Electroencephalographic sleep profiles and hypothalamic–pituitary–adrenocortical (HPA)-activity in kindergarten children : early indication of poor sleep quality associated with increased cortisol secretion

Objectives: In children, objective data carried out from sleep EEG monitoring are scarce. Furthermore, results associating the hypothalamic-pituitary-adrenocortical (HPA)-activity with sleep EEG measurements in children are missing. Therefore, our study aimed to investigate in preschool-children the association between sleep patterns and endocrine activity. Furthermore, children’s behavioral/emotional difficulties and competences were assessed in order to correlate psychological strain with sleep measures. Participants and methods: Sixty-seven kindergarten children (35 boys and 32 girls) aged 5.34 underwent EEG-monitoring for one night. For baseline HPA-activity assessment, saliva samples were collected immediately after awakening, whereas saliva samples before, while and after a psychological challenge were used to assess the HPA-activity under stress conditions. Results: Compared to girls, boys showed significantly more REM sleep time. After cluster analysis, children labeled as ‘poor’ sleepers (n = 27; 40,30%) showed significantly increased morning cortisol values, as compared to ‘good’ sleepers (n = 22; 32,83%). Furthermore, increased cortisol AUC values under stress conditions were significantly associated with an elevated number of awakenings after sleep onset, and more sleep time in stages 1 and 2. In addition, an increased sleep efficiency was significantly correlated with self-reported emotional/behavioral difficulties, i.e. with low degrees of impulsivity (r = -0.31; p < 0.05) and lower degrees of social inhibition and peer victimiziation (r = -0.26, p < 0.05). Conclusions: Our results underlined that already in preschool years, associations between objectively examined unfavorable sleep patterns, increased HPA-system activity and more difficult behavioral and psychosocial dimensions may be observed