The relationship of sleep problems between eight-year-old South African children and their mothers

Sleep problems are common among children and mothers. However, little is understood about sleep behaviours in low- and middle-income countries. Here we examine sleep behaviours and predictors among black, low-income, South African mothers and their eight-year-old children over time.

We administered standardised measures of sleep behaviours at eight years post-birth to a population cohort of mothers and children in 24 neighbourhoods of Cape Town, South Africa, in 2009-10. We assessed mothers and children six times over eight years with 84% retention since pregnancy. While 71% remained in Cape Town, about 29% of households moved to the profoundly rural Eastern Cape of South Africa. Mothers completed the Pittsburgh Sleep Quality Index and rated their children on the Children's Sleep Habits Questionnaire.

Among mothers, 29.5% reported sleep difficulties based on their global sleep score, with a mean sleep quality score of 3.72 (standard deviation (SD) = 2.6). Children's sleep scores were 64.4 (SD = 4.0), with subscale scores on sleep difficulties higher than documented in high-income countries (HICS). There was a relatively low inverse relationship between the quality of maternal and child sleep (r = -0.201; 95% confidence interval (CI) = -0.264, -0.136), which resulted in an R² value of 0.041 in the simple linear regression model. Problematic maternal sleep was associated with living in the rural Eastern Cape (P = 0.034), experiencing intimate partner violence (P = 0.052), and a higher score on the Edinburgh Postnatal Depression Scale (P < 0.001), but not alcohol use. Children's sleep difficulties decreased by 0.191 points (95% CI = -0.229, -0.152) with a one-unit increase in aggressive behaviour and, similarly, cognitive scores decreased by 0.035 points (95% CI = -0.063, -0.006). Household resources, such as formal vs. informal housing, income, and having water on the premises, were unrelated to sleep difficulties.

Counter to hypotheses, a small, inverse relationship existed between mothers' and children's sleep behaviours. Alcohol use, HIV status, and socioeconomic markers were unrelated to sleep, but intimate partner violence and depressive symptoms affect sleep negatively, similar to HICS.