Sleep during early childhood is often affected by a constellation of biological, behavioral, psychosocial, and cultural factors. 25 There has been a paucity of data to explore the relationship between nighttime awakenings and cognitive abilities in the healthy full-term developing children.
22 Meanwhile, other existing studies only focused on the clinical samples (eg, infants with frequent snoring), 23, 24 or high-risk young children (eg, those with autism). Nonetheless, this study was limited by a small sample size (n = 50) and a narrow age range of the study participants. 21 A previous study conducted in 10-month-old infants found that those with more fragmented sleep showed poorer performance on the Bayley Scales of Infant Development. However, few studies have explored nighttime awakenings in relation to cognitive development in infants and toddlers. 19, 20 Frequent nighttime awakenings could lead to fragmented sleep and compromise the quality of sleep in young children. 13 – 18 Apart from insufficient sleep, behavioral sleep problems may potentially have a negative effect on several aspects of child development, including cognitive functioning. 10 – 12 Specifically, the prevalence of nighttime awakenings among children 0 to 3 years of age ranges from 20% to 66%, depending on the defining criteria and age.
Sleep problems are common in infants and toddlers (eg, 75.9% in mainland China, 24.4% in the United States). For example, some studies found that short sleep duration during toddlerhood is associated with preschoolers' verbal and nonverbal performance, 6, 7 whereas others did not find an association between sleep duration and executive function from infancy to preschool age. 5 Although the effects of sleep duration on cognition and behavioral problems have been clearly demonstrated in older children, 5 the evidence of this association is less consistent in young children. 1 – 4 A meta-analytic review has reported a positive relationship between sleep duration and cognitive performance among 5- to 12-year-old children. Inadequate sleep may have disruptive effects on the cognitive functions and learning capacity in children and adolescents.
Future research is warranted to develop parent-based, sleep-focused educational intervention in the community and to examine the effects of such intervention on children's early development.
The findings provide a developmental context for the implications of nighttime awakenings in early years and underscore the need to address frequent nighttime awakenings particularly in toddlers. Study Impact: A distinct pattern of association between sleep quality (ie, frequency of nighttime awakenings) and cognitive abilities in young children at different developmental stages was found. Therefore, we conducted an epidemiological study to investigate different aspects of sleep in relation to cognitive abilities in a large representative community sample of infants and toddlers. Data on sleep and cognitive abilities in physically healthy young children remain scanty. Current Knowledge/Study Rationale: There is some evidence on the effects of sleep in early development, yet the existing studies are limited by a relatively small sample size and selected clinical populations (eg, preterm babies, infants with snoring).
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