Associations between sleep duration patterns and behavioral/cognitive functioning at school entry

Abstract

Objective: The aim of the study was to investigate the associations between longitudinal sleep duration patterns and behavioral/cognitive functioning at school entry.

Design, setting, and participants: Hyperactivity-impulsivity (HI), inattention, and daytime sleepiness scores were measured by questionnaire at 6 years of age in a sample of births from 1997 to 1998 in a Canadian province (N=1492). The Peabody Picture Vocabulary Test--Revised (PPVT-R) was administered at 5 years of age and the Block Design subtest (WISC-III) was administered at 6 years of age. Sleep duration was reported yearly by the children's mothers from age 2.5 to 6 years. A group-based semi-parametric mixture model was used to estimate developmental patterns of sleep duration. The relationships between sleep duration patterns and both behavioral items and neurodevelopmental tasks were tested using weighted multivariate logistic regression models to control for potentially confounding psychosocial factors.

Results: Four sleep duration patterns were identified: short persistent (6.0%), short increasing (4.8%),10-hour persistent (50.3%), and 11-hour persistent (38.9%). The association of short sleep duration patterns with high HI scores (P=0.001), low PPVT-R performance (P=0.002), and low Block Design subtest performance (P=0.004) remained significant after adjusting for potentially confounding variables.

Conclusions: Shortened sleep duration, especially before the age of 41 months, is associated with externalizing problems such as HI and lower cognitive performance on neurodevelopmental tests. Results highlight the importance of giving a child the opportunity to sleep at least 10 hours per night throughout early childhood.

Figure 1

Patterns of sleep duration at 2.5, 3.5, 4, 5 and 6 years of age:: short persistent sleepers (n=109; 6.0%),: short increasing sleepers (n=88; 4.8%),: 10-hour persistent sleepers (n=920; 50.3%), and: 11-hour persistent sleepers (n=712; 38.9%). Predicted (dashed lines) versus observed (solid lines) trajectories. Data courtesy of the Quebec Institute of Statistics.

Figure 2

Grey areas indicate percentage of children who had low performances on the PPVT-R, on the Block design or high hyperactivity ratings as a function of sleep duration patterns. Chi-square tests (4 X 2) were used to measure the distribution of low performance on the PPVT-R (P<0.001) and on the Block design subtest (P=0.001) and high hyperactivity ratings (P=0.04) with different sleep duration patterns. Data courtesy of the Quebec Institute of Statistics.