Sleep terrors in early childhood and associated emotional-behavioral problems

Abstract

Study objectives: While sleep terrors are associated with emotional-behavioral problems in school-aged children and adults, little is known about these associations in early childhood, when sleep terrors prevalence is at its highest. Moreover, studies using a longitudinal design and controlling for confounding variables are scarce. This study's objective was to determine whether the frequency of sleep terrors in toddlers predicts emotional-behavioral problems during the preschool years.

Methods: Participants (n = 324) were enrolled in the prospective Maternal Adversity Vulnerability and Neurodevelopment cohort study. The frequency of sleep terrors in children was assessed at 12, 18, 24, and 36 months using maternal reports. Children's emotional-behavioral problems were measured at 48 and 60 months using the Child Behavior Checklist. Relevant confounders linked to the child, mother, and environment were also taken into consideration.

Results: The frequency of sleep terrors was relatively stable across early childhood (16.7-20.5%). A generalized estimating equation revealed that the frequency of sleep terrors in early childhood was associated with increased emotional-behavioral problems at 4 and 5 years of age, more specifically with internalizing problems (P < .001), after controlling for child's sex, time point, family socioeconomic status, maternal depressive symptoms, and nighttime sleep duration. The frequency of sleep terrors was further associated with the emotionally reactive, anxious/depressed, and somatic complaints scales (P < .01).

Conclusions: This longitudinal study provides further support for a high prevalence of sleep terrors in early childhood. Our findings show meaningful associations between higher frequency of sleep terrors and emotional-behavioral problems as early as toddlerhood, especially internalizing problems.

Citation: Laganière C, Gaudreau H, Pokhvisneva I, et al. Sleep terrors in early childhood and associated emotional-behavioral problems. J Clin Sleep Med. 2022;18(9):2253-2260.

Keywords: emotional disorder; externalizing disorders; internalizing disorder; maternal depression; sleep terrors.

Figure 1. Frequency of sleep terrors in the MAVAN cohort.

The figure shows the percentage of children at each time point who presented sleep terrors at least sometimes according to maternal report. The reported frequency of sleep terrors was relatively stable across time (16.7–20.5%). Across all time points, 34.26% (n = 111) children of the sample (N = 324) presented sleep terrors at least once during early childhood (12–36 months).

Figure 2. Percentages of children with borderline-clinical degree of emotional–behavioral problems as a function of the presence or absence of sleep terrors.

The figure shows the percentages of children presenting a borderline or clinical degree of emotional–behavioral problems (T score of 60 and above) for the three scales of the Child Behavior Checklist (total score, internalizing problems, and externalizing problems) measured at 48 and 60 months as a function of the presence or absence of sleep terrors in early childhood (12–36 months). Among the 309 participants at 48 months, 102 of them presented sleep terrors during early childhood (12–36 months). Among the 263 participants at 60 months, 91 of them presented sleep terrors during early childhood (12–36 months). The percentage of children with a borderline-clinical degree of internalizing problems at 60 months was significantly higher among children with sleep terrors (23.1%) than among children without sleep terrors (11.0%) (χ² = 6.679, P = .010). CBCL = Child Behavior Checklist.