STUDY OBJECTIVES To examine the longitudinal and bidirectional association between nighttime sleep duration and emotional and behavioral problems (EBPs) over 15 months among pre-school children. METHOD Data of children aged 2-6 years from the control group of the Danish Healthy Start Study, a 15-month obesity prevention intervention, were used. Nighttime sleep duration was measured using a 7-day sleep record. EBPs were assessed by the Strengths and Difficulties Questionnaire Total Difficulties (SDQ-TD) score and Prosocial Behavior (SDQ-PSB) score. Multivariable regression models were conducted to examine the bidirectional associations between changes in nighttime sleep duration and SDQ scores. RESULTS With adjustment for child, family factors, parental stress level, every hour extra nighttime sleep at baseline was associated with a 1.02 decrease in SDQ-TD score and 77% lower odds of having an abnormal SDQ-TD score (≥90th percentile) at the follow-up (P=0.01). Children who increased their nighttime sleep duration over the 15-month demonstrated a similar concurrent reduction in SDQ-TD score (β=-1.28, P=0.02) compared to those who decreased or had no change in nighttime sleep duration. After additional adjustment for sleep problem and habit variables, the significant associations remained. No associations were found between nighttime sleep duration and SDQ-PSB scores. Examination of SDQ scores as predictors of subsequent changes in nighttime sleep duration showed no significant associations. CONCLUSIONS Among pre-school children, longer nighttime sleep duration was associated with a decline in EBPs, but not vice versa. Our study provides new longitudinal evidence to support sleep interventions to improve EBPs in early childhood.

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夜间睡眠时间与儿童早期情绪和行为问题的纵向关联：丹麦健康开始研究的结果

研究目标 研究 15 个月内学龄前儿童夜间睡眠时间与情绪和行为问题 (EBP) 之间的纵向和双向关联。方法 使用丹麦健康开始研究（一项为期 15 个月的肥胖预防干预措施）对照组 2-6 岁儿童的数据。使用 7 天的睡眠记录测量夜间睡眠持续时间。EBP通过优势和困难问卷总困难（SDQ-TD）得分和亲社会行为（SDQ-PSB）得分进行评估。进行多变量回归模型以检查夜间睡眠持续时间变化与 SDQ 评分之间的双向关联。结果 调整儿童、家庭因素、父母压力水平后，基线时每增加一小时夜间睡眠与 1. 02 SDQ-TD 评分下降，随访时 SDQ-TD 评分异常（≥90%）的几率降低 77%（P=0.01）。与夜间睡眠时间减少或没有变化的儿童相比，在 15 个月内增加夜间睡眠时间的儿童表现出类似的 SDQ-TD 评分同时降低（β=-1.28，P=0.02）。在对睡眠问题和习惯变量进行额外调整后，显着的关联仍然存在。夜间睡眠持续时间与 SDQ-PSB 评分之间未发现关联。将 SDQ 评分作为夜间睡眠持续时间随后变化的预测因子的检查显示没有显着关联。结论 在学龄前儿童中，较长的夜间睡眠时间与 EBP 的下降有关，但反之则不然。