Abstract
Children born small for gestational age (SGA) are more likely to develop high blood pressure. In prior studies, longer sleep duration is associated with lower BP, and SGA is associated with shorter sleep duration in childhood. We investigated whether sleep duration in early childhood modifies the association between SGA and higher childhood SBP in 1178 children recruited at birth and followed up to age 9 years. We ascertained birthweight and gestational age from medical records. We derived child sleep duration from maternal questionnaire interview. We calculated child SBP percentile according to U.S. reference data. We defined elevated SBP as SBP ≥75th percentile. In this sample, 154 (13.1%) children were born SGA. Children born SGA had higher SBP percentiles and higher risk of elevated SBP. Among children born SGA, those in the highest compared to the lowest tertile for sleep had a 12.28 lower (−22.00, −2.57) SBP percentile and 0.44 (0.25 to 0.79) times lower risk of developing elevated SBP. Our data are consistent with an interaction between SGA and sleep duration on childhood elevated SBP (Pinteraction = 0.0056). In conclusion, in this prospective birth cohort, longer sleep duration in early childhood may mitigate the blood pressure-raising effect of being born small.
Highlights
In a well-established U.S, predominantly urban, low income minority prospective birth cohort, a population know to be at high risk of hypertension, we aimed to examine the association of child sleep duration and child BP according to the level of birthweight for gestational age (BW-GA) category, and to test the hypothesis that longer sleep duration mitigates the positive association between small for gestational age (SGA) and systolic BP (SBP) later in childhood
The associations were not markedly different when we used a cutoff of SBP ≥90th percentile or ≥120 mmHg, or a cutoff of SBP/diastolic BP (DBP) ≥90th percentile or ≥120/80 mmHg11 (Supplementary Tables S7 and S8), or when we used alternative national BW-GA standards. In this prospective U.S birth cohort study, our findings provide further support for the hypothesis that being born SGA is associated with higher SBP throughout childhood
Adding to this body of literature, we demonstrate for the first time that longer nighttime sleep duration in early childhood significantly attenuated the association between SGA and higher SBP, such that the SBP of SGA children in the highest tertile of sleep duration was not appreciably different from children born appropriate for gestational age (AGA) or large for gestational age (LGA)
Summary
In a well-established U.S, predominantly urban, low income minority prospective birth cohort, a population know to be at high risk of hypertension, we aimed to examine the association of child sleep duration and child BP according to the level of birthweight for gestational age (BW-GA) category, and to test the hypothesis that longer sleep duration mitigates the positive association between SGA and systolic BP (SBP) later in childhood. The findings from our study have potential implications for primary prevention of hypertension and its consequences among high risk children during early developmental windows, as sleep duration represents a potentially modifiable risk factor
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