groups showed different patterns of attention to emotional faces. The waking group had a more pronounced attentional bias to fearful versus happy faces, whereas in the nonwaking group, attention to fearful and happy faces did not differ. In addition, at 24 months, the waking group had more dysregulation problems and lower social competence than the nonwaking group, but no clear differences in internalizing or externalizing problems were found. CONCLUSIONS Our results contribute to the literature by showing that during the first 2 years of life, signaled night awakening is associated with social information processing and socio-emotional behavior.
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Affiliation(s)
- Tiina E Mäkelä
- Psychology, Faculty of Social Sciences, Tampere University, Tampere, Finland
| | - Anneli Kylliäinen
- Psychology, Faculty of Social Sciences, Tampere University, Tampere, Finland
| | - Outi Saarenpää-Heikkilä
- Faculty of Medicine and Life Sciences, Tampere University, Tampere, Finland
- Department of Pediatrics, Tampere University Hospital, Tampere, Finland
| | - E Juulia Paavonen
- Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland
- Pediatric Research Center, Child Psychiatry, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Tiina Paunio
- Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland
- Psychiatry and SleepWell Research Program, Faculty of Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Jukka M Leppänen
- Department of Psychology and Speech-Language Pathology, University of Turku, Turku, Finland
| | - Mikko J Peltola
- Psychology, Faculty of Social Sciences, Tampere University, Tampere, Finland
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Seehagen S, Herbert JS, Zmyj N. Prior sleep timing and visual recognition of emotional faces in 6-month-old infants. Infant Behav Dev 2021; 65:101655. [PMID: 34689020 DOI: 10.1016/j.infbeh.2021.101655] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 09/15/2021] [Accepted: 10/08/2021] [Indexed: 11/16/2022]
Abstract
Face recognition is an important mnemonic ability for infants when navigating the social world. While age-related changes in face processing abilities are relatively well documented, less is known about short-term intra-individual fluctuations in this ability. Given that sleep deprivation in adults leads to impairments in information processing, we assessed the role of prior sleep on 6-month-old infants' (N = 17) visual recognition of faces showing three emotional expressions (neutral, sad, angry). Visual recognition was inferred by assessing novelty preferences for unfamiliar relative to familiarized faces in a visual recognition memory paradigm. In a within-subject design, infants participated once after they had recently woken up from a nap (nap condition) and once after they had been awake for an extended period of time (awake condition). Infants failed to show visual recognition for the neutral faces in either condition. Infants showed recognition for the sad and angry faces when tested in the awake condition, but not in the nap condition. This suggests that timing of prior sleep shapes how effectively infants process emotionally relevant information in their environment.
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Affiliation(s)
- Sabine Seehagen
- School of Psychology, University of Waikato, New Zealand; Faculty of Psychology, Ruhr University Bochum, Germany.
| | - Jane S Herbert
- School of Psychology, University of Wollongong, Australia
| | - Norbert Zmyj
- Department of Educational Sciences and Psychology, TU Dortmund University, Germany
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Yavuz-Kodat E, Reynaud E, Geoffray MM, Limousin N, Franco P, Bonnet-Brilhault F, Bourgin P, Schroder CM. Disturbances of Continuous Sleep and Circadian Rhythms Account for Behavioral Difficulties in Children with Autism Spectrum Disorder. J Clin Med 2020; 9:jcm9061978. [PMID: 32599848 PMCID: PMC7356341 DOI: 10.3390/jcm9061978] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 06/20/2020] [Accepted: 06/21/2020] [Indexed: 12/27/2022] Open
Abstract
Sleep disorders are among the most common comorbidities in children with Autism Spectrum Disorder (ASD), and subjectively defined sleep disturbances have been related to ASD symptom severity. However, no study has investigated the differential impact of objectively measured sleep and circadian rhythm disturbances on behavioral difficulties in this population. Fifty-two children with ASD aged 3-10 years underwent assessments of sleep and circadian rest-activity rhythms objectively with actigraphy and subjectively with the Children's Sleep Habits Questionnaire. Behavioral difficulties were assessed using the ABC-C. Group comparison analyses were used to compare sleep and circadian rhythm parameters of children with higher and lower behavioral difficulties and dominance analysis to rank predictors and address multicollinearity. Children with high irritability had a shorter continuous sleep period compared to those with lower irritability (-60 min, p = 0.04), as well as those with high stereotypic behaviors compared to children with less stereotypies (-75 min, p = 0.006). Objective circadian and sleep disturbances accounted together for, respectively, 17%, 18% and 36% of the variance in social withdrawal, irritability and stereotypic behaviors. The identification of both sleep and circadian rhythm disturbances as explanatory factors for behavioral difficulties warrants their inclusion in the existing behavioral management strategies for children with ASD.
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Affiliation(s)
- Enise Yavuz-Kodat
- Centre National de la Recherche Scientifique CNRS UPR 3212, Université de Strasbourg, Institut des Neurosciences Cellulaires et Intégratives, 8 allée du Général Rouvillois, 67000 Strasbourg, France; (E.Y.-K.); (P.B.); (C.M.S.)
| | - Eve Reynaud
- Centre National de la Recherche Scientifique CNRS UPR 3212, Université de Strasbourg, Institut des Neurosciences Cellulaires et Intégratives, 8 allée du Général Rouvillois, 67000 Strasbourg, France; (E.Y.-K.); (P.B.); (C.M.S.)
- Correspondence:
| | - Marie-Maude Geoffray
- Department of Child and Adolescent Neurodevelopmental Psychiatry, Le Vinatier Hospital, 95 Boulevard Pinel, 69678 Bron CEDEX, France;
- Health Services and Performance Research (HESPER), Claude Bernard University Lyon 1, 43 Boulevard du 11 Novembre 1918, 69622 Villeurbane CEDEX, France
| | - Nadège Limousin
- Department of Neurology and Clinical Neurophysiology, University Hospital Bretonneau, 2 Boulevard Tonnellé, 37044 Tours, France;
| | - Patricia Franco
- Pediatric Sleep, Hôpital Femme-Mère-Enfant, Hospices civils of Lyon, 59 Boulevard Pinel, 69500 Bron, France;
- Lyon Neuroscience Research Center U1028/UMR5292, Claude Bernard University Lyon 1, 43 Boulevard du 11 Novembre 1918, 69622 Villeurbane CEDEX, France
| | - Frédérique Bonnet-Brilhault
- UMR 1253, iBrain, Université de Tours, Inserm, CHRU de Tours, Centre Universitaire de Pédopsychiatrie, 2 Boulevard Tonnellé, 37044 Tours, France;
| | - Patrice Bourgin
- Centre National de la Recherche Scientifique CNRS UPR 3212, Université de Strasbourg, Institut des Neurosciences Cellulaires et Intégratives, 8 allée du Général Rouvillois, 67000 Strasbourg, France; (E.Y.-K.); (P.B.); (C.M.S.)
- Sleep Disorders Center, International Research Center for ChronoSomnology, Strasbourg University Hospitals, 1 place de l’Hôpital, 67000 Strasbourg, France
| | - Carmen M. Schroder
- Centre National de la Recherche Scientifique CNRS UPR 3212, Université de Strasbourg, Institut des Neurosciences Cellulaires et Intégratives, 8 allée du Général Rouvillois, 67000 Strasbourg, France; (E.Y.-K.); (P.B.); (C.M.S.)
- Sleep Disorders Center, International Research Center for ChronoSomnology, Strasbourg University Hospitals, 1 place de l’Hôpital, 67000 Strasbourg, France
- Department of Child and Adolescent Psychiatry, Strasbourg University Hospitals & University of Strasbourg Medical School, 67000 Strasbourg, France
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Jiang F. Sleep and Early Brain Development. ANNALS OF NUTRITION AND METABOLISM 2020; 75 Suppl 1:44-54. [DOI: 10.1159/000508055] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Accepted: 04/07/2020] [Indexed: 11/19/2022]
Abstract
The early years of life are characterized by dramatic developmental changes. Within this important time period lies the transition from newborn to childhood. Sleep is one of the primary activities of the brain during early development and plays an important role in healthy cognitive and psychosocial development in early life. This paper will first review the normal sleep characteristics and their development in neonates and children, including architecture of sleep, development of a healthy sleep rhythm in early childhood, sleep recommendations and cultural disparity, as well as important factors for establishing a healthy sleep pattern during the first years of life, such as regular and consistent bedtime routine, safe and comfortable sleep environment, and appropriate sleep onset associations. This paper then provides recent updates of evidence of the effects of sleep on early brain development, particularly on learning and memory, emotional regulation, and general cognitive development through behavioral and neurophysiological studies. As regards the mechanism, many experimental sleep deprivation studies in animals and adults have attempted to explain the underlying mechanisms of sleep on cognition and the emotional brain. Future studies are expected to delineate the effects of sleep on brain structural and functional networks in the developing brain with the marked development of image acquisition approaches and the novel analysis tools for infants and young children in recent years.
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A review of developmental consequences of poor sleep in childhood. Sleep Med 2018; 60:3-12. [PMID: 30660750 DOI: 10.1016/j.sleep.2018.11.021] [Citation(s) in RCA: 62] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2018] [Revised: 11/01/2018] [Accepted: 11/03/2018] [Indexed: 12/13/2022]
Abstract
Sleep is a fairly diverse and complex construct to operationalize in a scientific and naturalistic context. We report a systematic review and meta-analysis of reviews published in the last 5 years on poor sleep and developmental outcomes. Following the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines, 42 articles (or 1117 studies) qualified. They reported outcomes related to poor sleep investigated as sleep disorders (38.1%), sleep 'in general' (26.2%), sleep duration (23.8%), in terms of circadian rhythm (4.8%), intra-individual variability (2.4%), and napping (2.4%). Sleep was primarily subjectively reported (30.2%), yet the methodology of sleep assessment was often neither tabulated nor discussed. Overall, most papers had a health-scope, being primarily weight problems expressed as body mass index. Its relationship with performance was measured with the Wechsler intelligence tests, the child behavior checklist and the continuous performance test, whereas meta-analytic papers specifically focused on cognition with sleep disorder (i.e. sleep-disordered breathing; 38.6%), on health (i.e. weight) with sleep duration (25%) and behavior with sleep 'in general' (15.9%), having a high true variance. Nevertheless, an aggregated effect size d of 0.35 (95% confidence interval: 0.27-0.42) suggests that poor sleep is moderately affecting a child's performance and health. In conclusion, poor sleep can no longer be disregarded, yet methodologies that are more rigorous and a scope beyond health may foster a better understanding of the role of (poor) sleep across childhood neurodevelopment.
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