Young children who have irregular sleep routines and frequently wake up at night may be more likely to have psychotic symptoms in early adolescence, according to a report in JAMA Psychiatry. The report also noted that children who go to bed late and sleep for shorter periods at night may be at higher risk of developing borderline personality disorder (BPD) symptoms during early adolescence.
“Adequate sleep in childhood is essential for optimal cognitive and emotional functioning,” wrote Isabel Morales-Muñoz, Ph.D., of the University of Birmingham, United Kingdom, and colleagues. “[E]arly behavioral sleep problems may be modifiable risk factors associated with future psychopathologic symptoms.”
Morales-Muñoz and colleagues assessed data from the Avon Longitudinal Study of Parents and Children (ALSPAC), a large U.K. study that enrolled over 14,000 pregnant women from Avon between 1991 and 1992 and has been monitoring them and their children to examine how biology and environment influence health and disease as the children grow. As part of ALSPAC, parents reported on their children’s sleep behaviors at the ages of 6, 18, and 30 months and 3.5, 4.8, and 5.8 years. When the children in the study reached age 10, the researchers assessed their depressive symptoms; between age 11 and 12, the youth were asked about BPD symptoms; and between age 12 and 13, they were asked about psychotic symptoms.
Of the 6,333 youth who were evaluated for BPD, 472 reported BPD symptoms. Of the 7,155 youth evaluated for psychotic experiences, 376 reported symptoms.
Compared with youth with no psychotic symptoms, youth who reported psychotic symptoms had more frequent nightly awakenings at 18 months of age and less regular sleep routines at 6 and 30 months and 5.8 years of age. Youth who reported BPD symptoms went to bed later and slept less at 3.5 years of age compared with youth with no BPD symptoms.
The investigators also found that some of the associations between specific sleep problems and psychotic experiences were likely mediated by childhood depression; that is, children with more night awakenings or irregular sleep routines were at higher risk of depression at age 10, which then increased the risk of subsequent psychotic symptoms. Morales-Muñoz and colleagues did not find any mediating effect of depression between shorter sleep duration and BPD.
“These findings suggest that the associations between childhood sleep and psychotic experiences as well as childhood sleep and BPD symptoms in adolescence follow different pathways,” Morales-Muñoz and colleagues concluded.