Children's Hospital of Philadelphia.
University of Pennsylvania Perelman School of Medicine.
J Pediatr Psychol. 2021 Aug 11;46(7):878-890. doi: 10.1093/jpepsy/jsab022.
Sleep problems and cumulative risk factors (e.g., caregiver depression, socioeconomic disadvantage) have independently been linked to adverse child development, but few studies have examined the interplay of these factors. We examined whether cumulative risk exposure moderated the link between sleep problems, including insomnia and poor sleep health, and child psychological outcomes.
205 caregiver-child dyads (child Mage = 3.3 years; 53.7% girls; 62.9% Black, 22.4% non-Latinx White, and 4.4% Latinx; 85.4% maternal caregiver reporter) completed child sleep, family sociodemographic, and child psychological functioning (internalizing, externalizing, and executive functioning) questionnaires. Indexes of cumulative risk exposure, insomnia symptoms, and poor sleep health were created.
Ninety percent of children had ≥1 cumulative risks, 62.9% had ≥1 insomnia symptom, and 84.5% had ≥1 poor sleep health behavior. Increased insomnia symptoms were significantly associated with increased child internalizing, externalizing, and global executive functioning impairments controlling for child age, race/ethnicity, and sex. Poor sleep health behaviors were associated with internalizing concerns. Cumulative risk exposure was not associated with outcomes but moderated the association between insomnia symptoms and all psychological outcomes, such that children with higher cumulative risk exposure and insomnia symptoms had the greatest impairments. Children with the poorest sleep health behaviors and highest cumulative risks had the greatest internalizing concerns.
Insomnia symptoms in particular are associated with poor child outcomes, which are exacerbated when accompanied by greater cumulative risk exposure. Clinicians should assess sleep when treating early psychological concerns, especially within the context of increased cumulative risks.
睡眠问题和累积风险因素（例如照顾者抑郁、社会经济劣势）已被独立证明与儿童发育不良有关，但很少有研究探讨这些因素之间的相互作用。我们研究了累积风险暴露是否会调节睡眠问题（包括失眠和睡眠健康不佳）与儿童心理结果之间的关系。
205 对照顾者-儿童对（儿童年龄=3.3 岁；53.7%女孩；62.9%黑人，22.4%非拉丁裔白人，4.4%拉丁裔；85.4%母亲照顾者报告）完成了儿童睡眠、家庭社会人口统计学和儿童心理功能（内化、外化和执行功能）问卷。创建了累积风险暴露、失眠症状和睡眠健康不良的指标。
90%的儿童有≥1 种累积风险，62.9%有≥1 种失眠症状，84.5%有≥1 种睡眠健康不良行为。在控制儿童年龄、种族/民族和性别后，失眠症状增加与儿童内化、外化和整体执行功能障碍增加显著相关。睡眠健康不良行为与内化问题相关。累积风险暴露与结果无关，但调节了失眠症状与所有心理结果之间的关系，即具有较高累积风险暴露和失眠症状的儿童受到的影响最大。睡眠健康不良行为和累积风险最高的儿童表现出最严重的内化问题。
特别是失眠症状与儿童不良结果相关，当与更高的累积风险暴露同时出现时，情况会更糟。临床医生在治疗早期心理问题时，尤其是在累积风险增加的情况下，应评估睡眠情况。
