Abstract
Sleep is important for the maturation of the brain. A common feature of sleep in infancy is night awakening that differentiates it from sleep later in childhood. These night awakenings are normative and usually known to diminish with age. Some children, however, continue to have night awakenings, even though it would be physiologically possible to sleep through the night. These night awakenings are usually so called signaled night awakenings. Signaled night awakening refers to a night awakening that is signaled to parents, for example, with crying, and the parent’s assistance is needed for a child to fall asleep again. Signaled night awakenings can influence the well-being of the whole family. However, it is unknown whether signaled night awakening is associated with the child’s overall development. This dissertation aimed to determine whether signaled night awakening is associated with children’s development or particularly to certain aspects of development during the first two years of life.
Within the CHILD-SLEEP birth cohort two groups were formed based on parent-reported signaled night awakening. Thus far, children with three or more signaled night awakenings formed the waking group, and children with no more than one signaled night awakening formed the non-waking group. Child development was investigated longitudinally using versatile traditional and eye-tracking methods at eight and 24 months old covering aspects of cognitive, social, and emotional development. Dissertation includes three original publications. The main objective was to investigate whether children with signaled night awakenings differ from children without signaled night awakenings in cognitive, language, or motor functioning or in tasks measuring more specifically executive functioning, social information processing, and socio-emotional behavior. Additionally, the stability of signaled night awakening was investigated and whether children with signaled night awakenings differ in parent-rated sleep quality and duration from children without signaled night awakenings. Further, child sleep was also measured with motion sensors.
Based on the results, signaled night awakening is persistent continuing through infancy. Children with signaled night awakenings at eight months old had more parent-reported signaled night awakenings at 18 and 24 months old than children without signaled night awakenings. Moreover, sleep duration and quality differed between the two groups in data averaged across eight, 18, and 24 months old. Children with signaled night awakenings had shorter sleep duration and they spent more time awake during the night than children without signaled night awakenings. Motion sensor measures supported parent-reports as informants of signaled night awakenings. There were no differences in cognitive, language, or motor functioning between children with and without signaled night awakenings at eight or 24 months old. However, the children with signaled night awakenings had lower performance in a computerized executive functioning task than children without signaled night awakenings. The difference between groups was evident at 24 months old whereas at eight months old the two groups did not differ in their performance. With parent- ratings of executive functioning and more traditional executive functioning tasks at 24 months old, however, the two groups did not differ. Additionally, the children with signaled night awakenings showed a different pattern of attention to emotional faces across time than children without signaled night awakenings. More precisely, the children with signaled night awakenings had a more pronounced attentional bias to fearful faces relative to other face types than children without signaled night awakenings. Further, the children with signaled night awakenings had more parent- reported dysregulation problems and lower social competence than children without signaled night awakenings at 24 months old.
Taken together, signaled night awakening is often prolonged and possibly predisposes children to other changes in sleep quality and duration. Signaled night awakening seems to be predominantly associated with higher-order cognitive functioning, such as executive functioning and social or emotional information processing, and socio-emotional behavior. However, at least during the first two years of life, no differences were observed in the child’s overall development. According to the results, it seems that signaled night awakening is associated with a larger problem of self-regulation that possibly predisposes children to altered developmental trajectory. Additionally, the differences between groups were already visible within the first two years of life in a normative population without any major sleep difficulties. Signaled night awakening should be systematically assessed as part of well-child visits. If the child has frequent signaled night awakenings, special attention and follow-up should be paid to sleeping characteristics and the development of the child. Additionally, parents should be advised on how to support their child’s sleep and self-regulation skills in infancy.
Within the CHILD-SLEEP birth cohort two groups were formed based on parent-reported signaled night awakening. Thus far, children with three or more signaled night awakenings formed the waking group, and children with no more than one signaled night awakening formed the non-waking group. Child development was investigated longitudinally using versatile traditional and eye-tracking methods at eight and 24 months old covering aspects of cognitive, social, and emotional development. Dissertation includes three original publications. The main objective was to investigate whether children with signaled night awakenings differ from children without signaled night awakenings in cognitive, language, or motor functioning or in tasks measuring more specifically executive functioning, social information processing, and socio-emotional behavior. Additionally, the stability of signaled night awakening was investigated and whether children with signaled night awakenings differ in parent-rated sleep quality and duration from children without signaled night awakenings. Further, child sleep was also measured with motion sensors.
Based on the results, signaled night awakening is persistent continuing through infancy. Children with signaled night awakenings at eight months old had more parent-reported signaled night awakenings at 18 and 24 months old than children without signaled night awakenings. Moreover, sleep duration and quality differed between the two groups in data averaged across eight, 18, and 24 months old. Children with signaled night awakenings had shorter sleep duration and they spent more time awake during the night than children without signaled night awakenings. Motion sensor measures supported parent-reports as informants of signaled night awakenings. There were no differences in cognitive, language, or motor functioning between children with and without signaled night awakenings at eight or 24 months old. However, the children with signaled night awakenings had lower performance in a computerized executive functioning task than children without signaled night awakenings. The difference between groups was evident at 24 months old whereas at eight months old the two groups did not differ in their performance. With parent- ratings of executive functioning and more traditional executive functioning tasks at 24 months old, however, the two groups did not differ. Additionally, the children with signaled night awakenings showed a different pattern of attention to emotional faces across time than children without signaled night awakenings. More precisely, the children with signaled night awakenings had a more pronounced attentional bias to fearful faces relative to other face types than children without signaled night awakenings. Further, the children with signaled night awakenings had more parent- reported dysregulation problems and lower social competence than children without signaled night awakenings at 24 months old.
Taken together, signaled night awakening is often prolonged and possibly predisposes children to other changes in sleep quality and duration. Signaled night awakening seems to be predominantly associated with higher-order cognitive functioning, such as executive functioning and social or emotional information processing, and socio-emotional behavior. However, at least during the first two years of life, no differences were observed in the child’s overall development. According to the results, it seems that signaled night awakening is associated with a larger problem of self-regulation that possibly predisposes children to altered developmental trajectory. Additionally, the differences between groups were already visible within the first two years of life in a normative population without any major sleep difficulties. Signaled night awakening should be systematically assessed as part of well-child visits. If the child has frequent signaled night awakenings, special attention and follow-up should be paid to sleeping characteristics and the development of the child. Additionally, parents should be advised on how to support their child’s sleep and self-regulation skills in infancy.
Original language | English |
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Place of Publication | Tampere |
Publisher | Tampere University |
ISBN (Electronic) | 978-952-03-2700-2 |
ISBN (Print) | 978-952-03-2699-9 |
Publication status | Published - 2023 |
Publication type | G5 Doctoral dissertation (articles) |
Publication series
Name | Tampere University Dissertations - Tampereen yliopiston väitöskirjat |
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Volume | 724 |
ISSN (Print) | 2489-9860 |
ISSN (Electronic) | 2490-0028 |