Psychopathological correlates of early childhood sleep terror: associations with nutritional biomarkers, behavioral dysregulation, and sleep disturbance

Sleep terror (ST) is a common NREM parasomnia in early childhood and may be associated with broader emotional and behavioral dysregulation. However, its links with psychopathological symptoms and nutritional biomarkers remain unclear. This study compared children with ST and healthy controls (HC) in terms of psychopathology, sleep features, and biochemical markers, and explored short-term changes in a subgroup of children with ST receiving supplementation for documented micronutrient deficiencies. Forty-eight children aged 24–60 months with ST and 48 HC were evaluated for sociodemographic, sleep, biochemical, anthropometric, and standardized scale data obtained from electronic medical records. A subset of 25 children with ST with documented micronutrient deficiencies received guideline-based supplementation and had biochemical and scale reassessments after a mean interval of 90.6 days, as part of routine clinical follow-up. Children with ST showed shorter sleep duration and higher rates of bedtime resistance at the nominal level, but these differences did not survive FDR correction (FDR p = .092 and 0.069, respectively). Only nocturnal awakenings remained significant after FDR correction (FDR p = .028). In contrast, total anxiety, behavioral dysregulation, and sleep disturbance scores were markedly higher in the ST group and remained significant after FDR correction (all FDR p < .001). Vitamin D (20.4 vs. 25.8 ng/mL; p = .015, FDR p = .026), vitamin B12 (231.7 vs. 309.4 pg/mL; p = .002, FDR p = .003), and folate (11.3 vs. 13.1 ng/mL; p = .016, FDR p = .028) levels were lower in the ST group. At follow-up, vitamin B12 increased significantly (201.8→281.1 pg/mL; p = .006, FDR p = .009; r = .631, 95% CI [0.237, 0.926]), whereas other biomarkers did not change significantly after FDR correction. Anxiety, behavioral dysregulation, and sleep disturbance scores decreased substantially; however, change-score analyses did not show statistically robust associations between vitamin B12 change and symptom change after FDR correction. ST in early childhood was associated with a multidimensional profile of anxiety, behavioral dysregulation, parent-rated sleep disturbance, and lower vitamin D, vitamin B12, and folate levels. Clinical symptom differences remained robust after FDR correction. During naturalistic follow-up, vitamin B12 increased and symptom scores decreased, but change-score analyses did not support a direct biomarker–symptom association. These findings should be interpreted as hypothesis-generating. Larger prospective, controlled studies are needed to clarify the role of micronutrient status in early childhood ST.