Sleep problem profiles, hyperactivity-inattention, and psychosocial health among high-altitude preschool children

Abstract Background Sleep is closely related to children’s behavioral regulation and psychosocial functioning, yet preschool sleep is multidimensional and may vary substantially between children. High-altitude residence provides a distinctive ecological context for studying sleep. However, little is known about heterogeneity in measured sleep characteristics among preschool children living at high altitude, or how such heterogeneity relates to behavioral and psychosocial adjustment. This study identified sleep-problem profiles among high-altitude preschool children and examined their associations with hyperactivity-inattention, psychosocial health, and other adjustment outcomes. Methods This cross-sectional study included 244 preschool children from Lhasa, Xizang, China (approximately 3,650 m). Caregiver-reported sleep indicators included six sleep-problem dimensions and weekday and weekend sleep duration. Latent profile analysis identified sleep-problem profiles. Multivariable logistic regression examined correlates of profile membership. Profile differences in behavioral difficulties, health-related quality of life, and academic achievement were examined. Hierarchical regression was further used to examine whether hyperactivity-inattention was associated with psychosocial health after accounting for sleep-profile membership and covariates. Findings Two sleep-problem profiles were identified: a lower sleep-problem profile and a higher sleep-problem profile. Being an only child was associated with higher odds of membership in the higher sleep-problem profile, whereas daily screen time was not significantly associated with profile membership. Compared with children in the lower sleep-problem profile, those in the higher sleep-problem profile showed higher hyperactivity-inattention and lower psychosocial health. No significant profile differences were found for physical health or academic achievement. In hierarchical regression, hyperactivity-inattention was negatively associated with psychosocial health, and the association between sleep-profile membership and psychosocial health was attenuated but remained significant after hyperactivity-inattention was included. Conclusion Two profiles differing primarily in overall sleep-problem severity were identified among high-altitude preschool children. The higher sleep-problem profile was associated with poorer behavioral and psychosocial adjustment but not with concurrent academic achievement. Hyperactivity-inattention may be an important behavioral correlate of poorer psychosocial functioning among children with higher sleep problems.