Sleep patterns during infancy and neurodevelopmental and behavioral outcomes in early childhood: A prospective cohort study.

Abstract

Background: Infant sleep is multidimensional, with sleep habits and sleep problems often co-occurring and changing rapidly during early life. Evidence links infant sleep with later neurodevelopmental and behavioral outcomes, yet few studies have examined overall sleep patterns, their changes over time, and outcomes across multiple preschool domains. We examined associations of sleep patterns at 6 and 12 months and their transitions with preschool neurodevelopmental and behavioral outcomes.

Methods: This prospective cohort study included 1707 children from the Shanghai Birth Cohort. Infant sleep at 6 and 12 months was assessed using the Brief Infant Sleep Questionnaire. Sleep patterns were identified at each time point using latent class analysis based on multiple sleep indicators, and children with sleep data at both ages were classified into transition groups. At age 4, outcomes were assessed using the Strengths and Difficulties Questionnaire (SDQ), Social Responsiveness Scale-Short Form (SRS-SF), and Behavior Rating Inventory of Executive Function-Preschool Version (BRIEF-P). Multivariable linear regression estimated associations.

Results: At 6 and 12 months, 66.02% and 69.18% of infants were classified as having a good sleep pattern. Among children with sleep data at both time points, 51.57% had consistently good sleep, 16.68% improved, 14.44% deteriorated, and 17.31% had consistently poor sleep. Poor sleep at 6 months was associated with higher SDQ Total Difficulties scores. Poor sleep at 12 months was associated with higher SDQ Total Difficulties, SRS-SF Total, and BRIEF-P Global Executive Composite scores. Consistently poor sleep from 6 to 12 months was associated with less favorable outcomes than consistently good sleep.

Conclusion: Poorer infant sleep patterns, especially at 12 months and when persistent from 6 to 12 months, were associated with less favorable preschool neurodevelopmental and behavioral outcomes. These findings support infant sleep patterns as an early-life factor relevant to developmental research and monitoring.