Neurocognition and behavior are adversely affected in children ages 5 to 10 who have inconsistent sleep routines, independent of other sleep problems.
SEATTLE—Inconsistent sleep routines are associated with negative effects in children’s daytime functioning, and exist independently of snoring, according to a study presented at the 23rd Annual Meeting of the Associated Professional Sleep Societies.
Sarah Biggs, a PhD candidate in the Discipline of Pediatrics at the University of Adelaide in Australia, and colleagues, sought to determine how neurocognition and behavior in children were affected by sleep routines, and if the effects were concomitant with habitual snoring. “Current recommendations for healthy sleep in children are based around an optimal sleep length; however, these data show that a child may be getting the recommended amount of sleep, yet [can] still be at risk of impaired daytime functioning due to inconsistent sleep routines,” Ms. Biggs told Neurology Reviews.
Clinical Implications for Children
A total of 26 habitual snorers and 61 control subjects (mean age, 8.1), were selected from the South Australian Pediatric Sleep Survey. Participants completed a seven-day sleep diary before neurocognitive and behavioral analyses were conducted; the Differential Abilities Scales (DAS) and Child Behavior Checklist (CBCL) were used, respectively. Consistency of sleep routines was calculated as a coefficient of variation (CV) of bedtime, waketime, time in bed, and total sleep time. Group differences in neurocognition, behavior, and sleep were tested using ANOVA; predictive relationships were determined using linear regression.
Habitual snoring was an independent predictor of CBCL items—increased anxiety and depression, somatic complaints, social problems, aggressive behavior, internalizing, and anxiety and oppositional defiant problems. CV measures independently predicted deficiencies in verbal ability and total IQ. Rule-breaking behavior and somatic complaints also directly correlated with CV measures. Further, CV measures “added significantly to the variance of thought and affective problems over [those] of habitual snorers,” the researchers commented. Habitual snorers also showed more problematic behaviors on the CBCL, although within the normal range.
Improving Inconsistent Sleep Patterns
“These results support the notion that inconsistent sleep routine affects daytime functioning in children, independent of a sleep problem such as habitual snoring,” Ms. Biggs and coauthors stated. “Determination of the direction of the association is impossible in this study.” Further examination of this relationship requires treatment interventions to cultivate sleep routines, the investigators noted.
Treatment follows the concept of sleep hygiene and targets the modifiable behaviors of both parents and children, according to Ms. Biggs. “Thus, treatment would involve making behavioral adjustments to improve the consistency of bedtimes, rise times, and sleep duration across the week,” she stated. Some options are adhering to a specific bedtime every night, including weekends; establishing a bedtime ritual that begins 30 minutes before the set bedtime; removing distractions, such as electronic devices, from bedrooms; and limiting evening activities outside the home. “Sleep practices are also heavily influenced by social and cultural expectations,” Ms. Biggs continued. “As a result, lifestyle, family, or other commitments, and cultural practices must be considered when developing treatment strategies.
“Sleep/wake behavior can both affect entrainment of, and is in turn gated by, the circadian system, and children with highly variable bedtimes and sleep durations may have deficits in daytime functioning similar to those experienced in jet lag,” Ms. Biggs noted. “More research is needed to gain a better understanding of this potential association,” Ms. Biggs continued. “As inconsistent sleep routines may exist independently, as well as concomitantly, with sleep disorders, this result has serious implications for daytime functioning and sleep education,” she concluded.
—Laura Sassano