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Sleep duration, sleep problems and developmental trajectories of urinary incontinence: a prospective cohort study
Carol Joinson1, Mariusz T Grzeda2, Jon Heron3
1Centre for Academic Child Health, Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK. Carol.Joinson@bristol.ac.uk.
Insights
Adequate preschool sleep duration is linked to lower urinary incontinence (UI) risk in school-aged children. Sleep problems in early childhood may indicate future bladder control issues, affecting daytime and persistent wetting.
Area of Science:
- Pediatric Sleep Medicine
- Child Urology
- Developmental Pediatrics
Background:
- Urinary incontinence (UI) is a common childhood issue with potential long-term impacts.
- Preschool sleep patterns are increasingly recognized as crucial for child development.
- Understanding the link between early sleep and later continence is vital for preventative strategies.
Purpose of the Study:
- To investigate the association between preschool sleep duration and sleep problems with urinary incontinence (UI) at primary school age.
- To identify specific sleep characteristics that may predict UI trajectories in children.
- To inform early intervention strategies for children at risk of bladder control issues.
Main Methods:
- Utilized multinomial logistic regression analysis on data from the Avon Longitudinal Study of Parents and Children (ALSPAC) cohort.
- Examined sleep duration and sleep problems at age 3.5 years in relation to UI trajectories from ages 4-9 years.
- Adjusted for multiple confounding factors including sex, socioeconomic status, maternal support, developmental delay, stressful life events, temperament, and emotional/behavioral problems.
Main Results:
- Longer preschool sleep duration (>8.5 hours) was associated with a decreased probability of UI at school age.
- Each additional hour of sleep in preschool was linked to a 33% reduction in the odds of daytime wetting.
- Specific sleep problems, such as difficulty settling, breathing issues during sleep, and night waking, were associated with increased odds of daytime and persistent (day and night) wetting.
- Night-time waking and waking early were associated with reduced odds of bedwetting alone.
Conclusions:
- Preschool sleep duration is a significant protective factor against school-age urinary incontinence.
- Sleep problems in early childhood are associated with an increased likelihood of daytime and persistent wetting, but not exclusively bedwetting.
- Short sleep duration and sleep disturbances in early childhood may serve as early indicators for future bladder control difficulties.
Abstract:
To examine if preschool sleep duration and sleep problems are associated with urinary incontinence (UI) at primary school-age. We used multinomial logistic regression to examine the association of child sleep duration/problems (3½ years) with UI trajectories (4-9 years) in 8751 (4507 boys, 4244 girls) from the Avon Longitudinal Study of Parents and Children. We adjusted for sex, socioeconomic indicators, mothers' emotional/practical/financial support, developmental delay, stressful life events, temperament, and emotional/behaviour problems. Preschool children who slept more than 8½ hours per night had a decreased probability of UI at school-age. There was a 33% reduction in odds of daytime wetting per additional hour of sleep (odds ratio [OR] = 0.67, 95% confidence interval [CI] 0.52-0.86). Sleep problems were associated with increased odds of UI e.g., getting up after being put to bed was associated with daytime wetting (OR = 2.20, 95% CI 1.43-3.39); breathing problems whilst sleeping were associated with delayed bladder control (OR = 1.68, 95% CI 1.12-2.52), and night-time waking was associated with persistent (day and night) wetting (OR = 1.53, 95% CI 1.16-2.00). Waking during the night and waking up early in the morning were associated with reduced odds of bedwetting at school-age (OR = 0.76, 95% CI 0.61-0.96 and OR = 0.80, 95% CI 0.64-0.99 respectively). Preschool children who sleep for longer have a lower likelihood of UI at school-age, whilst those with sleep problems are more likely to experience daytime wetting and combined (day and night) wetting, but not bedwetting alone. Short sleep duration and sleep problems in early childhood could be indicators of future problems attaining and maintaining bladder control.
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