The association of mothers' and fathers' insomnia symptoms with school-aged children's sleep assessed by parent report and in-home sleep-electroencephalography

Highlights

• Maternal insomnia is associated with children's objectively measured sleep.

• Parental insomnia predicted increased parent reports of children's sleep problems.

• Maternal insomnia also predicted increased father reports of child's sleep problems.

• Effects of parental insomnia were not explained by children's objective sleep.

Abstract

Objective

Sleep plays an essential role for children's well-being. Because children's sleep is associated with parental sleep patterns, it must be considered in the family context. As a first aim of the present study, we test whether parental insomnia symptoms are related to children's in-home sleep-electroencephalography (EEG). Second, we examine the association between parental insomnia symptoms and maternal and paternal perception of children's sleep using actor–partner interdependence models.

Methods

A total of 191 healthy children enrolled in public school and aged 7–12 years took part in the study. Ninety-six were formerly very preterm born children. Children underwent in-home sleep-EEG, and parents reported children's sleep-related behavior by using the German version of the Children's Sleep Habits Questionnaire. Further, parents completed the Insomnia Severity Index to report their own insomnia symptoms.

Results

Maternal but not paternal insomnia symptoms were related to less children's EEG-derived total sleep time, more stage 2 sleep, less slow wave sleep, later sleep onset time, and later awakening time. Mothers' and fathers' own insomnia symptoms were related to their reports of children's bedtime resistance, sleep duration, sleep anxiety, night wakings, and/or daytime sleepiness. Moreover, maternal insomnia symptoms were associated with paternal reports of children's bedtime resistance, sleep anxiety, and sleep-disordered breathing. The associations between parental insomnia symptoms and parents' perception of children's sleep could not be explained by children's objectively measured sleep.

Conclusions

Mothers' insomnia symptoms and children's objective sleep patterns are associated. Moreover, the parents' own insomnia symptoms might bias their perception of children's sleep-related behavior problems.

Introduction

Sleep plays an essential role for children's daytime functioning including their well-being, emotion regulation, cognitive functioning, and academic performance [1], [2], [3], [4]. According to self- and parent-reports sleep problems are frequent: 30–40% of school-aged children seem to suffer from sleep disturbances such as difficulties initiating and maintaining sleep, as well as excessive daytime sleepiness [5], [6].

There is compelling evidence that children's sleep is associated with parental sleep patterns [7], [8], [9], [10], particularly with maternal sleep [8], [9], [11], [12], [13], [14]. The association was especially salient when parents' and children's sleep were measured with the same method, e.g., when both parental and children's sleep were reported by the parents [14] or measured with actigraphy [9] or sleep-electroencephalography (EEG) [8]. However, to date no study examined the association between parental insomnia symptoms and children's sleep measured by polysomnography (PSG), the gold-standard of sleep assessment. Similarly, evidence on the association between one parent's insomnia symptoms and the co-parent's perception of child sleep is missing.

Several possible mechanisms that could account for the relationship between parents' and children's sleep have been suggested. First, children may learn sleep habits from their parents, which could lead to high correspondence between parents' and children's sleep quality [15]. Second, both parents and children could for instance be affected by poor family functioning [16], [17], [18], [19] as well as by environmental stress related to poor socio-economic status leading to poor sleep patterns [20]. Third, children may share genetic variation with their parents that predisposes for poor sleep [21]. Fourth, in younger children, sleep difficulties can also affect parental sleep [22], [23].

A methodological issue that could account for the association between parental insomnia and parent reports of children's sleep difficulties in particular, is that parental insomnia may affect their perception of children's sleep without any real underlying sleep problem of the child [24]. This can be important because parents are often the first to perceive their children's sleep problems and to seek help. Aside from causing unnecessary costs, treatment for sleep disorders without a real underlying indication might be harmful and eventually even trigger children's sleep disturbances [25], [26]. This might happen in a similar fashion as described by Harvey's cognitive model of insomnia [27] which posits that selective attention and monitoring of sleep difficulties play a crucial role in triggering and perpetuating sleep disturbances.

Moreover, parent reports are often used to assess children's sleep-related behavior and sleep problems in research, since parent reports are practical and inexpensive [28], although being error-prone and possibly biased due to the parents' own sleep difficulties [24], [29]. Rönnlund et al. (2016) [24] for instance studied parents of children aged 2–6 years and measured children's sleep by actigraphy to identify to what degree parent reports were explained by children's actual sleep. Parents (who themselves suffered from poor sleep) more often reported sleep problems in their children, including disorders of initiating and maintaining sleep, disorders of sleep–wake transitions, and excessive daytime somnolence [24]. These associations could not be explained by objective (i.e., actigraphy) measures of children's sleep [24]. A possible explanation for this pattern of results is that parents who sleep poorly themselves show a negativity bias, such that they show increased attention towards and more often remember negative stimuli related to their child's sleep [24], [30], [31].

As a first aim of the present study, we tested whether maternal and paternal insomnia symptoms were related to children's sleep measured objectively with in-home sleep-EEG. Compared to laboratory-based PSG, in-home sleep-EEG assessment has the advantage that sleep is assessed in the ecological context where it normally occurs. We hypothesized that children show worse sleep patterns including shorter sleep duration and decreased sleep continuity when their mothers and fathers had increased insomnia symptoms. As a second aim of the present study we examined the association of parents' insomnia symptoms and their perception of their children's sleep. In order to account for the degree to which this relationship is explained by the children's actual sleep, we controlled children's objectively measured sleep (i.e., the EEG sleep-indices) in an additional step. We hypothesized that parents with more insomnia symptoms also perceive more sleep-related behavior problems in their children. Because the present study aims to extend our understanding of parental perception of children's sleep, the interdependence of maternal and paternal reports of children's sleep was examined using the Actor–partner interdependence model (APIM) [32]. Maternal and paternal perception of their children's sleep could be influenced by their own as well as by their partners' sleep problems. The APIM approach allowed to shed light onto the mutual interdependence of maternal and paternal perception of their children's sleep by disentangling so-called actor and partner effects; in the present context, actor effects denote associations between one parent's insomnia symptoms and his/her perception of the child's sleep-related behavior problems (Fig. 1, paths labeled ‘a’), whereas partner effects reflect the associations between one parent's insomnia symptoms and the other parent's perception of the child's sleep-related behavior problems (Fig. 1, paths labeled ‘b’).