Child Sleep Outcomes Research Articles

0930 Prenatal Cannabis Use and Sleep Outcomes in Children 9-10 Years of Age in the Adolescence Brain Cognitive Development Study

Abstract Introduction The fetal brain is densely populated with CB1 receptors that increase in number throughout gestation and might be involved in sleep processes since they are found in many brain areas related to the regulation of the sleep-wake cycle. THC binds to CB1 receptors, possibly altering neurodevelopment and fetal cortical circuitry in the womb. Studies have found prenatal cannabis use is associated with early sleep factors from as early as few days after birth to 3 years of age, yet no studies have examined associations in later childhood. Methods We used data from the Adolescent Brain Cognitive Development (ABCD) study to determine whether maternal reports of cannabis use while pregnant were associated with child sleep outcomes (The Sleep Disturbance Scale for Children) among 11,875 children ages 9-10. Regression analyses accounted for the nested nature of families (twin and non-twin sibling) and were estimated controlling for potential covariates including daily tobacco and weekly alcohol use during pregnancy, mother’s education, combined household income, parental marital status, child sex, and child age. Results Amongst mothers in our sample, 6% endorsed using cannabis while pregnant. Prenatal cannabis use was associated with lower sleep duration, disorders of initiating and maintaining sleep, disorders of arousal, sleep wake disorders, disorders of excessive somnolence, and a summed sleep score (all b >0.09 and p < 0.04) but not with sleep latency, sleep breathing disorders, and sleep hyperhidrosis (all b <0.08 and p >0.09). Conclusion Prenatal cannabis use was associated with increased childhood sleep deficits including shorter sleep duration and higher endorsements of sleep disorder symptoms. This is the first report of prenatal cannabis use being associated with sleep in childhood as late as 9-10 years of age. Although causality is not established, the results suggest potential long-term effects of prenatal cannabis use on sleep and the need for abstinence from cannabis use while pregnant. Support T32 DA017637. The ABCD Study is supported by the National Institutes of Health and additional federal partners under award numbers U01DA041022, U01DA041028, U01DA041048, U01DA041089, U01DA041106, U01DA041117, U01DA041120, U01DA041134, U01DA041148, U01DA041156, U01DA041174, U24DA041123, U24DA041147, U01DA041093, and U01DA041025 (https:// abcdstudy.org/federal-partners.html).

Identifying Modifiable Factors Linking Parenting and Sleep in Racial/Ethnic Minority Children.

Young children from racial and ethnic minority backgrounds are at risk for poor sleep, yet few studies have tested behavioral interventions in diverse samples. This study tests factors that could contribute to associations between parenting skills and child sleep to inform interventions for children at risk of poor sleep outcomes. Specifically, we examined household chaos, caregiver sleep knowledge, and caregiver sleep quality as putative mediators that may be relevant to interventions seeking to improve child sleep. Caregivers (M age 31.83 years; 46.2% African American; 52.1% Hispanic/Latinx, 95% female) of 119 1- to 5-year-old children (M age 3.99 years; 43.7% African American; 42.0% Hispanic/Latinx, 14.3% biracial; 51.3% female) completed measures of parenting practices, child and caregiver sleep, household chaos, and sleep knowledge. Indices of pediatric insomnia symptoms (difficulty falling/remaining asleep) and sleep health (sleep duration/hygiene) were constructed based on previous research. Parallel mediation models were conducted using ordinary least squares path analysis. Lower household chaos significantly attenuated the relationship between positive parenting skills and better child sleep health, suggesting chaos may serve as a potential mediator. There were no significant contributing factors in the pediatric insomnia model. Sleep knowledge was related to sleep health and caregiver sleep quality was related to pediatric insomnia, independent of parenting skills. Interventions to improve sleep in early childhood may be enhanced by targeting parenting skills and household routines to reduce chaos. Future longitudinal research is needed to test household chaos and other potential mediators of child sleep outcomes over time.

Food insecurity is associated with suboptimal sleep quality, but not sleep duration, among low-income Head Start children of pre-school age.

To examine the association between food insecurity and child sleep outcomes and to investigate whether parent psychosocial factors mediate such associations. Cross-sectional study. Usual wake time and bedtime, bedtime routine and sleep quality were reported by parents using the adapted Brief Infant Sleep Questionnaire. Food insecurity was assessed using the eighteen-item US Department of Agriculture Household Food Security Module. Parent psychosocial factors, including perceived stress, parenting self-efficacy and depressive symptomology, were assessed using validated scales. Multivariable logistic regression models were performed to determine the association between food insecurity and sleep outcomes controlling for potential confounders. Mediation analyses and Sobel tests were applied to test the mediating effect of psychosocial factors. Head Start pre-school classrooms in four regions across central Pennsylvania, USA. Low-income children of pre-school age (n 362) and their caregivers. Prevalence of household, adult and child food insecurity was 37·3, 31·8 and 17·7 %, respectively. Food security status at any level was not associated with child sleep duration or bedtime routine. Child food insecurity, but not household or adult food insecurity, was associated with 2·25 times increased odds (95 % CI 1·11, 4·55) of poor child sleep quality in the adjusted model. Perceived stress, self-efficacy and depressive symptomology mediated less than 2 % of the observed effect (all Sobel test P > 0·6). Food insecurity, particularly at the child level, is a potential modifiable risk factor for reducing sleep-related health disparities in early childhood. Future studies are needed to explore the plausible mechanisms underlying the associations between food insecurity and adverse child sleep outcomes.

Food Insecurity Is Associated with Suboptimal Sleep Quality Among Low-income Head Start Preschool-aged Children (P04-071-19)

ObjectivesInsufficient and/or poor child sleep has long-term health impacts across the life span. Food insecurity is prevalent among low-income populations and it is associated with adverse mental health and sleep outcomes in adults. Little is known about its influence on sleep in young children. We examined the association between food insecurity and sleep outcomes, and investigated whether parent psychosocial factors mediated such associations in a sample of preschool-aged children from low-income families. MethodsEligible children enrolled in Head Start were included in the analytic sample (n = 362). Usual wake and bedtime, bedtime routine and sleep quality were reported by parents using the adapted Brief Infant Sleep Questionnaire. Food insecurity was assessed using the 18-item USDA Household Food Security Module. Parent psychosocial factors, including perceived stress, parenting self-efficacy and depressive symptomology, were assessed using validated scales. Multivariable logistic regression models were performed to determine the association between food insecurity and sleep outcomes controlling for potential confounders. Mediation analyses and Sobel test were applied to test the mediating effect of individual parent psychosocial factors. ResultsPrevalence of household, adult, and child food insecurity was 37.3%, 31.8% and 17.7%, respectively. Food security status at any level was not associated with child sleep duration or bedtime routine frequency. Child food insecurity, but not household or adult food insecurity, was associated with 2.25 times increased odds (95%CI: 1.11, 4.55) of poor child sleep quality in the adjusted model. Perceived stress, self-efficacy, and depressive symptomology mediated less than 2% of the observed effect (all Sobel test p-values > 0.6). ConclusionsFood insecurity, particularly at the child level, is a potential modifiable risk factor for reducing sleep-related health disparities in early childhood. Future studies are needed to explore the plausible mechanisms underlying the associations between food insecurity and adverse sleep outcomes in children. Funding SourcesNone.

Prenatal particulate air pollution exposure and sleep disruption in preschoolers: Windows of susceptibility

BackgroundThe programming of sleep architecture begins in pregnancy and depends upon optimal in utero formation and maturation of the neural connectivity of the brain. Particulate air pollution exposure can disrupt fetal brain development but associations between fine particulate matter (PM2.5) exposure during pregnancy and child sleep outcomes have not been previously explored. MethodsAnalyses included 397 mother-child pairs enrolled in a pregnancy cohort in Mexico City. Daily ambient prenatal PM2.5 exposure was estimated using a validated satellite-based spatio-temporally resolved prediction model. Child sleep periods were estimated objectively using wrist-worn, continuous actigraphy over a 1-week period at age 4–5 years. Data-driven advanced statistical methods (distributed lag models (DLMs)) were employed to identify sensitive windows whereby PM2.5 exposure during gestation was significantly associated with changes in sleep duration or efficiency. Models were adjusted for maternal education, season, child's age, sex, and BMI z-score. ResultsMother's average age was 27.7 years, with 59% having at least a high school education. Children slept an average of 7.7 h at night, with mean 80.1% efficiency. The adjusted DLM identified windows of PM2.5 exposure between 31 and 35 weeks gestation that were significantly associated with decreased sleep duration in children. In addition, increased PM2.5 during weeks 1–8 was associated with decreased sleep efficiency. In other exposure windows (weeks 39–40), PM2.5 was associated with increased sleep duration. ConclusionPrenatal PM2.5 exposure is associated with altered sleep in preschool-aged children in Mexico City. Pollutant exposure during sensitive windows of pregnancy may have critical influence upon sleep programming.

Assisted conception, maternal personality and parenting: Associations with toddler sleep behaviour.

To explore the role of maternal personality (hardiness), sleep-related cognitions and bedtime involvement in child sleep behaviour during the second post-natal year in a sample of spontaneous and assisted conception first-time mothers. Mothers (n = 134 (spontaneous (n = 81); assisted (n = 53) conception)) reported on a resilience measure (hardiness) during pregnancy and child sleep at 7 and 19 months post-partum. At 19 months post-partum, mothers also reported on their cognitions and involvement around their child's bedtime, and half the sample used Actigraph monitors (Acitiwatch-16, Mini Mitter Co. Inc, Bend, OR, USA) to validate maternal report of child sleep. No significant differences were found between spontaneous and assisted conception mothers on any of the study variables; therefore, assisted and spontaneous samples were combined. Structural equation modelling confirmed that lower pre-birth maternal hardiness was associated with more problematic sleep-related cognitions (β = 0.23, P < 0.01) and involvement at bedtime (β = 0.29, P < 0.01) and poorer child sleep outcomes (β = -0.33, P < 0.001) during toddlerhood, even after considering concurrent maternal mood and child temperament. Pre-birth maternal hardiness rather than mode of conception contributes to parenting cognitions and behaviour around child sleep and, ultimately, toddlers' sleep outcomes. Findings suggest that targeting negative maternal perceptions of control and efficacy through clinical interventions could benefit toddlers' sleep.

Sleep Outcomes in Children With Hemifacial Microsomia and Controls: A Follow-up Study

Children with craniofacial anomalies are at high risk for sleep-disordered breathing (SDB), yet its prevalence among children with craniofacial conditions is not known. Children with hemifacial microsomia (HFM) are likely particularly vulnerable to SDB as a result of underdevelopment of the mandible and oropharynx. Nevertheless, most children with HFM are not referred for sleep studies. We hypothesized that sleep outcomes would be worse in children with HFM versus control subjects. We conducted a follow-up study among 124 case participants and 349 control subjects who previously participated in a study of HFM risk factors. Parents completed the Pediatric Sleep Questionnaire (PSQ) regarding symptoms of SDB and sleep habits. Regression models were adjusted for region, age, sex, race/ethnicity, and maternal education. Snoring was more commonly reported for children with HFM (29%) than for control subjects (17%). Compared with control subjects, children with HFM more often had symptoms consistent with SDB. On average, case participants' parents reported 1.9 times as many symptoms on the PSQ breathing scale and 1.3 times more symptoms on the PSQ sleepiness scale than did control subjects' parents, with little difference on the PSQ behavior scale. Parents of children with HFM reported 1.4 times more night awakenings than did control subjects' parents. Children with HFM experienced more snoring and other symptoms of SDB than did control subjects. Pediatricians should be aware of the increased vulnerability for SDB among children with mandibular or external ear underdevelopment or asymmetry and should refer to a sleep specialist as needed.