ABSTRACT
Objective: To investigate the influence of sleep fragmentation in infancy and toddler period on emotional and behavioral problems at the age of 6 years. Methods: Using a prospective cohort design, 262 children were extracted from mother-child birth cohort recruited from May 2012 to July 2013 in Renji Hospital, School of Medicine, Shanghai Jiao Tong University. Children's sleep and physical activities were assessed using actigraphy at 6, 12, 18, 24, and 36 months of age, from which the sleep fragmentation index (FI) at each follow-up point was calculated. Children's emotional and behavioral problems at 6 years of age were assessed using the strengths and difficulties questionnaire. Group-based trajectory model was applied to determine sleep FI in infancy and toddler period trajectory groups with Bayesian information criteria being used to determine the best fitting model. Children's emotional and behavioral problems between groups were examined with independent t test and linear regression models, etc. Results: A total of 177 children, with 91 boys and 86 girls, were included in the final analysis and were divided into 2 groups: high FI group (n=30) and low FI group (n=147). Compared with children in the low FI group, those in the high FI group presents with higher total difficulties score and higher hyperactivity or inattention score ((11.0±4.9) vs. (8.9±4.1), (4.9±2.7) vs. (3.7±2.3) scores, t=2.17, 2.23, both P<0.05, respectively), with the differences remaining significant after adjusting for covariates (t=2.08, 2.09, both P<0.05 respectively). Conclusion: High sleep fragmentation in infancy and toddler period is associated with more emotional and behavioral problems, especially hyperactivity or inattention problems, at 6 years of age.
Subject(s)
Male , Female , Humans , Infant , Child, Preschool , Child , Cohort Studies , Problem Behavior/psychology , Sleep Deprivation , Prospective Studies , Bayes Theorem , China , Surveys and QuestionnairesABSTRACT
<p><b>OBJECTIVE</b>To study the association between sleep hygiene and sleep duration and quality among school-age children, and to explore the risk factors related to poor sleep hygiene.</p><p><b>METHODS</b>Totally 2019 grade-five children were sampled by stratified cluster random sampling from 10 primary schools in Shanghai, during November and December 2009. Questionnaires were used to investigate children and their parents. Adolescent Sleep Hygiene Scale (ASHS) was used to inquiry sleep hygiene of children; Children Sleep Habits Questionnaire (CSHQ) was used to assess their sleep duration and quality; Family and Social Environment Questionnaire was used to collect demographic and socio-economic information. T-test, one-way ANOVA and multiple linear regression model were established to identify the risk factors for sleep hygiene.</p><p><b>RESULTS</b>The age of subjects was (10.81 ± 0.38) years old, 49.0% (989/2019) were boys. The ASHS total score was 125.43 ± 15.17, girls with better sleep hygiene than boys (127.05 ± 14.41 vs 123.74 ± 15.75, P < 0.05). The sleep duration was (9.47 ± 0.58)h/d, children slept less than 9 h/d had lower ASHS total score than those slept 9 - 10 h/d or over 10 h/d (121.69 ± 16.09 vs 126.17 ± 14.62 vs 126.50 ± 15.36, P < 0.05). Children with poor sleep quality had worse sleep hygiene than those with good sleep quality (121.00 ± 15.84 vs 128.36 ± 13.92, P < 0.05). Children with television set in bedroom had lower ASHS total score than the others (122.40 ± 15.76 vs 126.74 ± 14.66, P < 0.05). Children from single parent family had lower ASHS total score (117.90 ± 16.80 vs 125.94 ± 14.89, P < 0.05). Children whose father had irregular sleep or wake pattern had lower ASHS total score (122.65 ± 15.30 vs 125.89 ± 14.90 vs 127.79 ± 14.71, P < 0.05). The regression model confirmed that existence of television set in children's bedroom, single-parent family and father's irregular sleep pattern were the risk factors of poor sleep hygiene.</p><p><b>CONCLUSION</b>Sleep hygiene was closely associated with sleep duration and quality among school-age children. Children with television set in bedroom, male, from single parent family and whose father had irregular sleep or wake pattern had worse sleep quality.</p>