A population-based study exploring association of parasomnia symptoms with sleep onset delay among school-aged children

Ruoyu Lu; Rong Li; Yiting Chen; Ye Zhang; Wenhui Kang; Anda Zhao; Xiaoya Lin; Yabin Hu; Shijian Liu; Zhiwei Xu; Zhaohui Lu; Shenghui Li

doi:10.1016/j.sleep.2024.02.010

A population-based study exploring association of parasomnia symptoms with sleep onset delay among school-aged children

Sleep Med. 2024 May:117:1-8. doi: 10.1016/j.sleep.2024.02.010. Epub 2024 Feb 2.

Authors

Ruoyu Lu¹, Rong Li¹, Yiting Chen¹, Ye Zhang¹, Wenhui Kang¹, Anda Zhao¹, Xiaoya Lin², Yabin Hu³, Shijian Liu⁴, Zhiwei Xu⁵, Zhaohui Lu⁶, Shenghui Li⁷

Affiliations

¹ School of Public Health, Shanghai Jiao Tong University, Shanghai, 200025, China.
² Hainan Branch, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Sanya, China.
³ Department of Clinical Epidemiology and Biostatistics, Child Health Advocacy Institute, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
⁴ Hainan Branch, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Sanya, China; Department of Clinical Epidemiology and Biostatistics, Child Health Advocacy Institute, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
⁵ School of Medicine and Dentistry, Griffith University, Parklands Drive, Southport, QLD, 4222, Australia.
⁶ Hainan Branch, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Sanya, China; National Children's Medical Center, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China. Electronic address: luzhaohui@sjtu.edu.cn.
⁷ School of Public Health, Shanghai Jiao Tong University, Shanghai, 200025, China; Hainan Branch, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Sanya, China; MOE-Shanghai Key Laboratory of Children's Environmental Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China. Electronic address: lsh9907@163.com.

PMID: 38460489
DOI: 10.1016/j.sleep.2024.02.010

Abstract

Objective: Parasomnia is potentially implicated in sleep pattern and sleep architecture, however, evidence is quite limited. This study aimed to investigate the association between parasomnia symptoms and sleep onset delay among children through a large epidemiological study.

Methods: Two rounds of cross-sectional studies were conducted among 21,704 children aged 3-11; one taking place in Shanghai and the other in Sanya, Hainan province. Children's sleep characteristics were evaluated using the Children's Sleep Habits Questionnaire (CSHQ). Propensity score matching was adopted to balance the difference of covariates, and the logistic regression models were implemented to examine the associations between parasomnia symptoms and sleep onset delay.

Results: A total of 38.2 % of children had sleep onset delay. Parasomnias, especially non rapid eye movement (NREM) and rapid eye movement (REM) parasomnia symptoms, were associated with an increased risk of sleep onset delay (Sleep Walking: OR = 1.55; Sleep Terror: OR = 1.34; Nightmare: OR = 1.37, all p˂0.001). The similar findings were observed in stratified analyses according to sleep duration, and the association was pronounced in sleep sufficiency group (Sleep Walking: OR = 1.62; Sleep Terror: OR = 1.35; Nightmare: OR = 1.35, all p˂0.001). Moreover, a dose-dependent pattern was observed, in which cumulative parasomnia symptoms were associated with increasing risk of sleep onset delay (2 symptoms: OR = 1.19; ≥3 symptoms: OR = 1.40; by comparison with ≤1 symptom). All these findings were also similarly observed in the propensity score matching sample. Moreover, the associations were generally established in both Shanghai and Sanya children.

Conclusions: Parasomnia symptoms were associated with a higher risk of sleep onset delay independently of sleep duration among children. More studies are needed to enrich the current evidence, thus further clarifying the association and interaction among different sleep parameters.

Keywords: Parasomnia; Sleep; Sleep disorders; Sleep duration; Sleep latency; Sleep quality.

MeSH terms

Child
China / epidemiology
Cross-Sectional Studies
Humans
Night Terrors*
Parasomnias* / complications
Parasomnias* / diagnosis
Parasomnias* / epidemiology
Polysomnography
Sleep
Somnambulism*