Background Sleep problems and cumulative risk factors (e.g., caregiver depression, socioeconomic disadvantage) have independently been linked to adverse child development, but few studies have examined the interplay of these factors. We examined whether cumulative risk exposure moderated the link between sleep problems, including insomnia and poor sleep health, and child psychological outcomes. Methods 205 caregiver-child dyads (child Mage = 3.3 years; 53.7% girls; 62.9% Black, 22.4% non-Latinx White, and 4.4% Latinx; 85.4% maternal caregiver reporter) completed child sleep, family sociodemographic, and child psychological functioning (internalizing, externalizing, and executive functioning) questionnaires. Indexes of cumulative risk exposure, insomnia symptoms, and poor sleep health were created. Results Ninety percent of children had ≥1 cumulative risks, 62.9% had ≥1 insomnia symptom, and 84.5% had ≥1 poor sleep health behavior. Increased insomnia symptoms were significantly associated with increased child internalizing, externalizing, and global executive functioning impairments controlling for child age, race/ethnicity, and sex. Poor sleep health behaviors were associated with internalizing concerns. Cumulative risk exposure was not associated with outcomes but moderated the association between insomnia symptoms and all psychological outcomes, such that children with higher cumulative risk exposure and insomnia symptoms had the greatest impairments. Children with the poorest sleep health behaviors and highest cumulative risks had the greatest internalizing concerns. Conclusions Insomnia symptoms in particular are associated with poor child outcomes, which are exacerbated when accompanied by greater cumulative risk exposure. Clinicians should assess sleep when treating early psychological concerns, especially within the context of increased cumulative risks.

中文翻译：

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儿童早期的睡眠问题、累积风险和心理功能

背景 睡眠问题和累积风险因素（例如，看护者抑郁、社会经济劣势）与儿童发育不良独立相关，但很少有研究检验这些因素之间的相互作用。我们检查了累积风险暴露是否能缓和睡眠问题（包括失眠和睡眠健康不佳）与儿童心理结果之间的联系。方法 205 名看护人 - 儿童二人组（儿童法师 = 3.3 岁；53.7% 的女孩；62.9% 的黑人，22.4% 的非拉丁裔白人和 4.4% 的拉丁裔；85.4% 的产妇看护报告人）完成了儿童睡眠、家庭社会人口学和儿童心理功能（内化、外化和执行功能）问卷。创建了累积风险暴露、失眠症状和睡眠健康状况不佳的指数。结果 90%的儿童有≥1个累积风险，62.9%有≥1个失眠症状，84.5%有≥1个不良睡眠健康行为。失眠症状的增加与儿童内化、外化和控制儿童年龄、种族/民族和性别的全球执行功能障碍的增加显着相关。不良的睡眠健康行为与内化担忧有关。累积风险暴露与结果无关，但会缓和失眠症状与所有心理结果之间的关联，因此具有较高累积风险暴露和失眠症状的儿童的损害最大。睡眠健康行为最差、累积风险最高的儿童具有最大的内化担忧。结论 失眠症状尤其与儿童结局不佳有关，当伴随着更大的累积风险暴露时，这种情况会加剧。临床医生在治疗早期心理问题时应评估睡眠，尤其是在累积风险增加的情况下。