Adelaide Institute for Sleep Health, College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia.
The Health Observatory, Discipline of Medicine, The Queen Elizabeth Hospital Campus, University of Adelaide, Woodville, South Australia, Australia.
JAMA Netw Open. 2019 Sep 4;2(9):e1910861. doi: 10.1001/jamanetworkopen.2019.10861.
Life-course determinants of insomnia, particularly the long-term association of childhood behavioral problems with insomnia later in life, are unknown. As childhood behaviors are measurable and potentially modifiable, understanding their associations with insomnia symptoms may provide novel insights into early intervention strategies to reduce the burden.
To investigate the association between behavioral problems at 5, 10, and 16 years of age and self-reported insomnia symptoms at 42 years of age.
DESIGN, SETTING, AND PARTICIPANTS: This cohort study used data from the United Kingdom 1970 Birth Cohort Study, an ongoing large-scale follow-up study. Participants were followed up from birth (1970) to age 42 years (2012). Missing data were imputed via multiple imputation. Statistical analysis was performed from February 1 to July 15, 2019.
Behavior measured at 5, 10, and 16 years of age using the Rutter Behavioral Scale (RBS). Children's behavior was classified as normal (≤80th percentile), moderate behavioral problems (>80th to ≤95th percentile), and severe behavioral problems (>95th percentile) based on their RBS score.
Self-reported difficulties initiating or maintaining sleep (DIMS) were collected using a self-administered questionnaire at 42 years of age. Log-binomial logistic regression, adjusted for several potential confounders, was used to estimate the association of childhood behavioral problems with insomnia symptoms in adulthood. Sensitivity analyses were conducted to check robustness of the findings.
Participants were followed up from a baseline age of 5 years (n = 8050; 3854 boys and 4196 girls), 10 years (n = 9090; 4365 boys and 4725 girls), or 16 years (n = 7653; 3575 boys and 4078 girls) until age 42 years. There was a 39% higher risk of DIMS (odds ratio [OR], 1.39; 95% CI, 1.04-1.84; P = .06 for trend) for participants with severe behavioral problems at 5 years of age compared with those with a normal RBS score. The odds of DIMS plus not feeling rested on waking (DIMS plus) in participants with severe behavioral problems at 5 years of age were 29% higher (odds ratio, 1.29; 95% CI, 0.97-1.70; P = .14 for trend) than participants with a normal RBS score, although this result was not statistically significant. Moderate and severe behavioral problems at 16 years of age were positively associated with DIMS and DIMS plus (moderate: OR, 1.28; 95% CI, 1.07-1.52; severe: OR, 1.67; 95% CI, 1.22-2.30; P < .001 for trend) and DIMS plus (moderate: OR, 1.32; 95% CI, 1.11-1.56; severe: OR, 1.47; 95% CI, 1.09-1.98; P < .001 for trend). Externalizing behavioral problems at 5 and 10 years of age were positively associated with insomnia symptoms at 42 years of age.
This study is the first to show associations of early-life behavioral problems, particularly early- and middle-childhood externalizing problems, with insomnia symptoms in adulthood. These findings underline the importance of addressing insomnia from a life-course perspective and considering the benefits of early behavioral intervention to sleep health.
目前尚不清楚失眠的生命历程决定因素，尤其是儿童期行为问题与以后生活中的失眠之间的长期关联。由于儿童行为是可衡量且可能改变的，因此了解它们与失眠症状的关联可能为减少负担提供新的早期干预策略的思路。
调查 5 岁、10 岁和 16 岁时的行为问题与 42 岁时的自我报告失眠症状之间的关联。
设计、地点和参与者：本队列研究使用了英国 1970 年出生队列研究的数据，这是一项正在进行的大规模随访研究。参与者从出生（1970 年）开始随访至 42 岁（2012 年）。通过多次插补法对缺失数据进行了插补。统计分析于 2019 年 2 月 1 日至 7 月 15 日进行。
5 岁、10 岁和 16 岁时使用 Rutter 行为量表（RBS）测量的行为。根据他们的 RBS 分数，将儿童的行为分为正常（≤80 百分位）、中度行为问题（>80 至≤95 百分位）和严重行为问题（>95 百分位）。
42 岁时使用自我管理问卷收集自我报告的入睡困难（DIMS）。使用对数二项逻辑回归，调整了几个潜在的混杂因素，以估计儿童期行为问题与成年期失眠症状的关联。进行了敏感性分析以检查结果的稳健性。
参与者从基线年龄 5 岁（n=8050；3854 名男孩和 4196 名女孩）、10 岁（n=9090；4365 名男孩和 4725 名女孩）或 16 岁（n=7653；3575 名男孩和 4078 名女孩）开始随访至 42 岁。与 RBS 评分正常的参与者相比，5 岁时行为问题严重的参与者 DIMS（优势比[OR]，1.39；95%CI，1.04-1.84；P=0.06 趋势）的风险增加了 39%。5 岁时行为问题严重的参与者 DIMS 加上醒来时感觉未休息（DIMS 加）的可能性增加了 29%（优势比，1.29；95%CI，0.97-1.70；P=0.14 趋势），而与 RBS 评分正常的参与者相比，尽管这一结果没有统计学意义。16 岁时的中度和重度行为问题与 DIMS 和 DIMS 加（中度：OR，1.28；95%CI，1.07-1.52；重度：OR，1.67；95%CI，1.22-2.30；P<0.001 趋势）和 DIMS 加（中度：OR，1.32；95%CI，1.11-1.56；重度：OR，1.47；95%CI，1.09-1.98；P<0.001 趋势）呈正相关。5 岁和 10 岁时的外向行为问题与 42 岁时的失眠症状呈正相关。
这项研究首次表明，儿童期行为问题，尤其是早期和中期的外向行为问题，与成年后的失眠症状有关。这些发现强调了从生命历程的角度考虑失眠的重要性，并考虑到早期行为干预对睡眠健康的益处。
