Sleep and behavioral/emotional problems in children: A population-based study

Carvalho Bos, S.; Gomes, A.; Clemente, V.; Marques, M.; Pereira, A.T.; Maia, B.; Soares, M.J.; Cabral, A.S.; Macedo, A.; Gozal, D.; Azevedo, M.H.

doi:10.1016/j.sleep.2007.10.020

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Volume 10, Issue 1 , Pages 66-74, January 2009

Sleep and behavioral/emotional problems in children: A population-based study

S. Carvalho Bos
- Institute of Medical Psychology, Faculty of Medicine, Coimbra, Portugal
- Corresponding author. Address: Instituto de Psicologia Médica, Faculdade de Medicina da Universidade de Coimbra, Rua Larga, 3004-504 Coimbra, Portugal. Tel.: +351 239 857700; fax: +351 239 823170.
A. Gomes
- Department of Educational Sciences, Aveiro University, Portugal
V. Clemente
- Coimbra Hospital Centre, Portugal
M. Marques
- Institute of Medical Psychology, Faculty of Medicine, Coimbra, Portugal
A.T. Pereira
- Institute of Medical Psychology, Faculty of Medicine, Coimbra, Portugal
B. Maia
- Institute of Medical Psychology, Faculty of Medicine, Coimbra, Portugal
M.J. Soares
- Institute of Medical Psychology, Faculty of Medicine, Coimbra, Portugal
A.S. Cabral
- Institute of Medical Psychology, Faculty of Medicine, Coimbra, Portugal
A. Macedo
- Institute of Medical Psychology, Faculty of Medicine, Coimbra, Portugal
D. Gozal
- Division of Pediatric Sleep Medicine, Department of Pediatrics, University of Louisville, Louisville, KY 40202, USA
M.H. Azevedo
- Institute of Medical Psychology, Faculty of Medicine, Coimbra, Portugal

Received 31 July 2007; received in revised form 11 October 2007; accepted 18 October 2007.

Abstract

Background

The potential relationships between sleep–wake behaviors and emotional/disruptive problems in otherwise healthy school-aged children are unclear.

Methods

A parental questionnaire was developed for the epidemiologic survey of children’s sleep and wake behavioral patterns. The questions covered a wide range of features including sleep length (school days, weekends), time to fall asleep, night awakenings, bedtime and nighttime sleep-related behaviors, daytime sleepiness, irritability, and tiredness. To assess psychiatric symptomatology, the Rutter Scale B2 was completed by teachers. In addition to the total score, sub-scores of emotional, hyperactivity, and conduct problems were obtained. The representative population sample comprised 779 children (403 girls), with an age range of 6–11 years.

Results

Hyperactivity and conduct problems at school in boys were both associated with parental reports of bedtime resistance. Hyperactivity was also associated with longer sleep duration during weekends. Conduct and emotional problems in girls were associated with earlier bedtime during school days. Emotional problems in girls were also associated with longer sleep durations in school days and weekends.

Conclusion

Bedtime resistance was the only sleep behavior associated with either hyperactivity or conduct problems in children, and longer sleep durations appear to occur more frequently in children with both hyperactive or emotional problems. Information about good sleep hygiene at bedtime may help parents setting sleep limits.

Keywords: Sleep problems, Behavioral/emotional problems, Rutter scale B2, Primary-school aged children, School days/weekends, Bedtime resistance