Frequent night awakening and less regular sleep routines during childhood are associated with the onset of psychosis and borderline personality disorder (BPD) during adolescence, according to study results published in JAMA Psychiatry. Psychosis and BPD have previously been linked to persistent nightmares in childhood, and these findings highlight the importance of confronting sleep disturbances at young ages.
In this study, Isabel Morales-Muñoz, PhD, of the department of public health solutions, National Institute of Health and Welfare, Helsinki, Finland, and colleagues at the University of Birmingham in the United Kingdom pooled data from the Avon Longitudinal Study of Parents and Children birth cohort (N=13,488).
The face-to-face semi-structured Psychosis-Like Symptom Interview was used to assess psychotic experiences of children at 12 to 13 years of age, and the face-to-face semi-structured UK Childhood Interview for DSM-IV Borderline Personality Disorder was used to assess BPD symptoms in children at 11 to 12 years of age. Psychosis and BPD were correlated with assessments of parent-reported nighttime sleep duration, night awakening frequency, bedtime, and regularity of sleep routines when the children were 6, 18, and 30 months old as well as 3.5, 4.8, and 5.8 years of age.
Overall, the analysis included data for 7155 participants (52% girls) who reported on psychotic experiences at 12 to 13 years of age and 6333 participants (52% boys) who reported on BPD symptoms at 11 to 12 years. A total of 376 participants said they had psychotic experiences at 12 years, and 472 participants reported BPD symptoms at 11 years.
In logistic regression models, significant associations were found between psychotic experiences in adolescence and higher night awakening frequency at 18 months of age (odds ratio [OR], 1.13; 95% CI, 1.01-1.26; P =.03), as well as less regular sleep routines at 6 months (OR, 0.68; 95% CI, 0.50-0.93; P =.02), 30 months (OR, 0.64; 95% CI, 0.44-0.95; P =.02), and 5.8 years (OR, 0.32; 95% CI, 0.19-0.53; P <.001) of age. The onset of BPD symptoms at ages 11 to 12 years was associated with shorter nighttime sleep duration (OR, 0.78; 95% CI, 0.66-0.92; P =.004) and later bedtime at 3.5 years of age (OR, 1.32; 95% CI, 1.09-1.60; P =.005).
A mediation analysis was performed, which assessed depressive symptoms during the past 2 weeks with the short 13-item Mood and Feelings Questionnaire. The investigators also collected Total Mood and Feelings Questionnaire scores at 10 years of age. In this analysis, depression at 10 years of age exhibited a mediation effect on the associations between later psychosis with frequent night awakenings at 18 months of age (bias-corrected estimate, −0.005; 95% CI, −0.008 to −0.002; P =.002) as well as irregular sleep routines at 5.8 years of age (bias corrected estimate, −0.006; 95% CI, −0.010 to −0.003; P =.003).
Study limitations included the reliance on parent reports and the lack of objective measures of sleep variables, as well as inclusion of only individuals from the United Kingdom.
The investigators concluded that their findings “could contribute to the design of more personalized sleep and psychological interventions in psychosis and borderline personality disorder.”
Morales-Muñoz I, Broome MR, Marwaha S. Association of parent-reported sleep problems in early childhood with psychotic and borderline personality disorder symptoms in adolescence [published online July 1, 2020]. JAMA Psychiatry. doi:10.1001/jamapsychiatry.2020.1875.