Infants who slept in their own rooms by age 9 months slept significantly longer and better than those who continued sharing a room with their parents as recommended by the American Academy of Pediatrics, the authors of a prospective study of 279 mother-infant dyads reported June 5.

The findings “raise questions about the well-intended AAP recommendation that room-sharing should ideally occur for all infants until their first birthday,” wrote Ian M. Paul, MD, of Penn State University, Hershey, and his associates (Pediatrics. 2017 Jun 5. doi: 10.1542/peds.2017-0122). “Perhaps our most troubling finding was that room-sharing was associated with overnight transitions to bed-sharing, which is strongly discouraged by the AAP.”

Insufficient sleep leads to excess weight gain during infancy and sleep problems later in childhood and has negative implications for parents. “The desire to optimize infant sleep duration and consolidation, however, must be balanced with safe infant sleep,” the researchers emphasized. About 3,500 infants die annually of SIDS and other sleep-related deaths, about 90% of which occur before age 6 months. Currently, however, the AAP’s updated 2016 recommendations advise that infants sleep on a separate surface in their parents’ room for at least the first 6 months and ideally for 1 year (Pediatrics. 2016; 138:e20162938).

To examine relationships among where, how well, and how long infants slept, the researchers analyzed Brief Infant Sleep Questionnaires collected from first-time mothers of term singletons as part of the prospective, single-center Intervention Nurses Start Infants Growing on Healthy Trajectories (INSIGHT) study.

For 4-month-olds, average reported sleep duration was similar whether they slept alone or in the parental bedroom. Solo sleepers, however, had better sleep consolidation, averaging 46 more minutes of sleep at the longest stretch, compared with room sharers (P = .02). By age 9 months, infants who had slept alone by age 4 months averaged 40 more minutes of nightly sleep than room-sharers and 26 more minutes than infants who began sleeping alone after 4 months of age (P = .008). Furthermore, the average longest sleep span of early solo sleepers was 100 minutes more than that of room-sharers and 45 minutes more than that of infants who began sleeping alone between ages 4 and 9 months (P = .01).

At age 30 months, infants who had slept alone by age 9 months averaged 45 more minutes of nightly sleep than those who had shared a room (P = .004). Room-sharing at 4 months also was tied to a two-fold greater odds of having pillows, blankets, or other unsafe objects on the sleep surface, the researchers said. Together, the findings support revising the AAP recommendation until evidence conclusively supports it, they concluded.

The study’s funders included Penn State University, Hershey; Penn State Children’s Hospital; the U.S. Department of Agriculture; the Penn State Clinical and Translational Science Institute, and the National Institutes of Health/National Center for Advancing Translational Sciences. The investigators reported having no conflicts of interest.