Reduced sleep duration may raise the risk of developing symptoms of emotional and behavioral disorders in children, according to data published in JAMA Network Open. The population-based cohort study included 799 children (mean age, 6.0±0.2 years; 50.7% boys) in Norway who were participants in the Trondheim Early Secure Study.

Bror Ranum, CandPsych, of the department of psychology, Norwegian University of Science and Technology, Trondheim, and colleagues investigated associations between sleep duration and symptoms of psychiatric disorders in the sample, following participants biennially from age 4 to 12 years. They conducted semi-structured clinical interviews to assess emotional (anxiety disorders, phobias, major depressive disorder, and dysthymia) and behavioral (attention-deficit/hyperactivity disorder, conduct disorder, and oppositional defiant disorder) symptoms, and participants were stratified into 4 groups based on Strengths and Difficulties Questionnaire (SDQ) scores, with oversampling of children with emotional or behavioral problems.

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The study incorporated data from the Child and Adolescent Psychiatric Assessment and the Preschool Age Psychiatric Assessment. The researchers gathered information on sleep duration using Sadeh algorithm analysis of data derived from a triaxial accelerometer, which was worn by the children for a full week.

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Reduced sleep duration at age 6 years was correlated with emotional disorder symptoms at age 8 years (unstandardized regression coefficient, −0.44; 95% CI, −0.80 to −0.08; P =.02), and short sleep duration at 8 years predicted the development of emotional (unstandardized regression coefficient, −0.47; 95% CI, −0.83 to −0.11; P =.01) and behavioral (unstandardized regression coefficient, −0.49; 95% CI, −0.90 to −0.07; P =.02) symptoms after 2 years. For each half hour less of sleep at age 6 years, children had 0.22 more emotional disorder symptoms at age 8 years, with similar magnitudes seen for the trajectory from 8 to 10 years.

In boys but not girls in the cohort, reduced sleep duration at age 8 years (unstandardized regression coefficient, −0.65; 95% CI, −1.22 to −0.08; P =.03) and 10 years (unstandardized regression coefficient, −0.58; 95% CI, −1.07 to −0.08; P =.02) predicted the development of behavioral disorder symptoms 2 years later. This sex-specific finding was determined to be significant (P =.001).

One key study limitation was the limited generalizability to countries outside of Norway, which has a relatively low rate of psychiatric disorders. In addition, the study did not analyze the quality of sleep.

The investigators implicated “misperceptions of social cues,” neurocognitive issues, “heightened stress reactivity,” and “greater parental stress and fatigue” in the relationship between lower sleep duration and psychiatric disorders. They further suggested that “targeting sleep duration could be advantageous for mental health interventions.”


Ranum BM, Wichstrøm L, Pallesen S, Falch-Madsen J, Halse M, Steinsbekk S. Association between objectively measured sleep duration and symptoms of psychiatric disorders in middle childhood. JAMA Netw Open. 2019;2(12):e1918281.