Sleep-related difficulties in healthy children and adolescents

Abstract

Background: As sleep-related difficulties are a growing public health concern, it is important to gain an overview of the specific difficulty areas of the most vulnerable individuals: children. The current descriptive study presents the prevalence of sleep-related difficulties in two large samples of healthy children and adolescents and outlines the effects of age, gender, and socioeconomic status (SES) on various sleep-related difficulties.

Methods: Participants were 855 4-9 year-old children (child sample) and 1,047 10-17 year-old adolescents (adolescent sample) participating 2011-2015 in the LIFE Child study, a population-based cohort study in Germany. Parents of the child participants completed the Children's Sleep Habits Questionnaire (CSHQ), whereas adolescents self-administered the Sleep Self Report (SSR). Familial SES was determined by a composite score considering parental education, occupational status, and income. Multiple regression analyses were carried out to address the research question.

Results: Among 4-9 year-old children, the mean bedtime was reported to be 8 p.m., the mean wake-up time 7 a.m., and sleep duration decreased by 14 min/year of age. 22.6 % of the children and 20.0 % of the adolescents showed problematic amounts of sleep-related difficulties. In the child sample, bedtime resistance, sleep onset delay, sleep-related anxiety, night waking, and parasomnia were more frequent in younger than older children. In the adolescent sample, difficulties at bedtime were more frequent among the younger adolescents, whereas daytime sleepiness was more prominent in the older than the younger adolescents. Considering gender differences, sleep-related difficulties were more frequent among boys in the child sample and among girls in the adolescent sample. Lower SES was associated with increased sleep-related difficulties in the adolescent, but not the child sample.

Conclusions: The present results report sleep-related difficulties throughout both childhood and adolescence. Gender differences can already be observed in early childhood, while effects of SES emerge only later in adolescence. The awareness for this circumstance is of great importance for pediatric clinicians who ought to early identify sleep-related difficulties in particularly vulnerable individuals.

Keywords: Age; Children’s Sleep Habits Questionnaire (CSHQ); Gender; Sleep Self Report (SSR); Sleep difficulties; Socioeconomic status (SES).

Fig. 1

Sleep duration by age in the child sample. Note. Sleep duration by age according to the Children’s Sleep Habits Questionnaire (CSHQ), n = 855. The box indicates the first and third quartile and the median, and the point indicates the arithmetic mean. The whiskers represent the range between minimum and maximum, outliers are represented by a cross

Fig. 2

Prevalence of problematic amounts of sleep-related difficulties by age and gender. Note. Prevalence of problematic amounts of sleep-related difficulties by age and gender in the child sample (age groups 4−5, 6−7, and 8−9) and in the adolescent sample (age groups 10−11, 12−13, 14−15, and 16−17)

Fig. 3

Distribution of the total difficulties score by gender in the child sample and the adolescent sample. Note. Distribution of the total difficulties score by gender in the child sample (on the left, according to the Children’s Sleep Habits Questionnaire [CSHQ], score range = 33−99, n = 855) and the adolescent sample (on the right, according to the Sleep Self Report [SSR], score range = 18−54, n = 1,047). Shaded areas show split violin plots of the density function, with inserted boxes indicating the first and third quartile and the median, and with the point indicating the arithmetic mean. The displayed p-values are derived from linear regression analysis. Scores above the cut-off value indicate problematic amounts of sleep-related difficulties