Changes in Bedtime Schedules and Behavioral Difficulties in 7 Year Old Children

Abstract

WHAT'S KNOWN ON THIS SUBJECT: Links between clinically diagnosed sleep problems and adverse behavioral outcomes are well documented. However, in nonclinical populations, causal links between disrupted sleep and the development of behavioral difficulties are far from clear. WHAT THIS STUDY ADDS:Seven-year-old children with nonregular bedtimes had more behavioral difficulties than children who had regular bedtimes. There were clear doseresponse relationships, and the effects of not having regular bedtimes appeared to be reversible. abstract OBJECTIVES: Causal links between disrupted sleep and behavioral problems in nonclinical populations are far from clear. Research questions were as follows: Are bedtime schedules associated with behavioral difficulties? Do effects of bedtime schedules on behavior build up over early childhood? Are changes in bedtime schedules linked to changes in behavior?METHODS: Data from 10 230 7-year-olds from the UK Millennium Cohort Study, with bedtime data collected at 3, 5, and 7 years, and behavioral difficulties scores as rated by mothers and teachers were analyzed. RESULTS:Children with nonregular bedtimes had more behavioral difficulties. There was an incremental worsening in behavioral scores as exposure through early childhood to not having regular bedtimes increased: mother rated (nonregular any 1 age, b = 0.53; nonregular any 2 ages, b = 1.04; nonregular all 3 ages, b = 2.10, P , .001) and teacher rated (b = 0.22, b = 0.73, b = 1.85, P , .001). Difference in differences analysis showed that for children who changed from nonregular to regular bedtimes there were clear nontrivial, statistically significant improvements in behavioral scores: A change between age 3 and 7 corresponded to a difference of b = 20.63, and a change between age 5 and 7 corresponded to a difference of b = 21.02). For children who changed from regular to nonregular bedtimes between ages 5 and 7 there was a statistically significant worsening in scores, b = 0.42. Much of the previous work in this area has been cross-sectional or has not taken account of factors that might confound the association between sleep and behavioral difficulties. [8][9][10][11][12] Some studies have involved in-depth investigations using diary methods and actigraphy to monitor sleep, [13][14][15] but the generalizability of these findings from highly selective study samples is questionable. Only a couple of studies 16,17 have considered these relationships longitudinally, and a recent review article 7 highlighted the need for large-scale population-based studies to look at the links between sleep and behavior prospectively. CONCLUSIONS:In this article we add to what is known by examining data from a large, nationally representative prospective population-based cohort study to see whether and how bedtimes through early childhood relate to markers of child behavior at 7 years of age. We address the following research questions:1. Are bedtime schedules associated with behavioral difficulties?2. Do the effects of bedtime schedules build...

Sleep/Wake Patterns and Parental Perceptions of Sleep in Children Born Preterm

“…This is concerning because recent research suggests that the variability of sleep/wake patterns has a greater impact on daytime functioning than the amount of sleep obtained. 4,5,26 It has been shown that school-aged children with a greater than 60-minute difference in bedtimes across the week are four times more likely to exhibit hyperactive behaviors than children who sleep less than is recommended for their age. 4 These results have important implications for clinical management of preterm children as well as for future sleep health education.…”

“…Short sleep duration, and more recently, irregular night-to-night scheduling of bedtimes, have been associated with impaired cognitive performance, behavioral problems, and poor quality of life. [1][2][3][4][5] Maintaining healthy sleep practices may be particularly important for children born preterm, as preterm birth is also associated with the deleterious outcomes listed above. 6 In addition, children born preterm are at increased risk of sleep disorders such as obstructive sleep apnea (OSA) and periodic limb movements of sleep (PLMS).…”

Regulations to Promote Healthy Sleep Practices in Child Care

“…[1][2][3] Short sleep duration has also been associated with obesity in childhood in both cross-sectional and longitudinal studies. [4][5][6] The mechanisms linking insufficient sleep to obesity are, in part, related to the hormonal regulation of hunger and satiety.…”

The Importance of Sleep in the Early Years

“…However, in non-clinical populations, the picture is less clear and debate has centred upon whether disrupted sleep patterns are a consequence, or cause, of behavioural problems. Recent work has deployed data from the Millennium Cohort Study to examine how-and if-bedtimes throughout early childhood can relate to markers of child behaviour at 7 years of age [5][6][7].…”