Childhood sleep and adolescent chronic fatigue syndrome (CFS/ME): evidence of associations in a UK birth cohort

Abstract

Objective/background: Sleep abnormalities are characteristic of chronic fatigue syndrome (CFS, also known as 'ME'), however it is unknown whether sleep might be a causal risk factor for CFS/ME.

Patients/methods: We analysed data from the Avon Longitudinal Study of Parents and Children (ALSPAC) birth cohort. We describe sleep patterns of children aged 6 months to 11 years, who were subsequently classified as having (or not having) 'chronic disabling fatigue' (CDF, a proxy for CFS/ME) between the ages 13 and 18 years, and we investigated the associations of sleep duration at age nine years with CDF at age 13 years, as well as sleep duration at age 11 years with CDF at age 16 years.

Results: Children who had CDF during adolescence had shorter night-time sleep duration from 6 months to 11 years of age, and there was strong evidence that difficulties in going to sleep were more common in children who subsequently developed CDF. The odds of CDF at age 13 years were 39% lower (odds ratio (OR) = 0.61, 95% CI = 0.43, 0.88) for each additional hour of night-time sleep at age nine years, and the odds of CDF at age 16 years were 51% lower (OR = 0.49, 95% CI = 0.34, 0.70) for each additional hour of night-time sleep at age 11 years. Mean night-time sleep duration at age nine years was 13.9 (95% CI = 3.75, 24.0) minutes shorter among children who developed CDF at age 13 years, and sleep duration at age 11 years was 18.7 (95% CI = 9.08, 28.4) minutes shorter among children who developed CDF at age 16 (compared with children who did not develop CDF at 13 and 16 years, respectively).

Conclusions: Children who develop chronic disabling fatigue in adolescence have shorter night-time sleep duration throughout early childhood, suggesting that sleep abnormalities may have a causal role in CFS/ME or that sleep abnormalities and CFS/ME are associated with a common pathophysiological cause.

Keywords: ALSPAC; Adolescence; CFS/ME; Chronic fatigue syndrome; Paediatric; Sleep.

Fig. 1

Flowchart of Avon Longitudinal Study of Parents and Children (ALSPAC) participants who provided exposure and outcome data for this study.

Fig. 2

Mean night-time sleep duration at age 6–140 months among children who did or did not develop chronic disabling fatigue (CDF) at age 13, 16 or 18 years (vertical bars indicate 95% CI).

Fig. 3

Mean daytime sleep duration at age 6–81 months among children who did or did not develop chronic disabling fatigue (CDF) at age 13, 16 or 18 years (vertical bars indicate 95% CI).

Fig. 4

Mean total sleep duration at age 6–140 months among children who did or did not develop chronic disabling fatigue (CDF) at age 13, 16 or 18 years (vertical bars indicate 95% CI).

Fig. 5

Number of night-time awakenings at age 6–115 months among children who did or did not develop chronic disabling fatigue (CDF) at age 13, 16 or 18 years (vertical bars indicate 95% CI).

Fig. 6

Difficulty going to sleep at age 18–115 months among children who did or did not develop chronic disabling fatigue (CDF) at age 13, 16 or 18 years (vertical bars indicate 95% CI).

Fig. 7

Mean bedtime and waking time at age 6–140 months among children who did or did not develop chronic disabling fatigue (CDF) at age 13, 16 or 18 years (vertical bars indicate 95% CI).