Predictors of Sleep Habits in Premature Infants: A Cross-Sectional Study
Iranian Journal of Child Neurology,
Vol. 19 No. 4 (2025),
15 September 2025
,
Page 33-38
https://doi.org/10.22037/ijcn.v19i4.47721
Abstract
Objectives:
Despite the significant frequency of sleep disorders in premature infants, the specific causes remain unclear. Thus, pediatricians and other caregivers may be able to prevent the onset of sleep disorders in children. Accordingly, the present study aimed to assess the predictors of sleep habits among preschoolers born preterm.
Materials & Methods:
This cross-sectional, retrospective study included 174 preterm infants from the Semnan clinic in Iran between 2019 and 2020. All children between the ages of four and seven years old who were born before 37 weeks were included. Information on demographic variables and the Children’s Sleep Habits Questionnaire (CSHQ) was collected from the participants. The Research Ethics Committee of the Semnan University of Medical Sciences, Semnan, Iran (IR. SEMUMS.REC.1396.235).
Results:
The average age of children and mothers were 5.7±0.96 and 32.14 ±2.02 years old, respectively. The probability of familial conflict (OR = 2.73, 95% CI = 0.97-7.71, and P = 0.041), sleepwalking (OR=2.56, 95% CI=1.30-5.06, and p=0.006) and seclusion increased (OR=2.68, 95% CI=0.91-5.13, and P=0.034) in CSHQ 1< to 2 compared with CSHQ >2 in adjusted model History of psychological disorder, sleep drugs use, withdrawn and previously diagnosed sleep disorders, depression, nightmares, and sleeping alone no had significant association with CSHQ score.
Conclusion:
The study concluded that stress factors, such as family conflicts, behavioral changes like increased seclusion, as well as internal issues like sleepwalking, should be regularly investigated in children referred to clinics for sleep problems. Healthcare professionals need to assess how these symptoms may worsen or impact the effectiveness of treatment.
- sleep problems, behavioral disturbances, internalizing problems, children
How to Cite
References
Martin RJ, Fanaroff AA, Walsh MC. Neonatal-perinatal medicine. The Central Nervous System 8th ed Phialadelphia: Mosby. 2006:883-933.
Westrup B. Newborn Individualized Developmental Care and Assessment Program (NIDCAP)—family-centered developmentally supportive care. Early human development. 2007;83(7):443-9.
Blencowe H, Cousens S, Oestergaard MZ, Chou D, Moller A-B, Narwal R, et al. National, regional, and worldwide estimates of preterm birth rates in the year 2010 with time trends since 1990 for selected countries: a systematic analysis and implications. The lancet. 2012;379(9832):2162-72.
Axelin A. Parents as pain killers in the pain management of preterm infants. 2010.
Chawanpaiboon S, Vogel JP, Moller A-B, Lumbiganon P, Petzold M, Hogan D, et al. Global, regional, and national estimates of levels of preterm birth in 2014: a systematic review and modelling analysis. The Lancet Global Health. 2019;7(1):e37-e46.
Smith GC, Gutovich J, Smyser C, Pineda R, Newnham C, Tjoeng TH, et al. Neonatal intensive care unit stress is associated with brain development in preterm infants. Annals of neurology. 2011;70(4):541-9.
Horbar JD, Badger GJ, Lewit EM, Rogowski J, Shiono PH, Network VO. Hospital and patient characteristics associated with variation in 28-day mortality rates for very low birth weight infants. Pediatrics. 1997;99(2):149-56.
Lau C, Ambalavanan N, Chakraborty H, Wingate MS, Carlo WA. Extremely low birth weight and infant mortality rates in the United States. Pediatrics. 2013;131(5):855-60.
Maitre NL, Ballard RA, Ellenberg JH, Davis SD, Greenberg JM, Hamvas A, et al. Respiratory consequences of prematurity: evolution of a diagnosis and development of a comprehensive approach. Journal of Perinatology. 2015;35(5):313-21.
Thébaud B, Goss KN, Laughon M, Whitsett JA, Abman SH, Steinhorn RH, et al. Bronchopulmonary dysplasia. Nature reviews Disease primers. 2019;5(1):1-23.
Mahle WT, Clancy RR, McGaurn SP, Goin JE, Clark BJ. Impact of prenatal diagnosis on survival and early neurologic morbidity in neonates with the hypoplastic left heart syndrome. Pediatrics. 2001;107(6):1277-82.
Foreman SW. Maturation of State Organization in Preterm Infants During Hospitalization in the Neonatal Intensive Care Unit: University of Washington; 2007.
Foreman SW, Thomas KA, Blackburn ST. Individual and gender differences matter in preterm infant state development. Journal of Obstetric, Gynecologic & Neonatal Nursing. 2008;37(6):657-65.
Mirmiran M, Ariagno RL, editors. Influence of light in the NICU on the development of circadian rhythms in preterm infants. Seminars in Perinatology; 2000: Elsevier.
Holditch-Davis D, Scher M, Schwartz T, Hudson–Barr D. Sleeping and waking state development in preterm infants. Early human development. 2004;80(1):43-64.
Allen KA. Promoting and protecting infant sleep. Advances in neonatal care: official journal of the National Association of Neonatal Nurses. 2012;12(5):288.
Owens JA, Fernando S, Mc Guinn M. Sleep disturbance and injury risk in young children. Behavioral sleep medicine. 2005;3(1):18-31.
Boxwell G, Petty J, Kaiser L. Neonatal intensive care nursing: Routledge London; 2000.
Hoelzle M, Weiss M, Dillier C, Gerber A. Comparison of awake spinal with awake caudal anesthesia in preterm and ex‐preterm infants for herniotomy 1. Pediatric Anesthesia. 2010;20(7):620-4.
Gaspardo CM, Miyase CI, Chimello JT, Martinez FE, Linhares MBM. Is pain relief equally efficacious and free of side effects with repeated doses of oral sucrose in preterm neonates? PAIN®. 2008;137(1):16-25.
Owens JA, Spirito A, McGuinn M. The Children's Sleep Habits Questionnaire (CSHQ): psychometric properties of a survey instrument for school-aged children. Sleep-New York-. 2000;23(8):1043-52.
Fallahzadeh H, Etesam F, Asgarian FS. Validity and reliability related to the Persian version of the Children’s Sleep Habits Questionnaire. Sleep and Biological Rhythms. 2015;13(3):271-8.
Mindell JA, Owens J, Alves R, Bruni O, Goh DY, Hiscock H, et al. Give children and adolescents the gift of a good night’s sleep: a call to action. Sleep Medicine. 2011;12(3):203.
Moore M, Allison D, Rosen CL. A review of pediatric nonrespiratory sleep disorders. Chest. 2006;130(4):1252-62.
Hart CN, Cairns A, Jelalian E. Sleep and obesity in children and adolescents. Pediatric Clinics. 2011;58(3):715-33.
Varma P, Conduit R, Junge M, Jackson ML. Examining sleep and mood in parents of children with sleep disturbances. Nature and Science of Sleep. 2020;12:865.
Trickett J, Bernardi M, Fahy A, Lancaster R, Larsen J, Ni Y, et al. Disturbed sleep in children born extremely preterm is associated with behavioural and emotional symptoms. Sleep Medicine. 2021;85:157-65.
Manti F, Giovannone F, Aceti F, Giacchetti N, Fioriello F, Maugeri A, et al. Unraveling the Relationship between Sleep Problems, Emotional Behavior Disorders, and Stressful Life Events in Preschool Children. Journal of Clinical Medicine. 2022;11(18):5419.
Altevogt BM, Colten HR. Sleep disorders and sleep deprivation: an unmet public health problem. 2006.
Singareddy R, Moole S, Calhoun S, Vocalan P, Tsaoussoglou M, Vgontzas AN, et al. Medical complaints are more common in young school-aged children with parent reported insomnia symptoms. Journal of clinical sleep medicine. 2009;5(6):549-53.
Calhoun SL, Fernandez-Mendoza J, Vgontzas AN, Liao D, Bixler EO. Prevalence of insomnia symptoms in a general population sample of young children and preadolescents: gender effects. Sleep medicine. 2014;15(1):91-5.
Kalmbach DA, Anderson JR, Drake CL. The impact of stress on sleep: pathogenic sleep reactivity as a vulnerability to insomnia and circadian disorders. Journal of sleep research. 2018;27(6):e12710.
Grupe DW, Nitschke JB. Uncertainty and anticipation in anxiety: an integrated neurobiological and psychological perspective. Nature Reviews Neuroscience. 2013;14(7):488-501.
Anderson E, Shivakumar G. Effects of exercise and physical activity on anxiety. Frontiers in psychiatry. 2013;4:27.
Blume C, Garbazza C, Spitschan M. Effects of light on human circadian rhythms, sleep and mood. Somnologie. 2019;23(3):147-56.
Brockmann PE, Diaz B, Damiani F, Villarroel L, Núñez F, Bruni O. Impact of television on the quality of sleep in preschool children. Sleep medicine. 2016;20:140-4.
Perrault AA, Bayer L, Peuvrier M, Afyouni A, Ghisletta P, Brockmann C, et al. Reducing the use of screen electronic devices in the evening is associated with improved sleep and daytime vigilance in adolescents. Sleep. 2019;42(9):zsz125.
Chang AM, Santhi N, St Hilaire M, Gronfier C, Bradstreet DS, Duffy JF, et al. Human responses to bright light of different durations. The Journal of physiology. 2012;590(13):3103-12.
Lionetti F, Dellagiulia A, Verderame C, Sperati A, Bodale G, Spinelli M, et al. The Children's Sleep Habits Questionnaire: Identification of sleep dimensions, normative values, and associations with behavioral problems in Italian preschoolers. Sleep Health. 2021;7(3):390-6.
Waumans RC, Terwee CB, Van den Berg G, Knol DL, Van Litsenburg RR, Gemke RJ. Sleep and sleep disturbance in children: Reliability and validity of the Dutch version of the Child Sleep Habits Questionnaire. Sleep. 2010;33(6):841-5.
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