054 - Relationship between Sleep Problems and Social-Emotional Development at 12 Months of Age among Infants with Antenatal Opioid Exposure and Unexposed Controls

Publication Number: 54.6139

Carla Bann, RTI International, Apex, NC, United States; Jamie E. Newman, RTI International, Carrboro, NC, United States; Nicole Mack, RTI International, Chicago, IL, United States; Sara B.. DeMauro, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States; Namasivayam Ambalavanan, University of Alabama School of Medicine, Birmingham, AL, United States; Deanne Wilson-Costello, Case Western Reserve University School of Medicine, Cleveland, OH, United States; Myriam Peralta-Carcelen, University of Alabama at Birmingham, School of Medicine, Birmingham, AL, United States; Scott A. Lorch, The Children's Hospital of Philadelphia, Philadelphia, PA, United States; Catherine Limperopoulos, Children's National Health System, Washington DC, DC, United States; Jonathan Davis, Tufts Medical Center, Boston, MA, United States; Stephanie L. Merhar, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States

Background: Sleep habits during early childhood can impact child development and caregiver mental health. Limited information is available on the impact of antenatal opioid exposure on sleep beyond the neonatal period.

Objective: To evaluate differences in sleep problems among infants with antenatal opioid exposure and unexposed controls, identify sleep behaviors which are considered problematic, and explore the relationship between sleep problems and social-emotional development at 12 months of age.

Design/Methods: Analyses included 237 infants (155 opioid-exposed and 82 unexposed) enrolled in the ongoing Outcomes of Babies with Opioid Exposure study (Table 1). Caregivers of study infants completed the Brief Infant Sleep Questionnaire (BISQ) and Brief Infant-Toddler Social Emotional Assessment (BITSEA) when the child was 12 months of age. Logistic regression analyses were conducted to examine the relationship between antenatal opioid exposure and caregiver-reported sleep problems, controlling for maternal age, education, race, parity, insurance, C-section, and infant sex. Path analyses were used to examine the relationship between sleep problems and BITSEA scores; non-significant paths for demographic characteristics were removed for model parsimony.

Results: Caregivers of 43 (18%) of the infants reported that they consider their child’s sleep to be a problem. After controlling for demographic characteristics, children with antenatal opioid exposure had significantly higher odds of having problematic sleep (AOR (95% CI)=2.89 (1.22, 6.87), p=0.016) with 21% of children with antenatal opioid exposure having sleep problems compared to 12% of unexposed children (Table 1). Children with sleep problems were more likely to sleep in their parent’s bed (p=0.002), had more awakenings per night (p < 0.001), took longer to put to sleep at night (p=0.010), spent less time sleeping during the night (p < 0.001), and spent more time in wakefulness during the night (p < 0.001) (Table 2). Based on the path model, antenatal opioid exposure, C-section, and non-white race were associated with sleep problems which in turn were associated with higher problem scores and lower competence scores on the BITSEA (Figure 1).

Conclusion(s): Children with antenatal opioid exposure were more likely to have sleep problems based on caregiver report. Presence of sleep problems was associated with more social-emotional problems and poorer competence at 12 months of age. Sleep-related interventions may be helpful for improving social-emotional outcomes among children with antenatal opioid exposure.

Figure 1. Path Diagram of Sleep Problems and BITSEA Scores
Note: * p < 0.05, ** p < 0.001, *** p < 0.001; Model fit indices: CFI=0.96, TLI=0.93, and RMSEA=0.03.

Table 1. Adjusted Odds Ratios of Sleep Problems at 12 Months of Age by Antenatal Opioid Exposure and Demographic Characteristics (N=237)


Table 2. Sleep Habits and Behaviors by Presence of Sleep Problems


Figure 1. Path Diagram of Sleep Problems and BITSEA Scores
Note: * p < 0.05, ** p < 0.001, *** p < 0.001; Model fit indices: CFI=0.96, TLI=0.93, and RMSEA=0.03.

Table 1. Adjusted Odds Ratios of Sleep Problems at 12 Months of Age by Antenatal Opioid Exposure and Demographic Characteristics (N=237)


Table 2. Sleep Habits and Behaviors by Presence of Sleep Problems