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Sleep-Disordered Breathing as a Mediator Between Premature Birth and Behavior Problems in School-Aged Children: A
Yuli Hu1,2, Siqiong Jiang1, Shiyin Yang3
1Nursing Department of Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Xuhui, Shanghai, 200233, People's Republic of China.
Insights
Premature birth is linked to behavioral issues in children, with sleep-disordered breathing (SDB) playing a mediating role. This study highlights SDB as a significant factor in the connection between prematurity and childhood behavioral problems.
Area of Science:
- Pediatric Sleep Medicine
- Developmental Psychology
- Obstetrics
Background:
- Premature birth presents significant challenges in global obstetric care.
- The link between preterm infants and later behavioral problems is debated.
- The mediating role of sleep-disordered breathing (SDB) in this association is unexplored.
Purpose of the Study:
- To investigate the relationship between premature birth and behavioral problems in school-aged children.
- To examine the potential mediating role of sleep-disordered breathing (SDB) in this relationship.
- To address gaps in current understanding through a large-scale cross-sectional survey.
Main Methods:
- Recruited 18,138 children aged 6-10 years.
- Collected data on demographics, prematurity, SDB symptoms (using the Paediatric Sleep Questionnaire - PSQ), and behavioral problems (using the Conners' Parent Rating Scale - CPRS).
- Employed path analysis with bootstrap methods to analyze the data.
Main Results:
- Prematurity was associated with higher SDB symptoms (total PSQ score).
- Higher SDB symptoms correlated with increased behavioral problems across all CPRS dimensions.
- Prematurity showed direct associations with learning problems and anxiety, and SDB mediated the link to conduct, psychosomatic, and hyperactivity issues.
Conclusions:
- Sleep-disordered breathing may mediate the association between premature birth and behavioral problems in children.
- Cross-sectional design limits causal inference; longitudinal studies are needed.
- Further research should explore SDB interventions in preterm infants for neurodevelopmental benefits.
Background:
Premature birth poses a major challenge in global obstetric clinical practice. The relationship between preterm infants and behavioral problems in school-aged children remains debatable, and the mediating role of sleep-disordered breathing (SDB) in this connection has not been investigated. This study aimed to address these gaps through a large-scale cross-sectional survey.
Methods:
We recruited 18,138 children aged 6-10 from schools. Data on demographics, prematurity, SDB, and childhood behavioral problems were collected. The Paediatric Sleep Questionnaire (PSQ), a validated screening tool, assessed SDB symptoms, and the Conners' Parent Rating Scale (CPRS) evaluated behavioral problems. Path analysis with bootstrap methods was used for statistical analysis.
Results:
Among 18,138 participants, 8% (n = 1,450) were premature. After adjusting for age, gender, BMI z-score, maternal age, and maternal education level, prematurity showed a positive association with total PSQ score (B = 0.411, p < 0.01). Higher total PSQ scores were significantly associated with all six CPRS dimensions (all p < 0.05). While prematurity was not directly associated with Conduct, Psychosomatic, Impulsive-hyperactive, or Hyperactivity scores in CPRS (all p > 0.05), it demonstrated significant associations with Learning problems (β = 0.063, p = 0.005) and Anxiety scores (β = 0.076, p = 0.003). Mediation analysis showed PSQ accounted for a large proportion of associations between prematurity and Conduct, Psychosomatic, Impulsive - hyperactive, and Hyperactivity problems (95% Bootstrap CI excluded 0).
Conclusion:
Premature infants may exhibit behavioral problems significantly associated with SDB, though our cross-sectional design precludes causal inference and parent-reported SDB severity may bias true associations. Future studies should utilize longitudinal cohorts to explore whether SDB is involved in the relationship between prematurity and behavioral problems (eg, anxiety). Additionally, they should conduct pilot randomized controlled trials of SDB interventions in preterm infants to assess neurodevelopmental benefits. Final conclusions require subsequent causal validation.
