Aim
To determine whether children born extremely preterm are at increased risk for sleep disturbances and to explore relationships between extremely preterm birth, sleep and Attention Deficit and Hyperactivity Disorder (ADHD) and emotional symptoms.
Method
EPICure2 cohort study. Parents of 165 children born ≤26 weeks’ gestation (53% male) and 121 children born at term (43% male) completed the Children’s Sleep Habits Questionnaire, sleep disordered breathing subscale of the Pediatric Sleep Questionnaire, the emotional problems scale of the Strengths and Difficulties Questionnaire and the ADHD Rating Scale-5 at 11 years of age.
Results
Extremely preterm children had greater habitual snoring (adjusted odd ratio 6.8; 95% confidence interval 2.3, 20.3), longer sleep onset latency (Cohen’s d 0.33), more severe night waking (d 0.44) and more daytime sleepiness (d 0.40) than term-born children; there was no between-group difference in sleep duration. Among children without severe disability, night waking partially mediated the relationship between preterm birth and inattention (additional 5% of variance explained), hyperactivity/impulsivity (13%) and emotional problems (9%). Snoring partially mediated the relationship between preterm birth, hyperactivity/impulsivity and inattention (additional 1-5% of variance).
Conclusion
Children born extremely preterm are at increased risk of disturbed sleep compared to term-born children. As night waking partially mediated the relationship between preterm birth and ADHD symptoms and emotional problems, reducing sleep disturbance may improve sleep and reduce attention and emotional problems in this population.
Trickett, J., Bernardi, M., Fahy, A., Lancaster, R., Larsen, J., Ni, Y., Suonpera, E., Wolke, D., Marlow, N., Johnson, S. (2021 online first). Disturbed sleep in children born extremely preterm is associated with behavioural and emotional symptoms. Sleep Medicine, 85, 157-165. doi: https://doi.org/10.1016/j.sleep.2021.07.006