[Emotional and behavioral problems associated with sleep problems in preschool aged children]

Objective: To examine whether sleep problems are related to both emotional and behavioral problems in children aged 3-6 years. Methods: A large cross-sectional study was conducted in Anqing, Wuhu, Tongling and Yangzhou from March to June 2015. A total of 8 900 preschool aged children were included. Sleep problems were obtained by using adapted BISQ completed by the parents or the people who took care of children. Emotional and behavioral problems of the children were accessed by using Strengths and Difficulties Questionnaire (SDQ), and multivariate logistic regression model was used for statistical analyses. Results: The detected rates of emotional symptoms, conduct problems, hyperactivity problems, peer problems, total difficulties and prosocial behavior in preschool aged children were 9.0%, 13.9%, 18.9%, 25.5%, 13.6% and 16.2% respectively. All the detected rates were higher in boys than in girls except the higher rate of emotional symptoms. The proportions of children with high sleep quality, moderate sleep quality and poor or worse sleep quality were 3.9%, 52.9% and 43.2% respectively. After controlling the confounding factors of demographic variables, including gender, age, delivery mode, birth weight, birth height and patent's educational level, multinomial logistic regression analysis showed that the risk of emotional symptoms, conduct problems, hyperactivity problems, peer problems, total difficulties and prosocial behavior in children with longer sleep duration was lower than that in children with shorter sleep duration, the ORs were 0.86 (95%CI: 0.77-0.95), 0.85 (95%CI: 0.78-0.93), 0.85 (95%CI: 0.79-0.92), 0.87(95%CI: 0.81-0.93), 0.83 (95%CI: 0.76-0.91) and 0.82 (95%CI: 0.76-0.89) respectively. Compared with the children with good sleep quality, the risk of emotional symptoms, conduct problems, hyperactivity problems, peer problems, total difficulties and prosocial behavior were higher in children with poor or worse sleep quality, the ORs were 3.26 (95%CI: 2.40-4.42), 2.86 (95%CI: 2.16-3.78), 2.60 (95%CI: 2.00-3.38), 1.96 (95%CI: 1.52-2.54), 4.02 (95%CI: 3.06-5.27) and 2.56 (95%CI: 1.96-3.35) respectively. Conclusion: There was a negative impact of shorter sleep and poor or worse sleep on emotional and behavioral problems of preschool aged children.