Pathways to adolescent health sleep regulation and behavior

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.

Attachment anxiety, relationship context, and sleep in women with recurrent major depression

OBJECTIVE

To examine the relationship between attachment anxiety, marital status, bed-partner status, and sleep in recurrently depressed women.

METHODS

The current study measured polysomnography (PSG) and subjective sleep quality in 107 women with recurrent major depression. Women were categorized as high or low in attachment anxiety based on Bartholomew and Horowitz's Relationship Questionnaire (1991).

RESULTS

There were no significant main or interaction effects of any of the relationship measures on subjective sleep quality. In contrast, PSG results indicated that women with bed partners displayed better sleep efficiency (p < .005). Marital status was also associated with sleep efficiency (p < .05), and married women displayed significantly shorter sleep latencies as compared with never married women (p < .05). Anxiously attached women displayed a reduced percentage of stage 3-4 sleep (p < .05). Moreover, a significant interaction between attachment anxiety and marital status (p < .05) suggested that anxiously attached women who were previously married (i.e., divorced, separated, or widowed) displayed a particularly low percentage of stage 3-4 sleep.

CONCLUSIONS

Depressed women who exhibit an anxious attachment style and have experienced a marital rupture show reduced stage 3-4 sleep, which may signal a concomitant reduction in restorative cognitive and metabolic processes. Relationship context influences sleep continuity. These results provide a more nuanced approach to considering qualitative and structural aspects of relationships that may influence sleep.

Caring for children with sleep problems

Sleep disturbances are common in infants and children. Sleep disturbances in children not only disrupt the child and family but also impact parental and child well-being, daytime functioning, and behavior. Pediatric nurses care for the individual child as well as their family members. Understanding the importance of healthy sleep habits and the implications of inadequate sleep on child behavior and family-peer interactions provides nurses an opportunity to decrease family stress and increase positive coping, adaptation, and family function. Common types of sleep problems are presented, and recommendations for screening tools are included to help nurses better assess sleep problems in children and make appropriate referrals.

Legal piperazine-containing party pills--a new trend in substance misuse

In this Harm Reduction Digest Sheridan, Butler, Wilkins and Russell address the emergent phenomenon of so-called 'legal party pills' which have become a significant drug issue in New Zealand and elsewhere. Although banned in a number of countries, they are currently legally available in New Zealand where they are marketed as 'safe' alternatives' to 'illicit' drugs often used in the dance scene such as MDMA and amphetamines. The authors describe the availability and use of these substances in New Zealand, summarize what is known about their effects, and speculate on harm reduction interventions and mechanisms of control and their possible sequelae. The paper provides a timely account of an emerging drug issue of relevance to harm reduction internationally.

Ontogênese do sistema de temporização: a construção e as reformas dos ritmos biológicos ao longo da vida humana

Nesta revisão apresentamos fatos e comentários sobre a evolução dos sistemas de temporização ("relógios biológicos") na espécie humana. Na Introdução definimos alguns conceitos básicos da Cronobiologia que serão utilizados ao longo do artigo. Nas quatro seções subseqüentes, discutimos fatos marcantes que caracterizam a ritmicidade biológica em distintas etapas da ontogênese: bebês, adolescentes, adultos e idosos. Concluímos o artigo com um convite à reflexão sobre as perspectivas que se abrem com esse novo campo do conhecimento.

Sleep and the body mass index and overweight status of children and adolescents

Associations between sleep and the body mass index (BMI) and overweight status of children and adolescents were estimated using longitudinal data from a nationally representative sample of 2,281 children aged 3-12 years at baseline. Controlling for baseline BMI, children who slept less, went to bed later, or got up earlier at the time of the first assessment had higher BMIs 5 years later and were more likely to be overweight. Child age moderated the relationship between bedtime and BMI. In addition, the study reports nationally representative data on the sleep habits of American children aged 3-18 years. This study underscores the likely importance of sleep on children's physical health and suggests that sleep is important for understanding childhood weight problems.

Sleepless in America: inadequate sleep and relationships to health and well-being of our nation's children

OBJECTIVE

Our goal was to identify characteristics associated with inadequate sleep for a national random sample of elementary school-aged children (6-11 years) and adolescents (12-17 years).

METHODS

Data from 68418 participants in the 2003 National Survey of Children's Health were analyzed by using weighted bivariate and multivariate regression models. The dependent variable was report of not getting enough sleep for a child of his or her age >or=1 night of the past week. Independent variables included demographic characteristics, child health, school and other activities, and family life.

RESULTS

Parents of elementary school-aged children with inadequate sleep were more likely to report that their child was having problems at school or had a father with fair or poor health. Parents of adolescents with inadequate sleep were more likely to report that their child had an atopic condition, frequent or severe headaches, a parent with less-than-excellent emotional health, or experienced frequent parental anger. Inadequate sleep in both age groups was associated with parental report that their child usually or always displayed depressive symptomatology, family disagreements involved heated arguing, or parental concern that the child was not always safe at home, at school, or in their neighborhood.

CONCLUSIONS

Approximately 15 million American children are affected by inadequate sleep. Primary care providers should routinely identify and address inadequate sleep and its associated health, school, and family factors.

Pain, Sleep Disturbance, and Fatigue in Children With Leukemia and Their Parents: A Pilot Study

PURPOSE/OBJECTIVES

To determine the feasibility of collecting symptom data at home from school-age children with acute lymphoblastic leukemia (ALL) and from their fathers and mothers and to obtain initial descriptions of pain, sleep disturbance, and fatigue experienced by the family members at home.

DESIGN

Prospective and descriptive.

SETTING

Children's homes in Oregon and southwestern Washington.

SAMPLE

9 children with ALL (aged 8-16 years), 6 fathers, and 7 mothers. The children received vincristine during the maintenance phase of their outpatient chemotherapy treatments.

METHODS

With age-appropriate, paper-and-pencil diaries and wrist actigraphy, data were collected for three days in the families' homes. Families were reminded by telephone to complete their sleep and activity diaries.

MAIN RESEARCH VARIABLES

Pain, sleep disturbance, and fatigue in school-age children and their fathers and mothers.

FINDINGS

Most of the families who were approached indicated willingness to participate in the study. After receiving outpatient chemotherapy, the children reported pain, sleep disturbance, and fatigue data over three days. Fathers and mothers also reported symptoms. Actigraphy showed children waking more often during the night than mothers or fathers.

CONCLUSIONS

Children's pain, sleep disturbance, and fatigue suggest that the symptoms are influencing families' quality of life. Larger studies are needed to examine the symptom patterns and health outcomes of children, fathers, and mothers over the course of chemotherapy.

IMPLICATIONS FOR NURSING

Improving sleep and managing pain and fatigue after chemotherapy treatment for children with ALL may improve health outcomes for children and parents.

Sleep and sleep disorders in children and adolescents

Pediatric sleep disorders are common, affecting approximately 25% to 40% of children and adolescents. Although there are several different types of sleep disorders that affect youth, each disorder can have a significant impact on daytime functioning and development, including learning, growth, behavior, and emotion regulation. Researchers are only beginning to uncover the interaction between sleep and psychiatric disorders in children and adolescents, including depression, attention-deficit/hyperactivity disorder, and autism. This article reviews normal sleep and sleep disorders in children and adolescents, the assessment of sleep in pediatric populations, common pediatric sleep disorders, and sleep in children who have common psychiatric disorders.

Prevalence of sleep problems and their association with inattention/hyperactivity among children aged 6?15 in Taiwan

This study investigated the 6-month prevalence rates of sleep-related problems and their association with daytime inadvertent napping, inattention, hyperactivity/impulsivity, and oppositional symptoms in children and adolescents. A representative school-based sample of 2463 first to ninth graders was recruited using a multistage sampling method. The instruments included the Sleep Habits Questionnaire (including dyssomnia, parasomnia, sleep schedules, and sleep-disordered breathing), the Chinese Health Questionnaire, and the Chinese versions of the Conners' Parent and Teacher Rating Scales-Revised: Short forms. The informants were mothers and teachers. The linear and nonlinear mixed models were used for statistical analyses and sex and age were controlled in the model. Results showed that the rates of middle insomnia, disturbed circadian rhythm, mouth breathing, and daytime inadvertent napping increased with age; whereas those of bedwetting, bruxism, sleep terrors decreased with age. Dyssomnia, sleep-disordered breathing problems, daytime inadvertent napping, and sleep schedules were related to attention-deficit/hyperactivity disorder (ADHD)-related symptoms as assessed by mothers' and teachers' ratings. Parasomnia was associated with ADHD-related symptoms as assessed by mothers' ratings. Our findings suggest an age trend of sleep problems similar to those found in the literature and the association of daytime inadvertent napping, inattention, hyperactivity/impulsivity, and oppositional symptoms with sleep-related problems.

Light, dark, and melatonin: emerging evidence for the importance of melatonin in ocular physiology

Melatonin is a hormone, which is mainly produced by the pineal gland, a vestigial eye. Rather than the rods and cones, it is a newly discovered subgroup of photosensitive retinal ganglion cells, which is responsible for mediating the light-dark cycles, thus regulating melatonin's secretion. One of the correlates of the circadian rhythm of melatonin release is the habitual sleep pattern. Patients with circadian rhythm sleep disorders, including some blind patients with no light-induced suppression of melatonin, benefit from melatonin treatment. Melatonin is synthesized in the retina, lens, ciliary body as well as other parts of the body. In this review, we discuss the physiological roles of melatonin in the eye, as well as the potential therapeutic avenues currently under study.

Sleep disturbances in childhood-onset schizophrenia

Sleep disturbances in psychiatric disease have long been reported. However, research on sleep disturbances in child and adolescent psychiatric disorders is limited. We examined the relationship of sleep disturbance to clinical severity and co-morbid diagnoses (e.g. anxiety), for a population with childhood-onset schizophrenia (COS). Sixty-one COS patients underwent a medication-free inpatient observation period as part of an NIMH study of COS. Sleep quantity during the last 5-7 days of a patient's medication-free period was measured using safety records and daily nursing notes. Subjects were divided into two groups: "good sleepers" (>6 h) and "poor sleepers" (<6 h) based on the average of total hours slept per night. Comparisons between groups were made with respect to clinical ratings at both admission and during washout period, co-morbid diagnosis of generalized anxiety disorder (GAD) and a susceptibility gene (G72) for COS. The median average sleep score for the entire group was 6.1 (S.D.=2.01) h. The good and poor sleep groups differed significantly in terms of severity of positive symptoms (SAPS) and negative symptoms at admission (SANS) both on admission and during the medication-free period. There was no significant relationship between G72 genotypes and a past and/or present diagnosis of GAD. COS patients suffer from significant sleep disturbances and the sleep disturbance is highly related to the symptom severity. As there are numerous health implications of poor sleep, clinicians should have a low threshold for treating sleep disturbances in this population.

Sleep and adolescence. Do New Zealand teenagers get enough?

AIM

The objective of this study is to describe the sleep patterns of secondary school students in New Zealand.

METHODS

This study uses data from a national secondary school youth health survey conducted in 2001. A total of 9567 students completed the survey with an overall response rate of 64.3%. Students were asked if they felt they got enough sleep and the numbers of sleep hours were estimated from self-reported bedtimes and awakening times during the week and weekend.

RESULTS

A significant proportion (21%) of students reported not getting enough sleep. Inadequate sleep was more common among older students and female students of Maori and New Zealand European ethnicity. The average amount of sleep secondary school students report in New Zealand is 8 h and 40 min during the week and 9 h and 23 min during the weekend. There was a shift towards later bedtimes and fewer total sleep hours among older students. Increasing hours of extracurricular activities and employment were generally associated with less sleep, especially among students engaging in more than 5 h a day of these activities.

CONCLUSIONS

Significant numbers of secondary school students report inadequate sleep. Given the importance of adequate sleep on healthy adolescent development, parents and health professionals should be wary of the amount of extracurricular activities that young people engage in, especially part-time employment and the potential negative impact it may have on the adequacy of their sleep.

Major depressive disorder in adolescence: the role of subthreshold symptoms

OBJECTIVE

To examine the longitudinal association between individual subthreshold symptoms and onset of major depressive disorder (MDD) in adolescence.

METHOD

Data for analysis come from the Oregon Adolescent Depression Project, a prospective epidemiological study of psychological disorders among adolescents, ages 14 to 18 years, from the general community. A total of 1,709 adolescents completed the initial diagnostic assessments between 1987 and 1989 (T1) and approximately 1 year later (T2), 1,507 adolescents returned for readministration of assessments (88% response).

RESULTS

After controlling for history of depression and gender, seven of the nine DSM-III-R symptoms of depression predicted MDD incidence when tested in separate models. Endorsement of each symptom at T1 increased the likelihood of MDD incidence between T1 and T2. A summary model that included the seven DSM-III-R symptoms as predictors was significant, with sad mood contributing unique variance to the prediction of MDD onset (odds ratio = 2.01).

CONCLUSIONS

These findings suggest that much of the variance is shared among symptom predictors and the co-occurrence of symptoms is what constitutes the greatest risk. Moreover, the presence of sad mood contributes additional unique variance to prediction and supports the centrality of depressed mood to MDD.

Sleep and youth suicidal behavior: a neglected field

PURPOSE OF REVIEW

Sleep undergoes substantial changes during adolescence and suicide risk begins to increase during this period as well. This review focuses on recent literature on the relationship between sleep and suicidal behavior and proposes directions for future research.

RECENT FINDINGS

Adolescent sleep is characterized by widespread sleep restriction, irregular sleep schedules, daytime sleepiness, and elevated risk for sleep disturbances. More research on adolescent sleep and psychosocial impairment, psychiatric disorders, and suicidal behavior has been conducted. Suicidal psychiatric patients had more sleep disturbances including insomnia, hypersomnia, or nightmares than nonsuicidal patients. Shorter rapid eye movement latency and increased rapid eye movement activity have been noted to be a marker of suicidality in psychiatric patients. Epidemiological studies have demonstrated that insomnia, nightmares, and sleep insufficiency are associated with elevated risk for suicide. Although the link between insomnia and suicidal behavior appears to be mediated by depression, existing data suggest an independent predictive role of nightmares in future suicidal behavior.

SUMMARY

Sleep loss or disturbances are likely to signal an increased risk of future suicidal action in adolescents. Large-scale prospective studies and neurobiological studies are needed for a better understanding of the complex relationship between sleep, psychopathology, and youth suicidal behavior.

Adequate sleep among adolescents is positively associated with health status and health-related behaviors

BACKGROUND

Amount of sleep is an important indicator of health and well-being in children and adolescents. Adequate sleep (AS: adequate sleep is defined as 6-8 hours per night regularly) is a critical factor in adolescent health and health-related behaviors. The present study was based on a health promotion project previously conducted on adolescents in Tao-Yuan County, Taiwan. The aim was to examine the relationship between AS during schooldays and excessive body weight, frequency of visiting doctors and health-related behaviors among Taiwanese adolescents.

METHODS

A cross-sectional study design, categorical and multivariate data analyses were used. The hypotheses investigated were: high frequency of AS is positively associated with lack of obesity and less frequent visits to doctors; and high frequency AS is positively associated with health-related behavior.

RESULTS

A total of 656 boys (53.2%) and girls (46.8%), ranging in age from 13-18 years were studied between January and June 2004. Three hundred and fifty seven subjects (54%) reported that they slept less than the suggested 6-8 hours on schooldays. A significant negative association was found between low sleep and of the following health-related behaviors: (1) life appreciation; (2) taking responsibility for health; (3) adopting healthy diet; (4) effective stress management; (5) regular exercise; and (6) total AHP score. High frequency AS was associated with low frequencies of obesity after potential confounding factors were controlled. Junior high school adolescents reported significantly higher frequencies of AS than high school participants. Gender, family structure, home location and frequency of television watching or computer use were not significantly associated with AS.

CONCLUSION

These findings support the proposition that AS is associated with good health status and high-frequency adoption of health-related behavior. Furthermore, these findings suggest that inadequate sleep may be a screening indicator for an unhealthy lifestyle and poor health status. The results might be useful for future research into the development of intervention strategies to assist adolescents who are not receiving enough hours of sleep.

Sleep patterns in female adolescents with chronic musculoskeletal pain

This study examined sleep patterns in female adolescents with chronic musculoskeletal pain. Twenty-six participants with chronic musculoskeletal pain completed questionnaires during their clinic visit, and three 24-Hour Sleep Patterns Interviews during the following 2 weeks. Compared to normative data (Acebo & Carskadon, 2002), adolescents with chronic pain reported similar total sleep time (TST) and bedtimes. However, study participants reported significantly longer sleep onset latency, more night wakings, a later morning wake time, and more symptoms of daytime sleepiness. Pain improved after sleep for 27% of the study sample, and was associated with longer TST. Finally, depression and anxiety were related to daytime sleepiness, but not total sleep time or sleep onset latency. Female adolescents with chronic pain either may be more sensitive to the chronic sleep debt that is common in this age group, or they may experience underlying physiological sleep disrupters (e.g., periodic limb movement disorder) or sleep abnormalities (e.g., alpha-delta intrusions) not measured in this study. Additional research is needed to examine the complex relation between sleep and chronic musculoskeletal pain.

Marital Conflict and Disruption of Children's Sleep

Marital conflict was examined as a predictor of the quality and quantity of sleep in a sample of healthy 8- to 9-year-olds. Parents and children reported on marital conflict, the quantity and quality of children's sleep were examined through an actigraph worn for 7 consecutive nights, and child sleepiness was derived from child and mother reports. Increased marital conflict was associated with disruptions in the quantity and quality of children's sleep as well as subjective sleepiness, even after controlling for child age, ethnic group membership, socioeconomic status, sex, and body mass index. The results support the sensitization hypothesis in that exposure to marital conflict may influence an important facet of children's biological regulation, namely sleep.

Epidemiology of DSM-IV insomnia in adolescence: lifetime prevalence, chronicity, and an emergent gender difference

OBJECTIVE

The confluence of sleep/wake cycle and circadian rhythm changes that accompany pubertal development and the social and emotional developmental tasks of adolescence may create a period of substantial risk for development of insomnia. Although poor sleep affects cognitive performance and is associated with poor emotional and physical health, epidemiologic studies among adolescents have been limited. In this first epidemiologic study of insomnia defined by Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria in a US sample of adolescents, we estimated lifetime prevalence of insomnia, examined chronicity and onset, and explored the role of pubertal development.

METHODS

Data come from a random sample of 1014 adolescents who were 13 to 16 years of age, selected from households in a 400000-member health maintenance organization encompassing metropolitan Detroit. Response rate was 71.2%. The main outcome measured was DSM-IV-defined insomnia.

RESULTS

Lifetime prevalence of insomnia was 10.7%. A total of 88% of adolescents with a history of insomnia reported current insomnia. The median age of onset of insomnia was 11. Of those with insomnia, 52.8% had a comorbid psychiatric disorder. In exploratory analyses of insomnia and pubertal development, onset of menses was associated with a 2.75-fold increased risk for insomnia. There was no difference in risk for insomnia among girls before menses onset relative to boys, but a difference emerged after menses onset. In contrast, maturational development was not associated with insomnia in boys.

CONCLUSIONS

Insomnia seems to be common and chronic among adolescents. The often found gender difference in risk for insomnia seems to emerge in association with onset of menses.

Investigating health correlates of adolescent depression in Canada

BACKGROUND

The prevalence of depression rises sharply during adolescence. Understanding health correlates of adolescent depression may provide descriptive information with regard to which adolescents are more likely to be depressed. Health determinants have been found to have associations with depression in adult populations, but have never been investigated concurrently with depression in a national sample of adolescents in Canada. Therefore, the aim of the present investigation was to understand which health determinants would be significantly associated with adolescent depression.

METHODS

A sample of 17,557 adolescents was used from the Canadian Community Health Survey (CCHS) 1.1 to determine the health correlates of adolescent depression among males and females. To understand the relationship between health determinants, logistic regressions were conducted.

RESULTS

The survey had an 84.7% response rate. The past 12-month prevalence of depression among the sample of adolescents was 6.5% +/- 0.4% (3.4% +/- 0.27% for males and 9.8% +/- 0.44% for females). Reporting fair/poor perceived health, smoking, alcohol dependence, food allergies, migraine headaches, chronic bronchitis, and having physical health conditions had positive associations with depression for males and females. However, gender differences in the relationship between health correlates and depression were found. Even after controlling for all variables, females were still more likely to be depressed.

CONCLUSIONS

Several health determinants were associated with depression in adolescents in Canada. However, the relationship between some health determinants and depression functioned differently for males and females.

The association between pubertal status and sleep duration and quality among a nationally representative sample of U. S. adolescents

Many hormones play important roles in both pubertal development and sleep regulation. Because of the possible consequences of impaired sleep, including impaired health and cognition, it is important to examine whether an association between pubertal stage and sleep exists. The aim of this analysis is to examine the association between sleep and adolescent growth and developmental stage in a large sample of adolescents ages 12-16 years from a nationally representative longitudinal study. This analysis used the public-use data set of the National Longitudinal Study of Adolescent Health, an extensive survey of health and behavior among adolescents in the United States. The study included two interviews approximately 1 year apart. Pubertal development, sleep variables, and height are self-reported. Pubertal development scores were calculated by summing responses to three questions for each sex. The sleep variables include sleep duration, frequent insomnia (once/week or more), frequently waking tired (once/week or more), and insufficient sleep. The results indicate a sex difference in the association between sleep problems and pubertal development. Among females, there was a significant increase in sleep problems with increasing pubertal development score, but not among males. The negative association between sleep duration and pubertal development score, however, was significant in both males and females. There is no association between sleep duration and height velocity (inches/year) in this sample. The results, which are based on a large sample size, warrant further examination with more objective measures into the association between sleep and growth and development among adolescents.

Adolescent survivors: a secondary analysis of a clinical trial targeting behavior change

BACKGROUND

The late effects of radiation and chemotherapy increase childhood cancer survivors' risk of chronic health problems. Survivors' behavior is important in modifying this risk, yet adolescent and young adult survivors fail to engage in important health-promoting behaviors and frequently practice high-risk behaviors. This secondary analysis re-evaluated a multi-component behavior-change intervention that had previously demonstrated no impact in adolescent survivors of childhood cancer.

PROCEDURE

The parent trial compared 132 adolescent survivors in the intervention arm with 135 in the standard-care arm at baseline and at 1 year for disease and treatment knowledge, perception of late effects risk, and the frequency of health-risk and health-protective behaviors (combined as a single summative measure). In contrast, the secondary analysis examined each of the 14 behaviors separately. Additionally, an analysis of covariance (ANCOVA) was conducted to examine the change in health behaviors while statistically controlling for age, gender, and the wide variation in baseline behaviors.

RESULTS

Knowledge (P = 0.038), breast self-examination (BSE) (P < or = 0.0001) and testicular self-examination (P = 0.004) increased, as did perceptions about the need to change behavior (P = 0.004) and the effort needed to stay healthy (P < or = 0.0001). In the treatment group, junk food consumption decreased (P = 0.052) and smoking abstinence was maintained (P = 0.088). Significant interactions between gender and treatment group were demonstrated.

CONCLUSIONS

Health-risk and health-protective behaviors cannot be effectively combined in a one-dimensional measure. Gender and age influence the impact of interventions targeting health behavior in survivors. Future trials should include observation of the patient-clinician encounter, more complex sampling methods, and pre-trial knowledge of the distribution of the study behaviors.

Sleep disturbances and childhood sexual abuse

OBJECTIVE

This longitudinal, prospective study examined the relationship between childhood sexual abuse and later sleep problems in adolescence while taking into account cooccurring psychopathology that is closely related to sleep disruption [e.g., depression and posttraumatic stress disorder (PTSD)].

METHOD

Sleep disturbances in 147 females (78 sexually abused; 69 comparison) were assessed 10 years after disclosure of substantiated abuse. The follow-up protocol included self-report questions regarding typical sleeping patterns and sleep disturbances as well as measures of depression, PTSD, and lifetime victimization histories.

RESULTS

Sleep disturbances correlated significantly with both depression and PTSD. Hierarchical regression analysis showed that sexually abused participants reported significantly greater rates of sleep disturbances than comparison participants above and beyond depression and PTSD. Sleep disturbances were related to revictimization rates independent of sexual abuse, depression, and PTSD.

CONCLUSIONS

Assessments of sleep disturbances should be integrated into standard of care for adolescents who have experienced sexual abuse.

Adolescents, accidents and the need to extend our scope of research

Accidents in adolescence result in mortality and disability that in many cases could have been prevented. The issue is a multi-factorial complex phenomenon, where new research ideas are needed to improve outcome. This short communication presents several research ideas that could provide new relevant answers.

Psychosocial Factors, Gender, and Sleep

Low social support may contribute to poor sleep, more so than adverse aspects of demand and control and more so for women than men. This study on 1,179 working individuals, 623 women and 556 men, from the Multinational Monitoring of Trends and Determinants in Cardiovascular Disease (MONICA) study investigated the association between sleep and psychosocial factors. Chi-square analyses investigated the associations among sleep and demand, control, social networks, and emotional support. A logit log-linear model analyzed interactions. More women reported poorer sleep when perceiving adverse psychosocial factors. Interactive effects were found between adverse scores on demand, control, and emotional support. A multivariate partial least square analysis showed that poorer health, pain, and adverse aspects of emotional support and social networks contributed significantly to the pattern of poor sleep.

Vagal regulation and emotional intensity predict children's sleep problems

We examined the role of children's emotional intensity and vagal functioning in predicting sleep problems in healthy elementary school-aged children. Children's dispositional emotionality was examined via parent report, and their vagal regulation was assessed via respiratory sinus arrhythmia (RSA) during a baseline and a reaction time (RT) task. Sleep problems were examined through both child reports, and home monitoring with wrist actigraphs for four consecutive nights. Increased emotional intensity was predictive of a reduced amount of sleep and increased night activity. Less apt vagal regulation, characterized by lower levels of RSA suppression to the RT task, was predictive of increased sleep problems as assessed through both subjective and actigraphy-based measures of sleep. Results indicate that children's emotionality and regulation predict unique variance in the amount and quality of children's sleep, and suggest that they may underlie, at least in part, sleep disturbances in healthy children.

Age-related changes in sleep/wake patterns among Korean teenagers

INTRODUCTION

As children go through the transition from childhood to adolescence, many shifts occur in sleep/wake patterns related to intrinsic and extrinsic developmental changes. These shifts have been shown to result in corresponding shifts in sleep phase (later sleep onset) and sleep deprivation among teenagers in Western societies. However, the effect of these developmental changes on the sleep habits of Korean teenagers has not been analyzed. This study aims to quantify age-related changes in sleep/wake patterns among Korean teenagers and elucidate cultural and other factors causing these changes.

METHODS

The School Sleep Habits Survey was administered in homeroom classes to students in grades 5 to 12 (mean age: 13.7 +/- 2.4 years) selected via a 2-way stratification sampling method. The survey included items regarding usual sleep/wake patterns over the previous 2 weeks as well as measures of daytime sleepiness, sleep/wake-problem behavior, depressed mood, and morningness/eveningness.

RESULTS

A total of 1457 students (52.9% male) completed the survey. The higher the grade, the later bedtime was found to be on both school days and weekends. There was a similar relationship between increasing grade and earlier wake time on school days, but higher grades were associated with later wake time on weekends. Total sleep time decreased by approximately 3 hours on school nights and 1 hour on weekend nights from grades 5 to 12. Adolescents were severely sleep deprived, with mean school-night total sleep times of 6.02, 5.62, and 4.86 hours for 10th-, 11th-, and 12th-graders, respectively. In the higher grades, there was a greater discrepancy between school nights and weekends in terms of bedtime and wake time, and the magnitude of weekend oversleep increased. Older students also reported more daytime sleepiness, more sleep/wake-problem behavior, more depressed mood, and more eveningness preference. The chief reasons students cited for their sleep deprivation differed across grades: Academic demands and entertainment (such as Internet and television) were reported by 5th- and 6th-graders, entertainment and then academic demands by 7th-, 8th-, and 9th-graders, and early school start time and academic demands by 10th-, 11th- and 12th-graders.

CONCLUSIONS

This study clearly demonstrates that Korean adolescents do not get adequate sleep and that they have profound discrepancies in their sleep/wake patterns between school and weekend nights. Compared with previous studies from other countries, Korean students display even greater sleep deprivation and also more irregular sleep/wake patterns. This study also demonstrates that academic demands/stress and early school start time are the most important contributing factors for sleep deprivation among Korean adolescents. These findings stress the need to promote awareness of the magnitude of adolescent sleep deprivation and its detrimental effects in Korean society.

Anxiogenic effect of sleep deprivation in the elevated plus-maze test in mice

RATIONALE

Several clinical studies demonstrate that the absence of periods of sleep is closely related to occurrence of anxiety symptoms. However, the basis of these interactions is poorly understood. Studies performed with animal models of sleep deprivation and anxiety would be helpful in the understanding of the mechanisms underlying this relationship, but some animal studies have not corroborated clinical data, reporting anxiolytic effects of sleep deprivation.

OBJECTIVES

The aim of the present study was to verify the effects of different protocols of sleep deprivation in mice tested in the elevated plus-maze and to assess the effect of chlordiazepoxide and clonidine.

METHODS

Three-month-old male mice were sleep-deprived for 24 or 72 h using the methods of single or multiple platforms in water tanks. Mice kept in their home cages were used as controls. Plus-maze behavior was observed immediately after the deprivation period.

RESULTS

Mice that were sleep-deprived for 72 h spent a lower percent time in the open arms of the apparatus than control animals. This sleep deprivation-induced anxiety-like behavior was unaffected by treatment with chlordiazepoxide (5.0 and 7.5 mg/kg IP), but reversed by an administration of 5 or 10 microg/kg IP clonidine.

CONCLUSION

The results indicate that under specific methodological conditions sleep deprivation causes an increase in anxiety-like behavior in mice exposed to the elevated plus-maze.

Regulation of sleep and arousal: introduction to part VII

This paper introduces the theme of the relationship between sleep deprivation and behavior.

Sleepless in Chicago: tracking the effects of adolescent sleep loss during the middle school years

The influence of the sleep patterns of 2,259 students, aged 11 to 14 years, on trajectories of depressive symptoms, self-esteem, and grades was longitudinally examined using latent growth cross-domain models. Consistent with previous research, sleep decreased over time. Students who obtained less sleep in sixth grade exhibited lower initial self-esteem and grades and higher initial levels of depressive symptoms. Similarly, students who obtained less sleep over time reported heightened levels of depressive symptoms and decreased self-esteem. Sex of the student played a strong role as a predictor of hours of sleep, self-esteem, and grades. This study underscores the role of sleep in predicting adolescents' psychosocial outcomes and highlights the importance of using idiographic methodologies in the study of developmental processes.

The impact of galactosaemia on quality of life--a pilot study

Galactosaemia (galactose-1-phosphate uridyltransferase deficiency) is a pan-ethnic autosomal recessive disorder of galactose metabolism, with an estimated prevalence of 1 in 40-50000. In this pilot study, we aimed to examine the impact of galactosaemia on patients' everyday emotions, schooling, work, friendships, communication, physical activities, self-esteem and body image. We interviewed all patients with galactosaemia who attended our clinic over 2002-2003, aged 6 years and above (n = 13, age range 6-23 years) and, when possible, their parents (n = 12). The questionnaire used was based on an adaptation of the Minneapolis-Manchester QOL survey and the Australian Child Health Questionnaire. Interpersonal problems, bullying and having a hard time getting along with others, excessive anger on a regular basis, sleeping problems and problems with academic achievement, particularly with mathematics, were common. Significant differences were found between patients' and parents' perceptions, with 7/13 patients nominating the dietary restrictions and 4/7 parents nominating long-term issues as the most distressing aspect of having galactosaemia. In addition, most patients felt they were treated differently from their siblings by their parents, yet all parents felt they treated their child with galactosaemia as their other children. We conclude that galactosaemia has a significant impact on the psychosocial aspects of patients' lives. Clinicians should be aware that parents and patients can have different perspectives of the impact of galactosaemia on quality of life.

Sleep disorders in children

PURPOSE OF REVIEW

Childhood sleep disorders are one of the most prevalent complaints in the pediatrician's office. Infant sleep rhythm complaints from new mothers reach 46%, while childhood obstructive sleep apnea has a prevalence of 2% and adolescent insomnia with daily consequences surpasses that percentage.

RECENT FINDINGS

Each sleep disorder must be considered in context of age, as age influences the presentation and impact on the developing child or adolescent. For example, sleep-disordered breathing resulting in adult sleepiness can contribute to death in infants. The symptoms of narcolepsy are often masked until after adolescence, resulting in psychologically costly misdiagnoses.

SUMMARY

There are no outcome studies that track the long-term consequences of pediatric sleep disorders or their contribution to adult sleep problems, but this is an area of increasing research interest. This review assesses the most recent literature on pediatric sleep disorders from May 1, 2002, until April 30, 2003.

Aggression and violence: perspectives on integrating animal and human research approaches

Aggression and violence are concerns that engage us across society as moral and cultural issues. They are also critical issues for mental health research--both for survivors and for understanding how such behaviors occur. Interpersonal violence often explodes in deliberate acts of physical force leaving survivors behind with a diminished sense of control that is often shadowed by persistent fear and anxiety. The treatment of the victims is a clear and immediate concern; from their perspectives the medical consequences require effective attention whether they suffered as a result of acts of nature, mental disease, ideology, or combinations of these. At the same time preventing violent behavior from happening in the first place is a compelling challenge for public health research.