0999 Predictors Of Natural Resolution Of Behavioral Sleep Problems In Early Childhood

Abstract

Abstract Introduction Primary care providers are often unsure which patients require treatment for behavioral sleep problems of early childhood vs. which are likely to improve without intervention. Given limited treatment resources as well as the time and cost burden that intervention can pose for families, it may be helpful to identify the predictors of children whose behavioral sleep problems are likely to resolve -- and stay resolved -- without active intervention. Methods Here, we use the control arm of a randomized trial of 2.5 to 5 year-old community-recruited children with behavioral sleep problems to examine the natural history of behavioral sleep problems and the predictors of resolution. Of 217 families in the control arm, 146 had inadequate mean sleep duration at baseline (< 10.5 hours/night per diary) and were eligible for inclusion in the analysis. Data were drawn from sleep diaries and parent report surveys conducted at baseline, 3 and 12 months. Improvement was defined as increased duration by either at least 60 min from baseline or by 30 min to at least 10.5 hours/night. We conducted an exploratory logistic regression to identify predictors of natural resolution. Results Of the 146 eligible families, 130 had follow-up data at both 3 and 12 months and were included in this analysis. Of those 130, only 22 (17%) had substantially improved sleep by 3 months follow-up, and 10 of these continued to have improved sleep duration at 12 months. The strongest predictors of natural improvement both at 3 and 12 months were female child sex, having either infant or school-aged siblings, CBQ low-intensity pleasure score (i.e., children who tend to respond positively to cuddling, reading, and other gentle activities), mean duration of sleep onset latency per diary, parent-reported parasomnias on the CSHQ, and age under 4 years. Conclusion These findings suggest that contrary to common beliefs of both primary care providers and parents, relatively few children will experience a clinically meaningful improvement in sleep duration without intervention. Support This work is supported by a grant from the National Institutes of Health, Eunice Kennedy Shriver National Institute of Child Health & Human Development (NICHD): 5R01HD071937.