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Inadequate Sleep Related to Neurocognitive Difficulties for Children with Insomnia

Disease Spotlight | <b>Disease Spotlight: Insomnia</b>

Fan Nils Yang, PhD, postdoctoral researcher, University of Maryland, provides greater detail on the observational cohort study he did with colleagues, where they identified a link between neurocognitive function in children and insomnia.

Findings from the Adolescent Brain Cognitive Development (ABCD) study showed an association between inadequate sleep with children aged 9 to 10 years old and difficulties in neurocognitive development.1 The results highlighted the great impact that insufficient sleeping habits have on the development of their neurocognitive abilities, as well as focused on the promotion of interventions for children that improve sleeping habits and thus, developmental outcomes.2

In the study, participants were categorized as either insufficient sleepers (n= 4181) or sufficient sleepers (n = 4142). Consistent with previous findings, the data showed that insufficient sleep had widespread effects on baseline behavioral measures. Specifically, 32 of the 42 assessments used showed a significant difference at baseline between the sufficient sleep and insufficient sleep groups after propensity score matching. At the 2-year follow-up, similar patterns and effect sizes were observed. Using the Cohen’s ds of the difference between the sufficient and insufficient sleep groups at 2-year follow-up, investigators found that these effects were significantly correlated with one another (r = 0.85; 95% CI, 0.73-0.92; P <.001), suggesting that insufficient sleep has stable effects on adolescents’ behavioral problems, neurocognition, and mental health.

Coauthor, Fan Nils Yang, PhD, postdoctoral researcher, University of Maryland, was interviewed by NeurologyLive® to discuss further details about the study, including his thoughts on what their findings mean for future patients with insomnia and recommendations for future studies.

NeurologyLive®: Could you explain more about the study you conducted?

Fan Nils Yang, PhD: In this study, we provide strong evidence about the impact of insufficient sleep on early adolescents’ brain and behavior over two years. Specifically, by utilizing a population-based sample from the ABCD study (more than 11k 9-10-year-olds) and advanced statistical methods, we found that sleep less than 9 hours per day is associated with compromised cognitive and affective functions at both baseline and two-year follow-up. We also identified two neural mechanisms that underlie these impacts of insufficient sleep. Our findings might provide empirical and theoretical groundings for early sleep intervention programs to improve long-term developmental outcomes in adolescence.

What could your study mean for the future of patients with insomnia?

Adolescence is a crucial period for brain and cognitive development. For adolescents with insomnia, our study demonstrated what could the consequences of sleep loss be. For example, if someone consistently sleeps less than the recommended duration due to insomnia, the brain regions responsible for emotional regulation and memory will be underperforming, which in turn causes affective and cognitive dysfunctions. Given that these consequences could be long-lasting based on our study, early intervention for insomnia is needed for adolescents. Moreover, previous studies3 have shown that sleep problems and mental issues could reciprocally aggravate each other. Treating the underlying cause is as important as maintaining good sleep hygiene.

Did you find anything surprising in your results?

There are two results that surprised us. First, I did not expect the impacts of insufficient sleep at baseline on the brain and behavior is stable at the two-year follow-up. In other words, if a child did not have enough sleep at age 10, their brain and behavior at age 12 would still suffer from the consequences of lack of sleep. Second, previous literature suggests that fluid intelligence is more susceptible to sleep loss in children than crystallized intelligence. In contrast, our study shows the opposite. This discrepancy might be because we have a large sample size and carefully controlled key covariates of sleep duration that might not be possible in the previous research.

What should be done in future studies in this field of research?

We demonstrated that sleep duration has long-lasting impacts on the brain and behavior. Future studies may test whether these impacts are reversible or not, and if it is reversible, what’s the best intervention for the insufficient sleep-induced effects.

1. Yang FN, Xie W, Wang Z. Effects of sleep duration on neurocognitive development in early adolescents in the USA: a propensity score matched, longitudinal, observational study. Lancet Child Adolesc Health. 2022;6(10):705-712. doi:10.1016/S2352-4642(22)00188-2
2. University of Maryland School of Medicine. Children who lack sleep may experience detrimental impact on brain and cognitive development that persists over time: Research finds getting less than nine hours of sleep nightly associated with cognitive difficulties, mental problems, and less gray matter in certain brain regions. ScienceDaily. July 30, 2022. Accessed October 19, 2022. www.sciencedaily.com/releases/2022/07/220730125455.htm
3. Yang FN, Liu TT, Wang Z. Functional connectome mediates the association between sleep disturbance and mental health in preadolescence: A longitudinal mediation study. Hum Brain Mapp. 2022;43(6):2041-2050. doi:10.1002/hbm.25772