Psychological and lifestyle predictors of paediatric sleep disturbances: a cross-sectional study
TL;DR
Sleep disturbances are strongly associated with trait anxiety and independently related to evening screen exposure, while parental anxiety appears to exert its effect both directly and, in part, indirectly through child anxiety.
Abstract
Sleep disturbances are frequent in childhood and have been associated with emotional vulnerability and modifiable lifestyle behaviours. The relative and combined contributions of child anxiety, parental anxiety, and unstructured daily routines to paediatric sleep disturbances remain incompletely characterized. We conducted a cross-sectional study of 306 otherwise healthy children aged 3–14 years. Parents completed validated questionnaires assessing sleep disturbances, child anxiety, parental anxiety, and daily lifestyle habits, including evening screen exposure. Multivariable linear regression, mediation, and cluster analyses were performed to identify correlates of sleep disturbances and distinct profiles. Clinically significant sleep disturbances were identified in 39.2% of participants. Higher child trait anxiety was consistently associated with greater sleep disturbance severity (all P < .001). Evening screen exposure was independently associated with higher sleep disturbance scores (P < .05). Parental trait anxiety not directly associated with sleep disturbances both directly and indirectly through child trait anxiety, which mediated approximately 30% of the association (P < .001). Cluster analysis identified three distinct profiles, including two groups with comparable sleep disturbance severity but contrasting characteristics: one marked by high emotional vulnerability and one by predominant lifestyle dysregulation. Conclusion: Sleep disturbances are strongly associated with trait anxiety and independently related to evening screen exposure, while parental anxiety appears to exert its effect both directly and, in part, indirectly through child anxiety. Similar sleep complaints may reflect different underlying emotional and lifestyle mechanisms. A multidimensional assessment integrating anxiety screening and evaluation of evening habits may improve early identification of at-risk children and support targeted preventive strategies within routine paediatric care. What is Known: • Paediatric sleep disturbances are common and linked to psychological, family and lifestyle risk factors. • Most studies examine these factors in isolation rather than within an integrated framework. What is New: • Child trait anxiety was the strongest correlate of sleep disturbances and partially mediated the effect of parental anxiety; evening screen exposure and later bedtime contributed independently. • Children with similar sleep disturbance severity showed distinct emotional or lifestyle profiles, supporting multidimensional assessment.