Sleep Onset Difficulties Research Articles

Insomnia symptoms as long-term predictors of anxiety symptoms in middle-aged and older adults from the English Longitudinal Study of Ageing (ELSA), and the role of systemic inflammation

Insomnia, i.e., difficulties in sleep onset and sleep maintenance, may increase the risk of anxiety symptoms, although long-term follow-up studies are rarely reported. Here, we examined whether insomnia symptoms may predict anxiety symptoms in a 9-year follow-up, and whether inflammation may play a mediating role. Data from 1355 participants (63.44 ± 7.47 years, 55.1 % females) from the English Longitudinal Study of Ageing (ELSA) were analysed. Insomnia symptoms were assessed in 2012/13. High-sensitivity C-reactive protein (hs-CRP), a marker of systemic inflammation, was measured in 2016/17. Anxiety symptoms were assessed in 2020/21. After adjusting for confounders and baseline levels, structural equation modelling (SEM) revealed that insomnia symptoms significantly predicted anxiety symptoms (β = 0.357, p < .001) but not hs-CRP (β = −0.016, p = .634). Similarly, hs-CRP was not related to anxiety symptoms (β = −0.024, p = .453). The hs-CRP mediation hypothesis was therefore rejected (β = 0.0004; 95 % BCI -0.001 to 0.005), and multi-group SEM showed that sex did not moderate these paths. However, baseline diagnoses of anxiety disorders prospectively predicted higher hs-CRP (B = 0.083, p = .030). Results of the current study suggest that individuals with baseline anxiety disorders may be at higher risk of developing low-grade chronic inflammation. Several alternative psychophysiological mechanisms linking insomnia and anxiety symptoms should be explored, including autonomic and cortical pre-sleep arousal, cortisol reactivity, and pro-inflammatory cytokines. Finally, insomnia symptoms may be a treatment target to lower the risk of anxiety symptoms in elderly.

Intrafamilial associations of sleep multitrajectory groups between ages of 3 and 60 months in the SEPAGES cohort

ObjectivesWe investigated intrafamilial sleep evolution by identifying children’s sleep multitrajectory groups between 3- and 60-month of age and their association with parental sleep multitrajectory groups. MethodsWe included 180 children from the SEPAGES cohort (Grenoble, France) whose parents belonged to previously identified sleep multitrajectory groups, through group-based multitrajectory modeling, between 3 and 36months postpartum, using nighttime (NSD) and weekend daytime (DSD) sleep durations and subjective sleep loss, comprising “No,” “Subjective,” and “Global” sleep problems groups. Child sleep information (NSD, DSD, subjective sleep loss, night waking, and sleep onset difficulties) was collected by parental questionnaires at 3-, 12-, 36-, and 60-month. We identified sleep multitrajectory groups using group-based multitrajectory modeling in children and examined their associations with parental sleep multitrajectory groups using multinomial logistic regressions. ResultsWe identified three sleep multitrajectory groups in children: the “No/few” group (29.4%) had moderate NSD, long DSD, low subjective sleep loss/night waking/sleep onset difficulties prevalence, the “Moderate” group (60.0%) had long NSD and moderate DSD, and medium subjective sleep loss/night waking/sleep onset difficulties prevalence, and the “Global” group (10.6%) had the shortest NSD and DSD, and the highest subjective sleep loss/night waking/sleep onset difficulties prevalence. After adjusting for covariates, mothers in the “Global” group were more likely to have children in the same group, and mothers in “Subjective” and “Global” groups were less likely to have children in the “Moderate” group than in the “No/few” group. No association was identified with paternal or couple sleep multitrajectory groups. ConclusionsThe observed associations between parent-child sleep multitrajectory groups suggest greater maternal sensitivity to or involvement in the child’s sleep than the fathers. Early preventive sleep actions could improve sleep in children and mothers.

Exploring the Clinical and Genetic Landscape of Angelman Syndrome: Patient-Reported Insights from an Italian Registry.

Background: The Angelman Syndrome Registry (RISA) was developed as a retrospective study with the following objectives: to evaluate the clinical history of individuals with Angelman Syndrome (AS) in Italy and compare it with the existing literature; to investigate the feasibility of gathering data by directly involving participants in the data collection process; and to explore the relationship between different symptoms and genotypes. Methods: Established in 2018, RISA enrolled a total of 82 participants, with 62 (75.6%) providing complete data. Demographic, clinical, and genetic information was collected using electronic case report forms. Descriptive statistics characterized the sample, while associations between genotype and clinical characteristics were examined. Results: Descriptive analysis revealed a median participant age of 8.0 years, with males comprising 48.8% of the sample. Deletion (58.1%) was the most common genotype. The majority (82.2%) experienced epilepsy, with seizures typically onset before 3 years of age. Most patients (86.2%) required multiple anti-epileptic drugs for control, with generalized tonic-clonic seizures and atypical absence seizures being most prevalent. The deletion group exhibited more severe developmental delays and a trend towards higher seizure severity. Sleep problems affected 69.4% of participants, characterized by difficulties in sleep onset and maintenance. Conclusions: This study offers valuable insights into the clinical history and genetic characteristics of AS in Italy, consistent with the prior literature. Additionally, it underscores the efficacy of patient registries in capturing comprehensive data on rare diseases such as AS, highlighting their potential to advance research and enhance patient care.

Intense and problematic social media use and sleep difficulties of adolescents in 40 countries.

Social media has become a ubiquitous part of everyday life; however, evidence suggests patterns of social media use can affect sleep health in children and adolescents. This study aimed to examine the associations of intense and problematic social media use (SMU) with sleep-onset difficulties in adolescence. We analysed data from 212,613 adolescents aged 11-15 years (51.1% girls) from 40 European and North American countries that participated in the 2017/2018 Health Behaviour in School-aged Children survey. Intense SMU assessed how often respondents had online contact through social media, and problematic SMU was assessed by symptoms of addiction to social media. Sleep-onset difficulties were assessed using a self-reported item. Multilevel mixed-effects logistic regression was used to obtain the estimates. Sleep-onset difficulties were more common among girls than boys (27.1% vs 20.8%). Intense SMU was significantly associated with sleep-onset difficulties in boys in 17 countries and in girls in 25 countries, while problematic SMU was significantly associated in most of the participating countries. Overall, exposure to problematic SMU alone was highly associated with sleep-onset difficulties both in girls (OR 2.20, 2.04-2.38) and boys (OR 1.88, 1.73-2.04), while the association estimates for intense SMU were smaller and comparable across gender (Girls: OR 1.27, 1.23-1.31; Boys: OR 1.22, 1.18-1.27). Sensitivity analyses supported the above findings. Intense and/or problematic SMU were associated with sleep-onset difficulties across gender with associations being higher for problematic compared to intense SMU. Prospective research with objective measures is needed to understand the causal mechanisms underlying these relationships.

Longitudinal sleep multi-trajectories from age 1 to 5.5 years and their early correlates: results from the Étude Longitudinale Française depuis l'Enfance birth cohort study.

To identify sleep multi-trajectories in children from age 1 to 5.5 years and their early correlates. We collected early family, maternal, and child characteristics, including children's nighttime sleep duration (NSD) and daytime sleep duration (DSD), night waking (NW), and sleep-onset difficulties (SOD), by parental phone interviews at age 2 months and 1-, 2-, 3.5-, and 5.5 years. Group-based multi-trajectory modeling identified sleep multi-trajectory groups. Multinomial logistic regression assessed associations with early factors. We identified five distinct sleep multi-trajectory groups for NSD, DSD, NW, and SOD in 9273 included children. The "Good sleepers" (31.6%) and "Long sleepers" (31.0%) groups had low NW and SOD prevalence and shorter NSD but longer DSD in "Good sleepers" than in "Long sleepers." The "Good sleepers but few SOD" group (10.3%) had long NSD and DSD but a SOD peak at age 3.5 years; the "Improving NW and SOD" group (9.6%) showed short but rapidly increasing NSD to a plateau and high but decreasing NW and SOD; the "Persistent NW and SOD" group (17.5%) had persistent high NW and SOD. Maternal depression during pregnancy and sleep habits at age 1 (e.g. parental presence or feeding to fall asleep, sleeping at least part of the night away from own bed) were common risk factors associated with the most disordered sleep multi-trajectory groups. We identified distinct sleep multi-trajectory groups and early life-associated factors in preschoolers. Most of the factors associated with the most sleep-disordered multi-trajectory groups are likely modifiable and provide clues for early prevention interventions.

0364 The Effect of Lemborexant on Polysomnographic Sleep Parameters in Adults with Mild, Moderate, or Severe Obstructive Sleep Apnea

Abstract Introduction Several commonly prescribed hypnotics may worsen respiratory function, especially in the elderly. Lemborexant (LEM) is a dual-orexin-receptor-antagonist approved to treat adults with insomnia. In Studies 102 (NCT03471871) and 113 (NCT04647383), LEM demonstrated respiratory safety in subjects with mild, moderate, or severe obstructive sleep apnea (OSA) who did not report insomnia. The current analyses evaluated sleep variables from these studies. Methods Studies 102 and 113 were double-blind, placebo (PBO)-controlled, crossover studies in adults with untreated mild (apnea-hypopnea-index [AHI] ≥5 to &amp;lt; 15), moderate (AHI≥15 to &amp;lt; 30), or severe (AHI≥30) OSA, without insomnia. Subjects were randomized to two 8-night periods (separated by ≥14 days) treated with LEM 10mg (LEM10) or PBO. Latency to persistent sleep (LPS), sleep efficiency (SE), and wake after sleep onset (WASO) were assessed using polysomnography on Days 1 (D1) and 8 (D8). Results The analysis set comprised 39, 13, and 20 subjects with mild, moderate, or severe OSA, respectively. On both days, LPS was not statistically different from PBO in any group. Compared with PBO, SE was significantly greater on D1 in subjects with mild (LEM10, 90.43; PBO, 80.31; P&amp;lt; 0.0001), moderate (LEM10, 88.83; PBO, 84.02; P=0.016), and severe (LEM10, 87.76; PBO, 77.84; P&amp;lt; 0.0001) OSA. On D8, SE was significantly greater in subjects with mild (LEM10, 86.65; PBO, 80.59; P=0.003) and moderate (LEM10, 88.45; PBO, 80.70; P=0.004) OSA, with a trend towards significance in subjects with severe (LEM10, 85.60; PBO, 80.63; P=0.055) OSA. WASO was significantly lower (improved) on D1 in subjects with mild (LEM10, 33.30; PBO, 76.76; P&amp;lt; 0.0001), moderate (LEM10, 44.26; PBO, 64.71; P=0.008), and severe (LEM10, 42.03; PBO, 91.49; P&amp;lt; 0.0001) OSA. On D8, WASO was significantly lower in subjects with mild (LEM10, 51.74; PBO, 70.52; P=0.015) and moderate (LEM10, 49.16; PBO, 75.15; P=0.008) but not severe (LEM10, 59.85; PBO, 74.46; P=0.161) OSA. LEM was well-tolerated. Conclusion In untreated OSA subjects without insomnia, irrespective of OSA severity, LEM improved sleep maintenance versus PBO. LPS did not differ between treatments since such patients may not report sleep onset difficulties. These findings support the use of LEM for patients with comorbid insomnia and sleep apnea (COMISA). Support (if any) Eisai, Inc.

Sleep Problems, Circadian Rhythms, and Their Relation to Behavioral Difficulties in Children and Adolescents with Autism Spectrum Disorder.

This was an exploratory cross-sectional study comparing 45 children with ASD to 24 typically developing drug-naïve controls, group-matched on age, sex, and body mass index. Objective data was obtained using the following: an ambulatory circadian monitoring device; saliva samples to determine dim light melatonin onset (DLMO): and three parent-completed measures: the Child Behavior Checklist (CBCL); the Repetitive Behavior Scale-Revised (RBS-R); and the General Health Questionnaire (GHQ28). The CBCL and RBS-R scales showed the highest scores amongst poor sleepers with ASD. Sleep fragmentation was associated with somatic complaints and self-injury, leading to a higher impact on family life. Sleep onset difficulties were associated with withdrawal, anxiety, and depression. Those with phase advanced DLMO had lower scores for "somatic complaints"; "anxious/depressed" state; and "social problems", suggesting that this phenomenon has a protective role.

Associations between adolescent sleep difficulties and active versus passive screen time across 38 countries

BackgroundHigh screen use has been adversely linked with mental wellbeing; however, little is known about how active versus passive screen time are associated with sleep-onset difficulties among adolescents. MethodsWe analysed data from 38 European and North American countries that participated in the 2014 Health Behaviour in School-aged Children (HBSC) survey. Difficulties in falling sleep were assessed using a self-reported item with a 5-point Likert scale, and then dichotomised. Participants reported h/day of discretional time spent watching television, electronic gaming, and computer use. ResultsOf the 195,668 participants (Mage 13.59 [1.62] years; 51 % girls), about 25 % of girls reported sleep-onset difficulties, while the rate was 18 % in boys. Adolescents who played electronic games >4 h/day (≤1 h/day as reference) had 30 % higher odds in boys (OR 1.30; 95 % CI: 1.23–1.38) and 38 % higher odds in girls (OR 1.38; 95 % CI: 1.31–1.45) of reporting sleep difficulties. High computer use (>4 h/day) increased the odds of sleep difficulties by 41 % in boys (OR 1.41, 95 % CI: 1.33–1.49) and 61 % in girls (OR 1.61, 95 % CI: 1.53–1.69). Similarly, high television time (>4 h/day) had increased the odds of sleep difficulties by 15 % in boys (OR 1.15, 95 % CI: 1.08–1.22) and 19 % in girls (OR 1.19, 95 % CI: 1.12–1.25). LimitationsCross-sectional analyses cannot establish causality of the associations. ConclusionsHigher levels of recreational screen use of any type were associated with sleep-onset difficulties among adolescents with adverse effects being more prevalent in active than passive screen time. Prospective research with objective measures is warranted to understand causality of these relationships.

0451 Effect of Lemborexant Treatment on Polysomnographic Sleep Measures in Older Adults with Insomnia and Objective Short Sleep

Abstract Introduction In Phase 3 Study 304 (NCT02783729), lemborexant (LEM) provided significant benefit versus placebo (PBO) on polysomnographic (PSG) and sleep diary-based sleep onset and maintenance outcomes over 1mo in subjects with insomnia disorder. Based on evidence that patients with insomnia and objective short sleep (ISS [total sleep time; TST] &amp;lt;6hrs) may respond less well to interventions such as cognitive behavioral therapy for insomnia (CBT-I) than patients with insomnia and objective long sleep (TST ≥6hrs), we conducted post-hoc analyses of LEM efficacy in the ISS subgroup (subjects with PSG TST&amp;lt;6hrs). Methods Study 304 was a 1mo, randomized, double-blind, PBO- and active-controlled, parallel-group study in female (age ≥55y) and male (age ≥65y) subjects (n=1006). Subjects received PBO, LEM 5mg (LEM5), LEM 10mg (LEM10), or zolpidem tartrate extended-release 6.25mg (ZOL). Latency to persistent sleep (LPS) and wake after sleep onset (WASO) were assessed at Nights (NT) 1/2 and NT29/30 using PSG and averaged; change from baseline (paired PSGs during single-blind PBO run-in) were analyzed using mixed-effect model repeated measurement analysis. Results The ISS subgroup comprised 710/1006 (70.58%) subjects. Mean (SD) baseline LPS was similar across treatments: PBO=52.80(35.73); ZOL=54.77(40.93); LEM5=54.28(39.30); LEM10=53.31(34.45). On NT1/2, LEM5/10 led to statistically significantly greater (P&amp;lt;0.05) decreases from baseline (PBO=−9.65[36.52]; ZOL=−17.78[36.34]; LEM5=−22.02[31.62]; LEM10=−25.42[34.73]) versus PBO and ZOL. On NT29/30, LEM5/10 led to statistically significantly greater (P&amp;lt;0.0005) decreases from baseline (PBO=−11.88[35.09]; ZOL=−12.57[38.50]; LEM5=−25.37[37.06]; LEM10=−28.20[34.75] versus PBO. ZOL was not different from PBO. Mean (SD) baseline WASO was similar: PBO=123.79(37.21); ZOL=128.37(38.94); LEM5=128.14(37.52); LEM10=129.07(37.98). On NT1/2, LEM5/10 led to statistically significantly greater (P&amp;lt;0.0001) decreases from baseline (LSM[SE]: PBO=−23.52[2.74]; ZOL=−54.74[2.47]; LEM5=−60.58[2.45]; LEM10=−69.35[2.41] versus PBO. LEM10 was significantly different than ZOL (P&amp;lt;0.0001). On NT29/30, LEM5/10 led to statistically significantly greater (P&amp;lt;0.0001) decreases from baseline (PBO=−29.62[3.09]; ZOL=−46.86[2.80]; LEM5=−52.67[2.74]; LEM10=−55.37[2.70] versus PBO. LEM10 was significantly different than ZOL (P&amp;lt;0.05). Conclusion The data support LEM as an effective therapy for older adult patients with ISS and suggest LEM may be more beneficial than ZOL, particularly for patients with ISS and sleep onset difficulties. These findings suggest that LEM may be a reasonable therapy to consider for treating older patients with ISS where CBT-I may have relatively limited efficacy. Support (If Any) Eisai Inc.

Daily Associations Between Adolescent Sleep and Socioemotional Experiences During an Ongoing Stressor

PurposeOngoing stress can result in sleep disturbances and daytime socioemotional difficulties. Data on how sleep and daytime socioemotional functioning may be bidirectionally related to one another in the midst of an ongoing stressor are limited, particularly during adolescence, a developmental period when risk for the onset of mental health difficulties and sleep disturbances is high. MethodsParticipants (N = 459, ages of 13–18 years) were recruited from across the United States and completed an intake survey and one week of daily reports beginning 2 weeks after COVID-19 was declared a national emergency. Participants reported on their daily post-traumatic stress symptoms, positive and negative affect, loneliness, sleep onset difficulties, nightmares, sleep quality, and time in bed. ResultsLagged hierarchical linear models adjusting for age, sex, socioeconomic status, race, ethnicity, medication use, medical conditions, and ongoing stressors were estimated to examine bidirectional associations between night-time sleep and next-day mental health. Poorer sleep quality and more nightmares at night predicted higher next-day negative affect, and greater daytime negative affect predicted lower sleep quality and a greater likelihood of having nightmares the following night. Poor sleep quality predicted greater next-day post-traumatic stress, which, in turn, predicted poorer sleep quality the following night and more difficulties falling asleep. Poor sleep quality and a longer time in bed also predicted greater next-day loneliness. DiscussionOverall, these findings provide insight into how sleep disturbances and socioemotional difficulties unfold during a major life stressor in an adolescent sample.

Longitudinal association between sleep disturbance and inflammation, and the role of positive affect.

Previous longitudinal evidence suggested that sleep disturbance (i.e., difficulties in sleep onset and sleep maintenance) may be longitudinally associated with systemic inflammation, which is involved in the pathophysiology of mental and somatic illness. The mechanisms underlying this association, however, remain largely unexplored. In the context of health psychology, a substantial body of literature showed that positive affect may have a favourable impact on immune and inflammatory response and buffer the proinflammatory effects of stress. Therefore, the aim of this study was to assess whether subjective sleep disturbance is longitudinally associated with serum high sensitivity C-reactive protein (hs-CRP), a marker of systemic inflammation, and whether this association is mediated by a decrease in positive affect. The data of 1894 participants aged 64.11±8.02years from the English Longitudinal Study of Ageing (ELSA) across three waves of data collection were analysed. Self-reported sleep disturbance was assessed in 2008-2009, (wave 4), positive affect was assessed in 2010-2011 (wave 5), and hs-CRP was assessed in 2012-2013 (wave 6). Path analysis adjusted for health-related variables including depressive symptoms, cardiovascular disease, BMI, smoking, alcohol consume, and drug intake showed a significant direct effect of sleep disturbance to positive affect; positive affect directly predicted hs-CRP. Lastly, an indirect effect between sleep disturbance to hs-CRP through the mediating role of positive affect emerged. The findings suggest that sleep onset and sleep maintenance difficulties may be associated with inflammation through the mediation of low positive affect. The clinical significance of the findings should be further explored.

A Longitudinal Study of the Effects of Bed-Sharing Experience in Infancy on Sleep Outcomes at 2 Years Old

To assess the effects of bed-sharing experiences in infancy on sleep patterns and sleep problems at 2years of age. A total of 1564 children from an ongoing Shanghai Maternal-Child Pairs Cohort were included. Bed-sharing experiences were collected when children were 2, 6, and 24months old via caregiver-completed questionnaires (whether caregivers shared a bed with children during the night), and children's bed-sharing experiences were classified as follows: no bed-sharing, early-only bed-sharing, late-onset bed-sharing, and persistent bed-sharing. Sleep outcomes at month 24 were assessed using the Brief Infant Sleep Questionnaire. Sleep patterns and problems were compared among the 4 types of bed-sharing experiences. Of the 1564 infants, 10.10% had no bed-sharing, 18.35% had early-only, 27.94% had late-onset, and43.61% had persistent bed-sharing. Compared with children with no bed-sharing, children with late-onset and persistent bed-sharing had shorter nighttime sleep durations and longer daytime sleep durations (P<.05) and were more likely to snore (aOR 1.87 [95% CI 1.25-2.79]; aOR 1.68 [95% CI 1.14-2.47]) and have sleep onset difficulty (aOR 2.06 [95% CI 1.37-3.09]; aOR 2.07 [95% CI 1.41-3.05]). However, caregivers of infants in the late-onset and persistent bed-sharing groups perceived less problematic sleep (aOR 0.38 [95% CI 0.26-0.56] and aOR 0.40 [95% CI 0.28-0.58]). Bed-sharing is a common experience among Chinese children. Although bed-sharing may reduce caregivers' perception of children's problematic sleep, late-onset or persistent bed-sharing in infancy is associated with sleep problems at 2years of age.

Utilization of psychotropic medications in children with FASD: a retrospective review

BackgroundFetal Alcohol Spectrum Disorder (FASD) is a neurodevelopmental condition resulting from pre-natal alcohol exposure. In Canada, an estimated 1.4-4% of newborns are affected by FASD. FASD is often associated with behavioural comorbidities and many individuals require psychotropic medication. However, to date there are no FASD specific guidelines for prescribing medication. Recently, Mela and colleagues described four behavioural symptom clusters commonly seen in FASD with suggested pharmacologic treatment for each cluster within an algorithm. The primary objective was to compare the proposed treatment algorithm retrospectively to actual treatment in a real-world FASD pediatric practice. The secondary objective was to refine the description of symptom clusters which will be targeted with treatment.MethodsWe collected the diagnostic and medication history from all patient visits of a Regina Developmental Pediatrician who specializes in FASD diagnosis and medication treatment. Three hundred fifty-four FASD patients were identified between 2005 to 2020. The medications that would be predicted from the algorithm were compared to the real-world historical data. A positive case was defined as all algorithm-predicted medications matching the historical data; a negative case had one or more medications failing to match.ResultsOf the 354 patients, 36 were removed for insufficient information. Of the remaining 318 cases, 172 (54.1%) were positive compared to 146 (45.9%) negatives. In single prescription cases (n=147), the incidence of positives was 67.3%; in multi-prescriptions (n=72) it was 27.8%; and in cases where no prescription was needed (n=99), the positive incidence was 53.5%.ConclusionsThe prescription algorithm is promising but requires further refinement to accommodate the range of presentations in children with FASD. With respect to unclassified symptoms, we propose the following: sleep onset difficulty as hyperarousal; gender dysphoria and obsessive compulsive disorder as cognitive inflexibility; grief as emotional regulation; and autism spectrum disorder as hyperactive/neurocognitive.

Association between Physical Activity and Sleep Difficulties among Adolescents in Germany: The Role of Socioeconomic Status.

We examined sleep difficulties among adolescents in Germany and the association with physical activity (PA). Furthermore, we analyzed whether the association varied with the socioeconomic status (SES) among adolescent girls and boys in Germany. Using data from the German Health Interview Examination Survey for Children and Adolescents (KiGGS) study (Wave 2), 6599 adolescents aged 11 to 17 years were included in the analyses. We conducted sex-stratified logistic regression analyses. Dependent variables were unrecommended sleep duration (defined as a duration of sleep that does not meet the recommended duration), sleep-onset difficulties, trouble sleeping, and daytime sleepiness. Most adolescent girls and boys reported sleep difficulties. While no associations between PA and sleep difficulties were observed, a significant interaction between PA and SES was found for sleep duration in boys and daytime sleepiness in girls. Thus, adolescents with low SES had fewer sleep difficulties if they met the recommendation for PA, compared with those in other SES groups. In Germany, a large proportion of adolescents have sleep difficulties. We found that the experience of sleep difficulties varied according to PA, sex, and the family SES. Future sleep promotion programs should consider these differences.

Depressed mood and repetitive negative thinking in Delayed Sleep-Wake Phase Disorder: Treatment effects and a comparison with good sleepers.

Circadian dysregulation and depressed mood commonly co-occur in young people, yet mechanisms linking Delayed Sleep-Wake Phase disorder (DSWPD) with depression are poorly understood. The present study aimed to examine the role of repetitive negative thinking (RNT), by comparing sleep, RNT and depressive symptomology between 40 'good' sleeping young people and 63 with DSWPD, with (n=30) and without (n =33) self-reported doctor-diagnosed depression. Secondary analysis from a randomised controlled trial was also undertaken to observe changes in depressive symptoms and RNT as a result of treatment for DSWPD. The 60 young people with DSWPD (mean [SD] age of 15.9[2.2]years, 63% female) received either short (green) or long (red) wavelength bright light therapy (BLT) over 3weeks. Cross-sectional baseline comparisons revealed an escalating pattern of worse sleep, more RNT and higher depressed mood scores in the DSWPD young people compared to good sleepers. Across all participants, RNT accounted for the associations between sleep-onset difficulties and depressed mood at baseline. Symptoms of depression, RNT and sleep onset difficulties in DSWPD individuals significantly improved after treatment (d=0.47-0.65) and at the 1- (d=0.43-1.00) and 3-month follow-up (d=0.39-1.38), yet there were no differences between short- and long-wavelength BLT. Results provide preliminary evidence that RNT may link delayed sleep phase with depression. BLT conferred sleep benefits, but also improvements in depressed mood and RNT, and thus represents a potentially cost-effective strategy for young people experiencing delayed sleep phase and low mood.

216 Resilience, sleep difficulties, and subjective sleep quality during COVID-19

IntroductionWe have shown in a previous study that despite significant improvements in sleep patterns and sleep duration during COVID-19 in teens and young adults, only teens reported better sleep quality and satisfaction. Moreover, sleep difficulties seem to be more prominent in the older group during the pandemic, suggesting that there could be additional risk factors involved. The current study aimed to investigate the role of resilience in the association between changes in sleep and the subjective sleep quality (SSQ) in teens and young adults during COVID-19.Methods289 teens (12-17 years old) and 294 young adults (18-25 years old) completed the Connor-Davidson Resilience Scale-10 and an adapted version of the Pittsburgh Sleep Quality Index online. Teens and young adults were each divided into a resilient and less resilient group. Hierarchical regression models were conducted to examine the unique contribution of weekdays sleep duration, sleep difficulties, and resilience to SSQ. Sleep duration, sleep difficulties and SSQ before COVID-19, and gender were entered as controls.ResultsResults show that in less resilient teens, changes in sleep onset difficulties (β=-.285, p=.003), nocturnal and early awakenings (β=-.218, p=.019), and weekdays sleep duration (β=.282, p=.001) significantly predicted SSQ and explained 36.5% of the variance. In less resilient young adults, changes in nightmares (β=-.309, p=.027) and sleep onset difficulties (β=-.263, p=.012) significantly predicted SSQ and explained 24.1% of the variance. In resilient teens, changes in weekdays sleep duration (β=.296, p=.007) significantly predicted SSQ and explained 20.1% of the variance. In resilient adults, changes in sleep onset difficulties (β=-.325, p=.001), nocturnal and early awakenings (β=-.374, p=.000), and weekdays sleep duration (β=.192, p=.009) significantly predicted SSQ and explained 46.0% of the variance.ConclusionOur results suggest that resilience appears to be a protecting factor in the impacts of sleep difficulties on sleep quality, but only in adolescents. Indeed, in young adults, sleep difficulties seem to be a more important factor modulating sleep quality than changes in sleep duration. These results underline the importance of focusing on the intrinsic characteristics of each population to better target interventions.Support (if any):

701 Daily Associations Between Adolescent Sleep and Mental Health During the COVID-19 Pandemic

IntroductionSleep disturbances after a trauma forecast mental health difficulties such as post-traumatic stress symptoms (PTSS). COVID-19 has resulted in numerous stressors for youth (e.g., school closures, social isolation) that directly disrupt sleep and may have negative mental health consequences. However, investigations of sleep and adverse events in youth have primarily been limited to months or years after a trauma has occurred. How adolescent sleep patterns and mental health intersect during an ongoing adverse experience is unknown.MethodsAdolescents from the United States (N = 503; 80.9% female; 13–18 years) participated in an online daily diary study within 3 weeks after COVID-19 was declared a national emergency. Participants completed one week of twice daily reports (5406 observations) on their nightly sleep (sleep timing, sleep quality, sleep onset difficulties, and nightmares) and daytime mental health symptoms (COVID-19 PTSS, positive affect, negative affect, and loneliness).ResultsMixed models adjusting for age, sex, and socioeconomic status indicated that cyclical, bidirectional effects emerged, with daytime mental health symptoms predicting same-night sleep disturbances, and sleep disturbances predicting next-day mental health. Greater PTSS predicted sleep onset difficulties (Estimate = .02, SE = .004, t = 5.56 p < .001) and sleep onset difficulties predicted next-day PTSS (Estimate = .35, SE = .17, t = 2.04, p < .05). Greater daytime negative affect predicted greater nightmares (Estimate = .07, SE = .01, t = 4.97, p < .001), and nightmares predicted marginally more next-day negative affect (Estimate = .07, SE = .04, t = 1.66, p = .09). PTSS (Estimate = .01, SE = .003, t = 3.47, p < .001) and negative affect (Estimate = .05, SE = .03, t = 2.06, p < .05) both predicted poorer sleep quality the following night.ConclusionFindings suggest that mental health symptoms during the onset of the COVID-19 pandemic are associated with increased sleep disturbances. In turn, these sleep disturbances predict increased mental health symptoms. Overall, results provide a greater understanding of youth sleep patterns during COVID-19 and how sleep disturbances may inhibit resilience in the context of an ongoing stressor.Support (if any)Center for American Indian and Rural Health Equity

COVID-19 and sleep patterns in adolescents and young adults

ObjectiveIn March 2020, the world experienced a global pandemic, which involved the shutdown of schools or a transposition to remote teaching in most countries. The objective of the present study was to investigate the impact of the COVID-19 pandemic related lockdown on sleep patterns and sleep quality in adolescents and young adults. MethodsAn online survey was conducted in June 2020 with adolescents and young adults (n = 498) aged 12–25 years. Participants had to answer questions on sleep, first retrospectively, referring to the time prior to the pandemic, and then referring to the time during the pandemic. ResultsA pronounced shift towards later sleep combined with an increase in sleep duration was found during the pandemic. However, these changes in sleep habits were more pronounced in adolescents than in young adults and seem to occur mostly during weekdays compared to weekends. During the pandemic, teens also reported an improvement in daytime sleepiness and subjective sleep quality, while young adults reported an increase in sleep difficulties associated with sleep onset difficulties, nocturnal and early morning awakenings, and nightmares. ConclusionsThe COVID-19 related lockdown seems to have had a beneficial effect on sleep in adolescents. In young adults, benefits are not as obvious. These results support that later school start times would be beneficial for adolescents. However, in young adults it could be important to investigate the effects of other situational or interindividual factors (stress, lifestyle habits, employment, etc.).

The Role of Technology and Social Media Use in Sleep-Onset Difficulties Among Italian Adolescents: Cross-sectional Study.

BackgroundThe use of technology and social media among adolescents is an increasingly prevalent phenomenon. However, there is a paucity of evidence on the relationship between frequency of use of electronic devices and social media and sleep-onset difficulties among the Italian population.ObjectiveThe aim of this study is to investigate the association between the use of technology and social media, including Facebook and YouTube, and sleep-onset difficulties among adolescents from Lombardy, the most populous region in Italy.MethodsThe relationship between use of technology and social media and sleep-onset difficulties was investigated. Data came from the 2013-2014 wave of the Health Behavior in School-aged Children survey, a school-based cross-sectional study conducted on 3172 adolescents aged 11 to 15 years in Northern Italy. Information was collected on difficulties in falling asleep over the last 6 months. We estimated the odds ratios (ORs) for sleep-onset difficulties and corresponding 95% CIs using logistic regression models after adjustment for major potential confounders.ResultsThe percentage of adolescents with sleep-onset difficulties was 34.3% (1081/3151) overall, 29.7% (483/1625) in boys and 39.2% (598/1526) in girls. It was 30.3% (356/1176) in 11-year-olds, 36.2% (389/1074) in 13-year-olds, and 37.3% (336/901) in 15-year-olds. Sleep-onset difficulties were more frequent among adolescents with higher use of electronic devices, for general use (OR 1.50 for highest vs lowest tertile of use; 95% CI 1.21-1.85), use for playing games (OR 1.35; 95% CI 1.11-1.64), use of online social networks (OR 1.40 for always vs never or rarely; 95% CI 1.09-1.81), and YouTube (OR 2.00; 95% CI 1.50-2.66).ConclusionsThis study adds novel information about the relationship between sleep-onset difficulties and technology and social media in a representative sample of school-aged children from a geographical location that has not been included in studies of this type previously. Exposure to screen-based devices and online social media is significantly associated with adolescent sleep-onset difficulties. Interventions to create a well-coordinated parent- and school-centered strategy, thereby increasing awareness on the unfavorable effect of evolving technologies on sleep among adolescents, are needed.

The role of technology and social media use on sleep-onset difficulties among Italian adolescents: a cross-sectional study

The role of technology and social media use on sleep-onset difficulties among Italian adolescents: a cross-sectional study