Abstract
BackgroundThe aims of this study were to estimate the prevalence of Delayed Sleep Phase Syndrome (DSPS) in adolescence, and to examine the association to insomnia and school non-attendance.MethodsData stem from a large population based study in Hordaland County in Norway conducted in 2012, the ung@hordaland study. In all, 10,220 adolescents aged 16–18 years (54% girls) provided self-reported data on a range of sleep parameters: DSPS was defined according to the International Classification of Sleep Disorders, Revised (ICSD-R) criteria, while insomnia was defined according to the Quantitative Criteria for Insomnia. Other sleep parameters included time in bed, sleep duration, sleep efficiency, oversleeping, sleep onset latency, wake after sleep onset, subjective sleep need, sleep deficiency, sleepiness and tiredness. Sleep data were calculated separately for weekdays and weekends. Data on school non-attendance were provided by official registers.ResultsThe prevalence of DSPS was 3.3%, and significantly higher among girls (3.7%) than boys (2.7%). There was a strong overlap between DSPS and insomnia, with more than half of the adolescents with DSPS also meeting the criteria for insomnia (53.8% for boys and 57.1% for girls). Adolescents with DSPS had significantly higher odds ratios (OR) of non-attendance at school. After adjusting for sociodeographical factors, insomnia and depression, the adjusted ORs for days of non-attendance were OR = 3.22 (95% CI: 1.94-5.34) for boys and OR = 1.87 (95% CI: 1.25-2.80) for girls. A similar effect was found for hours of non-attendance for boys, with an adjusted OR = 3.05 (95% CI: 1.89-4.92). The effect for girls was no longer significant after full adjustment (OR =1.48 [95% CI: 0.94-2.32]).ConclusionsThis is one of the first studies to estimate the prevalence of DSPS in adolescents. The high prevalence of DSPS, and overlap with insomnia, in combination with the odds of school non-attendance, suggest that a broad and thorough clinical approach is warranted when adolescents present with symptoms of DSPS.
Highlights
The aims of this study were to estimate the prevalence of Delayed Sleep Phase Syndrome (DSPS) in adolescence, and to examine the association to insomnia and school non-attendance
Previous epidemiological studies of adolescents using different operationalizations of DSPS have estimated prevalence rates from 1.9% [8] in a study basing the definition of DSPS on the International Classification of Sleep Disorders (ICSD-R), to 8.4% [9] employing a much wider definition
The review concluded that DSPS was likely to be underestimated in adolescence due to the general sleep pattern in adolescents mirroring some of the sleep characteristic of DSPS [10]
Summary
The aims of this study were to estimate the prevalence of Delayed Sleep Phase Syndrome (DSPS) in adolescence, and to examine the association to insomnia and school non-attendance. No studies have used these new criteria, two previous studies, surveying the general population with age ranges from adolescence to adults, based their estimates on multiphased assessments with screening questionnaires, sleep diaries as well as on clinical interviews. These two studies concluded on prevalence rates from 0.13% to 0.17% [5,6]. Previous epidemiological studies of adolescents using different operationalizations of DSPS have estimated prevalence rates from 1.9% [8] in a study basing the definition of DSPS on the International Classification of Sleep Disorders (ICSD-R), to 8.4% [9] employing a much wider definition. Since trend studies suggest an increase in sleep onset difficulties among adolescents [11] new and updated surveys of the prevalence of DSPS are warranted
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