Sleep problems and executive dysfunctions in pre-school children

Aim The aim of the study was to examine the relationship between sleep problems and executive functions in pre-school children as reported by parents/caregivers. Methods This cross-sectional study of caregiver-child dyads was conducted in a public kindergarten school in Northern Thailand. Sleep problems were evaluated using the Children's Sleep Habits Questionnaire (CSHQ), whereas executive functions were assessed using the Behavioural Rating Inventory of Executive Function - pre-school version (BRIEF-P). T-scores greater than 65 of the BRIEF-P were defined as deficits in executive functions. Multiple linear regressions were performed to assess the association between the executive function components and the total CSHQ scores. Results Participants included 356 children, with a mean age of 5.04 (0.54) years. The total CSHQ scores of the executive dysfunction group were significantly higher than those of the group with executive functions below the cutoff (P < 0.001), which indicated more of sleep problems, including sleep-onset delay, night waking and daytime sleepiness. However, the duration of night sleep, night awake, afternoon nap and total sleep time reported by parents did not differ between the two groups. Weak positive correlations between the total CSHQ and subscale scores and the Global Executive Composite score of the BRIEF-P were noted. After adjusting for confounding variables, including child's age, gender, prematurity, maternal age and education, family income and media viewing time from the multiple linear regression analysis, the total CSHQ scores were significantly correlated with worse Global Executive Composite scores, which is the summary of five domains of executive functions (P < 0.001). Conclusions This study highlights the association between sleep problems and deficits in executive functions in healthy pre-school children. Health-care providers are encouraged to consistently advocate for proper sleep hygiene and practices to enhance executive functions in pre-schoolers.