Sex differences in sleep disturbances in middle childhood: findings from an urban pediatric cohort study

While sleep differs in adult males and females, its variation by sex during childhood is less understood. We examined sex differences in sleep measures in children and explored the influences of selective socio-demographic and health-related factors on these associations.

The cohort included 323 participants aged 6-12 years who resided predominantly in low-income urban neighborhoods. Sleep duration and maintenance efficiency were assessed using wrist actigraphy. Sleep-disordered breathing (SDB) was assessed from overnight in-home testing. Validated questionnaires assessed sleep-related impairment and sleep disturbance. Linear and logistic regression modeled associations between sex and sleep outcomes, testing for effect modification by demographics, indoor environment, and neighborhood factors.

Male children had higher odds for short sleep duration (<8 hours; Odds Ratio [OR] = 1.81, 95% confidence interval [CI] = 1.06, 3.08) and low sleep efficiency (<85%; OR = 2.04, 95% CI = 1.24, 3.35), which persisted after adjusting for health-related factors. Male sex was associated with a 17.4% higher geometric mean of SDB respiratory event frequency (p < .05). Effect modification analysis showed stronger associations between male sex and lower sleep efficiency for children older than 10 years, between male sex and short sleep duration for minority children, and between male sex and SDB for children of mothers with lower education. No sex differences were observed in parent-reported sleep outcomes.

Male children were at higher risk for several objectively measured but not for caregiver-reported sleep outcomes; findings were unexplained by common health problems. Risk appeared further elevated in males who were older than 10 years and were of minority ethno-racial background or from homes with low maternal education.