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Association between early childhood sleep difficulties and subsequent psychiatric illness
Eric Pease1, Julia Shekunov1, Samuel T Savitz2,3
1Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota.
Insights
Early childhood sleep disruptions can impact psychiatric health. Polysomnography (PSG) findings and parent reports showed little agreement, indicating limited clinical utility for predicting later psychiatric illness in young children.
Area of Science:
- Pediatric sleep medicine
- Child psychiatry
- Clinical neurophysiology
Background:
- Chronic childhood sleep disruptions are linked to increased psychiatric disease prevalence.
- Early detection and intervention are crucial, as remitted sleep issues may negate later psychiatric risks.
- Clinicians currently rely on caregiver reports for diagnosing and managing childhood sleep problems.
Purpose of the Study:
- To investigate if polysomnogram (PSG) findings offer insights into childhood sleep difficulties.
- To determine if PSG results correlate with the risk of subsequent psychiatric illness.
- To compare PSG findings with caregiver-reported sleep concerns.
Main Methods:
- A cohort of 348 children aged 5 years and younger with clinical sleep issues was identified.
- Retrospective review of caregiver reports, PSG results, and subsequent psychiatric diagnoses.
- Statistical analyses included chi-squared, Fisher's exact tests, and Cohen's kappa for agreement.
Main Results:
- Comparisons between PSG findings and subsequent psychiatric diagnoses were largely non-significant.
- Agreement between caregiver-reported sleep concerns and PSG findings was slight to fair.
- Caregiver reports did not reliably predict PSG results.
Conclusions:
- Parental subjective sleep concerns indicate different pathologies than those detected by PSG.
- Adding PSG to caregiver reports has limited clinical utility for assessing psychiatric illness risk in young children.
- Further research may be needed to refine diagnostic tools for early childhood sleep disorders and associated psychiatric risks.
Study Objectives:
Chronic disruptions to sleep in childhood are associated with increased prevalence of psychiatric disease later in development. When sleep disruptions remit before adolescence, the increased prevalence of psychiatric disease is no longer observed, highlighting the importance of early detection and intervention. Clinicians typically rely on caregivers' reports for diagnosis and management of childhood sleep challenges. We examined whether findings on polysomnogram (PSG) can offer similar insight into childhood sleep difficulties and the risk of subsequent psychiatric illness.
Methods:
A cohort was identified of 348 children ages 5 years 11 months and younger with sleep difficulties rising to the level of formal clinical workup. A retrospective review of caregiver-reported sleep concerns, PSG results, and subsequent psychiatric illness was completed. PSG findings were compared to presence of psychiatric illness later in life as well as caregivers' reported concerns. Chi-squared and Fisher's exact tests were completed to evaluate correlations and Cohen's kappa was used to evaluate agreement.
Results:
With only a few exceptions, comparisons between clinician findings on PSG and subsequent psychiatric diagnoses were statistically nonsignificant. Similarly, the relationship between caregivers' subjective reports about sleep and clinicians' findings on PSG demonstrated only slight to fair agreement, suggesting reported concerns were not predictive of PSG results.
Conclusions:
Parental reports of subjective sleep concerns are indicative of different sleep pathologies compared to sleep pathologies detected on PSG. The addition of PSG to caregiver-reported data appears to have limited clinical utility in understanding sleep concerns associated with the risk of subsequent psychiatric illness in young children.
Citation:
Pease E, Shekunov J, Savitz ST, et al. Association between early childhood sleep difficulties and subsequent psychiatric illness. J Clin Sleep Med. 2023;19(12):2059-2063.
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