Posted on

Study Reveals Link Between Sleep Disturbances and Emotional/Behavioral Issues in Preschool-Aged Children

A recent cohort study conducted in Shanghai, China, involving 17,182 preschool-aged children, sheds light on the association between sleep disturbances and emotional and behavioral difficulties (EBDs). The study, part of the Shanghai Children’s Health, Education and Lifestyle Evaluation–Preschool (SCHEDULE-P), spanned from November 2016 to October 2023.

Key Findings:

  1. Negative Association with Resolved EBDs: Incident and stable sleep disturbances were negatively associated with resolved EBDs after adjustment.
  2. Positive Association with Incident EBDs: Both incident and stable sleep disturbances were positively associated with incident EBDs after controlling for confounding factors.
  3. Resolved Sleep Disturbances: Resolved sleep disturbances were positively associated with resolved EBDs.
  4. Prevalence Rates: The prevalence of EBDs at school entry and graduation years was 27.8% and 18.7%, respectively. Sleep disturbances were prevalent at 41.3% and 31.5% in these respective years.
  5. Types of Sleep Disturbances: Specific types of sleep disturbances, including night waking, sleep-disordered breathing, and parasomnias, showed varying risks associated with EBDs.
  6. Importance of Sleep Health: The findings underscore the crucial role of sleep health in promoting the mental well-being of preschool-aged children.


  1. Screening and Intervention: The study emphasizes the importance of routine screening for sleep disturbances in preschool-aged children and underscores the need for targeted interventions to address specific types of sleep issues.
  2. Psychosocial Well-Being: Successful management of sleep disturbances may contribute to the psychosocial well-being of preschoolers, highlighting the interconnectedness of sleep and mental health.
  3. Policy and Clinical Implications: The study suggests the need for policy changes, incorporating sleep-related inquiries into developmental screenings in schools and primary care contexts. It also calls for interventions addressing both sleep disturbances and EBDs.

Limitations and Future Directions:

  1. Parental Reporting: The study relies on parental reports for sleep disturbances and EBDs, potentially introducing biases.
  2. Generalization: The high socioeconomic status of the sample raises questions about generalizing findings to other populations, especially those with lower socioeconomic status.
  3. Causality: The epidemiological design cannot establish causality, and bidirectional associations need consideration.

In conclusion, this pioneering study highlights the nuanced relationship between sleep disturbances and emotional/behavioral issues in preschool-aged children, offering insights that could guide targeted interventions for improved psychosocial outcomes in this population.

Credit: JAMA Network Open, Yujiao Deng