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Published on: October 2, 2019
Associations between gestational age and childhood sleep: a national retrospective cohort study
Jiajun Lyu1, John A Groeger2, Anna L Barnett3
1Shanghai Key Laboratory of Maternal Fetal Medicine, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, 2699 Gaoke Road, Shanghai, China.
Insights
Children born preterm, early-term, or post-term experience worse sleep quality and shorter sleep duration compared to full-term infants. These findings highlight the need for monitoring sleep disorders in these at-risk preschool populations.
Area of Science:
- Pediatric Sleep Medicine
- Developmental Pediatrics
- Public Health
Background:
- Sleep is crucial for healthy childhood brain development.
- The impact of various gestational ages on preschooler sleep remains unclear.
- Previous studies have not comprehensively examined sleep outcomes across the full spectrum of gestational ages.
Purpose of the Study:
- To investigate the association between gestational age at birth and sleep outcomes in preschoolers.
- To compare sleep quality and quantity in children born preterm, early-term, and post-term versus full-term.
Main Methods:
- A national retrospective cohort study of 114,311 Chinese children aged 3-5 years.
- Parental reports on daily sleep hours and pediatric sleep disorders using the Children's Sleep Habits Questionnaire (CSHQ).
- Analysis using linear and logistic regression models to assess gestational age effects on sleep outcomes.
Main Results:
- Children born very-preterm, moderate-preterm, late-preterm, early-term, and post-term exhibited significantly worse sleep (higher CSHQ scores) than full-term children.
- Increased odds of pediatric sleep disorders were observed in very-preterm, moderate-preterm, late-preterm, and post-term groups.
- Shorter daily sleep duration was associated with very-preterm, moderate-preterm, late-preterm, early-term, and post-term births compared to full-term.
Conclusions:
- All degrees of preterm, early-term, and post-term birth are linked to increased risks of sleep disorders and reduced sleep duration in preschoolers.
- These findings necessitate increased monitoring for adverse sleep outcomes in children born outside the full-term range.
- Long-term monitoring is recommended for preschoolers with preterm, early-term, or post-term birth histories.
Background:
Both sleep quality and quantity are essential for normal brain development throughout childhood; however, the association between preterm birth and sleep problems in preschoolers is not yet clear, and the effects of gestational age across the full range from preterm to post-term have not been examined. Our study investigated the sleep outcomes of children born at very-preterm (<31 weeks), moderate-preterm (32-33 weeks), late-preterm (34-36 weeks), early-term (37-38 weeks), full-term (39-40 weeks), late-term (41 weeks) and post-term (>41 weeks).
Methods:
A national retrospective cohort study was conducted with 114,311 children aged 3-5 years old in China. Children's daily sleep hours and pediatric sleep disorders defined by the Children's Sleep Habits Questionnaire (CSHQ) were reported by parents. Linear regressions and logistic regression models were applied to examine gestational age at birth with the sleep outcomes of children.
Results:
Compared with full-term children, a significantly higher CSHQ score, and hence worse sleep, was observed in very-preterm (β = 1.827), moderate-preterm (β = 1.409), late-preterm (β = 0.832), early-term (β = 0.233) and post-term (β = 0.831) children, all p<0.001. The association of pediatric sleep disorder (i.e. CSHQ scores>41) was also seen in very-preterm (adjusted odds ratio [AOR] = 1.287 95% confidence interval [CI] (1.157, 1.433)), moderate-preterm (AOR = 1.249 95% CI (1.110, 1.405)), late-preterm (AOR = 1.111 95% CI (1.052, 1.174)) and post-term (AOR = 1.139 95% CI (1.061, 1.222)), all p<0.001. Shorter sleep duration was also found in very-preterm (β = -0.303), moderate-preterm (β = -0.282), late-preterm (β = -0.201), early-term (β = -0.068) and post-term (β = -0.110) compared with full-term children, all p<0.01. Preterm and post-term-born children had different sleep profiles as suggested by subscales of the CSHQ.
Conclusions:
Every degree of premature, early-term and post-term birth, compared to full-term, has an association with sleep disorders and shortened daily sleep duration. Preterm, early-term, and post-term should therefore all be monitored with an increased threat of sleep disorder that requires long-term monitoring for adverse sleep outcomes in preschoolers.
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