Disclosures: One study author reports funding from Oxford University Press and the National Institute for Health Research Clinical Research Network, as well as personal fees from Medical Defence Union, outside the submitted work; another author reports attending an education event sponsored by Janssen. Morales-Muñoz reports no relevant financial disclosures.
Sleep problems during early childhood may be associated with the onset of psychosis and borderline personality disorder, or BPD, in adolescence, according to results of a cohort study published in JAMA Psychiatry.
“Although recent longitudinal research indicates that childhood nightmares are associated with the development of adolescent psychosis and BPD, those studies focused only on parasomnias, whereas the associations of more frequent sleep problems (ie, behavioral sleep problems) in early childhood, such as short sleep and frequent night awakenings, or inappropriate sleep practices have not been investigated,” Isabel Morales-Muñoz, PhD, of the department of public health solutions at the National Institute for Health and Welfare in Finland, and colleagues wrote. “Given that 15% to 30% of children younger than 5 experience behavioral sleep problems, there is a need to understand these sleep problems.”
Adults and adolescents with BPD commonly exhibit psychotic symptoms, and genetic overlap exists; however, it is unclear whether childhood sleep disturbances are similarly associated with these conditions because of their overlap or whether sleep may have a different pathway in BPD than psychosis.
Morales-Muñoz and colleagues aimed to evaluate prospective associations between multiple parent-reported sleep problems among young children and psychotic and BPD symptoms at ages 11 to 13 years, as well as the role of depression in these associations at age 10. In the current study, they analyzed data of 13,488 participants of the Avon Longitudinal Study of Parents and Children birth cohort who had data available for more than 13 years. The Avon study included pregnant women from the U.K. who had expected delivery dates between April 1991 and December 1992. The investigators assessed psychotic experiences at ages 12 to 13using the Psychosis-Like Symptom Interview, as well as BPD symptoms at ages 11 to 12using the U.K. Childhood Interview for DSM-IV Borderline Personality Disorder. Parents reported on their child’s regularity of sleep routines, nighttime sleep duration, night awakening frequency and bedtime when the child was aged 6, 18 and 30 months, as well as at ages 3.5, 4.8 and 5.8 years.
A total of 7,155 participants reported on psychotic symptoms and 6,333 reported on BPD symptoms. Irregular sleep routines at 6 months (OR = 0.68; 95% CI, 0.5-0.93), 30 months (OR = 0.64; 95% CI, 0.44-0.95 and 5.8 years (OR = 0.32; 95% CI, 0.19-0.53), as well as higher night awakening frequency at 18 months (OR = 1.13; 95% CI, 1.01-1.26) were significantly linked to psychotic experiences in adolescence. Shorter nighttime sleep duration (OR = 0.78; 95% CI, 0.66-0.92) and later bedtime at age 3.5 years (OR = 1.32; 95% CI, 1.09-1.6) were significantly linked to BPD symptoms. Mediation analysis revealed consistent results among all these associations, apart from later bedtime at age 3.5 and BPD in adolescence, which demonstrated no association. Depression at age 10 mediated associations between irregular sleep routines at age 5.8 and frequent night awakenings at age 18 months with psychosis.
“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,” the researchers wrote. “These results could contribute to the design of more personalized sleep and psychological interventions in psychosis and BPD.”