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J Psychiatr Res. 2015 Jan;60:141-7. doi: 10.1016/j.jpsychires.2014.10.005. Epub 2014 Oct 16.

The role of sleep and the hypothalamic-pituitary-adrenal axis for behavioral and emotional problems in very preterm children during middle childhood.

Author information

1
Department of Psychology, University of Basel, Missionsstrasse 62, 4055 Basel, Switzerland.
2
Center for Affective, Stress and Sleep Disorders, Psychiatric Clinics of the University of Basel, Wilhelm Klein-Strasse 27, 4027 Basel, Switzerland; Department of Sport, Exercise and Health, Division of Sport Science, Faculty of Medicine, University of Basel, Birsstrasse 320 B, 4052 Basel, Switzerland.
3
Center for Affective, Stress and Sleep Disorders, Psychiatric Clinics of the University of Basel, Wilhelm Klein-Strasse 27, 4027 Basel, Switzerland.
4
Division of Neuropediatrics and Developmental Medicine, University Children's Hospital Basel, Spitalstrasse 33, 4056 Basel, Switzerland.
5
Department of Psychology, University of Basel, Missionsstrasse 62, 4055 Basel, Switzerland. Electronic address: sakari.lemola@unibas.ch.

Abstract

Very preterm children are at higher risk to develop behavioral and emotional problems, poor sleep, and altered hypothalamic-pituitary-adrenocortical activity (HPAA). However, knowledge on objective sleep and HPAA as well as their role for the development of behavioral and emotional problems in very preterm children is limited. Fifty-eight very preterm children (<32nd gestational week) and 55 full-term children aged 6-10 years underwent one night of in-home polysomnographic sleep assessment. HPAA was assessed with four saliva samples in the morning (morning cortisol secretion) and four saliva samples in the evening (evening cortisol secretion). Parents completed the Strengths and Difficulties Questionnaire (SDQ) to assess children's behavioral and emotional problems and a subscale of the Children's Sleep Habits Questionnaire to assess sleep disordered breathing. Very preterm children showed more behavioral and emotional problems (SDQ total behavioral/emotional difficulties, emotional symptoms), poorer sleep (more nocturnal awakenings, more stage 2 sleep, less slow wave sleep), and faster decreasing evening cortisol secretion compared to full-term children. Across the whole sample, more stage 2 sleep and/or less slow wave sleep were associated with more SDQ total behavioral/emotional difficulties, hyperactivity-inattention, and peer problems. Lower morning cortisol secretion and lower evening cortisol secretion were associated with more conduct problems. In very preterm children, increased SDQ total behavioral/emotional difficulties was partially explained by less restorative sleep including more stage 2 sleep and less slow wave sleep. This result points to the importance of restorative sleep for the behavioral and emotional development of very preterm children during middle childhood.

KEYWORDS:

Behavioral problems; Emotional problems; Hypothalamic-pituitary-adrenocortical activity; Polysomnography; Preterm birth; Sleep

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