Sleep Troubles in Infancy Tied to Later BPD, Psychosis

Some sleep patterns in infancy were associated with psychotic experiences and borderline personality disorder (BPD) symptoms in adolescence, a cohort study from England found.

Among 7,155 mother-child pairs, children whose mothers reported that they had irregular sleep routines in childhood, and frequent night awakenings at 18 months, were significantly more likely to have psychotic symptoms by 12 to 13 years than children who did not wake up frequently at night (odds ratio 1.13, 95% CI 1.01-1.26, P=0.03), reported Isabel Morales-Muñoz, PhD, of the University of Birmingham in England, and colleagues.

Compared with children with regular sleep patterns, children who slept less at night (OR 0.78, 95% CI 0.66-0.92, P=0.004) and had later bedtimes at 3.5 years (OR 1.32, 95% CI 1.09-1.60, P=0.005) showed associations with BPD symptoms in adolescence, they wrote in JAMA Psychiatry.

“Our findings indicate that there might be a direct association between sleep duration and later BPD symptoms, and this might suggest that altered circadian rhythm might explain this direct association,” Morales-Muñoz told MedPage Today in an email.

Also, depression at age 10 mediated the association between behavioral sleep problems and psychosis, but did not mediate the association between sleep patterns and BPD symptoms, Morales-Muñoz said.

“Another explanation might be that other factors may mediate this association, such as emotion dysregulation,” Morales-Muñoz said.

In two prior studies using the same cohort, nightmares and night terrors in early childhood were associated with psychotic symptoms and BPD later in life.

Early childhood is a critical window for brain development, but it is also a time when sleep problems are common, with up to 30% of parents of young children reporting night waking or other disturbances, commented Ariel A. Williamson, PhD, of the Children’s Hospital of Philadelphia, who was not involved in this research.

As such, it would be useful to know the proportion of children in this cohort who had sleep problems that persisted through adolescence, Williamson noted, citing a prior study she conducted in which this rate was about 7%.

Moreover, because sleep problems were reported by parents, it’s unclear whether night awakenings or sleep problems were due to behavioral problems or nightmares. These findings are also likely influenced by shared environmental and genetic factors between children and parents, who may have varying degrees of tolerance for which sleep disturbances are considered problematic, Williamson told MedPage Today.

“While these findings are important and add to a body of literature showing early sleep problems could be a marker for some types of mental and behavioral dysregulation, we still have a lot to learn about the method by which those can persist over childhood, and whether they really result in psychiatric diagnoses later in life,” Williamson said.

The Avon Longitudinal Study of Parents and Children (ALSPAC) recruited pregnant women in the late 1990s who reported children’s sleep patterns at 6 months, 18 months, 30 months, 3.5 years, 4.8 years, and 5.8 years. BPD and psychotic symptoms were identified through in-person interviews with children at ages 11 to 13 years using validated scales and DSM-IV criteria. Finally, depression was assessed with the Mood and Feelings Questionnaire at age 10.

The data was adjusted for maternal age, child sex, and prematurity, as well as family adversity, emotional temperament, and childhood abuse, researchers reported. Notably, more than half the original sample was lost to follow-up (57.1%) at ages 11 to 12 years, and those lost to attrition were more likely to be boys, with higher scores in family adversity and depression, they noted.

In total, 7,155 adolescents had psychotic experiences at ages 12 to 13 years, and 6,333 children reported BPD symptoms at ages 11 to 12 years. The cohort was 52% female with around 5% of infants born premature.

A lower chance of psychosis was observed among children with regular sleep patterns at 6 months (OR 0.68, 95% CI 0.50-0.93, P=0.02), 30 months (OR 0.64, 95% CI 0.44-0.95, P=0.02), and 5.8 years (OR 0.32, 95% CI 0.19-0.53, P<0.001), the authors noted.

The parental reports of children’s sleep patterns were subject to bias and the findings from this cohort may not be generalizable to other populations, which are limitations, the authors noted. Also, pervasive developmental delays, the degree of prematurity, hyperactivity, and parental mental health problems were not measured in this study and could be confounding the analysis, Morales-Muñoz said.