Associations between a novel measure of sleep health and cognitive functioning in middle childhood: a crosssectional Environmental Influences on Child Health Outcomes cohort study

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Abstract Study Objectives Research linking children’s sleep to cognitive outcomes is inconsistent and has largely focused on one aspect of sleep, such as duration, rather than measuring multiple dimensions of sleep health. We hypothesized that children’s sleep health would be positively associated with inhibitory control and cognitive functioning. Method We cross-sectionally assessed 1595 participants (ages 7–11) from the Environmental influences on Child Health Outcomes cohort using the NIH Toolbox Cognition Battery, Environmental influences on Child Health Outcomes Sleep Health of Children and Adolescents questionnaire, and Patient Reported Outcome Measurement Information System Sleep Disturbance/Sleep-related Impairment instruments. We created a novel scale measuring sleep health using dichotomous “good–bad” cutoffs for sleep duration, timing, latency, satisfaction, and alertness. We used generalized estimating equations and random forest models to examine associations between sleep health and inhibitory control, working memory, processing speed, cognitive flexibility, episodic memory, reading decoding, and receptive vocabulary. Results Sleep health did not have statistically significant associations with any aspect of cognitive functioning. Notably, over 75 per cent of our sample had good sleep health. Conclusions This study assessed sleep health as a multi-faceted construct, distinguishing between “good” and “poor” sleep health across several domains. The absence of statistically significant associations between sleep health and cognitive functioning suggests children’s cognitive functioning may not be cross-sectionally related to multidimensional sleep health measures. Experimentally manipulating key sleep domains such as duration or timing (as done in prior research) may be more robust. Future research might benefit from examining the cumulative impact of poor sleep health over time. Statement of significance It is essential to identify variables affecting children’s cognitive functioning because it is associated with many important health outcomes. This is the first study, to our knowledge, that captures a multidimensional measure of sleep health and cognitive functioning for children aged 7–11 years, providing results generalizable to a broad range of children, not just those with a cognitive impairment or sleep disorder. By measuring sleep health from a multidimensional standpoint, we avoid the pitfall of simply measuring sleep as the presence/non-presence of a sleep disorder. Our study findings indicate that subjectively measured sleep health is not associated with cognitive functioning in a large, nationally representative sample. Future studies would benefit from measuring sleep health longitudinally, building on our retrospective, cross-sectional study.

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