Associations between gestational age and childhood sleep: a national retrospective cohort study

Abstract

Background Both sleep quality and quantity are essential for normal brain development throughout childhood; however, the association between preterm birth and sleep problems in preschoolers is not yet clear, and the effects of gestational age across the full range from preterm to post-term have not been examined. Our study investigated the sleep outcomes of children born at very-preterm (<31 weeks), moderate-preterm (32–33 weeks), late-preterm (34–36 weeks), early-term (37–38 weeks), full-term (39–40 weeks), late-term (41 weeks) and post-term (>41 weeks). Methods A national retrospective cohort study was conducted with 114,311 children aged 3–5 years old in China. Children’s daily sleep hours and pediatric sleep disorders defined by the Children’s Sleep Habits Questionnaire (CSHQ) were reported by parents. Linear regressions and logistic regression models were applied to examine gestational age at birth with the sleep outcomes of children. Results Compared with full-term children, a significantly higher CSHQ score, and hence worse sleep, was observed in very-preterm (β = 1.827), moderate-preterm (β = 1.409), late-preterm (β = 0.832), early-term (β = 0.233) and post-term (β = 0.831) children, all p<0.001. The association of pediatric sleep disorder (i.e. CSHQ scores>41) was also seen in very-preterm (adjusted odds ratio [AOR] = 1.287 95% confidence interval [CI] (1.157, 1.433)), moderate-preterm (AOR = 1.249 95% CI (1.110, 1.405)), late-preterm (AOR = 1.111 95% CI (1.052, 1.174)) and post-term (AOR = 1.139 95% CI (1.061, 1.222)), all p<0.001. Shorter sleep duration was also found in very-preterm (β = −0.303), moderate-preterm (β = −0.282), late-preterm (β = −0.201), early-term (β = −0.068) and post-term (β = −0.110) compared with full-term children, all p<0.01. Preterm and post-term-born children had different sleep profiles as suggested by subscales of the CSHQ. Conclusions Every degree of premature, early-term and post-term birth, compared to full-term, has an association with sleep disorders and shortened daily sleep duration. Preterm, early-term, and post-term should therefore all be monitored with an increased threat of sleep disorder that requires long-term monitoring for adverse sleep outcomes in preschoolers.

The Association Between Maternal Sleep and Circadian Rhythms During Pregnancy and Infant Sleep and Socioemotional Outcomes

“…Mothers with sleep problems may show increased levels of exhaustion and subsequently be less emotionally available to their child, provide lower levels of linguistic and cognitive stimulation, or be less likely to institute healthy child sleep habits, leading to poorer offspring socioemotional development. In addition, prenatal sleep disturbances have been previously associated with shorter GA 4 , which is also associated with infant sleep disturbances 40 , suggesting a pathway from maternal to infant sleep disturbances through early birth. Future research should further elucidate the extent to which the current ndings re ect prenatal programming of the developing fetal nervous system versus the in uence of features of the postnatal environment.…”

Associations of preterm and early-term birth with suspected developmental coordination disorder: a national retrospective cohort study in children aged 3–10 years

“…Moreover, the brain structures of very preterm infants in early and term magnetic resonance imaging have been correlated with their concurrent motor, neurological and neurobehavioral functions [ 55 ]. Except for the affected brain development of preterm children, insufficient lung functioning and alterations in sleep patterns that have been associated with preterm birth may also affect the motor development of children [ 38 , 56 ]. Furthermore, a range of parental factors related to preterm childcaring, such as increased parental concern about preterm children, may reduce children’s participation in physical activities, which can also affect the motor development of preterm children.…”

“…All assessors had proficient experience in conducting psychological assessments with children in a similar age range, and all assessors were trained with a two-day training program and were qualified to individually administer the MABC-2 test. More information regarding the quality control of the data collection can be found in our previous publication [ 8 , 37 , 38 ]. All children were assessed individually in their nurseries or schools.…”

Prenatal second-hand smoke exposure and the risk of suspected developmental coordination disorder in preschoolers: A nationwide retrospective cohort study in China

“…Each parent signed an informed consent before the investigation. More details on the survey and dataset have been described and published elsewhere ( 25 , 26 ).…”