Prevalence, Patterns, and Persistence of Sleep Problems in the First 3 Years of Life

Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229-3039, USA.
PEDIATRICS (Impact Factor: 5.47). 01/2012; 129(2):e276-84. DOI: 10.1542/peds.2011-0372
Source: PubMed


Examine the prevalence, patterns, and persistence of parent-reported sleep problems during the first 3 years of life.
Three hundred fifty-nine mother/child pairs participated in a prospective birth cohort study. Sleep questionnaires were administered to mothers when children were 6, 12, 24, and 36 months old. Sleep variables included parent response to a nonspecific query about the presence/absence of a sleep problem and 8 specific sleep outcome domains: sleep onset latency, sleep maintenance, 24-hour sleep duration, daytime sleep/naps, sleep location, restlessness/vocalization, nightmares/night terrors, and snoring.
Prevalence of a parent-reported sleep problem was 10% at all assessment intervals. Night wakings and shorter sleep duration were associated with a parent-reported sleep problem during infancy and early toddlerhood (6-24 months), whereas nightmares and restless sleep emerged as associations with report of a sleep problem in later developmental periods (24-36 months). Prolonged sleep latency was associated with parent report of a sleep problem throughout the study period. In contrast, napping, sleep location, and snoring were not associated with parent-reported sleep problems. Twenty-one percent of children with sleep problems in infancy (compared with 6% of those without) had sleep problems in the third year of life.
Ten percent of children are reported to have a sleep problem at any given point during early childhood, and these problems persist in a significant minority of children throughout early development. Parent response to a single-item nonspecific sleep query may overlook relevant sleep behaviors and symptoms associated with clinical morbidity.

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    • "Using measures of global sleep problems within primary care, parents in two studies identified a prevalence rate of 11e12% in children [16] [17], a rate similar to that of community surveys conducted in other settings (e.g., [3] [18]). When queried about specific sleep concerns, prevalence rates reported included 11e17% for snoring or sleep disordered breathing, 0.4e29% for various parasomnias , 16% for daytime sleepiness, and up to 41% for symptoms of insomnia [16] [17] [19]. "
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    ABSTRACT: Primary care is a critical setting for screening and management of pediatric sleep difficulties. This review summarizes studies examining the prevalence of sleep problems in primary care settings as well as current practices in screening, diagnosis, and management, including behavioral recommendations and medications. Potential barriers to effectively addressing sleep are also reviewed. Despite the high prevalence of pediatric sleep problems in primary care, rates of screening and management are low. Primary care providers receive minimal sleep training and have resulting gaps in knowledge and confidence. Parents similarly have gaps in knowledge and many factors contribute to their identification of sleep as problematic. Recommendations to improve the provision of sleep services in pediatric primary care are made in the areas of research, practice, and education. Copyright © 2015 Elsevier Ltd. All rights reserved.
    Sleep Medicine Reviews 01/2015; DOI:10.1016/j.smrv.2015.01.004 · 8.51 Impact Factor
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    • "Most longitudinal studies actually show a decline in the prevalence of sleep disturbances from one to six years of age (Petit et al., 2007; Wake et al., 2006). Thus, signaling an awakening can be considered a universal and transient phenomenon, but it can persist among some children and evolve into a sleep problem (Byars et al., 2012). Recognizing factors that contribute to the persistence of sleep disturbances is important for the early identification of children at risk of developing long-term sleep disorders and suggest novel interventions. "
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    ABSTRACT: The development of sleep-wake regulation in infants depends upon brain maturation as well as various environmental factors. The aim of the present study was to evaluate sleep duration and quality as a function of child attachment to the mother. One hundred and thirty-four mother-child dyads enrolled in the Maternal Adversity, Vulnerability and Neurodevelopment (MAVAN) project were included in this study. Attachment was assessed with the Strange Situation procedure at 36 months and maternal sleep reports were collected at 6, 12, 24 and 36 months. Differences in sleep characteristics were assessed with mixed models with one factor (attachment group) and one repeated measure (age). Children classified as disorganized had a significantly lower duration of nocturnal sleep, went to bed later, signaled more awakenings, had shorter periods of uninterrupted sleep (only at 12 months) and had shorter periods of time in bed (only at 6 months) than children classified as secure and/or ambivalent (p < 0.05). This is the first study to show that children with insecure disorganized attachment present a distinct sleep pattern in comparison with those with secure or ambivalent attachment between 6 and 36 months of age. Sleep disturbances could exacerbate difficulties in these families that are already considered vulnerable.
    Attachment & Human Development 09/2014; 17(1):1-20. DOI:10.1080/14616734.2014.953963 · 2.38 Impact Factor
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    • "It is increasingly being shown to be associated with adverse health outcomes, notably an increased risk of obesity [3]. The health implications of short sleep make it important to understand its determinants, particularly in early life when patterns of sleep behaviour may be being established [4]. There are currently no clinical recommendations to define optimal sleep in early childhood [5], but sleeping <11 h per night substantially increases the risk of obesity in children under 5 years of age [3] [6]. Between 18 and 24 months of age, children sleep on average 11.3 h a night and 1.5 h during the daytime [7]. "
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    ABSTRACT: Objective The aim of this study was to identify socio-demographic and home environmental predictors of shorter sleep in early childhood and to examine whether effects were mediated by the timing of bedtime or wake time. Methods Participants were from Gemini, a British birth cohort of twins, and included 1702 children; one randomly selected from each twin pair. Parents reported nighttime sleep duration at an average age 15.8 months (range 14 to 27 months) using a modified version of the Brief Infant Sleep Questionnaire. Multiple logistic regression models were used to identify predictors of shorter sleep for this study. Results Using a cut off of <11 hours a night, shorter sleep was reported in 14.1% of children. Lower maternal education, non-white ethnic background, being male, low birth weight, living in a home with >1 older child, and watching >1 hour of TV in the evening, were independently associated with shorter sleep. Mediation analyses showed that associations between education, ethnicity, evening TV viewing and sleep were driven predominantly by later bedtimes, while sex differences were driven predominantly by earlier wake times in boys. Conclusion In this sample, multiple environmental factors were associated with shorter sleep in young children, with several operating predominantly through later bedtime. An emphasis on the importance of an early and consistent bedtime could help promote healthy sleep and reduce inequalities in child health.
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