The association between sleep problems and academic performance in primary school-aged children: Findings from a Norwegian longitudinal population-based study.

Kjell Morten Stormark,Mari Hysing,Ståle Pallesen,Hedvik Elisabeth Fosse,Kenji J Tsuchiya

doi:10.1371/journal.pone.0224139

Kjell Morten Stormark, Mari Hysing + Show 3 more

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https://doi.org/10.1371/journal.pone.0224139

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Abstract

The purpose of this study was to examine the longitudinal association between concurrent, transitory and persistent difficulties initiating and maintaining sleep (DIMS) on academic performance in children in a. longitudinal child-cohort (N = 3986) targeting school-aged children when they were 7–9 years (T1) and 11–13 years (T2) old, whilst controlling for mental health problems. DIMS were parent-reported at T1 and T2 and academic performance teacher-reported at T2. Mental health was based on child self-report at T2 using the Strength and Difficulties Questionnaire (SDQ). In all, 10.6% (n = 423) of the children had poor school performance at T2. These had more symptoms of externalizing and internalizing mental health problems (p. < 001) compared to their peers at T2. A logistic regression analysis showed that both concurrent DIMS (at T2, but not at T1) and persistent DIMS (at both T1 and T2) was associated with elevated risk of poor academic performance. After controlling for mental health problems, only persistent DIMS was associated with increased risk of poor academic performance. Transitory DIMS (DIMS at T1 but not at T2) did not increase the risk of later poor academic performance. A mediation analysis also revealed that the association between DIMS and poor school performance was mediated by mental health problems, in addition to an overall significant direct relative effect of DIMS on poor school performance in the persistent DIMS group. These findings support the notion that sleep problems in children are associated with impaired academic performance, and extends past findings demonstrating that sleep problems may not increase the risk of poor academic performance unless they persist over time. The negative effects of persistent sleep problems suggest that more emphasis should be put on preventive interventions of sleep problems in school-aged children.

Highlights

Sleep problems are common in children [1] and adolescents [2,3,4,5,6,7],with estimated prevalence ranging from 11% [8] to 47% [9] depending on factors like study sample, mode of assessment [10] and self- [11] vs caregiver [12]-report, and how sleep problems are defined and conceptualized [13]
Comparisons between the poor academic performance and control group constituting the children with average-to-good academic performance revealed statistically significant differences in terms of difficulties initiating and maintaining sleep (DIMS), pubertal development, family economy, and level of parental education and mental health scores
Sleep problems and school performance academic performance, the risk that the results were due to common method bias [62], which has been pointed out as a limitation in the past studies on adolescents’ sleep and school performance [84], is substantially reduced. These findings add to the current knowledge about the relationship between sleep problems and academic performance by examining this relationship longitudinally, and at the same time controlling for mental health problems, gender, pubertal status and socioeconomic status

Summary

Introduction

Sleep problems are common in children [1] and adolescents [2,3,4,5,6,7],with estimated prevalence ranging from 11% [8] to 47% [9] depending on factors like study sample, mode of assessment [10] and self- [11] vs caregiver [12]-report, and how sleep problems are defined and conceptualized [13]. Subjective self- or parent-report of children’s difficulties initiating and maintaining sleep have, in addition to objective actigraphy or polysomnography recordings during sleep, served as indices for sleep quality [29], which have been found to be more strongly related to mental well-being [30] and academic performance in young adults [31] and children [32] than measures of sleep duration. The concept of sleep quality implies that good sleep is subjective, which objective measures of sleep cannot always assess [33, 34]

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