Sleep duration in preschool age and later behavioral and cognitive outcomes: an individual participant data meta-analysis in five European cohorts.

Kathrin Guerlich, Demetris Avraam, Tim Cadman, Lucinda Calas, Marie-Aline Charles, Ahmed Elhakeem, Silvia Fernández-Barrés, Mònica Guxens, Barbara Heude, Jesús Ibarluzea, Hazel Inskip, Jordi Julvez, Deborah A Lawlor, Mario Murcia, Theodosia Salika, Jordi Sunyer, Muriel Tafflet, Berthold Koletzko, Veit Grote, Sabine Plancoulaine

Journal: European child & adolescent psychiatry 2024;33(1):167-177

PMID: 36749392

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Abstract

Short sleep duration has been linked to adverse behavioral and cognitive outcomes in schoolchildren, but few studies examined this relation in preschoolers. We aimed to investigate the association between parent-reported sleep duration at 3.5 years and behavioral and cognitive outcomes at 5 years in European children. We used harmonized data from five cohorts of the European Union Child Cohort Network: ALSPAC, SWS (UK); EDEN, ELFE (France); INMA (Spain). Associations were estimated through DataSHIELD using adjusted generalized linear regression models fitted separately for each cohort and pooled with random-effects meta-analysis. Behavior was measured with the Strengths and Difficulties Questionnaire. Language and non-verbal intelligence were assessed by the Wechsler Preschool and Primary Scale of Intelligence or the McCarthy Scales of Children's Abilities. Behavioral and cognitive analyses included 11,920 and 2981 children, respectively (34.0%/13.4% of the original sample). In meta-analysis, longer mean sleep duration per day at 3.5 years was associated with lower mean internalizing and externalizing behavior percentile scores at 5 years (adjusted mean difference: - 1.27, 95% CI [- 2.22, - 0.32] / - 2.39, 95% CI [- 3.04, - 1.75]). Sleep duration and language or non-verbal intelligence showed trends of inverse associations, however, with imprecise estimates (adjusted mean difference: - 0.28, 95% CI [- 0.83, 0.27] / - 0.42, 95% CI [- 0.99, 0.15]). This individual participant data meta-analysis suggests that longer sleep duration in preschool age may be important for children's later behavior and highlight the need for larger samples for robust analyses of cognitive outcomes. Findings could be influenced by confounding or reverse causality and require replication.

Address: Division of Metabolic and Nutritional Medicine, Department of Pediatrics, Dr. von Hauner Children's Hospital, LMU University Hospital Munich, Lindwurmstr. 4, 80337, Munich, Germany.; Population Health Sciences Institute, Newcastle University, Newcastle, UK.; Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.; Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.; Population Health Science, Bristol Medical School, University of Bristol, Bristol, UK.; Université Paris Cité and Université Sorbonne Paris Nord, Inserm, INRAE, Center for Research in Epidemiology and StatisticS (CRESS), 75004, Paris, France.; Université Paris Cité and Université Sorbonne Paris Nord, Inserm, INRAE, Center for Research in Epidemiology and StatisticS (CRESS), 75004, Paris, France.; Ined, Inserm, Joint unit Elfe, Aubervilliers, France.; Population Health Science, Bristol Medical School, University of Bristol, Bristol, UK.; MRC Integrative Epidemiology Unit at the University of Bristol, Bristol, UK.; Barcelona Institute for Global Health (ISGlobal), Barcelona, Catalonia, Spain.; CIBER Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain.; Universitat Pompeu Fabra, Barcelona, Catalonia, Spain.; Barcelona Institute for Global Health (ISGlobal), Barcelona, Catalonia, Spain.; CIBER Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain.; Universitat Pompeu Fabra, Barcelona, Catalonia, Spain.; Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC, University Medical Centre, Rotterdam, The Netherlands.; CIBER Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain.; Biodonostia Health Research Institute, Group of Environmental Epidemiology and Child Development, 20014, San Sebastian, Spain.; Ministry of Health of the Basque Government, Sub-Directorate for Public Health and Addictions of Gipuzkoa, 20013, San Sebastian, Spain.; Faculty of Psychology of the University of the Basque Country, 20018, San Sebastian, Spain.; MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton General Hospital, Southampton, UK.; NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK.; Barcelona Institute for Global Health (ISGlobal), Barcelona, Catalonia, Spain.; CIBER Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain.; Clinical and Epidemiological Neuroscience Group (NeuroÈpia), Institut d'Investigació Sanitària Pere Virgili (IISPV), Reus (Tarragona), Catalonia, Spain.; CIBER Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain.; Epidemiology and Environmental Health Joint Research Unit, FISABIO-Universitat Jaume I-Universitat de València, Valencia, Spain.; Servicio de Análisis de Sistemas de Información Sanitaria, Conselleria de Sanitat, Generalitat Valenciana, Valencia, Spain.; MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton General Hospital, Southampton, UK.; Barcelona Institute for Global Health (ISGlobal), Barcelona, Catalonia, Spain.; Universitat Pompeu Fabra, Barcelona, Catalonia, Spain.; Parc de Salut Mar, Barcelona, Catalonia, Spain.; Division of Metabolic and Nutritional Medicine, Department of Pediatrics, Dr. von Hauner Children's Hospital, LMU University Hospital Munich, Lindwurmstr. 4, 80337, Munich, Germany. [email protected].; Université Paris Cité and Université Sorbonne Paris Nord, Inserm, INRAE, Center for Research in Epidemiology and StatisticS (CRESS), 75004, Paris, France. [email protected].

DOI: 10.1007/s00787-023-02149-0

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MeSH Terms: Child, Humans, Child, Preschool, Sleep Duration, Language, Wechsler Scales, Sleep, Cognition