Sleep quality, duration and behavioral symptoms among 5–6-year-old children

The objective of the present study was to examine whether parent-reported short sleep duration and sleeping difficulties are related to behavioral symptoms among pre-school aged children. The study is a cross-sectional survey of 297 families with 5–6-year-old children. The Sleep Disturbance Scale for children was used to measure sleep duration and sleeping difficulties, and the Child Behavior Checklist and Teacher’s Report Form were used to measure attention problems, and internalizing and externalizing symptoms. In multivariate logistic regression models, short sleep duration was according to parental reports related to inattention (adjusted odds ratio 4.70, 95% CI 1.58–14.00), internalizing (adjusted odds ratio 3.84, 95% CI 1.32–11.21), and total psychiatric symptoms (adjusted odds ratio 3.53, 95% CI 1.23–10.17) while according to teacher's reports it was almost significantly related to internalizing symptoms (adjusted odds ratio 4.20, 95% CI 0.86–20.51). Sleeping difficulties were strongly related to all subtypes of psychiatric symptoms according to parental reports (adjusted odds ratios ranging from 6.47 to 11.71) and to externalizing symptoms according to teachers’ reports (adjusted odds ratio 7.35, 95% CI 1.69–32.08). Both short sleep duration and sleeping difficulties are associated with children's behavioral symptoms. Intervention studies are needed to study whether childrens behavioral symptoms can be reduced by lengthening sleep duration or improving sleep quality

Pikkulasten normaali unen kehitys ja siihen vaikuttavat tekijät

Ensimmäisen kahden elinvuoden aikana unen laadussa tapahtuu moninaisia muutoksia. Viimeistään 2-3 kuukauden iässä pisimmät unijaksot alkavat sijoittua yöhön ja päiväunet vähenevät. Noin puolen vuoden ikään mennessä nukahtamisviive lyhenee alle 30 minuuttiin, mikä heijastelee vuorokausirytmin kypsymistä. Lyhyet yöheräämiset ovat yleisiä koko ensimmäisen ikävuoden ajan ja vähenevät vasta toisella ikävuodella itsesäätelyn kehityksen myötä. Pitkittynyt yövalvominen on epätyypillistä kaikissa ikäryhmissä. Pienten lasten uniongelmat ovat yleisiä. Erilaiset ulkoiset tekijät, kuten somaattiset sairaudet, perheen vuorokausirytmi, valaistusolosuhteet ja iltarutiinit, vanhemmuus sekä muutokset kasvuympäristössä vaikuttavat helposti lapsen nukkumiseen. Hoitosuunnitelmaa laadittaessa tulisikin ensimmäisenä kiinnittää huomiota unenhuoltoon jo ennen kuin varsinaisia interventioita suunnitellaan.publishedVersionPeer reviewe

The significance of supportive and undermining elements in the maternal representations of an unborn baby

Objective: The maternal representations of an unborn baby begin to develop during pregnancy. However, the factors that moderate them are not well identified. The objective of this study was to jointly explore supportive and undermining factors in the maternal representations of an unborn baby and motherhood. Methods: Cross-sectional data comprising 1646 women studied during the third trimester of pregnancy. Maternal expectations were measured using a 12-item self-report questionnaire, Mother's Representations about an Unborn Baby. Depression, anxiety, family atmosphere and adult attachment were measured using standardised questionnaires. Statistical analysis is based on multivariate linear regression analysis. Results: The most powerful predictors of a mother's prenatal expectations were the mother's educational status, age, closeness in adult relationships, higher levels of depressive symptoms and family atmosphere. In accordance with our hypothesis, depression was related to the mother's more negative expectations on their relationship with the unborn baby and on regularity in the baby's sleeping and eating patterns. A positive family atmosphere and the mother's ability for closeness and dependence (i.e. confidence) in adult relationships were related to more positive expectations of the mother-unborn baby relationship. On the other hand, stress, anxiety and adverse life events were not related to the mother's expectations of her unborn baby. Conclusions: The results may be helpful in identifying families who need early professional support and call for studies where the prenatal phase is explored as a proactive phase for the development of the child-parent relationship.Peer reviewe

Exposure to electronic media was negatively associated with speech and language development at 18 and 24 months

Aim: This study evaluated early speech and language development at 18 and 24 months, and associated factors, based on parental reports. Method: We followed up the CHILD-SLEEP birth cohort of 1667 Finnish-speaking families, who were randomly recruited in 2011–2013 during routine visits to maternity clinics in the Pirkanmaa Hospital District of Finland. The women were approximately 32 weeks’ pregnant at enrolment. Parents reported the size of their child's expressive vocabulary, word combinations, intelligibility, finger-pointing and adherence to instructions. A subsample was studied using the Expressive Language subscale of the Bayley Scales of Infant and Toddler Development, Third Edition. Results: The children's vocabulary was smaller than previously reported. At 18 months of age, 68.8% of the 997 children had a vocabulary of 20 words or less and 35.7% used about five words at most. At 24 months, 32.4% of the 822 children had a vocabulary of 50 words or less and 18.4% used about 20 words at most. Longer child and parental exposure to electronic media was negatively associated with the size of the child's expressive vocabulary. Conclusion: Vocabulary size at 18 and 24 months was smaller than previously reported and negatively associated with exposure to electronic media.Aim This study evaluated early speech and language development at 18 and 24 months, and associated factors, based on parental reports. Method We followed up the CHILD-SLEEP birth cohort of 1667 Finnish-speaking families, who were randomly recruited in 2011-2013 during routine visits to maternity clinics in the Pirkanmaa Hospital District of Finland. The women were approximately 32 weeks' pregnant at enrolment. Parents reported the size of their child's expressive vocabulary, word combinations, intelligibility, finger-pointing and adherence to instructions. A subsample was studied using the Expressive Language subscale of the Bayley Scales of Infant and Toddler Development, Third Edition. Results The children's vocabulary was smaller than previously reported. At 18 months of age, 68.8% of the 997 children had a vocabulary of 20 words or less and 35.7% used about five words at most. At 24 months, 32.4% of the 822 children had a vocabulary of 50 words or less and 18.4% used about 20 words at most. Longer child and parental exposure to electronic media was negatively associated with the size of the child's expressive vocabulary. Conclusion Vocabulary size at 18 and 24 months was smaller than previously reported and negatively associated with exposure to electronic media.Peer reviewe

The adapted American Academy of Sleep Medicine sleep scoring criteria in one month old infants : A means to improve comparability?

Objective: The lack of standards induces variability in the sleep staging of infants less than two months of age. We evaluated the feasibility of the 2012 AASM sleep scoring rules for healthy one month old infants. Methods: 84 polysomnographies were scored into sleep stages with the adapted AASM criteria. The acquired sleep parameters were compared with the parameters in the literature. In addition the effect of age on sleep was studied. Results: The two independent scorers achieved substantial agreement by using the adapted AASM criteria. The infants' sleep parameters showed marked variability. The amount of active sleep was 36.7% (mean, range 21.3-54.1%), quiet sleep 41.5% (30.3-57.7%) and indeterminate sleep 21.6% (9.7-36.0%). With age sleep became more continuous, but the sleep stage percentages did not change. Our sleep parameters differed clearly from the parameters presented in the literature. Conclusions: The adapted scoring rules were reproducible. This encourages their use in clinical practice, as no uniform recommendations exist. Significance: Normal values are essential in pediatric sleep medicine and the individual variability in the sleep parameters of healthy infants advocates the standardisation of scoring methods. Here we present sleep stage normative values for one month old infants based on the AASM scoring criteria. (C) 2015 International Federation of Clinical Neurophysiology. Published by Elsevier Ireland Ltd. All rights reserved.Peer reviewe

Parental reports showed that snoring in infants at three and eight months associated with snoring parents and smoking mothers

Aim This prospective study examined the prevalence of snoring during infancy and the prenatal and postnatal risk factors for this condition. Methods The study population comprised 1388 infants from the CHILD-SLEEP birth cohort, who were recruited in the Pirkanmaa Hospital District, Finland, between 2011 and 2013. Sleep and background factor questionnaires were filled out prenatally by parents and when the infant was three and eight months old. Results The prevalence of habitual snoring was 3.2% at the age of three months and 3.0% at eight months, and snoring infants had more sleeping difficulties at those ages, with odds ratios (ORs) of 3.11 and 4.63, respectively. At three months, snoring infants slept for a shorter length of time (p = 0.001) and their sleep was more restless (p = 0.004). In ordinal logistic regression models, parental snoring (adjusted OR = 1.65 and 2.60) and maternal smoking (adjusted OR = 2.21 and 2.17) were significantly associated with infant snoring at three and eight months, while formula feeding and dummy use (adjusted OR = 1.48 and 1.56) were only associated with infant snoring at three months. Conclusion Parental snoring and maternal smoking increased the risk of snoring. Infants who snored also seemed to suffer more from other sleep difficulties.Peer reviewe

Sleep disturbances and depressive and anxiety symptoms during pregnancy : associations with delivery and newborn health

Background Sleep disturbances and mood symptoms are common in late pregnancy; according to the literature, they can affect delivery and newborn outcomes. This study evaluated the effect of sleep and mood symptoms on delivery and newborn health, because there are insufficient and partly contradictory studies on the topic. Methods A cohort of 1414 mothers in their third trimester was enrolled in this prospective cross-sectional questionnaire study. Validated questionnaires were assessed for the measurement of sleep disturbances and depressive and anxiety symptoms. The data on delivery and newborn outcomes were obtained from hospital medical records. Results Sleep disturbances were very common. A higher insomnia score (beta = - 0.06, p = 0.047) and longer sleep need (beta = 0.07, p = 0.047) were related to delivery at a lower gestational age. In addition, a higher insomnia score (beta = - 28.30, p = 0.010) and lower general sleep quality (beta = - 62.15, p = 0.025) were associated with lower birth weight, but longer sleep duration and longer sleep need with a higher birth weight (beta = 28.06, p = 0.019; beta = 27.61, p = 0.028, respectively). However, the findings regarding birth weight lost their significance when the birth weight was standardized by gestational weeks. Concerning Apgar scores and umbilical artery pH, no associations were found. Snoring was associated with a shorter duration of the first phase of delivery (beta = - 78.71, p = 0.015) and total duration of delivery (beta = - 79.85, p = 0.016). Mothers with higher insomnia, depressive, or anxiety symptoms were more often treated with oxytocin (OR 1.54 95% CI 1.00-2.38, p = 0.049, OR 1.76, 95% CI 1.02-3.04, p = 0.049 and OR 1.91, CI 95% 1.28-2.84, p < 0.001, respectively) and those with higher depressive and anxiety symptoms were delivered more often with elective cesarean section (OR 4.67, 95% CI 2.04-12.68, p < 0.001 and OR 2.22, 95% CI 1.03-4.79, p = 0.042). Conclusions Maternal sleep disturbances and mood symptoms during pregnancy are associated with delivery and newborn health. However, nearly, all the outcomes fell within a normal range, implying that the actual risks are low.Peer reviewe

Univaikeudet raskauden aikana - riskitekijä synnytyksen jälkeiselle masennukselle

In the general population, sleeping problems can precede an episode of depression. We hypothesized that sleeping problems during pregnancy, including insomnia symptoms, shortened sleep, and daytime tiredness, are related to maternal postnatal depressiveness. We conducted a prospective study evaluating sleep and depressive symptoms, both prenatally (around gestational week 32) and postnatally (around 3months after delivery) in the longitudinal CHILD-SLEEP birth cohort in Finland. Prenatally, 1667 women returned the questionnaire, of which 1398 women participated also at the postnatal follow-up. Sleep was measured with the Basic Nordic Sleep Questionnaire (BNSQ) and depressive symptoms with a 10-item version of the Center for Epidemiological Studies Depression Scale (CES-D). Altogether, 10.3% of the women had postnatal depressiveness (CES-D 10 points). After adjusting for main background characteristics and prenatal depressiveness (CES-D 10), poor general sleep quality (AOR 1.87, 95% CI 1.21-2.88), tiredness during the day (AOR 2.19, 95% CI 1.41-3.38), short sleep 6 and 7h, sleep latency >20min, and sleep loss 2h were associated with postnatal depressiveness (all pPeer reviewe