Child and family predictors of insomnia from early childhood to adolescence.

BACKGROUND: Insomnia is prevalent among children and adolescents and is associated with a wide range of negative outcomes. Knowledge about its determinants is therefore important, but due to the lack of longitudinal studies, such knowledge is limited. The aim of the present inquiry is to identify child and family predictors of future pediatric insomnia within a psycho-bio-behavioral framework. METHODS: A representative community sample (n = 1,037) was followed biennially from 4 to 14 years of age (2007-2017). Insomnia was defined based on the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) criteria and was diagnosed by a semistructured clinical interview of children (from age eight years of age) and parents (all ages). Predictors included parent ratings of child emotional reactivity, family functioning, and marital conflict; self-reports of personality; and teacher-rated emotion regulation skills. RESULTS: Random intercept cross-lagged analyses revealed that within-person increases (ie, relative to the child's typical levels across childhood) in emotional reactivity and decreases in emotion regulation skills predicted insomnia diagnosis two years later from ages 4 to 14 after adjusting for previous insomnia and all unmeasured time-invariant factors. Previous insomnia was the strongest predictor of later insomnia, whereas family functioning and marital conflict did not predict insomnia. CONCLUSIONS: Increases in emotional reactivity and decreases in emotion regulation skills predicted insomnia above and beyond all unmeasured time-invariant factors and could be targets for interventions. Previous insomnia predicted later insomnia, thereby underscoring the importance of detecting, preventing, and treating insomnia at an early age.

Persistent Short Sleep from Childhood to Adolescence: Child, Parent and Peer Predictors.

PURPOSE: Many children have periods when they sleep too little, with widely recognized detrimental effects. Less is known about persistent short sleep during childhood. Therefore, the present study aimed to investigate the prevalence of persistent short sleep in school-aged children and identify a set of child, parent, and peer predictors thereof. PARTICIPANTS AND METHODS: Objectively measured sleep duration (hip-held accelerometer) was biennially assessed in a community sample followed from 6 to 14 years (n=801). A latent profile analysis was applied to assess whether a subgroup of children slept consistently short across time and predictors of persistent short sleep were determined through regression analysis. RESULTS: A subgroup of children (n=160; 20.2%) was identified as having persistent short sleep across time. Temperamental negative affectivity (ß=0.08; 95% CI=0.01, 0.15; p=0.03) and low observer-assessed parental emotional availability (ß=-.09; 95% CI=-.18, -.01; p=0.04) predicted membership to that group. Teacher ratings of victimization from bullying were not associated with persistent short sleep (ß=0.01; 95% CI: -.10, 11; p=0.88). CONCLUSION: High child temperamental negative affectivity and low parental emotional availability may be involved in the development of persistent short sleep through childhood.

Prevalence and stability of insufficient sleep measured by actigraphy: a prospective community study.

BACKGROUND: It is well established that reduced sleep has detrimental effects on school-aged children's functioning, but the prevalence and stability of objectively measured insufficient sleep throughout childhood is unknown. METHODS: A sample of 799 children was followed biennially with 24-h 7-day accelerometer (hip-placed) measurements from ages 6 to 12 years. Insufficient sleep was conceptualized as sleeping <7 h on average (AIS) and as the number of nights with <7 h of sleep (NNIS). RESULTS: The prevalence of AIS ranged from 1.1% to 13.6%. Of those without AIS, 15.1-64.5% had >1 NNIS. At ages 6-10 years, NNIS was higher on weekend nights, but at age 12 years NNIS was lower on weekends (18.1%) compared to weekdays (23.4%). The stability of AIS was low from ages 6 to 8 years and from 8 to 10 years, but increased from age 10 to 12 years, whereas NNIS evidenced higher stability, increasing sharply through late middle childhood. CONCLUSIONS: The prevalence of AIS was low during the preschool and early school years but increased toward preadolescence. The 2-year stability of insufficient sleep was very low when conceptualized as AIS and moderate when defined as NNIS, hence NNIS might be more sensitive than AIS. Insufficient sleep appears transient in middle childhood and thus might not warrant intervention unless it fosters impairment and endures.

Association Between Objectively Measured Sleep Duration and Symptoms of Psychiatric Disorders in Middle Childhood.

Importance: The long-term association between sleep duration and mental health in children is currently unknown. Objective: To investigate the prospective associations between sleep duration and symptoms of emotional and behavioral disorders at ages 6, 8, 10, and 12 years. Design, Setting, and Participants: This population-based cohort study obtained data from the Trondheim Early Secure Study in Trondheim, Norway. A representative, stratified random sample of children born between January 1, 2003, and December 31, 2004, were invited to participate. Participants were followed up biennially from age 4 years (2007-2008) to 12 years (2013-2014). Data analysis was conducted from January 2, 2019, to May 28, 2019. Main Outcomes and Measures: Sleep duration was assessed with 1 week of continuous use of a triaxial accelerometer. Symptoms of emotional (anxiety and depression) and behavioral (oppositional defiant, conduct, and attention-deficit/hyperactivity) disorders were measured by semistructured clinical interviews (using the Preschool Age Psychiatric Assessment and the Child and Adolescent Psychiatric Assessment) with parents (at all ages) and children (from age 8 years). Results: The analytical sample comprised 799 children (mean [SD] age at time point 2, 6.0 [0.2] years; 405 [50.7%] boys; and 771 [96.5%] Norwegian). Shorter sleep duration at age 6 years (ß [unstandardized regression coefficient] = -0.44; 95% CI, -0.80 to -0.08; P = .02) and 8 years (ß = -0.47; 95% CI, -0.83 to -0.11; P = .01) forecasted symptoms of emotional disorders 2 years later. Comparatively short sleep duration at age 8 years (ß = -0.65; 95% CI, -1.22 to -0.08; P = .03) and 10 years (ß = -0.58; 95% CI, -1.07 to -0.08; P = .02) was associated with symptoms of behavioral disorders 2 years later among boys but not among girls at age 8 years (ß = -0.14; 95% CI,- 0.52 to 0.24; P = .48) or 10 years (ß = -0.05; 95% CI, = -0.49 to 0.40; P = .84). These associations were statistically significant among boys compared with girls at age 8 years (Δχ21 = 13.26; P < .001) and 10 years (Δχ21 = 10.25; P = .001). Symptoms of psychiatric disorders did not forecast sleep duration at any age. Conclusions and Relevance: This study found an association between short sleep duration and increased risk of future occurrence of emotional disorder symptoms in both boys and girls and between reduced sleep and behavioral disorder symptoms in boys. These results suggest that improving sleep in children may help protect against the development of symptoms of common psychiatric disorders and may be advantageous in the treatment of such disorders.