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Nighttime Sleep Duration and Externalizing Behaviors of Preschool Children

Scharf, Rebecca J. MD, MPH*; Demmer, Ryan T. PhD, MPH; Silver, Ellen J. PhD; Stein, Ruth E.K. MD

Journal of Developmental & Behavioral Pediatrics: July/August 2013 - Volume 34 - Issue 6 - p 384–391
doi: 10.1097/DBP.0b013e31829a7a0d
Original Articles

Objective: To examine how many hours preschool children in the United States sleep at night and to test the hypothesis that children with shorter nighttime sleep duration are more likely to exhibit externalizing behaviors.

Methods: The Early Childhood Longitudinal Study-Birth Cohort is a nationally representative longitudinal cohort study that followed children born in 2001 through kindergarten. This cross-sectional study examines the preschool wave (n = ∼8950). We estimated nighttime sleep duration from parent's reports of their 4-year-old child's typical weekday bed and wake times. Parents rated their child on 6 different externalizing behaviors (overactivity, anger, aggression, impulsivity, tantrums, and annoying behaviors) on a scale from 1 through 5 using the Preschool and Kindergarten Behavior Scale—second edition. Multivariable regression analyses were used to examine the association between sleep duration and behavior scores and to control for possible confounders.

Results: Results are weighted to total United States population, ∼3,895,100 children born in 2001. Mean sleep duration was 10.47 hours. Mean bedtime was 8:39 PM and wake time was 7:13 AM. The adjusted odds ratios for children sleeping <9.44 hours (1 standard deviation below the mean) versus those sleeping ≥9.44 hours for 6 different externalizing behavior outcomes were as follows: overactivity = 1.30 (95% confidence interval [CI], 1.03–1.65); anger = 1.40 (95% CI, 1.15–1.71); aggression = 1.81 (95% CI, 1.36–2.41); impulsivity = 1.44 (95% CI, 1.12–1.86); tantrums = 1.46 (95% CI, 1.16–1.85); and annoying behaviors = 1.40 (95% CI, 0.97–1.87).

Conclusion: Shorter nighttime sleep duration in preschool children is associated with higher likelihood of externalizing behavioral symptoms based on parental report.

*Division of Developmental and Behavioral Pediatrics, Department of Pediatrics, University of Virginia, Charlottesville, VA;

Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY;

Department of Pediatrics, Einstein College of Medicine, Bronx, NY.

Address for reprints: Rebecca J. Scharf, MD, MPH, Department of Pediatrics, Division of Developmental and Behavioral Pediatrics, University of Virginia, 2270 Ivy Road, Charlottesville, VA 22903; e-mail:

This investigation was supported by MCHB 2T77MC00009.

Disclosure: The authors declare no conflict of interest.

Received December 08, 2012

Accepted April 10, 2013

© 2013 by Lippincott Williams & Wilkins