Sleep Problems In Adolescents Research Articles

0962 CONCOMITANT AND LONGITUDINAL CHILDHOOD SLEEP CHARACTERISTICS ASSOCIATED WITH EXTERNALIZING PROBLEMS DURING ADOLESCENCE

Sleep problems have been linked to externalizing problems during adolescence. There is limited knowledge as to the temporal childhood sleep characteristics and subsequent adolescent externalizing problems. Our aims were 2-fold: 1) to examine whether sleep characteristics are concomitantly associated with externalizing problems at 15 years and 2) to investigate whether childhood sleep characteristics predicted externalizing problems at 15 years. Longitudinal data on 1441 children were collected by questionnaires and interviews from 5 months to 15 years (13 waves). At 15 years, sleep characteristics and externalizing problems were completed according to the adolescent’s opinion. Childhood sleep characteristics trajectories (nocturnal sleep duration, nocturnal awakening duration and sleep latency) were completed according to the mother’s opinion (2.5 months to 10 years). Pearson correlations, t-tests and Anovas were performed (p<.05). Concomitant associations were found for sleep need (p=0.01), total sleep time during weekdays (p<0.001), daytime drossiness (p<0.001) and trouble waking up (p<0.001) except for total sleep time during weekend (n.s). We found that children which followed the long sleep latency trajectory presents significant more externalizing problems at 15 years compared to children which followed the short/normal sleep latency trajectory (p=.02). Concomitant adolescent sleep problems (sleep need, total sleep time during weekdays, daytime drossiness and trouble waking up) are associated with externalizing problems at 15 years whereas childhood long sleep latency predicted the emergence of externalizing problems at 15 years. Institute of Statistics of Quebec.

The SENSE Study: Treatment Mechanisms of a Cognitive Behavioral and Mindfulness-Based Group Sleep Improvement Intervention for At-Risk Adolescents.

The aim of this study was to test whether a cognitive behavioral and mindfulness-based group sleep intervention would improve sleep and anxiety on school nights in a sample of at-risk adolescents. We also examined whether benefits to sleep and anxiety would be mediated by improvements in sleep hygiene awareness and presleep hyperarousal. Secondary analysis of a randomized controlled trial conducted with 123 adolescent participants (female = 60%; mean age = 14.48) who had high levels of sleep problems and anxiety symptoms. Participants were randomized into a sleep improvement intervention (n = 63) or active control "study skills" intervention (n = 60). Preintervention and postintervention, participants completed the Pittsburgh Sleep Quality Index (PSQI), Spence Children's Anxiety Scale (SCAS), Sleep Beliefs Scale (SBS), and Presleep Hyperarousal Scale (PSAS) and wore an actiwatch and completed a sleep diary for five school nights. The sleep intervention condition was associated with significantly greater improvements in actigraphy-measured sleep onset latency (SOLobj), sleep diary measured sleep efficiency (SEsubj), PSQI, SCAS, SBS, and PSAS, with medium to large effect sizes. Improvements in the PSQI and SCAS were specifically mediated by the measured improvements in the PSAS that resulted from the intervention. Improvements in SOLobj and SEsubj were not specifically related to improvements in any of the putative treatment mechanisms. This study provides evidence that presleep arousal but not sleep hygiene awareness is important for adolescents' perceived sleep quality and could be a target for new treatments of adolescent sleep problems.

Disentangling the effects of depression on trajectories of sleep problems from adolescence through young adulthood

BackgroundLittle is known about the differential influences of between- and within-person effects of depression as well as its long-term impacts on sleep problems in adolescents. This study aims to disentangle these differences by estimating three effects of depression (i.e., long-term, immediate, and fluctuating). MethodsThe sample included 1345 males and 1283 females in Taiwan. In multilevel models, the between- (i.e., long-term and immediate) and within-person (i.e., fluctuating) effects were estimated by using the average and time-varying scores of depression, respectively. The interactions between long-term and the other effects were also tested to determine the moderating effects of long-term influences. ResultsSignificant immediate and long-term effects of depression were found for both sexes, indicating that adolescents with higher levels of depression were at increased risks for future sleep problems. For females only, the long-term effects further exacerbated the negative influences of immediate effects of depression on sleep problems. Moreover, the fluctuating effects were found to change over time in females and the influences were more pronounced in young adulthood. LimitationsThe self-reported measures of both depression and sleep problems may produce common method variance and bias the results. Our measurements were adapted from various existing scales to increase their applicability; therefore, the internal consistency was not high. ConclusionsOur findings provide insight regarding who is at risk for sleep problems and when this risk would occur based on the effects of depression. They also highlight the importance of both immediate and long-term effects of depression on development of sleep problems.

Sleep problems in children and adolescents at pediatric clinics.

PurposeTo investigate the frequency of childhood sleep problems at pediatric clinics in Seoul and Gyeonggi provinces.MethodsChildren (n=936) and their parents who visited 5 primary and 1 secondary pediatric outpatient clinics were invited to complete a Pediatric Sleep Questionnaire.ResultsAmong patients, 901 (96.3%) answered questionnaires in sufficient detail for evaluation. The participant's mean age was 4.35±3.02 years (range, 0–18 years). The male to female ratio was 1:0.93 (466 boys, 435 girls). Habitual snoring (>3 day/week) was reported in 16.9% of the participants. The prevalence of habitual snoring in children <2 years and those between 2–5 years was 9% and 18%, respectively. Sleep disordered breathing was found in 15.1% (106 of 700) of children >2 years. Insomnia was reported in 13.2% of children. The prevalence of sleepwalking, night terrors, and bruxism, is 1.6%, 19%, and 21.1%, respectively. Snoring was associated with increased incidence of sleepwalking, night terrors, and bruxism. Age was associated with insomnia and habitual snoring (P<0.05). Insomnia was more prevalent in younger (21%) than in older children (6%). Snoring was more frequent in both preschool (34%) and school-aged children (33%). The frequency of sleep disordered breathing and insomnia did not vary significantly with gender. However, snoring was more prevalent in boys.ConclusionSleep problems are frequent among children in Korea. Children with snoring have an increased risk of sleepwalking, night terror, and bruxism. Primary clinicians should consider children's sleep habits to improve their health.

Characteristics of Sleep in a Pediatric Population Seeking Mental Health Services

This study explored characteristics of sleep and other presenting problems in children and adolescents seeking mental health services within an outpatient clinic. Primary caregivers seeking outpatient mental health services for their children between the ages of 2 - 18 completed a measure assessing various aspects of their children’s sleep, emotional and behavioral problems, and use of electronics at bedtime. Results showed reduced sleep durations compared to recommended guidelines. Results also indicated that sleep duration was negatively associated with the total number of problems listed for both the youngest and school aged groups. Children and adolescents with worries and fears, irritability, and mood swings had significantly less sleep, and participants with sadness had longer sleep latencies. Regarding use of electronics, participants with televisions in the bedroom reported significantly less hours of sleep than those without. The average number of hours of television watched per week was positively correlated with the number of minutes of sleep latency, while videogame usage was negatively correlated with sleep duration. The study results indicated that sleep disturbances are significant issues impacting youth who are experiencing mental health issues. These results also emphasize the importance of a thorough sleep assessment for children who present for mental health services.

Relationships Between Smoking and Sleep Problems in Black and White Adolescents

The relationship between sleeping and smoking during adolescence remains unclear and is likely complex. We aim to evaluate the longitudinal reciprocal associations between sleep problems, sleep duration, and smoking among non-Hispanic white (NHW) and non-Hispanic black (NHB) youth.Prospective cohort study.NEXT Generation Health Study.A national sample (N = 1394) of NHB and NHW 10th graders were surveyed annually between 2009 (Wave 1) and 2012 (Wave 3).N/A.Past 30-day smoking, chronic difficulty falling asleep, recent difficulty falling asleep, difficulty staying asleep, and weekday and weekend sleep duration were measured at each wave. Using structural equation models, we observed significant autocorrelations over time for sleep problems and sleep duration. We found significant reciprocal, prospective relationships between smoking and sleep problems. The strengths of the relationships differed by race, with a stronger association between sleep problems and subsequent smoking for NHB than NHW youth. Conversely, a stronger association between smoking and subsequent sleep problems for NHW than NHB youth was observed. These association were independent of demographics, snoring or sleep apnea, body mass index, depressive symptoms, alcohol use, and soda consumption.Reciprocal and prospective relationships exist for youth smoking and sleep problems and duration in both NHW and NHB youth. Further research is needed to unravel the complex relationship between the direct effects of nicotine, lifestyle choices that may link smoking and sleep problems, and racial differences.

Morningness–eveningness correlates with sleep time, quality, and hygiene in secondary school students: a multilevel analysis

At the onset of puberty, students shift their sleep to later hours, but school starts early. It is suggested that evening orientation and early school start times do not go well together. Therefore, the aim of this study was to investigate sleep problems in adolescence, and it was expected that the adolescents' eveningness orientation is associated with many sleep-related problems. Students of secondary education (n = 3201; mean = 13.8 ± 1.8 years) filled out a self-report questionnaire containing measures of morningness–eveningness, sleep time (midpoint of sleep, social “jetlag”), sleep length (on schooldays and on weekends), sleep quality, and sleep hygiene as well as questions on electronic screen media use. The impact of circadian preference on sleep time (midpoint of sleep and social jetlag), sleep length (on schooldays and on weekends), sleep quality, and sleep hygiene of adolescents was tested via multilevel analyses while controlling for covariates on the student level (age, sex, screen media use, and time leaving home) and on the class level (school type, grade level, and school start time). Morningness–eveningness was a significant predictor of all dependent variables and associations were highest (β > 0.40) for midpoint of sleep, social jetlag, problems with going to bed, problems with falling asleep, and problems with returning to wakefulness. Providing guidance for parents on sleep hygiene behavior routines for their child, an educational program in sleep hygiene, and later school start times could help to synchronize adolescents' circadian rhythms to daily educational and social demands.

The social gradient of sleep in adolescence: results from the youth@hordaland survey.

Background: A social gradient of sleep problems has been demonstrated in both children and adults, but our knowledge about possible social determinants of adolescent sleep problems remains limited. Methods: A large population-based study in Norway surveyed 10 220 adolescents aged 16–19 years in 2012. Multiple socioeconomic status (SES) indicators and assessment of sleep, including DSM-5 insomnia, sleep duration, weekend–weekdays differences, as well as sleep deficit and delayed sleep phase were included. Results: Insomnia was more frequent among adolescents from families with lower parental education, parents outside the workforce and among adolescents reporting lower perceived family financial circumstances. Adolescents from lower social strata reported a significantly shorter sleep duration, more sleep deficits, later bedtimes and larger weekday–weekend sleep differences. The associations were present across all SES measures. For example, the mean sleep duration was 6:03 (95% CI: 5:55–6:12) among adolescents with mothers with primary school education, compared with sleep duration of 6:24 (95% CI: 6:20–6:27) and 6:35 (95% CI: 6:31–6:38) among adolescent with mothers having a secondary school and university degree, respectively ( P < 0.001). The highest rate of insomnia was found in families with worse perceived financial circumstances (32%), when compared with 17–18% in families with better perceived financial circumstances. Depressive symptoms and family cohesion could account for some, but not all of the association. Conclusions: Lower SES was a robust determinant of adolescent sleep patterns and sleep problems, corroborating evidence of a social gradient in sleep from young children and adults. Targeted intervention for adolescents in low SES may be indicated to improve sleep.

A longitudinal study of the bidirectional relationship between adolescent depression and sleep problems

Objective To explore the bidirectional relationship between adolescent depression and sleep problems using the structural equation model (SEM)approach in a cross-lagged model. Methods The three-round longitudinal data of 1006 adolescents (aged from 12 to 18) were analyzed which were drawn from a longitudinal study named Chinese Adolescent Mental Health Research Program.The adolescents were assessed with the Center for Epidemiological Studies Depression Scale(CES-D) and Pittsburgh Sleep Quality Index(PSQI). The studies were conducted about every 12 months in three years. Results The scores of depression were 5.55±4.70 at first round, 6.68±5.68 at the second round and 7.00±5.41 at the third round.The scores of sleep problems were 5.01±2.72 at the second round and 5.25±2.76 at the third round. The correlation analyses showed that there were significant cross-sectional and cross-waves correlations between depression and sleep problems(r=0.20~0.56, P 0.05). Conclusion There is a stable bidirectional relationship between adolescent depression and sleep problems across time instead of a one-way relationship. Adolescent depression and sleep problems can predict each other during adolescent development. Key words: Sleep; Depression; Adolescent; Bidirectional relationship

The association between maternal postnatal depressive symptoms and offspring sleep problems in adolescence

Sleep problems are associated with increased risk of physical and mental illness. Identifying risk factors is an important method of reducing public health impact. We examined the association between maternal postnatal depression (PND) and offspring adolescent sleep problems. The sample was derived from Avon Longitudinal Study of Parents and Children (ALSPAC) participants. A sample with complete data across all variables was used, with four outcome variables. A sensitivity analysis imputing for missing data was conducted (n = 9633). PND was associated with increased risk of sleep problems in offspring at ages 16 and 18 years. The most robust effects were sleep problems at 18 years [adjusted odds ratio (OR) for a 1 s.d. increase in PND, 1.26, 95% confidence interval (CI) 1.15-1.39, p < 0.001] and waking more often (adjusted OR 1.14, 95% CI 1.05-1.25, p = 0.003). This remained after controlling for confounding variables including antenatal depression and early sleep problems in infancy. PND is associated with adolescent offspring sleep problems. Maternal interventions should consider the child's increased risk. Early sleep screening and interventions could be introduced within this group.

Preschool executive control and sleep problems in early adolescence

ABSTRACTObjective: Although numerous studies have documented the effects of sleep loss on executive control (EC) and related abilities, research examining the impact of early EC on subsequent sleep problems is lacking. Therefore, the current study reports on a longitudinal investigation of EC in preschool as a predictor of sleep–wake problems and daytime sleepiness in early adolescence. Participants: The participants were 141 children (48.6% female) recruited from the community for a longitudinal study spanning preschool through early adolescence, with an oversampling for high sociodemographic risk (34.1% based on eligibility for public medical insurance, free or reduced lunch status, or family income-to-needs below the federal poverty line). Methods: Participants completed a battery of developmentally appropriate tasks assessing major aspects of EC (working memory, inhibitory control, flexible shifting) during a laboratory visit at age 4 years, 6 months. Participants also completed a follow-up session in early adolescence (between ages 11 years and 13.5 years; mean age = 11.82 years, SD = .62 years), during which they completed self-report measures of sleep–wake problems and daytime sleepiness. Results: Structural equation modeling results indicate that preschool EC (represented by a single latent construct) significantly negatively predicted both sleep–wake problems and daytime sleepiness in early adolescence, with poorer EC predicting greater subsequent sleep problems. Conclusions: Poorer EC abilities during the critical period of preschool may be a risk factor for later sleep problems in adolescence. Given that EC appears to be modifiable, early interventions to promote EC development may help prevent subsequent sleep problems and promote long-term health trajectories.

17.0 Bath, Bed, and Beyond: Treating Sleep Problems in Children and Adolescents

17.0 Bath, Bed, and Beyond: Treating Sleep Problems in Children and Adolescents

Sleep problems in adolescents with Asperger syndrome or high-functioning autism

Background Autism is a neurodevelopmental disorder defined by deficits in social interaction, communication, and restricted repetitive behavior. Research studies indicate that children with autism spectrum disorders suffer from more sleep problems than the general population.

Sleep quality among internally displaced Georgian adolescents and population-based controls

Sleep problems in children and adolescents are a significant public health concern and may be linked to a variety of psychoemotional difficulties. This study aimed to evaluate sleep quality and associated factors in conflict-affected Georgian adolescents after 9 months of forced displacement. Thirty-three internally displaced adolescents (mean age 11.4 years) and 33 adolescents (mean age 10.8 years) from the general population completed the Epworth Sleepiness Scale and the Children's Depression Inventory (CDI). Parents completed the Children's Sleep-Wake Scale and provided information on their socioeconomic status (SES) and the adolescents' sleep behavior, academic performance, and peer social relationships. The groups differed significantly in sleep quality, peer relationships, SES, and CDI scores. In the internally displaced group, the only significant predictor of sleep quality was SES, which increased the predictive capacity of the model (demographic and psychosocial variables) by 20% in the hierarchical analyses. The most significant predictor in the non-internally displaced group was CDI. This research indicates that displacement may affect sleep quality and psychosocial functioning. The importance of family SES as a contributing factor to displaced adolescents' poor sleep quality is highlighted. An integrated approach designed to improve the psychosocial environment of internally displaced adolescents is needed for their protection.

Sleep problems in children and adolescents with epilepsy: Associations with psychiatric comorbidity.

Sleep problems are common in pediatric epilepsy and may influence seizure control, daytime functioning, and overall quality of life. Knowledge of factors contributing to sleep problems is likely to improve treatment. The aim of this study was to investigate associations between psychiatric comorbidity and parent-reported and self-reported sleep problems in a sample of children and adolescents with epilepsy. Participants were children and adolescents (N=94), aged 10-19years, with generalized or focal epilepsy who had been referred to a tertiary epilepsy treatment center in Norway. Participants underwent a thorough clinical assessment and 24h of EEG registration. Information on sleep problems was obtained from parents using the Children's Sleep Habit Questionnaire (CSHQ) and from self-reporting using the Sleep Self-Report (SSR) questionnaire. Psychiatric diagnoses were established using the semistructured psychiatric interview Schedule for Affective Disorders and Schizophrenia - Present and Lifetime Version (Kiddie-SADS-PL). Both the total and subdomain CSHQ and SSR scores were high in comparison with scores from population-based samples. Having one or more psychiatric disorder(s) was significantly associated with elevated scores on both the CSHQ and the SSR. With the exception of parent-reported parasomnias, associations between sleep problems and psychiatric disorders remained significant after adjusting for relevant epilepsy variables. Psychiatric comorbidity explained about one-third of the variance of the reported sleep problems in children and adolescents with epilepsy.

Sleepy Teens and Energy Drink Use: Results From an Ethnically Diverse Sample of Youth

ABSTRACTThis study examines the association between use of energy drinks or products (EP), EP expectancies, and the association between EP use and sleep in a racially and ethnically diverse sample (N = 2,485) of adolescents. Prevalence of EP use was approximately 18%, with no statistically significant racial or ethnic differences in prevalence. There were significant racial and ethnic differences in EP expectancies; Hispanic and Multiracial or Other groups endorsed less positive expectancies than Whites and Asians. EP use was significantly associated with later weekend bedtimes, shorter weekend total sleep time (TST), a smaller weekend–weekday difference in TST, and more trouble sleeping, even after adjusting for covariates. There were no significant race or ethnicity interactions between EP use and sleep. EP use is an independent correlate of sleep problems in adolescents across racial or ethnic groups.

What's Keeping Teenagers Up? Prebedtime Behaviors and Actigraphy-Assessed Sleep Over School and Vacation

PurposeTechnology-related behaviors (e.g., computer use) before bedtime (BT) have been associated with poorer and shorter sleep in adolescents; however, less is known about other behaviors in relation to sleep. This study characterized a range of behaviors in the hour before bed (i.e., pre-BT behaviors [PBBs]) and examined their relationship with sleep parameters during school and vacation periods (i.e., restricted and extended sleep opportunities, respectively). Mechanistic roles of chronotype and cognitive presleep arousal (PSAcog) were also examined. MethodsDuring the last week of a school term and throughout a 2-week vacation, 146 adolescents (47.26% male, age M ± standard deviation = 16.2 ± 1.0 years) from the general community completed daily sleep measure using actigraphy, self-report measures on PBBs and PSAcog (Presleep Arousal Scale) for both school and vacation periods, and chronotype (Morningness–Eveningness Questionnaire). ResultsAdolescents engaged in a variety of behaviors before bed. Notably, playing video games was associated with significantly later school and vacation BT and shorter school sleep duration (controlling for chronotype). During vacation, online social media was associated with significantly longer sleep onset latency, and this relationship was mediated by higher PSAcog. In contrast, on school nights, spending time with family was associated with significantly earlier BT and longer sleep duration. ConclusionsTechnology-related PBBs video games and online social media were risk factors for shorter and poorer sleep, whereas time with family was protective of sleep duration. In addressing sleep problems in adolescents, therapeutic procedures that target the potentially addictive nature of technology use and reduce PSAcog were implicated.

Sleep problems and self-harm in adolescence.

Although self-harm and sleep problems are major public health problems in adolescence, detailed epidemiological assessment is essential to understand the nature of this relationship. To conduct a detailed assessment of the relationship between sleep and self-harm in adolescence. A large population-based study in Norway surveyed 10 220 adolescents aged 16-19 years on mental health, including a comprehensive assessment of sleep and self-harm. Adolescents with sleep problems were significantly more likely to report self-harm than those without sleep problems. Insomnia, short sleep duration, long sleep onset latency, wake after sleep on set as well as large differences between weekdays versus weekends, yielded higher odds of self-harm consistent with a dose-response relationship. Depressive symptoms accounted for some, but not all, of this association. The findings highlight a strong relationship between sleep problems and self-harm. Interventions to reduce adolescent self-harm ought to incorporate sleep problems as a treatment target.

Paediatric Off-Label Use of Melatonin--A Register Linkage Study between the Norwegian Prescription Database and Patient Register.

The aims were, for the entire Norwegian population aged 4-17years, to study the prevalence of melatonin use during 2004-2012, recurrent use in incident users and psychiatric and neurological morbidity in recurrent users. Data on dispensed melatonin were retrieved from the Norwegian Prescription Database and linked to diagnostic data from the Norwegian Patient Register. Outcome measures were the following: 1-year prevalence of use, proportion of recurrent use (use over three consecutive 365-day periods among incident users in 2009) and annual number of milligrams and number of prescriptions dispensed in recurrent users. The prevalence of registered ICD-10 diagnoses during the period of 2008-2012 was given for the recurrent users. The prevalence of melatonin use increased annually in both genders during 2004-2012 (boys: 3.4-11.0 per 1000; girls: 1.5-7.7 per 1000). Twenty-nine per cent of boys and 23% of girls were recurrent melatonin users, with highest level of recurrent use among the youngest (aged 4-8years; boys: 47%, girls: 42%). In the third year, the median annual amount of melatonin dispensed was 1080 (IQR 586-1800) milligrams in boys and 900 (IQR 402-1620) milligrams in girls. Among recurrent users, 91% had a diagnosis of either psychiatric (84%) or neurological (32%) disorder. Off-label recurrent use of melatonin seems to have acquired a role mainly in treating secondary sleep problems in children and adolescents with psychiatric and neurological disorders. Once melatonin has been started, a large proportion of patients continue for at least 3years, in doses corresponding to daily use in the majority.

Evaluation of novel school-based interventions for adolescent sleep problems: does parental involvement and bright light improve outcomes?

ObjectivesThe current study aimed to evaluate school-based motivational sleep education programs (SEPs) with adjunct bright light therapy (BLT) and/or parental involvement (PI). DesignRandomized controlled trial. SettingSix high schools, matched on socio-economic status (SES). ParticipantsA total of 193 adolescents (mean age, 16.3 ± 0.4 years, 79%f). InterventionClasses were randomly assigned to (i) SEP + BLT, (ii) SEP + PI, (iii) SEP + BLT + PI, or (iv) classes-as-usual (CAU). Sleep education programs involved 4×50 minute classes (over 4 weeks) based on a Motivational Interviewing framework (Sleep Med 2011;12:246-251). Students in BLT groups attempted a weekend phase advance using portable green light LED glasses (500 nm; 506 lux). Parents of PI groups watched a series of 4 YouTube clips (2-3 minutes in length) outlining their adolescent's learning in class and how they could assist. Students in the CAU groups continued their regular classes. MeasurementsOnline questionnaires measuring sleep knowledge, sleep patterns (bedtime, sleep latency, total sleep time [TST], etc) and mood at preintervention and postintervention and 6-week follow-up. Intervention groups also completed a motivation-to-change questionnaire and provided qualitative feedback. ResultsImprovements in sleep knowledge (d = 0.59-0.88), sleep onset latency (d = 0.45-0.50), TST (d = 0.32-0.57), and mood (d = 0.24-0.46) were observed in all intervention groups relative to the CAU group. Similar improvements were observed in a subgroup of students identified as having delayed sleep timing (ie, sleep knowledge: d = 0.45-0.92; sleep onset latency: d = 0.59-0.82; TST: d = 0.82-1.18). Increases in motivation to regularize out of bedtimes, obtain morning bright light (BLT groups), and avoid sleeping-in on weekends occurred (all P < .005). ConclusionsThis motivational SEP produced meaningful and similar benefits for adolescents in all intervention groups. Longer BLT (ie, over school holidays) and more intensive parental inclusion should be investigated in future studies.