Circadian rhythms refer to biological rhythms that have an endogenous period length of approximately 24 hr. However, not much is known about the variance in the development of the sleep-wake rhythm. The study objectives were (a) to describe the normative variation in the development of a sleep-wake rhythm in infancy, (b) to assess whether slower development is related to sleep quality and (c) to evaluate factors that are related to the slower development of a sleep-wake rhythm. The study is based on a representative birth cohort. Questionnaires at the ages of 3 (n = 1,427) and 8 months (n = 1,302) and actigraph measurement at 8 months (n = 372) were available. Infants with significant developmental delays (n = 11) were excluded. The results are based on statistical testing and multivariate modelling. We found that the average percentage of daytime sleep was 36.3% (standard deviation [SD], 8.5%) at 3 months and 25.6% (SD, 6.6%) at 8 months. At both time-points, infants with slower sleep-wake rhythm development slept more hours per day, had a later sleep-wake rhythm, more difficulties in settling to sleep and longer sleep-onset latency; they also spent a longer time awake during the night. According to actigraph registrations, we found that the infants with slow development of a sleep-wake rhythm slept less and had a later start and end to night-time sleep than the other infants. Infants' sleep-wake rhythm development is highly variable and is related to parent-reported and objectively measured sleep quality and quantity. Interventions to improve the sleep-wake rhythm might improve sleep quality in these infants.
K E Y W O R D Sinfant, sleep, sleep-wake rhythms