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Sleep problems from age two to five years and neurological outcome in children born extremely preterm: a
Kristine Marie Stangenes1,2, Mari Hysing3, Maria Vollsæter4
1Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.
Insights
Sleep problems in extremely preterm (EPT) children are linked to lower cognitive function and neurodevelopmental disabilities (NDD). Addressing sleep issues is crucial for improving developmental outcomes in these vulnerable children.
Area of Science:
- Pediatrics
- Neuroscience
- Developmental Psychology
Background:
- Extremely preterm (EPT) birth (<28 weeks gestation) is a risk factor for sleep disturbances and neurodevelopmental disabilities (NDD).
- Understanding the relationship between sleep problems and developmental outcomes in EPT children is vital for early intervention.
Purpose of the Study:
- To investigate the association between sleep problems and cognitive, motor, and sensory functions in five-year-old children born EPT.
- To identify potential strategies for enhancing developmental outcomes in EPT children by addressing sleep issues.
Main Methods:
- A national cohort of EPT children born in Norway (1999-2000) was studied.
- Parental questionnaires assessed sleep problems from ages two to five.
- Cognitive, motor, and NDD assessments were conducted at age five.
Main Results:
- 28.5% of EPT children experienced general sleep problems.
- Sleep problems were significantly associated with lower Full Scale IQ (<85).
- Moderate to severe NDD (NDD 2-3) showed a higher prevalence of general and specific sleep problems.
Conclusions:
- Sleep problems in EPT children are linked to impaired cognitive function and NDD.
- Interventions targeting sleep disturbances are recommended for comprehensive care of EPT children.
- Addressing sleep is essential for improving long-term developmental trajectories in EPT populations.
Introduction:
Premature birth is associated with a higher risk of sleep problems and neurodevelopmental disabilities (NDD). We examined relationships between sleep problems and cognitive, motor, and sensory functions in a national cohort of five-year-old children born extremely preterm (EPT) with the purpose of identifying possible means of improving developmental outcomes.
Methods:
This study was part of a national cohort study of all children born extremely preterm, defined here as gestational age less than 28 completed weeks, or birth weight below 1,000 g, born in Norway in 1999 and 2000. Parents completed a structured retrospective questionnaire at age five to assess sleep problems from ages two to five years. We assessed cognitive function using the Wechsler Preschool and Primary Scale of Intelligence-Revised (WPPSI-R), evaluated motor function with the Movement Assessment Battery for Children (M-ABC) and classified cerebral palsy (CP) according to the Gross Motor Function Classification System (GMFCS). NDD was graded from no NDD (no disabilities) to NDD 2 and 3 (moderate and severe disability).
Results:
Of 372 eligible children, 253 (68%) participated. Parents reported that 28.5% had general sleep problems from ages two to five years. Prevalences of specific problems were 21.7% for nighttime awakenings, 17.8% for difficulty falling asleep, 5.9% for early morning awakening and 1.6% for late morning awakening. Children with Full scale IQ < 85 were at increased risk of general sleep problems (adjusted odds ratio - aOR 1.8), as well as nighttime awakenings (aOR 2.8), and early morning awakenings (OR 2.9), but not for difficulty falling asleep compared to those with higher IQ levels.EPT children with moderate to severe NDD (NDD 2 and 3) showed a higher prevalence of general sleep problems [adjusted odds ratio (aOR) 3.9], nighttime awakenings (aOR 4.8), and early morning awakenings (OR 7.9) compared to those with no NDD (NDD 0).
Conclusion:
General and specific sleep problems were associated with low cognitive function and moderate to severe NDD. Our findings underscore the importance of addressing sleep within a comprehensive care framework for EPT children and highlight the need for addressing and target interventions for sleep problems.
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