Pathways to adolescent health sleep regulation and behavior

Sleep actigraphy pattern and behavioral/emotional difficulties in kindergarten children: association with hypothalamic-pituitary-adrenocortical (HPA) activity

BACKGROUND

Various studies of adult endocrinology and sleep show close connections between poor sleep quality, deterioration of the HPA axis and negative psychological characteristics. However, the extent to which these associations may have already emerged and developed in childhood remains unclear.

METHODS

A total of 82 preschoolers (age 4.91+/-0.48) underwent activity monitoring for seven consecutive days and nights, wearing a digital movement-measuring instrument. Additionally, on the first and on the last morning of sleep registration, the activity of the HPA axis was assessed via the amount of cortisol in the saliva. Psychological and behavioral assessments were also made.

RESULTS

Three sub-groups of good (22%), normal (58.5%) and poor (19.5%) sleepers were distinguished. Poor sleep patterns were associated with higher HPA activity and with behavioral/emotional difficulties.

CONCLUSIONS

The interplay between unfavorable sleep patterns, deterioration of the HPA axis and behavioral/emotional difficulties is already apparent in pre-school children.

Adolescent development of the reward system

Adolescence is a developmental period characterized by increased reward-seeking behavior. Investigators have used functional magnetic resonance imaging (fMRI) in conjunction with reward paradigms to test two opposing hypotheses about adolescent developmental changes in the striatum, a region implicated in reward processing. One hypothesis posits that the striatum is relatively hypo-responsive to rewards during adolescence, such that heightened reward-seeking behavior is necessary to achieve the same activation as adults. Another view suggests that during adolescence the striatal reward system is hyper-responsive, which subsequently results in greater reward-seeking. While evidence for both hypotheses has been reported, the field has generally converged on this latter hypothesis based on compelling evidence. In this review, I describe the evidence to support this notion, speculate on the disparate fMRI findings and conclude with future areas of inquiry to this fascinating question.

Sleep and the transition to adolescence: a longitudinal study

STUDY OBJECTIVES

To assess the links between sleep and pubertal development using a longitudinal design.

DESIGN

Three consecutive annual assessments of sleep and pubertal development. Sleep was assessed using a week of home actigraphy.

SETTING

Naturalistic sleep in the home setting of school children, Tel Aviv Area, Israel.

PARTICIPANTS

A sample of 94 (41 boys) typically developing healthy school-age children (age range at first assessment: 9.9-11.2 years).

INTERVENTION

N/A.

MEASUREMENTS AND RESULTS

The Petersen's Pubertal Development Scale (PDS) and Sexual Maturation Scale (SMS) were used to assess pubertal development, and a week of actigraphy served to assess naturalistic sleep patterns. The results reflect expected developmental trends: an increase in signs of pubertal maturation, delayed sleep onset, and shorter sleep time. After controlling for age, significant relationships were found between sleep onset time, true sleep time, and number of night wakings at Time 1 and pubertal ratings at Time 2, and pubertal changes from Time 1 to Time 2. Delayed and disrupted sleep at Time 1 predicted faster pubertal changes from Time 1 to Time 2. These results were supported by structural equation modeling. These findings were similar in boys and girls.

CONCLUSIONS

Based on these longitudinal data, it appears that pubertal changes in sleep (delayed sleep phase and disrupted sleep patterns) antedate bodily changes associated with puberty. The underlying mechanisms explaining these predictive links should be further explored.

Possible insomnia predicts some risky behaviors among adolescents when controlling for depressive symptoms

This study investigated whether previously reported links between sleep and risk taking among adolescents (E. M. O'Brien & J. A. Mindell, 2005) are associated-concurrently, longitudinally, or both-with sleep or underlying depression. The present study analyzed data from a nationally representative sample of 4,353 adolescents in the United States who had participated in Waves I and II of the National Longitudinal Study of Adolescent Health (J. R. Udry, 1998). In the present study, grade, gender, depressive symptoms, and possible insomnia served as predictor variables to calculate the odds ratios for 4 categories of risky behaviors. After the authors accounted for other predictors, possible insomnia significantly predicted smoking, delinquency (within each wave but not longitudinally), and drinking and driving (Wave II and longitudinally). Possible insomnia may contribute to some types of risky behaviors over the effects of depressive symptoms.

High exercise levels are related to favorable sleep patterns and psychological functioning in adolescents: a comparison of athletes and controls

PURPOSE

To investigate whether chronic vigorous exercising is related to improved sleep and psychological functioning, and whether this association varies with gender. Both lay and scientific opinions hold that physical activity is an efficient remedy and preventative measure for poor sleep. However, empirical evidence on adolescents is very limited.

METHODS

A total of 434 adolescents (258 athletes, 176 controls; mean age 17.2 years) took part in the study. Weekly hours spent exercising were 17.69 hours and 4.69 hours, respectively. To assess sleep patterns and psychological functioning, participants completed a sleep log for 7 consecutive days and several self-rating questionnaires.

RESULTS

Compared with controls, athletes reported better sleep patterns including higher sleep quality, shortened sleep onset latency, and fewer awakenings after sleep onset, as well as less tiredness and increased concentration during the day. Athletes reported significantly lower anxiety and fewer depressive symptoms. Compared with males, females reported fewer variations in sleep. Male controls had particularly unfavorable scores related to sleep and psychological functioning.

CONCLUSIONS

Findings suggest that chronic vigorous exercising is positively related to adolescents' sleep and psychological functioning. Results also indicate that males with low exercise levels are at risk for increased sleep complaints and poorer psychological functioning.

'Football is good for your sleep': favorable sleep patterns and psychological functioning of adolescent male intense football players compared to controls

It is commonly assumed that physical activity exerts a favorable impact on sleep, although scientific evidence is lacking. This study investigated the impact of football sports on the sleep patterns of 36 male chronic and intense football players and 34 controls. Participants completed a sleep log for seven consecutive days. Compared to controls, football players reported shorter sleep onset latency, fewer awakenings, higher scores of sleep quality and a lower variability of sleep from weekdays to weekends. The findings suggest that football sports activity is positively associated with both quantitative and qualitative dimensions of sleep.

Adolescent development of the reward system

Adolescence is a developmental period characterized by increased reward-seeking behavior. Investigators have used functional magnetic resonance imaging (fMRI) in conjunction with reward paradigms to test two opposing hypotheses about adolescent developmental changes in the striatum, a region implicated in reward processing. One hypothesis posits that the striatum is relatively hypo-responsive to rewards during adolescence, such that heightened reward-seeking behavior is necessary to achieve the same activation as adults. Another view suggests that during adolescence the striatal reward system is hyper-responsive, which subsequently results in greater reward-seeking. While evidence for both hypotheses has been reported, the field has generally converged on this latter hypothesis based on compelling evidence. In this review, I describe the evidence to support this notion, speculate on the disparate fMRI findings and conclude with future areas of inquiry to this fascinating question.

Sleep patterns and impulse control among Japanese junior high school students

Adolescents with decreased impulse control exhibit behavioral problems. Lifestyles are related to impulse control. However, the relations of sleep patterns and impulse control among adolescents are unknown. Thus we examined how sleep patterns were associated with impulse control among Japanese junior high school students. Surveys were completed by a nationwide sample of 1934 students. A significant association between decreased impulse control and bedtimes after midnight was revealed. Specific lifestyle factors related to bedtimes after midnight were older age, greater numbers of hours spent watching television, lack of participation in an extracurricular activity, greater use of convenience stores, and increased attendance at cram schools. This study revealed that going to sleep after midnight was significantly related to decreased impulse control among adolescents. Data about specific lifestyle factors related to going to sleep after midnight should be useful in preventing those behaviors demonstrated by school children that derive from decreased impulse control.

The neurocognitive effects of sleep disruption in children and adolescents

Sleep problems in children and adolescents are common, and sleep disruption is associated with a wide range of behavioral, cognitive, and mood impairments, including hyperactivity, reduced school grades, and depression. Insufficient or fragmented sleep may induce sleepiness, which is associated with problematic behavior, impaired learning, and/or negative mood. Furthermore, treatment of sleep disruption, by improving sleep hygiene or treating specific sleep disorders, is often associated with improvements in daytime performance, suggesting a common mechanism for the behavioral manifestations. This article reviews the daytime manifestations of sleep disruption.

Insomnias of childhood and adolescence

Childhood insomnias (CI) are a diverse group of sleep-related problems that present across the first 2 decades of life, ranging widely in severity. Little is understood about the origins of CI which are likely heterogeneous. Nevertheless, effective treatments for younger children have been shown to be efficacious. Defined within a development framework, this article reviews common correlates and causes of CI during the first two decades. A practical approach to the evaluation and treatment of insomnias among children and youth is presented.

Safe enough to sleep: sleep disruptions associated with trauma, posttraumatic stress, and anxiety in children and adolescents

Sleep disturbance is an essential symptom of posttraumatic stress disorder, and recent evidence suggests that disrupted sleep may play an important role in the development of posttraumatic stress disorder following traumatic stress. The authors review several aspects of sleep as it relates to posttraumatic stress disorder. First, there is an association between traumatic stress and different components of disrupted sleep in children and adolescents. Second, sleep disruption appears to be a core feature of other pediatric anxiety disorders, and the authors consider if this preexisting sleep vulnerability may explain in part why preexisting anxiety disorders are a risk factor for developing posttraumatic stress disorder following a traumatic event. Third, the authors consider attachment theory and the social context of trauma and sleep disruption. This article concludes with a consideration of the therapeutic implications of these findings.

Childhood sleep problems, early onset of substance use and behavioral problems in adolescence

BACKGROUND

Very few prospective studies examine the relationship between childhood sleep problems and subsequent substance use. In this study, we examined how sleep problems at ages 3-8 predicted onset of alcohol, cigarette, and marijuana use in adolescence. We also investigated the relationships between childhood sleep problems and adolescent internalizing and externalizing problems.

METHODS

Study participants were 292 boys and 94 girls from a community sample of high risk families and controls in an ongoing longitudinal study.

RESULTS

Controlling for parental alcoholism, sleep problems at ages 3-8 predicted onset of alcohol, cigarette, and marijuana use among boys and onset of alcohol use among girls. Childhood sleep problems were related to maternal ratings of internalizing and externalizing problems during adolescence for both boys and girls. Adjusting for these problems did not weaken the effects of sleep problems on onset of substance use.

CONCLUSIONS

This is to our knowledge the first study that prospectively examines gender differences in the relationship between sleep problems and early onset of substance use. Childhood sleep problems predicted early onset of substance use for boys but not girls. If childhood sleep problems indeed increase the probability of substance use onset, greater attention by parents to sleep problems in children and adolescents would potentially have ameliorative long-term effects. Parents are encouraged to explore different ways to help their children sleep better, including obtaining information and suggestions from their primary care physicians.

Patterns of daily activity and time spent in bed of adult women and adolescent and preadolescent girls from a rural community in Senegal, West Africa

BACKGROUND

In rural Africa, women and adolescent girls sustain a high burden of domestic and agricultural tasks. This could result in energy imbalance and impair their nutritional status.

OBJECTIVE

The aim of the study was to investigate activity during the day and time spent in bed during the night for adult women and adolescent and preadolescent girls living in the same household. The hypothesis was that more prolonged physical inactivity and time spent in bed could be an efficient means for lowering energy expenditure and hence maintaining an adequate nutritional state.

METHODS

Physical activity during the day was qualitatively recorded using 'spot observation' (Super 1989), and quantitatively using accelerometers. A total of 110 females--55 adult women, 45 adolescents and 10 preadolescents--were included in the study. Anthropometric measurements (weight, height and four subcutaneous skinfolds) served as indicators of nutritional status.

RESULTS

Day-to-day reliability of accelerometry counts was acceptable (average intraclass correlation coefficient = 0.73). Differences in daytime activity varied according to age group. Adolescent and preadolescent girls had higher overall activities than adults (p < 0.01). Preadolescent girls went to bed earlier and for longer periods than adult women (p < 0.001). There existed significant relationships between time spent in bed and activity during the day in adult women but not in adolescent or preadolescent girls. A significant relationship between nutritional status and physical activity indices was observed in preadolescent and adolescent girls, but not in women.

CONCLUSIONS

The findings partially support the hypothesis of some compensation of daytime activity by time spent in bed in adult women, but not in adolescent or preadolescent girls.

Adolescents living the 24/7 lifestyle: effects of caffeine and technology on sleep duration and daytime functioning

OBJECTIVE

Adolescents may not receive the sleep they need. New media technology and new, popular energy drinks may be implicated in sleep deficits. In this pilot study we quantified nighttime technology use and caffeine consumption to determine effects on sleep duration and daytime behaviors in adolescents. We hypothesized that with increased technology use, adolescents increase caffeine consumption, resulting in insufficient sleep duration.

PATIENTS AND METHODS

Subjects were recruited from a pediatric office in a proximal suburb of Philadelphia, Pennsylvania. Inclusion criteria for this study were middle and high school subjects aged 12 to 18 years old. The questionnaire, Adolescent Sleep, Caffeine Intake, and Technology Use, was developed by the investigators to measure adolescents' intake of caffeinated drinks, use of nighttime media-related technology, and sleep behaviors. Descriptive statistics characterized the subjects, their caffeine and technology use, and sleep variables. Regression models assessed the relationships between caffeine, technology use, and sleep variables, having adjusted for age, race, gender, and BMI.

RESULTS

Sleep was significantly related to the multitasking index. Teenagers getting 8 to 10 hours of sleep on school nights tended to have 1.5- to 2-fold lower multitasking indices compared with those getting less sleep. Thirty-three percent of the teenagers reported falling asleep during school. Caffeine consumption tended to be 76% higher by those who fell asleep. The log-transformed multitasking index was significantly related to falling asleep during school and with difficulties falling asleep on weeknights.

CONCLUSIONS

Many adolescents used multiple forms of technology late into the night and concurrently consumed caffeinated beverages. Subsequently, their ability to stay alert and fully functional throughout the day was impaired by excessive daytime sleepiness. Future studies should measure more than television hours when evaluating the impact of nighttime activities on sleep patterns in adolescents.

Adolescents' sleep behaviors and perceptions of sleep

BACKGROUND

Sleep duration affects the health of children and adolescents. Shorter sleep durations have been associated with poorer academic performance, unintentional injuries, and obesity in adolescents. This study extends our understanding of how adolescents perceive and deal with their sleep issues.

METHODS

General education classes were randomly selected from a convenience sample of three high schools in the Midwest. Three hundred eighty-four ninth- to twelfth-grade students (57%) completed a self-administered valid and reliable questionnaire on sleep behaviors and perceptions of sleep.

RESULTS

Most respondents (91.9%) obtained inadequate sleep (<or= 9 hours) on most school nights of the week, with 10% reporting less than 6 hours of sleep each week night. The majority indicated that not getting enough sleep had the following effects on them: being more tired during the day (93.7%), having difficulty paying attention (83.6%), lower grades (60.8%), increase in stress (59.0%), and having difficulty getting along with others (57.7%). Some students reported engaging in harmful behaviors to help them sleep: taking sleeping pills (6.0%), smoking a cigarette to relax (5.7%), and drinking alcohol in the evening (2.9%). Students who received fewer hours of sleep were significantly more likely to report being stressed (p = .02) and were more likely to be overweight (p = .04).

CONCLUSIONS

Inadequate sleep time may be contributing to adolescent health problems such as increased stress and obesity. Findings indicate a need for sleep hygiene education for adolescents and their parents. A long-term solution to chronic sleep deprivation among high school students could include delaying high school start times, such as was done successfully in the Minneapolis Public School District.

Sleepless in adolescence: prospective data on sleep deprivation, health and functioning

We estimate prevalence, incidence and persistence of short sleep or sleep deprivation in a two wave cohort study of 4175 youths 11-17 years old at baseline and 3134 of these a year later. Data were collected using computer interviews and questionnaires. Sleep deprivation was defined as 6h or less per night during the past 4 weeks. Weighted logistic regression procedures were employed to calculate prevalence, incidence, persistence/chronicity, and odds ratios. Prevalence rates and rates of persistence suggest sleep deprivation is highly prevalent and chronic. Multivariate analyses indicate that short sleep increases risk across multiple domains of dysfunction, suggesting pervasive deleterious effects. The broad impact of sleep deprivation and its pervasiveness suggests interventions will need to focus on multilevel changes to increase sleep time and reduce the negative impact of sleep deprivation among adolescents.

Evaluation of a school-based intervention for adolescent sleep problems

STUDY OBJECTIVES

The present study investigated the effectiveness of a school-based intervention in increasing sleep knowledge and improving adolescent sleep problems.

DESIGN

A randomized, controlled trial using 2 groups (program class, classes-as-usual: [CAU]) assessed over 3 time points (pre-program, post-program, 6-week follow-up).

PARTICIPANTS/SETTING

Eighty-one students (mean age = 15.6 +/- 0.6 y; 33% male) from 2 schools in South Australia. Schools provided one class to participate in the sleep intervention program (N = 41) and a second class to act as a control class (N = 40).

INTERVENTION

Four 50-minute classes across a 4-week period. Classes consisted of educating adolescents on promoting and maintaining a healthy lifestyle based on a cognitive-behavior therapy framework.

MEASUREMENTS AND RESULTS

Data were collected pre-program, post-program, and at 6-week follow-up using an online questionnaire. Qualitative student and teacher data were collected at post-program. Baseline data indicated sleep problems were prevalent (53.1% insufficient sleep on school nights [< 8 h] and 77.8% discrepant school/weekend rise times [> 2 h]). These 2 criteria identified 36 adolescents with a delayed sleep timing (DST; Program, N = 21; CAU, N = 15). The program increased sleep knowledge (P = 0.001); however, analyses revealed no significant effects on target sleep variables as compared with the CAU class for the entire group (all P > 0.05). For DST adolescents, there was a significant interaction for reducing the discrepancy between school and weekend out of bed times (P = 0.002). There was no impact on other sleep parameters or depressed mood.

CONCLUSIONS

School-based sleep interventions for adolescents are a novel method for addressing a prevalent problem. Future programs should develop ways to motivate adolescents to change sleep practices.

Mad, sad and hormonal: the gendered nature of adolescent sleep disturbance

Up to 40 percent of adolescents experience some form of sleep difficulty, with adolescent girls often reporting higher levels of sleep disturbance and daytime fatigue than boys. This article explores the literature surrounding female adolescent sleep disturbance. The findings reveal that sleep problems in young women can be linked to girls being at an increased risk for puberty-related fatigue, sexual abuse, a higher prevalence of mental illness and sensitivity to familial disruption, and increased domestic and grooming expectations. Implications for nursing practice include initiating conversations about sleep, sleep disturbance and sleeping arrangements when working with adolescent girls. Nurses should gather accurate sleep histories, provide adolescent girls and their caregivers with information and recommend interventions to improve sleep if necessary. Nurses should remain sensitive to the confounding effects of pubertal status, menarche and the cyclic release of hormones when designing and conducting future research into female adolescent sleep disturbance.

Individual differences in childhood sleep problems predict later cognitive executive control

STUDY OBJECTIVE

To determine whether individual differences in developmental patterns of general sleep problems are associated with 3 executive function abilities-inhibiting, updating working memory, and task shifting-in late adolescence.

PARTICIPANTS

916 twins (465 female, 451 male) and parents from the Colorado Longitudinal Twin Study.

MEASUREMENTS AND RESULTS

Parents reported their children's sleep problems at ages 4 years, 5 y, 7 y, and 9-16 y based on a 7-item scale from the Child-Behavior Checklist; a subset of children (n = 568) completed laboratory assessments of executive functions at age 17. Latent variable growth curve analyses were used to model individual differences in longitudinal trajectories of childhood sleep problems. Sleep problems declined over time, with approximately 70% of children having > or = 1 problem at age 4 and approximately 33% of children at age 16. However, significant individual differences in both the initial levels of problems (intercept) and changes across time (slope) were observed. When executive function latent variables were added to the model, the intercept did not significantly correlate with the later executive function latent variables; however, the slope variable significantly (P < 0.05) negatively correlated with inhibiting (r = -0.27) and updating (r = -0.21), but not shifting (r = -0.10) abilities. Further analyses suggested that the slope variable predicted the variance common to the 3 executive functions (r = -0.29).

CONCLUSIONS

Early levels of sleep problems do not seem to have appreciable implications for later executive functioning. However, individuals whose sleep problems decrease more across time show better general executive control in late adolescence.

The multidimensional correlates associated with short nocturnal sleep duration and subjective insomnia among Taiwanese adolescents

STUDY OBJECTIVES

The aim of this study was to examine the correlates associated with short nocturnal sleep duration and subjective insomnia, including individual factors, family factors, peer factors, school factors, and the problematic use of high-tech devices among a large-scale representative population of Taiwanese adolescents.

DESIGN

Cross-sectional study.

SETTING

A total of 23 junior high and 29 senior high/vocational schools were randomly selected across southern Taiwan.

PARTICIPANTS

Eight thousand four adolescent students.

INTERVENTIONS

N/A.

MEASUREMENTS AND RESULTS

The multidimensional correlates associated with short nocturnal sleep duration and subjective insomnia were examined using chi2 automatic interaction detection analysis and logistic regression analysis models. The results indicated that an older age, self-reported depression, being in the third year of school, drinking coffee at night, and problematic Internet use were significantly associated with short nocturnal sleep duration in adolescents. Furthermore, self-reported depression, low school affinity, high family conflict, low connectedness to their peer group, and problematic Internet use were associated with subjective insomnia in adolescents.

CONCLUSIONS

The results of this study indicate that a variety of individual, family, peer, and school factors were associated with short nocturnal sleep duration and subjective insomnia in adolescents. Furthermore, the correlates of short sleep duration were not identical to those of subjective insomnia. Parents and health professionals should be wary of sleep patterns among adolescents who have the identified correlates of short nocturnal sleep duration and subjective insomnia.

Siesta and sleep patterns in a sample of adolescents in Greece

BACKGROUND

Sleep behaviors and disturbances in adolescence are being increasingly investigated. The aim of the present study was to investigate the sleep habits of adolescents living in provincial Greece.

METHODS

Responses to pre-constructed questionnaires on sleep habits and disturbances from 471 high-school students (259 boys; 212 girls), aged 14-18 years, attending four high schools of rural and semi-urban areas in north-western Greece, were analyzed.

RESULTS

The median nocturnal and total sleep duration was 7.5 h (range, 2.5-11 h) and 8.5 h (range, 2.5-14 h), respectively, and the average bedtime was 23.55 hours. Male students, older adolescents and residents of towns went to bed later than female students, younger adolescents and residents of villages (P = 0.039, P = 0.0003 and P = 0.056, respectively). Siesta on a regular basis was reported by 43% and on an occasional basis by 46% of the students. Siesta median duration was 1.5 h (range 0.5-4.5 h). Daytime sleepiness, difficulties in morning awakening and in falling asleep, and night awakenings were reported by 26.3%, 17.4%, 17.2% and 11.2%, respectively. Students who had siestas reported less daytime sleepiness (P < 0.0001). Significant differences were observed between boys and girls regarding sleep disturbances.

CONCLUSION

Adolescents in provincial Greece present with a different sleep pattern as compared to their northern European peers, characterized by late bedtime and midday siesta. Similarly to their peers in other countries, considerable rates of sleep disturbances were reported.

Are adolescents chronically sleep-deprived? An investigation of sleep habits of adolescents in the Southwest of Germany

BACKGROUND

Adolescent sleep receives increasing attention. Several studies have shown that adolescents generally do not sleep enough. This survey assessed adolescents' sleep patterns, and results were compared with sleep logs.

METHODS

A total of 818 students aged 12-18 attending three different school types were asked to complete a questionnaire, adapted from the 'School Sleep Habits Survey', and filled in a sleep protocol over 2 weeks. Information on sleep patterns and demographic data were obtained additionally.

RESULTS

A total of 601 students completed the questionnaire (i.e. 73.5% return rate), 55.1% female and 44.9% male. Average sleep duration during the week amounted to 8.04+/-0.89 h and 9.51+/-1.65 h on weekends. Sleep duration times on school days decreased from an average 8.64+/-0.83 h for the age category 12-13 years to 7.83+/-0.72 h for students above 16 years. 91.6% of all students slept less than 9.2 h per night during the week. Data from the 153 returned sleep logs showed even lower sleep times (7.75+/-0.82 h for school nights).

CONCLUSIONS

The main hypothesis that students sleep on average considerably less than the recommended 9 h during weekdays was confirmed. Bedtimes changed throughout the week with the latest on Friday and Saturday nights and the least sleep around midweek. There were no significant group differences regarding school type and environment (rural vs. urban). Interestingly, the majority reported only little daytime sleepiness and no impaired performance. Results regarding the consequences of chronic sleep deprivation in the literature are inconclusive. The impact on physiological parameters, especially metabolic functions, requires further investigations.

Psychosocial functioning and sleep patterns in children and adolescents with cleft lip and palate (CLP) compared with healthy controls

OBJECTIVE

The aim of this study was twofold: to assess psychological functioning, interactional competencies, and sleep patterns in children and adolescents with cleft lip and palate (CLP), and to compare these results with those from age- and gender-matched controls. It was hypothesized that participants with CLP would exhibit greater difficulties in psychological functioning, more interactional difficulties, and poorer sleep patterns than those without CLP.

PARTICIPANTS

Thirty-two children and adolescents with CLP and 34 controls were recruited. Ages ranged from 6 to 16 years.

MAIN OUTCOME MEASURES

For psychosocial assessment, the Strength and Difficulties Questionnaire (SDQ) and a questionnaire on interactional competencies (PIELCQ) were completed; for sleep assessment, a sleep log was completed for seven consecutive nights.

RESULTS

Participants with and without CLP did not differ with respect to emotional problems, conduct problems, or hyperactivity. With respect to interactional competencies, participants with CLP were six times more likely to report difficulties. Unfavorable sleep patterns were associated with psychosocial strain but not with the presence of CLP.

CONCLUSIONS

RESULTS indicate that children and adolescents with CLP may report that they have sleep irregularities as often as those without CLP. In adolescence, the presence of CLP may be associated with increased difficulties. Consequently, skill training to improve context-related social competencies may be appropriate.

Restless legs syndrome and periodic limb movement disorder in children and adolescents

Restless Legs Syndrome (RLS) has been recognized as a common and treatable neurologic disorder in adults for some time, but the occurrence of RLS in children and adolescents has seen relatively delayed acceptance. A large, population-based study has recently reported a 1.9% and 2% prevalence of RLS in children and adolescents, respectively. RLS in children is closely associated with periodic limb movement disorder (PLMD), and symptoms of both may range from mild to severe. An early, accurate diagnosis of RLS or PLMD provides substantial benefits to an individual's quality of life, especially in cases of poor-sleep related intellectual or emotional dysfunction. Treatment plans should use emerging knowledge of how RLS and PLMD affect children and adolescents to correctly identify these disorders and aim to reduce or eliminate symptoms. Best-fitting therapy will consider severity of symptoms, comorbid conditions, and phenotypic variables. Promising progress has been made in understanding the genetic components of RLS as well as the role of iron deficiency in exacerbating symptoms. A review of current research on RLS and PLMD in children and adolescents is presented.

Sleep patterns and problems among chinese adolescents

OBJECTIVES

Little is known about sleep patterns and problems in Chinese adolescents. This study was designed to examine sleep/wake patterns and problems and their associations with parent sleep among adolescents in China.

METHODS

This report represents part of an epidemiological study of sleep and health in 6 high schools in Jinan city, China. A total of 1056 adolescents and 838 parents completed a questionnaire in March or April 2005. Participants consisted of 625 boys and 441 girls, 557 seventh-graders (mean age: 13.5 +/- 0.6 years) and 509 tenth-graders (mean age: 16.4 +/- 0.7 years), and 603 mothers and 235 fathers. Adolescents and parents reported their own sleep/wake patterns and problems.

RESULTS

Average morning rising time (5:56 am vs 8:13 am) and sleep duration (7.5 hours vs 9.4 hours) differed significantly between weekdays and weekends. Compared with seventh-graders, 10th-graders went to bed later and awoke earlier, resulting in approximately 1 hour of sleep less. Of the adolescents, 18.8% reported their sleep quality as poor, 26.2% were not satisfied with their sleep, 16.1% had insomnia, and 17.9% had daytime sleepiness. Significant but low adolescent-parent correlations were observed for sleep/wake patterns and perceived sleep quality. Difficulty initiating sleep in adolescents was significantly associated with history of insomnia in mothers and fathers.

CONCLUSIONS

Sleep insufficiency, insomnia, and daytime sleepiness are prevalent in Chinese adolescents. Sleep insufficiency on weekdays may be attributable to earlier morning rising to meet school schedules. Parental history of insomnia is associated with elevated risk for insomnia symptoms in adolescent offspring, although adolescent-parent correlations in sleep/wake patterns are relatively low.

The sleepy adolescent: causes and consequences of sleepiness in teens

The majority of adolescents do not obtain the recommended amount of sleep, resulting in significant daytime sleepiness. For most adolescents, insufficient sleep results from the interaction between intrinsic factors such as puberty and extrinsic factors such as school start times. Insufficient sleep and sleepiness impact all areas of adolescent functioning, including academic, psychological and behavioural, which underscores the importance of evaluating sleepy adolescents. While polysomnography is required for the diagnosis of certain sleep disorders, causes of sleepiness are generally best identified with a detailed sleep history and daily sleep diary. The management of sleep problems in adolescents involves treating any underlying sleep disorders, increasing total sleep time and improving other environmental factors that impact sleep. Recognition and management of insufficient sleep and sleepiness is important for the health and functioning of adolescents.

University students and "the all nighter": correlates and patterns of students' engagement in a single night of total sleep deprivation

This study evaluated the self-reported patterns, motivations, and correlates of engagement in a single night of total sleep deprivation (SN-TSD) in a sample of 120 university students at a 4-year liberal arts college. Participants' mean age . was 20.1 years; the sample was 63% female. Measures included the Owl-Lark Scale of circadian preference; the Beck Depression Inventory; and the Pittsburgh Sleep Quality Index (PSQI); as well as self-reported usual bedtime, rise time, and total sleep time. Students' cumulative grade point averages (GPAs) were also obtained; these were reported from the university registrar. Sixty percent of students surveyed reported engaging in SN-TSD once or more since coming to college. No differences between genders or among class standing with respect to use of SN-TSD were detected. Engagement in SN-TSD was associated with later self-reported bedtimes, evening preference, and poorer academic achievement as measured by GPA. A trend for increased symptoms of depression was detected; sleep quality as measured by the PSQI was not related to engagement in SN-TSD.

Adolescents with insomnia and substance abuse: consequences and comorbidities

Adolescents have high rates of sleep disorders and substance abuse, both of which have been associated with deleterious effects on mood, attention, and behavior. This article reviews data on the prevalence of sleep disorders, substance abuse problems, and comorbid psychiatric conditions in the adolescent population. Studies have consistently demonstrated that the prevalence of sleep problems is under-reported in adolescents in both clinical and community samples. The bidirectional correlation between substance use and sleep disturbances is also discussed. Based on the findings presented here, the authors conclude that it is imperative to improve the detection and treatment of sleep problems in children and adolescents. By treating sleep disturbances and targeting poor sleepers with additional counseling and education regarding the risk of substance use, clinicians may be able to prevent or delay the adverse effects of addiction. At the very least, the presence of insomnia should alert clinicians to the need for further evaluation for drug and alcohol abuse.

Sleep disturbance preceding completed suicide in adolescents

We examined sleep difficulties preceding death in a sample of adolescent suicide completers as compared with a matched sample of community control adolescents. Sleep disturbances were assessed in 140 adolescent suicide victims with a psychological autopsy protocol and in 131 controls with a similar semistructured psychiatric interview. Rates of sleep disturbances were compared between groups. Findings indicate suicide completers had higher rates of overall sleep disturbance, insomnia, and hypersomnia as compared with controls within both the last week and the current affective episode. Group differences in overall sleep disturbance (both within the last week and present episode), insomnia (last week), and hypersomnia (last week) remained significant after controlling for the differential rate of affective disorder between groups. Similarly, overall sleep disturbance (last week and present episode) and insomnia (last week) distinguished completers in analyses accounting for severity of depressive symptoms. Only a small percentage of the sample exhibited changes in sleep symptom severity in the week preceding completed suicide, but of these, a higher proportion were completers. These findings support a significant and temporal relationship between sleep problems and completed suicide in adolescents. Sleep difficulties should therefore be carefully considered in prevention and intervention efforts for adolescents at risk for suicide.

Persistence and change in symptoms of insomnia among adolescents

OBJECTIVE

To estimate the incidence, chronicity, and remission of symptoms of insomnia and to examine factors associated with the incidence and chronicity of insomnia among adolescents.

METHODS

Data were collected using diagnostic interviews and questionnaires from 4175 youths aged 11 to 17 years at baseline, and 3134 of these youths followed-up a year later. Subjects were sampled from large managed care populations in a metropolitan area of over 4.7 million. Insomnia was assessed by youth-reported DSM-IV symptom criteria.

RESULTS

One year incidence was 13.9% for 1 or more symptoms, 5.5% for 1 or more symptoms plus daytime fatigue or sleepiness, and 5.3% for insomnia caseness. Rates of chronicity were 45.8% for 1 or more symptoms, 34.7% with daytime fatigue or sleepiness, and 22.8% for insomnia caseness. There were no effects of age, sex, or family income in predicting incidence or chronicity of insomnia. There was a weak association of both somatic and psychological dysfunction with risk of future sleep outcomes, with stronger prediction for psychological dysfunction.

CONCLUSIONS

These results document further the public health burden of insomnia among adolescents. Prevalence of insomnia is comparable to that of other major psychiatric disorders such as mood, anxiety, disruptive, and substance use disorders. Incidence over one year also is high. Insomnia represents a chronic condition, further enhancing burden.

Predictors of persistent and new-onset fatigue in adolescent girls

OBJECTIVE

The purpose of this study was to investigate the stability of fatigue in adolescents and to explore whether psychological, somatic, and lifestyle factors are involved in the onset and persistence of fatigue during adolescence.

METHODS

In this longitudinal study, a total of 653 adolescent girls (aged 14.40 +/- 1.45 years) who previously participated in an epidemiological study filled out questionnaires 6 (T2) and 12 (T3) months after the initial assessment (T1). Fatigue severity, depression, anxiety, and chronic fatigue syndrome-related symptoms were assessed. We determined the prevalence of severely fatigued cases at T2 and T3 and evaluated whether persistently fatigued participants initially differed from nonfatigued participants and participants with transient fatigue. We examined which factors predicted the development of new-onset fatigue and investigated whether changes in fatigue covaried with changes in other complaints and changes in lifestyle.

RESULTS

Of all participants who were severely fatigued at T1, 25.7% were persistently fatigued throughout the study. Persistently fatigued participants had higher levels of depression and anxiety at the beginning of the study, were less physically active, and slept shorter. New-onset fatigue was predicted by depression, less physical activity, and more nightlife activities. Interestingly, new onset was not predicted by initial levels of fatigue. Persistently fatigued participants did not differ in initial fatigue severity from short-term fatigued patients. A decrease in fatigue severity was associated with a decrease in depression, anxiety, and chronic fatigue syndrome-related symptoms and, to a lesser extent, with an increase in physical activity and sleep duration.

CONCLUSIONS

The stability of severe fatigue among adolescents is substantial. The involvement in the onset and persistence of fatigue suggests that both preventive and therapeutic strategies with respect to fatigue treatment in adolescents should concentrate on emotional well-being. Moreover, adolescents at risk should be stimulated to spend more time on physical activities and to sleep longer.

Chronic insomnia and its negative consequences for health and functioning of adolescents: a 12-month prospective study

PURPOSE

To estimate prevalence and chronicity of insomnia and the impact of chronic insomnia on health and functioning of adolescents.

METHODS

Data were collected from 4175 youths 11-17 at baseline and 3134 a year later sampled from managed care groups in a large metropolitan area. Insomnia was assessed by youth-reported DSM-IV symptom criteria. Outcomes are three measures of somatic health, three measures of mental health, two measures of substance use, three measures of interpersonal problems, and three of daily activities.

RESULTS

Over one-fourth reported one or more symptoms of insomnia at baseline and about 5% met diagnostic criteria for insomnia. Almost 46% of those who reported one or more symptoms of insomnia in Wave 1 continued to be cases at Wave 2 and 24% met DSM-IV symptom criteria for chronic insomnia (cases in Wave 1 were also cases in Wave 2). Multivariate analyses found chronic insomnia increased subsequent risk for somatic health problems, interpersonal problems, psychological problems, and daily activities. Significant odds (p < .05) ranged from 1.6 to 5.6 for poor outcomes. These results are the first reported on chronic insomnia among youths, and corroborate, using prospective data, previous findings on correlates of disturbed sleep based on cross-sectional studies.

CONCLUSIONS

Insomnia is both common and chronic among adolescents. The data indicate that the burden of insomnia is comparable to that of other psychiatric disorders such as mood, anxiety, disruptive, and substance use disorders. Chronic insomnia severely impacts future health and functioning of youths. Those with chronic insomnia are more likely to seek medical care. These data suggest primary care settings might provide a venue for screening and early intervention for adolescent insomnia.

Objective sleep in pediatric anxiety disorders and major depressive disorder

OBJECTIVE

To examine objective and subjective sleep problems in early-onset anxiety and depression.

METHOD

Children and adolescents (46% female, ages 7 to 17 years) with anxiety disorders (n = 24), major depressive disorder (MDD) without comorbid anxiety disorders (n = 128), or no history of psychiatric disorder (n = 101) spent two consecutive nights in a sleep laboratory and completed self-reports of sleep quality.

RESULTS

On objective measures, the anxiety group exhibited more awakenings than the MDD group, less slow-wave sleep than the control or MDD group, and greater night 2 sleep latency than the MDD or control group. The anxiety group exhibited no decrease in rapid eye movement latency from the first night to the second. The MDD group exhibited less time awake than the control group and less stage 1 sleep than the anxiety or control group. On subjective measures, young people with anxiety reported greater sleep latency on the second night and no decrease in sleep latency. Age was covaried in analyses.

CONCLUSIONS

Findings provide objective and subjective evidence of sleep disturbance in children and adolescents with anxiety disorders and replicate findings of limited objective sleep disturbance in those with MDD. Sleep problems are an important consideration when treating young people with anxiety.

Middle school start times: the importance of a good night's sleep for young adolescents

With the onset of adolescence, teenagers require 9.2 hr of sleep and experience a delay in the timing of sleep. In the "real world" with early school start times, however, they report less sleep, striking differences between their school-weekend sleep schedules, and significant daytime sleepiness. Prior studies demonstrated that high schoolers with later school starts do not further delay bedtime but obtain more sleep due to later wake times. This study examined sleep-wake patterns of young adolescents attending urban, public middle schools with early (7:15 a.m.) versus late (8:37 a.m.) start times. Students (N = 205) were assessed at 2 time periods. Students at the late-starting school reported waking up over 1 hr later on school mornings and obtaining 50 min more sleep each night, less sleepiness, and fewer tardies than students at the early school. All students reported similar school-night bedtime, sleep hygiene practices, and weekend sleep schedules.

Correlates for poor sleepers in a Los Angeles high school

BACKGROUND AND PURPOSE

We explored sleep patterns including morning-evening preference and their associations with other lifestyle determinants among high school students.

PARTICIPANTS AND METHODS

We conducted a cross-sectional survey of students grades 9-12 from a private high school in the United States. One hundred and thirty-one students completed an online survey comprising 23 original, investigator-created questions, a mood scale, the Pittsburgh Sleep Quality Index (PSQI), and the Horne-Ostberg Morningness-Eveningness Questionnaire (MEQ).

RESULTS

We found that 80% of students reported a sleep deficit. As defined by the PSQI, 69% of girls and 58% of boys in this sample were poor sleepers. Eveningness was a strong predictor of poor sleep, particularly among students aged 15 years (odds ratio [OR] 9.92; 95% confidence interval [CI], 1.52-64.8), among whom poor sleep quality was also associated with a higher body mass index (BMI) (OR, 6.97; 95% CI, 1.01-48.2).

CONCLUSIONS

Our pilot study suggests that morningness-eveningness is a strong predictor of sleep quality among high school students.

Are prenatal psychological or physical stressors associated with suboptimal outcomes in neonates born to adolescent mothers?

Examined whether prenatal psychological stress and/or physical stress were associated with suboptimal neonatal outcomes in a pilot study of adolescent mothers (n=20). The results provide preliminary support for associations between prenatal psychological stress and little evidence for the association between prenatal physical stress and suboptimal neonatal outcomes.