Early Childhood Co-Sleeping Predicts Behavior Problems in Preadolescence: A Prospective Cohort Study

Sleep problems and executive dysfunctions in pre-school children

AIM

The aim of the study was to examine the relationship between sleep problems and executive functions in pre-school children as reported by parents/caregivers.

METHODS

This cross-sectional study of caregiver-child dyads was conducted in a public kindergarten school in Northern Thailand. Sleep problems were evaluated using the Children's Sleep Habits Questionnaire (CSHQ), whereas executive functions were assessed using the Behavioural Rating Inventory of Executive Function - pre-school version (BRIEF-P). T-scores greater than 65 of the BRIEF-P were defined as deficits in executive functions. Multiple linear regressions were performed to assess the association between the executive function components and the total CSHQ scores.

RESULTS

Participants included 356 children, with a mean age of 5.04 (0.54) years. The total CSHQ scores of the executive dysfunction group were significantly higher than those of the group with executive functions below the cutoff (P < 0.001), which indicated more of sleep problems, including sleep-onset delay, night waking and daytime sleepiness. However, the duration of night sleep, night awake, afternoon nap and total sleep time reported by parents did not differ between the two groups. Weak positive correlations between the total CSHQ and subscale scores and the Global Executive Composite score of the BRIEF-P were noted. After adjusting for confounding variables, including child's age, gender, prematurity, maternal age and education, family income and media viewing time from the multiple linear regression analysis, the total CSHQ scores were significantly correlated with worse Global Executive Composite scores, which is the summary of five domains of executive functions (P < 0.001).

CONCLUSIONS

This study highlights the association between sleep problems and deficits in executive functions in healthy pre-school children. Health-care providers are encouraged to consistently advocate for proper sleep hygiene and practices to enhance executive functions in pre-schoolers.

Childhood sleep: assessments, risk factors, and potential mechanisms

BACKGROUND

Sleep problem is a highly prevalent health issue among pediatric populations across the world. In this review, we aimed to identify risk factors contributing to sleep deficiency and poor sleep hygiene in children. Potential biological, psychosocial, and environmental mechanisms as well as research gaps in the literature are also discussed.

DATA SOURCES

A comprehensive search for relevant English language full-text, peer-reviewed publications was performed focusing on pediatric sleep studies from prenatal to childhood and adolescence in a variety of indexes in PubMed, SCOPUS, and Psych Info. Both relevant data based and systematic reviews are included.

RESULTS

This paper summarizes many risk factors for childhood sleep problems, including biological (e.g., genetics, gender, age and puberty, prenatal factors, postnatal factors); nutritional (e.g., macronutrients, micronutrients, omega-3 fatty acids, obesity); environmental (e.g., heavy metals, noise, light, air pollution); interpersonal (e.g., family, exposure to violence, screen media use, physical injury); and community/socioeconomic variables (e.g., racial/ethnicity and cultural factors, neighborhood conditions and socioeconomic status, school factors, public health disasters/emergencies), to better understand the development of sleep problems in children.

CONCLUSIONS

Poor childhood sleep is a multifactorial issue affected by a wide range of prenatal and early-life biological, environmental, and psychosocial risk factors and contributors. A better understanding of these risk factors and their mechanisms is an important first step to develop future research and prevention programs focusing on pediatric sleep problems.

The physical home environment and sleep: What matters most for sleep in early childhood

The physical home environment is thought to play a crucial role in facilitating healthy sleep in young children. However, relatively little is known about how various features of the physical home environment are associated with sleep in early childhood, and some of the recommendations clinicians make for improving child sleep environments are based on limited research evidence. The present study examined how observer and parent descriptions of the child's physical home environment were associated with child sleep, measured using actigraphy and parent's reports, across a year in early childhood. The study used a machine learning approach (elastic net regression) to specify which aspects of the physical home environment were most important for predicting five aspects of child sleep, sleep duration, sleep variability, sleep timing, sleep activity, and latency to fall asleep. The study included 546 toddlers (265 females) recruited at 30 months of age and reassessed at 36 and 42 months of age. Poorer quality physical home environments were associated with later sleep schedules, more variable sleep schedules, shorter sleep durations, and more parent-reported sleep problems in young children. The most important environmental predictors of sleep were room sharing with an adult, bed sharing, and quality of both the child's sleep space and the wider home environment. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Longitudinal bidirectional association between sleep and behavior problems at age 6 and 11 years

BACKGROUND

Although a growing number of longitudinal studies have found that sleep problems precede behavior problems, few have examined potential bidirectional relationships longitudinally. The present study examined prospective associations between sleep problems and internalizing, externalizing, and attention problems over the course of childhood.

METHODS

Participants included 775 children from the China Jintan Cohort Study. Sleep problems were rated by mothers at ages six and 11.5, as well as self-reported by children at age 11.5. Behavior problems were rated by mothers and teachers at ages six and 11.5, and self-reported by children at age 11.5.

RESULTS

At age six, 15.0% of children were reported to have sleep problems as rated by mothers. At age 11, this prevalence was 12% as rated by mothers and 20% as rated by youth. Bidirectional relationships between sleep problems and behavior problems were observed. Mother-reported sleep problems at age six were predictive of self-reported internalizing and attention problems at age 11.5, even after controlling for baseline behavioral problems. At age six, teacher-reported externalizing, internalizing, and attention problems, and mother-rated internalizing and externalizing problems were all related to sleep problems at age 11.5, even after controlling for baseline sleep problems. Other sociodemographic covariates including child sex, age, and parental education were controlled for.

CONCLUSIONS

Findings provide further support for the reciprocal relationship between sleep problems and behavior problems. Early interventions that target both types of problems may be especially effective in preventing this aggravating health-behavior cycle.

Parental perceived child sleep problems: A concept analysis

PURPOSE

This paper aims to delineate a conceptual analysis of parental perceived child sleep problems.

DESIGN AND METHODS

Rodger's evolutionary approach to concept analysis was employed. A systematic literature search of PubMed, CINAHL, Medline, and PsycINFO was conducted from inception to June 2020. Peer-reviewed papers written in English focusing on parental perception of their children's sleep problems were included.

RESULTS

A total of 47 papers were included for analysis. Parental perceived child sleep problems can be defined as parental reliance on their observations and beliefs, and perceived locus of control to appraise an array of children's sleep-related signs and behaviors, which may contain bias but still reflects certain aspects of children's sleep health status. A wide range of physiological, psychosocial, familial, environmental, and cultural factors may contribute to parental perceived child sleep problems, which may further contribute to parent-child dyads' physical and mental health as well as the whole family's general wellness.

PRACTICE IMPLICATIONS

Defining the concept of parental perceived child sleep problems facilitate health professionals a foundation for consistent use, understanding, and evaluation of parent-reported child sleep outcome. Future research on the standard conceptual and operational definition of parental perceived child sleep problem, and its potential antecedents and consequences is warranted. The characteristic of parental perceived sleep problems, together with child sleep history and objective sleep measures should be integrated to evaluate child sleep health.