Continuity and Change in Poor Sleep from Childhood to Early Adolescence

Pesonen, A.-K., Martikainen, S., Heinonen, K., Wehkalampi, K., Lahti, J., Kajantie, E., & Räikkönen, K. (2014). Continuity and Change in Poor Sleep from Childhood to Early Adolescence. Sleep, 37(2), 289–297. doi:10.5665/sleep.3400ObjectivesThis study aims to increase understanding of continuity and change in sleep over a four-year period, from childhood (eight y) to early adolescence (12 y).

1. Examine the contributions of pubertal maturation to actigraphy-based sleep and parent-reported sleep disorders in early adolescence.
2. Examine the mean-level and rank-order continuity and change in actigraph estimates of sleep from age eight to 12 y, and the continuation of parent-rated sleep disorders from childhood to early adolescence.
3. Because the associations between parent-rated sleep disorders and actigraph estimates of sleep are poorly understood, Investigate their associations both in cross-section and longitudinally.

Hypotheses: Not Provided.Design Cohort study, cross-sectional analyses, longitudinalVariables Measured, Instruments Used

1. Objective Sleep
   1. At age eight, participants wore actigraphs for 7.1 nights on average.
   2. At age 12, participants wore actigraphs for 8.4 nights on average.
2. Sleep Disorders
   1. Sleep Disturbance Scale for Children- (Self- Report)
3. Pubertal Maturity
   1. Continuous Pubertal Development Scale - (Self-reported at age eight)
   2. Picture-assisted categorical Tanner Scales- (Self-reported at age eight)

Participants

• N= 348
• Participant ages: Children tested at age eight, and again at age 12
• Location: Helsinki, Finland
• Eligibility: The children came from an urban community-based cohort comprising 1,049 infants born between March and November 1998 in Helsinki, Finland
• SES: Authors classified the socioeconomic status of the family, used for the attrition analyses only, according to the highest self-reported level of education of either parent in 2006, at the child's age of eight.

Limitations

1. Attrition was greater in families with low educational status than in families in which either parent had an upper tertiary-level education.
2. Self-reported sleep disorders would also have provided the measurement greater validity, as parents may sometimes be unaware of the sleep problems of their children. This may have diminished the potential to find correlations between actigraph estimates of sleep and sleep disorders, but in addition, measuring continuation requires repeated measurement with the same method.
3. Validity estimates of the fragmentation index and sleep latency have been reported to be significantly weaker than those reported for sleep duration and sleep efficiency in studies with various actigraph systems. Although actigraphy can provide information about sleep patterns over several days, PSG would have provided more reliable estimates of sleep quality.
4. Peer-reviewed cross-validation studies do not exist between the two models of Actiwatch we used.

Findings

1. The current study showed that among 11- to 13-y-old children, the stage of pubertal maturity was not associated with alterations in sleep, whether measured with actigraphs or with parent reports of sleep disorders.
2. Childhood sleep patterns showed both significant continuity and change toward early adolescence.
3. Over the four-year  follow-up period of the current study, from age eight to 12, significant, paralleled mean-level changes occurred in the sleep of girls and boys: sleep duration decreased by 28 and 19 min, the duration of catch-up sleep increased by 27 and 11 min, and bedtime was delayed by 64 and 60 min in girls and boys, respectively.
4. However, although sleep duration decreased, sleep quality, as indicated by sleep efficiency and fragmentation, improved slightly.
5. Children with short sleep duration in childhood are especially at risk for inadequate sleep during early adolescence. Pubertal maturity was not associated with sleep in early adolescence, but older age, irrespective of pubertal status, showed a modest association.
6. Parent-rated sleep disorders showed high stability over the four-year assessment period, but had no association with the actigraph estimates of sleep.