Sleep Problem Trajectories and Cumulative Socio-Ecological Risks: Birth to School-Age

doi:10.1016/j.jpeds.2019.07.055

The Journal of Pediatrics

Volume 215, December 2019, Pages 229-237.e4

Portions of this study were presented at the International Paediatric Sleep Association Congress, April 27-29, 2018, Paris, Ile-de-France, France; and the Pediatric Academic Societies annual meeting, May 5-8, 2018, Toronto, Canada.

https://doi.org/10.1016/j.jpeds.2019.07.055 Get rights and content

Objectives

To evaluate whether there are distinct childhood sleep problem trajectories from birth to 10-11 years and to assess associations with cumulative socio-ecological risks (child, family, context).

Study design

Participants were 5107 children from the Longitudinal Study of Australian Children—Birth Cohort. At birth, cumulative risk indexes were generated for birth, parenting, family, socioeconomic, and neighborhood risks. Parent-reported child sleep problems were assessed biennially from ages 0-1 to 10-11 years. Sleep problem trajectories were derived using latent class analysis. Multivariable logistic regression was used to examine associations with risk indexes.

Results

Five distinct trajectories emerged: persistent sleep problems through middle childhood (7.7%), limited infant/preschool sleep problems (9.0%), increased middle childhood sleep problems (17.0%), mild sleep problems over time (14.4%), and no sleep problems (51.9%). Cumulative mother- and father-reported family risks (distress; marital/relational hostility) were linked to nearly all of the trajectories, whereas father- and mother-reported parenting risks were associated with fewer trajectories. Birth risks were associated with increased middle childhood sleep problems. Neighborhood risks were not associated with any trajectories. Socioeconomic risks were linked to mild and persistent sleep problem trajectories. Cumulative risk indexes were most associated with increased middle childhood sleep problems.

Conclusions

This study identified distinct longitudinal sleep problem trajectories, suggesting the need for continuous sleep screening over development. Cumulative risks assessed at birth—primarily maternal and paternal family risks—predicted these trajectories, especially for the sleep problems in middle childhood trajectory. Preventive interventions targeting modifiable factors, particularly caregiver distress and marital/relational hostility, could benefit child sleep.

Section snippets

Methods

Data were drawn from the first 6 waves of the prospective Growing up in Australia: The Longitudinal Study of Australian Children (LSAC)—Birth Cohort (B-cohort). Technical details about the study design and methods have been described elsewhere.³⁷ In 2004, LSAC employed a 2-stage cluster sampling design to enroll the cohort. In the first stage, Australian postcodes were sampled after stratifying by state and urban/rural status to ensure proportional geographic representation. Within each

Results

Table IX shows the birth cohort demographic information. There were similar proportions of girls and boys (51.1% male). The mother served as the primary reporter for the majority of children (96.1%). Most families were 2-parent families (90.6%), spoke English as the primary language at home (85.6%), and had parents who had completed at least high school (68.3% of mothers; 59.8% of fathers). Mean cumulative risk scores for each index are also presented in Table IX. The correlations between risk

Discussion

This study identified distinct sleep problem trajectories from birth to middle childhood and examined associations with cumulative socio-ecological risks assessed at birth. In line with previous studies,6, 11, 59 approximately one-half of children showed no sleep problems, 9% showed only early childhood sleep problems, and 14% exhibited mild increases in sleep problems through ages 10-11 years. Three of the 5 trajectories included sleep problems in the first year of life. Interestingly, 17% of

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: Supported by the National Heart, Lung, and Blood Institute (T32HL007953-17 [to A.W.]); the Eunice Kennedy Shriver National Institute of Child Health and Human Development (K23HD094905 [to A.W.]); the Sleep Research Society Foundation (to A.W.); the National Health and Medical Research Council (Practitioner Fellowship, 1136222 [to H.H.]); and the Victorian Government's Operational Infrastructure Support Program (to J.Q.). The authors declare no conflicts of interest.

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Original ArticleSleep Problem Trajectories and Cumulative Socio-Ecological Risks: Birth to School-Age

Objectives

Study design

Results

Conclusions

Section snippets

Methods

Results

Discussion

Acad Pediatr

J Pediatr

Sleep Med

Sleep Med Rev

Sleep Med

Sleep Med Rev

Sleep Health

Sleep Med

Sleep Health

Sleep Med

Children Youth Services Rev

Ambul Pediatr

Sleep Med

J Am Acad Child Adolesc Psychiatry

Sleep Med Rev

Women Birth

Later emotional and behavioral problems associated with sleep problems in toddlers: a longitudinal study

JAMA Pediatr

A developmental cascade model of behavioral sleep problems and emotional and attentional self-regulation across early childhood

Behav Sleep Med

Early childhood sleep patterns and cognitive development at age 6 years: the Generation R Study

J Pediatr Psychol

The developmental course of sleep disturbances across childhood relates to brain morphology at age 7: the Generation R Study

Sleep

Prevalence, patterns, and persistence of sleep problems in the first 3 years of life

Pediatrics

Outcomes of infant sleep problems: a longitudinal study of sleep, behavior, and maternal well-being

Pediatrics

Early childhood profiles of sleep problems and self-regulation predict later school adjustment

Br J Educ Psychol

Developmental trajectories of sleep problems from childhood to adolescence both predict and are predicted by emotional and behavioral problems

Front Psychol

Insomnia, health-related quality of life and health outcomes in children: a seven year longitudinal cohort

Sci Rep

Toward an experimental ecology of human development

Am Psychologist

Sleep tight, act right: negative affect, sleep and behavior problems during early childhood

Child Dev

Relations between toddler sleep characteristics, sleep problems, and temperament

Dev Neuropsychol

Maternal depressive symptoms and household income in relation to sleep in early childhood

J Pediatr Psychol

Sleep problems in preschoolers and maternal depressive symptoms: an evaluation of mother-and child-driven effects

Dev Psychol

Maternal emotional availability at bedtime predicts infant sleep quality

J Family Psychol

Preschoolers' sleep behaviour: associations with parental hardiness, sleep-related cognitions and bedtime interactions

J Child PsycholPsychiatry

Parental depressive symptoms and children's sleep: the role of family conflict

J Child Psychol Psychiatry

Family chaos and child functioning in relation to sleep problems among children at risk for obesity

Behav Sleep Med

Economic adversity and children's sleep problems: multiple indicators and moderation of effects

Health Psychol

Objective and subjective socioeconomic gradients exist for sleep in children and adolescents

Health Psychol

Cumulative risk and child development

Psychol Bull

Development and assessment of cumulative risk measures of family environment and parental investments in the Longitudinal Study of Australian Children

Soc Indicators Res

Cumulative risk, cumulative outcome: a 20-year longitudinal study

PLoS One

Original Article
Sleep Problem Trajectories and Cumulative Socio-Ecological Risks: Birth to School-Age