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. 2021 Oct:59:101494.
doi: 10.1016/j.smrv.2021.101494. Epub 2021 May 1.

A systematic review of the association between sleep health and stress biomarkers in children

Monica R Ordway  1 , Eileen M Condon  2 , Bridget Basile Ibrahim  2 , Emily A Abel  3 , Melissa C Funaro  4 , Janene Batten  4 , Lois S Sadler  5 , Nancy S Redeker  2
Affiliations

A systematic review of the association between sleep health and stress biomarkers in children

Monica R Ordway et al. Sleep Med Rev. 2021 Oct.

Abstract

Sleep is intimately linked with the stress response system. While the evidence for this connection has been systematically reviewed in the adult literature, to our knowledge no studies have examined this relationship in young children. Recent scientific interest in understanding the effects of adverse environments in early childhood, including an emphasis on understanding the role of sleep, highlights the importance of synthesizing the current evidence on the relationship between sleep and the stress response system in early childhood. The aim of this systematic review is to examine the relationship between sleep health and biomarkers of physiologic stress (neuroendocrine, immune, metabolic, cardiovascular) in healthy children ages 0-12 y. Following PRISMA guidelines, we identified 68 empirical articles and critically reviewed and synthesized the results across studies. The majority of studies included school-age children and reported sleep dimensions of duration or efficiency. Overall, evidence of associations between sleep health and stress biomarkers was strongest for neuroendocrine variables, and limited or inconsistent for studies of immune, cardiovascular, and metabolic outcomes. Gaps in the literature include prospective, longitudinal studies, inclusion of children under the age of 5 y, and studies using objective measures of sleep.

Keywords: Biomarkers; Healthy brain and child development study; Pediatrics; Physiological stress; Sleep; Sleep health; Stress; Stress response; Systematic review; Toxic stress.

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Conflict of interest statement

Conflicts of interest The authors do not have any conflicts of interest to disclose.

Figures

Fig. 1.
Fig. 1.
Overview of stress response system and suggested connection with sleep health based on adult studies. In the physiological response to stress, activation of the sympathetic nervous system (SNS) and hypothalamic-pituitary-adrenal (HPA) axis leads to release of glucocorticoids, catecholamines, and cytokines. These primary mediators act as part of a complex, non-linear network in the “fight or flight” response to stress. The parasympathetic nervous system (PNS) also plays a regulatory role as part of a negative feedback loop. Over time, prolonged release of primary mediators causes wear and tear on physiological systems and contributes to secondary outcomes, including but not limited to the examples provided (Condon, 2018; Juster et al., 2010). Evidence from adult studies suggests that sleep health interacts with multiple components of the stress response system, including a bidirectional relationship with the HPA axis and regulation by inflammatory cytokines [5,9,12,86,94,104].
Fig. 2.
Fig. 2.
PRISMA flow diagram. From: Moher D, Liberati A, Tetzlaff J, Altman DG, The PRISMA Group (2009). Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement. PLoS Med 6(7): e1000097. doi:10.1371/journal.pmed1000097
Fig. 3.
Fig. 3.
Physiological systems examined A) over time in studies of sleep health in children, B) by age group, and C) by sleep characteristic.
See this image and copyright information in PMC

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