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Poster #36 - Link between Poor Sleep and Lower Cognitive Achievement in Urban, Low-Income Preschool Children

Fri, March 22, 2:30 to 3:45pm, Baltimore Convention Center, Floor: Level 1, Exhibit Hall B

Integrative Statement

It has been reported that preschool children living in urban and low-income communities have been reported to have increased numbers of sleep problems. In addition, preschool children with increased levels of sleep-disordered breathing have demonstrated lower levels of cognitive achievement. To further study the relationships between cognitive function and sleep problems in populations of preschool children, we studied three-to-five-year-old children from low-income families accessing community agencies for housing, food, and clothing assistance. Families were enrolled in a six-hour educational program, Working For Kids: Building Skills. This program is designed to teach the effects of early learning environments and experiences on brain development, particularly experiences that help buffer the impact of early life stresses. Data was collected from children whose parents consented to participate (n=43). Data collected included baseline measures of sleep, exposure to adverse childhood experiences (ACEs), cognitive function, and social-emotional development. Sleep assessments utilized the Child Sleep Habits Questionnaire (CSHQ) and cognitive function assessments included the NIH Toolbox Dimensional Change Card Sort (DCCS) and Picture Vocabulary Test (PVT) assessments, as well as the Ages and Stages Questionnaire (ASQ-3) subscales for communication skills and problem-solving. PVT performance is a measure of general vocabulary knowledge and is considered a strong measure of experience-based learning, and DCCS a measure of cognitive flexibility. There was a significant negative correlation between CSHQ scores and performance on the PVT (rho=-0.42, p=0.006), such that children with more sleep problems scored more poorly on the PVT. This finding was driven by the CSHQ bedtime resistance (rho=-0.41, p=0.008) and night-time waking (rho=-0.55, p<0.001) subscales, but not by sleep-disordered breathing (rho=-0.015, p=0.93). The night-time waking subscale of the CSHQ was also negatively correlated with performance on the DCCS (rho=-0.36, p=0.031) and the ASQ communication subscale score (rho=-0.391, p=0.009). And, the sleep anxiety subscale of the CSHQ was negatively correlated with the ASQ problem-solving subscale score (rho=-0.372, p=0.014). Examining the cognitive assessment scores of the children with the top quartile of CSHQ scores vs. the bottom quartile of the CSHQ scores showed that children with high CSHQ scores had significantly lower PVT (p=0.009) and DCCS (p=0.014) scores compared to children with low CSHQ scores. The child ACE score correlated negatively with both the ASQ communication subscale score (rho=-0.30, p=0.05) and the problem solving subscale score (rho=-0.34, p=0.024), but there were no significant correlations between any cognitive measure and parent ACE score, family income, parent education or number of people in the household. We conclude that there is a strong association between poor sleep and lower cognitive performance in terms of experience-based learning, cognitive flexibility, problem-solving and communication skills. These relationships are not driven by sleep-disorder breathing, but rather by other aspects of sleep physiology and behavior in preschool children living in urban, low-income communities.

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