Source/Disclosures
Disclosures: One study author reports funding from Oxford University Press and the National Institute for Health Research Clinical Research Network, as well as personal fees from Medical Defence Union, outside the submitted work; another author reports attending an education event sponsored by Janssen. Morales-Muñoz reports no relevant financial disclosures.
July 02, 2020
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Childhood sleep problems linked to adolescent psychosis, borderline personality disorder

Source/Disclosures
Disclosures: One study author reports funding from Oxford University Press and the National Institute for Health Research Clinical Research Network, as well as personal fees from Medical Defence Union, outside the submitted work; another author reports attending an education event sponsored by Janssen. Morales-Muñoz reports no relevant financial disclosures.
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Sleep problems during early childhood may be associated with the onset of psychosis and borderline personality disorder, or BPD, in adolescence, according to results of a cohort study published in JAMA Psychiatry.

We already knew from previous research that sleep is a key factor associated with developmental psychopathologic symptoms, and few recent longitudinal attempts have shown that some specific sleep problems (ie, nightmares) occurring in childhood were associated with BPD and psychotic symptoms in adolescence,” Isabel Morales-Muñoz, PhD, of the department of public health solutions at the National Institute for Health and Welfare in Finland, told Healio Psychiatry. “However, we still did not know whether other more frequent sleep problems that commonly appear in childhood (ie, behavioral sleep problems, such as frequent night awakenings, short sleep duration, late bedtime or irregular sleep routines) precede the onset of BPD and psychotic symptoms in adolescence. Also, we were interested in examining whether depression (which is commonly associated with both sleep problems and mental health problems) might mediate this association between behavioral sleep problems in early childhood and BPD and psychotic symptoms in adolescence, and this is something that had not been investigated previously.”

child sleeping in bed
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Adults and adolescents with BPD commonly exhibit psychotic symptoms, and genetic overlap exists; however, it is unclear whether childhood sleep disturbances are similarly associated with these conditions because of their overlap or whether sleep may have a different pathway in BPD than psychosis.

Morales-Muñoz and colleagues aimed to evaluate prospective associations between multiple parent-reported sleep problems among young children and psychotic and BPD symptoms at ages 11 to 13 years, as well as the role of depression in these associations at age 10. In the current study, they analyzed data of 13,488 participants of the Avon Longitudinal Study of Parents and Children birth cohort who had data available for more than 13 years. The Avon study included pregnant women from the U.K. who had expected delivery dates between April 1991 and December 1992. The investigators assessed psychotic experiences at ages 12 to 13using the Psychosis-Like Symptom Interview, as well as BPD symptoms at ages 11 to 12using the U.K. Childhood Interview for DSM-IV Borderline Personality Disorder. Parents reported on their child’s regularity of sleep routines, nighttime sleep duration, night awakening frequency and bedtime when the child was aged 6, 18 and 30 months, as well as at ages 3.5, 4.8 and 5.8 years.

A total of 7,155 participants reported on psychotic symptoms and 6,333 reported on BPD symptoms. Irregular sleep routines at 6 months (OR = 0.68; 95% CI, 0.5-0.93), 30 months (OR = 0.64; 95% CI, 0.44-0.95 and 5.8 years (OR = 0.32; 95% CI, 0.19-0.53), as well as higher night awakening frequency at 18 months (OR = 1.13; 95% CI, 1.01-1.26) were significantly linked to psychotic experiences in adolescence. Shorter nighttime sleep duration (OR = 0.78; 95% CI, 0.66-0.92) and later bedtime at age 3.5 years (OR = 1.32; 95% CI, 1.09-1.6) were significantly linked to BPD symptoms. Mediation analysis revealed consistent results among all these associations, apart from later bedtime at age 3.5 and BPD in adolescence, which demonstrated no association. Depression at age 10 mediated associations between irregular sleep routines at age 5.8 and frequent night awakenings at age 18 months with psychosis.

These findings highlight the relevance of assessing and/or considering the important role of sleep problems already in early childhood as a potential risk factor for the development of prospective psychopathology in adolescence," Morales-Muñoz told Healio Psychiatry. "Further, different behavioral sleep problems should be addressed, depending on the psychopathology (ie, frequent night awakenings and irregular sleep routines are more relevant in psychosis, while the target in BPD should be sleep duration). The results of this study could have important implications for helping practitioners identify children who might be at higher risk for psychotic experiences or BPD symptoms in adolescence, and potentially lead to the design of more effectively targeted sleep or psychological interventions to prevent the onset or attenuate these mental disorders.”