Trajectories of reported sleep duration associate with early childhood cognitive development

A systematic review and meta-analysis of group-based trajectory modeling of sleep duration across age groups and in relation to health outcomes

STUDY OBJECTIVES

To shed light on understanding sleep duration trajectories (SDTs) using different classification methods and their outcomes, this study aimed to (1) identify common SDTs among different age groups, (2) investigate the alignment versus differences between SDTs identification by group-based trajectory modeling (GBTM) and clinical standards, and (3) examine the impacts of SDTs on health outcomes.

METHODS

A systematic literature search from four databases yielded 34 longitudinal SDT studies with GBTM analyses spanning three or more data waves. Apart from the proportion meta-analysis, a three-level meta-analysis was conducted with 14 of the studies that examined the association between SDT groups and health outcomes. Assessment of study quality was performed using the Guidelines for Reporting on Latent Trajectory Studies checklist.

RESULTS

Qualitative analysis identified four age-related SDT classes based on longitudinal trends: "persistent sleepers," "increase sleepers," "decrease sleepers," and "variable sleepers." Meta-analysis also showed differential proportions of "GBTM-defined shortest sleepers" across age groups and sample regions, as well as significant discrepancies in the prevalence of short sleep identified by clinical standards (=50% vs. 15% per GBTM). Overall, SDTs predicted emotional and behavioral outcomes, neurocognitive problems, and physical health (OR = 1.538, p < 0.001), in GBTM-defined "short," "fluctuating," "long," and "decreasing" sleepers as compared to the "adequate" group. The effects were stronger in adolescents and in datasets with more waves.

CONCLUSIONS

The identification of the GBTM-defined "short," "fluctuating," "long," and "decreasing" SDT groups and their associations with various health outcomes supported longitudinal investigations, as well as the development of interventions focusing on both the length and stability of sleep durations, especially in younger populations. Study registration: PROSPERO registration number CRD42023412201.

Effect of sleep duration on child development in Fortaleza, Northeastern Brazil

OBJECTIVE

The present study's objective is to assess whether sleep duration affects Early Childhood Development (ECD). A prospective cohort study was carried out with 278 mother-child dyads in the city of Fortaleza, northeastern Brazil, with data collection every 6 months.

METHOD

The data used in this study are from the third (18 months) and fourth (24 months) survey waves. Information on sleep duration was collected using the Brief Infant Sleep Questionnaire (BISQ) and information on ECD using the Caregiver Reported Early Development Instrument (CREDI). Crude and adjusted regression models were run for each CREDI domain as an outcome with 5 % significance.

RESULTS

The authors found that after adjusting for maternal age and schooling, family income, and the presence of other children in the house, night sleep duration was associated with better ECD scores (cognitive: coef. 0.14; 95 % CI 0.04,0.24; language: coef. 0.10; 95 % CI 0.01,0.19; motor: coef. 0.10; 95 % CI 0.03,0.18; socio-emotional: coef. 0.16; 95 % CI 0.06,0.25; overall: coef. 0.14; 95 % CI 0.04,0.24), and the time awake at night associated with worse scores (cognitive: coef. -0.12; 95 % CI -0.23,0.02; motor: coef. -0.09; 95 % CI -0.17,-0.01; socio-emotional: coef. -0.11; 95 % CI -0.21,-0.01; overall: coef. -0.11; 95 % CI -0.21,-0.01).

CONCLUSIONS

Nocturnal sleep duration affects ECD as expressed in all CREDI scores (cognitive, language, motor, social-emotional, and overall).

Association between infant sleep and neurodevelopment in a prospective birth cohort study

OBJECTIVES

To investigate the association of infant sleep and sleep trajectories through the first year of life with infant neurodevelopment.

METHODS

This study was conducted with 3251 infants in China. Sleep parameters were evaluated by the Brief Infant Sleep Questionnaire at 42days, 6months, and 1year of age. Neurodevelopment was evaluated at 1year of age using the Bayley Scales of Infant and Toddler Development, Third Edition. The latent variable growth curve model was used to evaluate the developmental trajectories of infant sleep, including total sleep duration trajectories, night awakening trajectories and sleep onset latency trajectories. Poisson regression was applied to assess the association between sleep parameters and sleep trajectories and infant neurodevelopment.

RESULTS

Infants with frequent night awakenings at 6months had a higher risk of nonoptimal gross motor development. Additionally, infants with prolonged sleep onset latency at 1year had an increased risk of nonoptimal fine and gross motor development. A consistent frequent night-awakening trajectory increased the risk of nonoptimal gross motor development (adjusted relative risk, 1.52; 95% confidence interval, 1.09 to 2.10). Furthermore, an increasing trajectory in sleep onset latency was associated with an increased risk of nonoptimal fine (adjusted relative risk, 2.70; 95% confidence interval, 1.12 to 6.51) and gross motor development (adjusted relative risk, 2.76; 95% confidence interval, 1.70 to 4.48). However, no significant association was observed between total sleep duration, or its trajectory, and infant neurodevelopment.

CONCLUSIONS

Sleep problems or specific sleep trajectories during the initial year of life may increase risk of compromised neurodevelopment.

Night Sleep, Parental Bedtime Practices and Language Development in Low-Risk Preterm and Full-Term Late Talkers: A Longitudinal Study in the Third Year of Life

Background: Studies on night sleep and parental bedtime practices and their associations with language development in populations at risk of language delay and neonatal conditions, such as late talkers and preterm children, are scarce. Objectives: Our objective was to longitudinally examine the development of night sleep (total night sleep difficulties, settling, night waking, and co-sleeping), parental bedtime practices (total parental bedtime practices, active physical comforting, encouraging autonomy, and leaving to cry), and expressive language (word and sentence production), and their associations in low-risk preterm and full-term late talkers from 31 to 37 months of age. Methods: Parents of 38 late talkers, 19 low-risk preterm and 19 full-term children, completed the Italian versions of the Infant Sleep Questionnaire, the Parental Interactive Bedtime Behavior Scale, and the MacArthur-Bates Communicative Development Inventory Words and Sentences Long Form. Results: Late talkers' night sleep difficulties, such as settling to sleep and night waking, decreased over time, with low-risk preterm late talkers experiencing more night waking and co-sleeping than full-term peers. Parents reported that instances of active physical comforting and leaving to cry also decreased, with parents of low-risk preterm late talkers reporting higher active physical comforting scores than parents of full-term peers. Improvements in parental practices of encouraging autonomy were significantly associated with increased sentence production from 31 to 37 months. Conclusions: Findings highlight the importance of monitoring night sleep in preterm and full-term late talkers. They also suggest that populations vulnerable to sleep and language delays may particularly benefit from targeted interventions promoting autonomy in their bedtime routines, which, in turn, could support their language development trajectories.

Associations of Infant Sleep Characteristics with Childhood Cognitive Outcomes

OBJECTIVE

The objective of this study was to quantify associations of infant 24-hour sleep duration and nighttime sleep consolidation with later child cognition.

METHODS

This study included children from Project Viva, a prospective cohort in Massachusetts with (1) sleep measures in infancy (median age 6.4 months) and (2) child cognition in early childhood (median age 3.2 years) or mid-childhood (median age 7.7 years). Main exposures were parental reports of infant 24-hour sleep duration and nighttime sleep consolidation (% of total daily sleep occurring at nighttime). Cognitive outcomes were (1) early childhood vocabulary and visual-motor abilities and (2) mid-childhood verbal and nonverbal intelligence quotient (IQ), memory, and visual-motor abilities. We examined associations of infant sleep with childhood cognition using linear regression models adjusted for child sex, age, and race or ethnicity; maternal age, education, and parity; and household income.

RESULTS

Early and mid-childhood analyses included 1102 and 969 children, respectively. Most mothers reported infant race or ethnicity as White (69%) and were college graduates (71%). The mean infant 24-hour sleep duration was 12.2 ± 2.0 hours, and the mean nighttime sleep consolidation was 76.8% ± 8.8%. Infant 24-hour sleep duration was not associated with any early or mid-childhood outcomes. Higher infant nighttime sleep consolidation was associated with higher mid-childhood verbal intelligence (β: 0.12 points per % nighttime sleep; 95% CI, 0.01-0.22), but not with any early childhood cognitive measures.

CONCLUSION

In this cohort, higher infant nighttime sleep consolidation was associated with higher verbal IQ in mid-childhood. Future studies should investigate causal relationships of infant sleep consolidation with child cognition among diverse populations.

Shorter night-time sleep duration and later sleep timing from infancy to adolescence

BACKGROUND

Here, we (a) examined the trajectories of night-time sleep duration, bedtime and midpoint of night-time sleep (MPS) from infancy to adolescence, and (b) explored perinatal risk factors for persistent poor sleep health.

METHODS

This study used data from 12,962 participants in the Avon Longitudinal Study of Parents and Children (ALSPAC). Parent or self-reported night-time sleep duration, bedtime and wake-up time were collected from questionnaires at 6, 18 and 30 months, and at 3.5, 4-5, 5-6, 6-7, 9, 11 and 15-16 years. Child's sex, birth weight, gestational age, health and temperament, together with mother's family adversity index (FAI), age at birth, prenatal socioeconomic status and postnatal anxiety and depression, were included as risk factors for persistent poor sleep health. Latent class growth analyses were applied first to detect trajectories of night-time sleep duration, bedtime and MPS, and we then applied logistic regressions for the longitudinal associations between risk factors and persistent poor sleep health domains.

RESULTS

We obtained four trajectories for each of the three sleep domains. In particular, we identified a trajectory characterized by persistent shorter sleep, a trajectory of persistent later bedtime and a trajectory of persistent later MPS. Two risk factors were associated with the three poor sleep health domains: higher FAI with increased risk of persistent shorter sleep (OR = 1.20, 95% CI = 1.11-1.30, p < .001), persistent later bedtime (OR = 1.28, 95% CI = 1.19-1.39, p < .001) and persistent later MPS (OR = 1.30, 95% CI = 1.22-1.38, p < .001); and higher maternal socioeconomic status with reduced risk of persistent shorter sleep (OR = 0.99, 95% CI = 0.98-1.00, p = .048), persistent later bedtime (OR = 0.98, 95% CI = 0.97-0.99, p < .001) and persistent later MPS (OR = 0.99, 95% CI = 0.98-0.99, p < .001).

CONCLUSIONS

We detected trajectories of persistent poor sleep health (i.e. shorter sleep duration, later bedtime and later MPS) from infancy to adolescence, and specific perinatal risk factors linked to persistent poor sleep health domains.

Associations between sleep duration trajectories and cognitive decline: A longitudinal cohort study in China

OBJECT

The relationship between sleep duration trajectories and cognitive decline remains uncertain. This study aims to examine the connections between various patterns of sleep duration and cognitive function.

METHODS

Group-based trajectory modeling (GBTM) was employed to identify longitudinal trajectories of sleep duration over four-year follow-up period, while considering age, sex and nap duration as adjustments. Logistic regression was utilized to analyze the association between sleep trajectories and cognition, with odds ratios (OR) and 95 % confidence intervals (CI) reported. Subgroup analyses based on various demographic characteristics were conducted to explore potential differences in sleep trajectories and cognitive decline across different population subgroups.

RESULTS

A total of 5061 participants were followed for four years, and three sleep duration trajectories were identified: high increasing (n = 2101, 41.6 %), stable increasing (n = 2087, 40.7 %), and low decreasing (n = 873, 17.7 %). After adjustment for basic demographic information, health status, and baseline cognition, the high increasing trajectory was found to be associated with cognitive decline in terms of global cognition (OR:1.52,95 %CI:1.18-1.96), mental intactness (OR:1.36,95 %CI:1.07-1.73) and episodic memory (OR:1.33, 95 %CI:1.05-1.67), as compared to stable increasing trajectory. These associations were particularly prominent among the non-elderly population (≤65 years) and those without depressive symptoms.

CONCLUSION

This study suggests that both high increasing and low decreasing sleep duration trajectories are linked to cognitive decline, as compared to the stable increasing trajectory. Long-term attention to changes in sleep duration facilitates early prevention of cognitive decline.

Infants' early recovery from sleep disturbance is associated with a lower risk of developmental delay in the Japan Environment and Children's Study

To examine whether patterns, such as the timings of onset or recovery from sleep disturbance, are associated with later developmental problems, including autism spectrum disorder (ASD). Mothers participating in the Japan Environment and Children's Study with a child aged 3 years were included in the analyses. Children were assessed for short sleep and frequent awakenings at 1 month, 6 months, and 1 year of age. Developmental problems were evaluated at 3 years of age based on ASD diagnosis and developmental delay, using the Japanese translation of the Ages and Stages Questionnaire (ASQ) 3rd edition. Sleep disturbance patterns were classified by onset age, and developmental problem risks were examined based on onset/recovery ages. Among 63,418 mother-infant dyads, 0.4% of infants were later diagnosed with ASD, and 14.4% had abnormal scores on any ASQ domains. The later the onset of short sleep, the lower the risk of abnormal ASQ scores (RR of short sleep onset at 1 year: 1.41; 6 months: 1.52; 1 month: 1.57). The earlier the infants recovered from short sleep persistence, the lower the risk of developmental delay (RR of remittance of sleep problems identified at 1 month by 6 months: 1.07; 1 year: 1.31; not before 1 year: 1.57). Although not all patterns were significant, later short sleep onset and earlier recovery were associated with lower ASD risk. These findings may have significant implications for future interventions in infant development.

Daytime sleep duration during infancy as an indicator for cognitive development at school age: a prospective cohort study

STUDY OBJECTIVES

The reduction in daytime sleep during early life is considered one of the indicators of the maturation of sleep patterns, which is closely associated with cognitive development. The current study aims to analyze the relationships between daytime sleep duration (DSD) during infancy and cognitive development at 6 and 10 years.

METHODS

The study included 262 mothers with their newborns from the Shanghai Sleep Birth Cohort Study, spanning 11 follow-ups from 42 days to 10 years. Sleep parameters were assessed using parent-reported questionnaires at each follow-up, and cognitive development was evaluated with the Wechsler Intelligence Scale for Children, fourth edition at 6 and 10 years.

RESULTS

Two distinct DSD trajectories in early childhood were identified: "typical DSD" (66.7%) and "infancy excessive DSD" (33.3%). Children in the "infancy excessive DSD" trajectory exhibited lower working memory scores than those in the "typical DSD" trajectory at 6 years (mean difference = 5.90, 95% confidence interval [1.83, 9.96], P = .005) and 10 years (mean difference = 4.37, 95% confidence interval [0.26, 8.48], P = .037). Additional analysis in a relatively homogeneous sample consistently showed correlations between DSD trajectories and working memory performance. No consistent significant differences were found in other domains of cognitive development.

CONCLUSIONS

Excessive daytime sleep during infancy may serve as an early indicator for poor working memory at school age. These findings raise concerns about the long-term cognitive development of infants with excessive DSD.

CITATION

Lin J, Jiang Y, Xiao X, et al. Daytime sleep duration during infancy as an indicator for cognitive development at school age: a prospective cohort study. J Clin Sleep Med. 2024;20(7):1069-1077.

Group-based sleep trajectories in children and adolescents: A systematic review

Sleep is crucial for health and development. Evidence indicates that sleep changes over time and distinct subgroups may experience different longitudinal patterns. This study systematically reviewed the studies that used latent trajectory modeling to investigate sleep trajectories of children and adolescents aged 0-18 years, and summarized the associated determinants and health-related outcomes. We searched PubMed, Embase, CENTRAL, PsycINFO, and Web of Science, identifying 46 articles that met our criteria. To ensure the reliability of the review, only studies rated as good or fair in terms of methodological quality were included, resulting in a total of 36 articles. Group-based trajectories were identified on several sleep dimensions (i.e., sleep duration, general and specific sleep problems, and bed-sharing behavior) and three or four trajectories were reported in most studies. There was a convergence trend across sleep duration trajectories during the first six years of life. Studies on specific sleep problem (i.e., insomnia, night-waking, and sleep-onset difficulties) typically identified two trajectories: consistent, minimal symptoms or chronic yet fluctuating symptoms. Lower socioeconomic status, maternal depression, and night feeding behaviors were the most frequently reported determinants of sleep trajectories. Membership in a group with certain adverse patterns (e.g., persistent short sleep duration) was associated with increased risks of multiple negative health-related conditions, such as obesity, compromised immunity, neurological problems, substance use, or internalizing/externalizing symptoms. Generally, there is potential to improve the quality of studies in this field. Causality is hard to be inferred within the current body of literature. Future studies could emphasize early life sleep, incorporate more assessment timepoints, use objective measures, and employ experimental design to better understand changes of and mechanisms behind the various sleep trajectories and guide targeted interventions for at-risk subpopulations.

Association between sleep duration and serum neurofilament light chain levels among adults in the United States

Background

Neurofilaments are neuron specific skeleton proteins maintaining axon transduction speed, leaked into cerebrospinal fluid and serum after axonal injury or neuron death. Sleep duration change has long related to many health issues but lack laboratory examination.

Methods

This study enrolled total 10,175 participants from 2013 to 2014 National Health and Nutrition Examination Survey and used a multi-variable linear model to analyze the relationship between sleep duration and serum neurofilament light chain (sNfL) level.

Results

There was a fixed relationship between sleep duration and sNfL level (β = 0.65, p = 0.0280). After adjusted for covariates, this relationship still (β = 0.82, p = 0.0052). Segmented regression showed that the turning point of sleep duration was 7 h 1 h decrease in sleep duration was significantly associated with -1.26 higher sNfL level (95 % CI: 2.25, -0.28; p = 0.0115) when sleep duration <7 h; however, 1 h increase in sleep duration was significantly associated with 3.20 higher sNfL level (95 % CI: 2.13, 4.27; p < 0.0001) when sleep duration >7 h. Furthermore, the stratified analysis indicated that the associations between sleep duration and sNfL level were stronger among those normal body mass index and trouble sleeping (p-interaction <0.0001 and 0.0003).

Conclusion

In summary, there was a J-shaped relationship between sleep duration and sNfL level in the United States of America representative group, these may suggest that extreme sleep duration can be deleterious judged by sNfL level. And still need large cohort study to determine the accurate relationship, and cluster analysis to infer the nervous disease connected with extreme sleep duration.

Early sleep duration trajectories and children's cognitive development: a prospective cohort study

We aimed to investigate the association between sleep duration trajectories and cognitive performance in preschool-aged Chinese children. We included 2131 children from the Ma'anshan birth cohort (MABC) study. Sleep duration trajectories from 6 to 48 months of age were determined using the group-based trajectory modeling (GBTM). Children's intellectual development was assessed using the Wechsler Preschool and Primary Scale of Intelligence. Compared to those with a medium total sleep duration trajectory, children with a short total sleep duration trajectory had poorer cognitive performance on the Visual Spatial Index (VSI) (β = -3.65; 95% CI = -6.77 to -0.53), which was associated with an increased risk of a low full-scale intelligence quotient (FSIQ) (OR = 1.60; 95% CI = 1.02 to 2.51). The short total sleep duration trajectory was associated with a low VSI compared with both the medium total sleep duration trajectory and the long total sleep duration trajectory. Compared to children with normal nighttime sleep duration and normal daytime sleep duration trajectories, children with short nighttime sleep and long daytime sleep duration trajectories, normal nighttime sleep and long daytime sleep duration trajectories, and short nighttime sleep and normal daytime sleep duration trajectories all had lower cognitive performance. The restricted cubic spline (RCS) also showed that children with and appropriate total sleep duration, an adequate nighttime sleep duration, and a moderate daytime sleep duration had higher FSIQ.

CONCLUSIONS

The results of this study emphasize that a medium total sleep duration, adequate sleep at nighttime, and appropriate sleep in the daytime appear to be more beneficial for children's cognitive development.

WHAT IS KNOWN

• Sleep duration in infancy is strongly associated with neurocognitive development.

WHAT IS NEW

• Medium and long total sleep duration trajectories are beneficial for children's cognitive performance compared to the short total sleep duration trajectory. • A medium total sleep duration, adequate sleep at nighttime and appropriate sleep in the daytime appear to be more beneficial for children's cognitive development.

Prenatal exposure to per- and polyfluoroalkyl substances and infant sleep disturbance: A prospective cohort study

BACKGROUND

Prenatal exposure to per- and polyfluoroalkyl substances (PFAS) may adversely affect fetal brain development, yet no study has investigated the potential association between prenatal PFAS exposure and infant sleep.

OBJECTIVES

To explore the associations of prenatal PFAS exposure with infant sleep disturbances during the first year of life in a prospective cohort study.

METHODS

We recruited 4127 pregnant women from the Shanghai Birth Cohort (SBC) and followed their children from birth to 12 months old. A total of 2366 infants were included in the 6-month analyses, and 2466 infants in the 12-month analyses. Ten PFAS were quantified in blood serum collected in the first trimester. Sleep quality was measured using the Brief Infant Sleep Questionnaire. We used multiple linear regression and multinomial logistic regression to estimate the individual effects of PFAS on sleep outcomes. We utilized a quantile-based g-computation model to determine the joint effects of the PFAS mixture on infant sleep outcomes. Additionally, generalized estimating equation (GEE) models were performed to examine the longitudinal effects of PFAS exposure during pregnancy.

RESULTS

In infants aged 6 months, perfluorooctane sulfonate and perfluoroheptanoic acid were associated with a more than 2-fold risk of parent-reported sleep problems as severe. Perfluorodecanoic acid was associated with an increased risk of often or almost always snoring in one-year-old infants (relative risk ratios, 1.79; 95% CI, 1.12-2.86). PFAS mixtures were positively associated with nighttime awakenings both among infants aged 6 months (β, 0.11; 95% CI, 0.04-0.19) and 12 months (β, 0.11; 95% CI, 0.05-0.18). Prenatal exposure to PFAS were associated with longer sleep latency, increased nighttime awakenings, longer nocturnal wakefulness hours, snoring, and earlier sleep-onset time in infants aged 6-12 months, according to GEE models.

CONCLUSIONS

Our study suggests that prenatal exposure to PFAS may increase the risk of sleep disturbance in infants.

Associations between sleep trajectories up to 54 months and cognitive school readiness in 4 year old preschool children

Purpose

This study explores the association between the duration and variation of infant sleep trajectories and subsequent cognitive school readiness at 48–50 months.

Methods

Participants were 288 multi-ethnic children, within the Growing Up in Singapore Towards healthy Outcomes (GUSTO) cohort. Caregiver-reported total, night and day sleep durations were obtained at 3, 6, 9, 12, 18, 24 using the Brief Infant Sleep Questionnaire and 54 months using the Child Sleep Habits Questionnaire. Total, night and day sleep trajectories with varying durations (short, moderate, or long) and variability (consistent or variable; defined by standard errors) were identified. The cognitive school readiness test battery was administered when the children were between 48 and 50 months old. Both unadjusted adjusted analysis of variance models and adjusted analysis of covariance models (for confounders) were performed to assess associations between sleep trajectories and individual school readiness tests in the domains of language, numeracy, general cognition and memory.

Results

In the unadjusted models, children with short variable total sleep trajectories had poorer performance on language tests compared to those with longer and more consistent trajectories. In both unadjusted and adjusted models, children with short variable night sleep trajectories had poorer numeracy knowledge compared to their counterparts with long consistent night sleep trajectories. There were no equivalent associations between sleep trajectories and school readiness performance for tests in the general cognition or memory domains. There were no significant findings for day sleep trajectories.

Conclusion

Findings suggest that individual differences in longitudinal sleep duration patterns from as early as 3 months of age may be associated with language and numeracy aspects of school readiness at 48–50 months of age. This is important, as early school readiness, particularly the domains of language and mathematics, is a key predictor of subsequent academic achievement.