Sleep issues among infants and young children linked to mental health disorders in adolescence, study reveals
Waking up frequently at night at 18 months and irregular sleep at 6 and 30 months and 5.8 years were associated with psychotic experiences in children ages 12 and 13
Sleep problems among infants and very young children, such as irregular routines and impaired duration, may be linked to the development of certain mental health disorders in adolescence. The World Health Organization (WHO) defines an adolescent as any person between ages 10 and 19. Researchers from the University of Birmingham's School of Psychology found that young children who routinely woke up frequently during the night and experienced irregular sleep routines were associated with psychotic experiences as adolescents. They also found that children who slept for shorter periods at night and went to bed later were more likely to be associated with borderline personality disorder (BPD) by the time they were 11 or 12-years-old.
“We know from previous research that persistent nightmares in children have been associated with both psychosis and borderline personality disorder. But nightmares do not tell the whole story. We've found that a number of behavioral sleep problems in childhood can point towards these problems in adolescence,” says lead researcher, Dr Isabel Morales-Muñoz, in the analysis published in JAMA Psychiatry. The research team assessed 13,488 participants in the Avon Longitudinal Study of Parents and Children (ALSPAC) birth cohort who were followed up for more than 13 years. Pregnant women from Avon, UK, with expected dates of delivery from April 1, 1991, to December 31, 1992, were invited to take part in the study. The data was analyzed from May 1 to December 31, 2019.
Psychotic experiences at 12 to 13 years of age were assessed using the Psychosis-Like Symptom Interview, and BPD symptoms at 11 to 12 years of age were tested using the UK Childhood Interview for Borderline Personality Disorder. Parent-reported nighttime sleep duration, night awakening frequency, bedtime, and regularity of sleep routines were examined when the child was 6, 18, and 30 months and 3.5, 4.8, and 5.8 years of age. Of the participants, 7,155 reported psychotic experiences at ages 12 to 13 years (including 3,718 girls or 52%) and 6,333 (3,280 girls or 52%) reported BPD symptoms at ages 11 to 12.
“We know that adolescence is a key developmental period to study the onset of many mental disorders, including psychosis or BPD. This is because of particular brain and hormonal changes that occur at this stage. It’s crucial to identify risk factors that might increase the vulnerability of adolescents to the development of these disorders, identify those at high risk, and deliver effective interventions. This study helps us understand this process, and what the targets might be. Sleep may be one of the most important underlying factors -- and it's one that we can influence with effective, early interventions, so it's important that we understand these links,” says Professor Steven Marwaha, senior author of the study.
The researchers found that frequent night awakenings at 18 months of age and irregular sleep routines at 6 months, 30 months, and 5.8 years of age were associated with psychotic experiences at 12 to 13 years of age. This supports existing evidence that insomnia contributes to psychosis but suggests that these difficulties may be already present years before psychotic experiences occur, explain authors. The team also found that children who had less sleep during the night and went to bed later at 3.5 years of age were related to borderline personality disorder symptoms at 11 to 12 years of age. These results suggest a specific pathway from toddlers through to adolescents with BPD, which is separate from the pathway linked with psychosis, says the study.
“Higher night awakening frequency at 18 months of age (odds ratio 1.13) and less regular sleep routines at 6 months (odds ratio 0.68), 30 months (odds ratio 0.64), and 5.8 years (odds ratio 0.32) of age were significantly associated with psychotic experiences in adolescence. Whereas, shorter nighttime sleep duration (odds ratio 0.78) and later bedtime at 3.5 years of age (odds ratio 1.32) were significantly associated with BPD symptoms,” write authors. The research team also investigated whether the links between infant sleep and mental disorders in teenagers could be mediated by symptoms of depression in children aged 10 years. They found that depression mediated the links between childhood sleep problems and the onset of psychosis in adolescents, but this mediation was not observed in borderline personality disorder, suggesting the existence of a direct association between sleep problems and BPD symptoms.
“This is the first study, to our knowledge, to examine the prospective associations between early childhood sleep problems and adolescent psychotic experiences and borderline personality disorder symptoms. The findings suggest that some behavioral sleep problems in childhood are distinctively associated with the onset of psychosis and BPD in adolescence, following different pathways. Furthermore, depression at 10 years of age may mediate only the association with psychosis. These findings contribute to the design of more personalized sleep and psychological interventions in psychosis and BPD,” says the research team.