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Prenatal exposure to manganese and objectively measured sleep disturbances in early childhood
Francheska M Merced-Nieves1, Elena Colicino2, Brent Coull3
1Department of Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Department of Environmental Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Institute for Exposomic Research, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
Insights
Prenatal exposure to manganese (Mn) is linked to altered sleep patterns in children. Higher manganese levels were associated with shorter sleep duration, while low levels correlated with increased wakefulness after sleep onset and reduced sleep efficiency.
Area of Science:
- Environmental Health
- Neurodevelopmental Science
- Sleep Medicine
Background:
- Childhood sleep is crucial for neurodevelopment, making identification of modifiable risk factors a priority.
- Sleep neuroarchitecture development begins prenatally, highlighting the importance of in-utero exposures.
- Manganese (Mn) is an essential trace element for neurodevelopment but can be neurotoxic at insufficient or excessive levels.
Purpose of the Study:
- To examine the associations between prenatal urinary manganese (Mn) levels and objectively measured sleep outcomes in young children.
- To explore potential sex-specific effects of prenatal Mn exposure on child sleep.
- To identify environmental factors, such as metal exposure, that may influence sleep architecture from early development.
Main Methods:
- Utilized multi-day actigraphy (n=222) and single-night in-home polysomnography (PSG) (n=102) to objectively assess sleep in children aged 6.7 ± 2.0 years.
- Employed multivariable linear regression and generalized additive models to analyze linear and non-linear associations between prenatal log-transformed Mn levels and sleep parameters.
- Investigated sex-specific effects using 2-way interaction terms and categorized Mn levels into tertiles (low, moderate, high) to examine non-linear relationships.
Main Results:
- A doubling in prenatal Mn levels was associated with decreased average sleep period duration (-30.9 min) and sleep duration (-21.9 min) on actigraphy, with more pronounced effects in males.
- Children exposed to low prenatal Mn levels exhibited increased wake after sleep onset (WASO) (+89.6 min) and reduced sleep efficiency (-6.47%) on PSG compared to those with moderate exposure.
- Results indicate a non-linear relationship between Mn levels and sleep outcomes, suggesting a potential U-shaped or inverted U-shaped effect.
Conclusions:
- Prenatal exposure to manganese is associated with altered sleep architecture in early childhood.
- Both insufficient and excessive prenatal manganese exposure may negatively impact sleep, affecting duration, wakefulness, and efficiency.
- Environmental exposures during pregnancy represent a critical window for potential disruption of neurodevelopment and sleep patterns.
Abstract:
Inadequate sleep in childhood can impact long-term neurodevelopmental outcomes; thus, identifying modifiable risk factors amenable to intervention is a priority. Development of sleep neuroarchitecture begins in utero. Manganese (Mn) is a trace element known to be both an essential element for optimal neurodevelopment and, at insufficient or excess levels, a neurotoxicant. We examined associations between prenatal urinary Mn levels and objectively measured sleep outcomes in children aged 6.7 ± 2.0 years and explored sex-specific effects. Sleep was assessed using multi-day actigraphy (n = 222) and single-night in-home polysomnography (PSG) (n = 102). Linear and non-linear associations between prenatal log-transformed Mn levels and sleep outcomes were examined using multivariable linear regression and generalized additive models, respectively. Non-linear associations were examined based on low, moderate (referent group) and high Mn levels indexed by tertiles. Sex-specific effects were evaluated using 2-way interaction terms. A doubling increase in Mn was associated with a 30.9 min (95 % CI = -52.0, -9.86) decrease of average sleep period duration and a 21.9 min (95 % CI = -39.9, -4.02) decrease of average sleep duration on actigraphy; associations were more pronounced in males. Compared to children born to mothers with moderate prenatal urinary Mn levels, children whose mothers had "low" Mn had a percent increase in minutes of wake after sleep onset (WASO) (β = 89.6; 95 % CI = 16.2, 206.5) and a decrease in sleep efficiency percentage (β = -6.47; 95 % CI = -11.3, -1.68) on PSG. Sleep problems may be influenced by environmental exposures, such as metals, and disruption can occur as early as pregnancy.
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