0
We're unable to sign you in at this time. Please try again in a few minutes.
Retry
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
Retry
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Original Investigation |

Later Emotional and Behavioral Problems Associated With Sleep Problems in Toddlers A Longitudinal Study

Børge Sivertsen, PhD1,2,3; Allison G. Harvey, PhD4; Ted Reichborn-Kjennerud, PhD, MD1,5; Leila Torgersen, PhD1; Eivind Ystrom, PhD1,6; Mari Hysing, PhD2
[+] Author Affiliations
1Division of Mental Health, Norwegian Institute of Public Health, Bergen
2Regional Centre for Child and Youth Mental Health and Child Welfare, Uni Research Health, Bergen, Norway
3Department of Psychiatry, Helse Fonna HF, Haugesund, Norway
4Department of Psychology, University of California, Berkeley
5Institute of Psychiatry, University of Oslo, Oslo, Norway
6Department of Psychology, Faculty of Social Sciences, University of Oslo, Oslo, Norway
JAMA Pediatr. 2015;169(6):575-582. doi:10.1001/jamapediatrics.2015.0187.
Text Size: A A A
Published online

Importance  Childhood sleep problems have been linked to a range of adverse health outcomes, but there is limited knowledge as to the temporal association between sleep problems and subsequent emotional and behavioral problems in young children.

Objective  To examine whether sleep problems in toddlers aged 18 months are related to both concurrent and subsequent emotional and behavioral problems in preschool children aged 5 years.

Design, Setting, and Participants  A large population-based longitudinal study was conducted in September 2014 using data from the Norwegian Mother and Child Cohort Study conducted at the Norwegian Institute of Public Health from June 1, 1999, to December 31, 2008. A total of 32 662 children or pregnancies were included.

Exposures  Sleep was assessed by mother-reported child sleep duration and nocturnal awakenings.

Main Outcomes and Measures  Emotional and behavioral problems were measured with items from the Child Behavior Checklist and operationalized according to recommended clinical cutoffs, corresponding to T scores of greater than 65 (93rd percentile). Risk ratios (RRs) were calculated using negative binomial regression, controlling for emotional and behavioral problems at 18 months and other relevant covariates.

Results  Short sleep duration (≤10 hours) in 556 children (1.7%) and frequent nocturnal awakenings (≥3 times) in 1033 children (3.2%) at 18 months significantly predicted both concurrent and later incidence of emotional and behavioral problems at 5 years. The longitudinal RRs were generally larger for internalizing problems, with adjusted RRs of 1.59 (95% CI, 1.23-2.08) for both short sleep duration and 1.57 (95% CI, 1.28-1.93) for nocturnal awakenings; RRs for externalizing problems were 1.77 (95% CI, 1.37-2.30) and 1.25 (95% CI, 1.00-1.58), respectively. Additional adjustment for emotional and behavioral problems at 18 months slightly reduced the strength of these associations, and all RRs remained significant in the fully adjusted models.

Conclusions and Relevance  Early sleep problems predict later development of emotional and behavioral problems. Intervention studies are needed to examine whether sleep programs targeting early childhood may avert the onset of later adverse outcomes.

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

Figures

Tables

References

Correspondence

CME
Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.

Multimedia

Some tools below are only available to our subscribers or users with an online account.

1,991 Views
2 Citations
×

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

Related Content

Customize your page view by dragging & repositioning the boxes below.

Articles Related By Topic
Related Collections
PubMed Articles
Jobs
brightcove.createExperiences();