UC San Diego

The effects of prenatal alcohol exposure on sleep quality have been understudied, and the possibility that sleep disturbances contribute to deficits in other domains has not been explored. The current study aimed to characterize sleep quality in children with fetal alcohol spectrum disorders (FASD) and understand relationships with neurobehavioral functioning.Participants aged 6-10 years with (alcohol-exposed [AE] = 27) and without (control [CON] = 27) prenatal alcohol exposure were included in the study. Objective sleep was measured via 24-hour actigraphy for two weeks. Parents completed sleep diaries and sleep questionnaires (Children’s Sleep Habits Questionnaire, Pediatric Sleep Questionnaire). Children completed neuropsychological testing (NIH Toolbox Cognition Battery) and parents completed the Child Behavior Checklist (CBCL) and Behavior Rating Inventory of Executive Functioning – Second Edition (BRIEF-2) as measures of problem behaviors and executive functioning skills. For a subset of participants (n = 31), neuropsychological assessment was modified and conducted remotely due to COVID-19. Multivariate analysis of variance was used to characterize the sleep profile (objective, subjective) and examine group differences. Multiple regression examined the relationships between sleep quality and neurobehavioral performance. There were no group differences on actigraphy metrics averaged across two weeks; however, AE showed significantly greater intraindividual variability on most actigraphy measures, particularly total sleep time. Parents reported significantly more sleep problems in AE than CON, primarily driven by sleep onset delay, night wakings, and daytime sleepiness. AE performed significantly lower than CON on the subset of cognitive measures administered to the full sample. CBCL and BRIEF-2 scores were significantly higher for AE compared to CON, reflecting more behavioral and executive functioning problems. Greater sleep time variability was significantly correlated with poorer memory performance and more behavior problems, but did not moderate effects of group. There were no significant differences between the pre-COVID and COVID samples. Despite similar two-week average sleep outcomes, children with FASD showed greater intraindividual sleep variability and parents reported more sleep problems. Across the sample, greater sleep time variability was associated with poorer episodic memory and more behavior problems. Interventions targeting variability in sleep, particularly sleep duration variability, may improve sleep quality and some aspects of cognition and behavior in children with FASD.