Pathways to adolescent health sleep regulation and behavior

[Sleep behavior and problems in children and adolescents of a psychiatric day clinic sample: results and requirements for systematic diagnostic]

Sleep behavior and problems in children and adolescents of a psychiatric day clinic sample: results and requirements for systematic diagnostic Abstract. Sleep disorders are common in adults as well as children and adolescents. Children and adolescents in psychiatric treatment (CAP) are especially affected by sleep problems. Cognitive behavioral therapy represents the first-line treatment, preceded by a standardized procedure for sleep diagnostics. To date, no study has investigated sleep behavior in CAP day clinics in Germany. In this study, N = 46 children/adolescents receiving CAP treatment in a day clinic completed a sleep diary (7 days) and a sleep anamnesis scheme with the help of their parents, and their sleep behavior was assessed by a clinician. Furthermore, a parent- and a self-report questionnaire plus a clinical assessment of the mental disorders in the children/adolescents were collected. 52 % of the children/ adolescents exhibited sleep disorders or sleep abnormalities (= sleep disorder symptoms in the context of comorbid disorders), in particular problems falling asleep or to falling asleep and sleeping through the night (26 %). In addition, 33 % reported having nightmares. Their sleep behavior correlated significantly with their external behavior problems (r = .38 .61, p = .02-.04); their sex (female: p = .01-≤ .001, |d| = 1.57-2.50) and their age (older: p = .05, |d| = .78) also significantly influenced sleep behavior. Particularly external behavior problems were associated with sleep problems in this day-care population. In summary, a multi-method-multi-informant procedure should be established for the systematic diagnostics of sleep abnormalities, together with individualized cognitive-behavioral therapy of sleep problems, especially in patients with external behavior problems.

Daytime sleepiness underlies the link between adverse parenting and youth psychopathology among adolescent girls

INTRODUCTION

Adverse parenting is associated with sleep problems in adolescence, including sleep quality, inadequate sleep, and daytime sleepiness. Adolescents who experience sleep problems are at greater risk for developing internalizing and externalizing problems. However, research on the intervening role of sleep in the link between adverse parenting and youth psychopathology remains limited. The present study aimed to examine the indirect effects of adverse parenting on youth internalizing and externalizing psychopathology via sleep problems, and to examine the moderating role of gender in associations between parenting and sleep.

METHODS

Participants were 101 low-income youth aged 9-12 (52.5% female; 75.2% African-American) and their primary caregivers. Families were from a non-metropolitan region in the Southeastern United States. Data were collected at two time points (T1; Mage = 10.28, SD = 1.2; T2; Mage = 12.08, SD = 1.2). Adverse parenting was measured at T1, youth-reported sleep problems (inadequacy, disturbance) and daytime sleepiness were assessed at T2, and parent-reported internalizing and externalizing symptoms were measured at T2.

RESULTS

Daytime sleepiness served as an intervening variable in associations between adverse parenting and internalizing and externalizing problems, but sleep problems did not. This indirect association was moderated by gender, such that the association between adverse parenting and daytime sleepiness only emerged as significant for girls.

CONCLUSIONS

These findings suggest that daytime-related sleep behaviors may serve as a mechanism through which harsh or neglectful parenting is related to internalizing and externalizing psychopathology in adolescence, particularly for adolescent girls.

A nationwide cross-sectional study of difficulty waking up for school among adolescents

STUDY OBJECTIVES

To determine the prevalence of and risk-factors for difficulty waking up for school among adolescents.

METHODS

We used a self-administered questionnaire (140 junior high schools [JHSs]; 124 senior high schools [SHSs]) selected randomly in 2012 from throughout Japan.

RESULTS

Total response rate: 60.7%. Data from 38,494 JHS and 61,556 SHS students were analyzed. The prevalence of at least one instance of school tardiness/absence due to difficulty waking up over a 30-day period was 10.9(95% confidence-interval:10.5-11.3)%/2.9(2.7-3.1)% for JHS-boys and 7.7(7.3-8.1)%/2.0(1.8-2.2)% for JHS-girls. The prevalence was 15.5(15.1-15.9)%/5.6(5.3-5.9)% for SHS-boys and 14.4(14.0-14.8)%/5.9(5.6-6.2)% for SHS-girls. We used ordinal regression to identify the risk factors associated with the experience of school tardiness/absence. Factors significantly associated with school tardiness in all four groups (JHS boys/girls, SHS boys/girls) were "no-participation-in-club-activities," "early-morning-awakening," "feeling bad throughout a morning," "drinking," and "smoking." Among associated factors, the highest odds ratio was found for monthly smoking-days (none vs. at least one-day or more) for JHS-girls at 5.30(3.57-7.85). Factors significantly associated with school absence in all four groups were "no wishing to go to university," "no participation in club activities," "disorders of initiating and maintaining sleep," "long internet use," "drinking," "smoking," "poor-mental-health" and "feeling bad throughout a morning." Among associated factors, the highest odds ratio was found for monthly smoking-days (none vs. at least one-day or more) for JHS-girls at 4.60(3.45-6.15).

CONCLUSIONS

These results suggest that the risk factors for difficulty waking up among adolescents are sleep status, lifestyle, and mental health, which can indicate the presence of an underlying disease.

Associations of frequent pain symptoms with excessive daytime sleepiness in adolescents: a longitudinal study

STUDY OBJECTIVES

Pain symptoms, sleep disturbance, and daytime sleepiness are common in adolescents. This study examined the cross-sectional and prospective associations between pain symptoms and excessive daytime sleepiness (EDS) in a large sample of adolescents.

METHODS

Participants were 7,072 adolescents (mean age = 14.6 years) in a follow-up study of behavior and health in Shandong, China. A self-administered structured questionnaire was used to assess pain symptoms (headache, stomachache, and other general pain), body weight and height, sleep, anxiety/depression, substance use, and family environment in November-December in 2015 and one year later. The Chinese adolescent daytime sleepiness scale (CADSS) was used to measure daytime sleepiness.

RESULTS

Of the sample, 19.8% and 23.2% had moderate or severe EDS at baseline and at 1-year follow-up, respectively. The prevalence and 1-year incidence rates of EDS significantly increased with the frequencies of pain symptoms. Frequent pain was significantly associated with increased risk of EDS at baseline (OR=2.01, 95% CI=1.56-2.59), incident EDS (OR=1.41, 95% CI=1.03-1.93), and persistent EDS (OR=2.17, 95% CI=1.52-3.09) while adjusting for adolescent and family covariates, including anxiety/depression, nocturnal sleep duration, insomnia symptoms, frequent snoring, body mass index, and hypnotic use. Similar associations were observed across headache, stomachache, and other pain.

CONCLUSIONS

Frequent pain is significantly and independently associated with increased risk of EDS. Our findings suggest that assessing and treating pain symptoms is important to improve healthy sleep and reduce risk of EDS in adolescents. Further research is needed to understand the underlying psychological and neurobiological mechanisms between pain and daytime sleepiness in adolescents.

Pathways to adolescents' health: chronotype, bedtime, sleep quality and mental health

The strong relationship between sleep and health is defined in the literature. While the need for sleep increases in adolescence with the effect of physiological and hormonal changes, the studies have highlighted the serious sleeping problems of adolescents compared to childhood and adulthood. This study aimed to examine the relationship between chronotype, bedtime, sleep quality and mental health among adolescents. This research was a descriptive-relational study. A total of 1083 students constituted the group of the research. The data were collected through the Morningness-Eveningness Questionnaire (MEQ) and General Health Questionnaire and a questionnaire consisting of some questions about sleep. In the evaluation of data, multiple regression, mediation and path analysis were performed. Age, having problems affecting sleep, difficulties falling asleep, sharing the room with someone else and lack of leisure activities were related to bedtime. It was found that determinants of sleep quality were the variables related to sleep itself. Being a male student, having problems affecting sleep, difficulties falling at sleep, waking up during the night, getting support in the morning for waking up and lack of leisure activities negatively affected mental health. MEQ scale was interpreted as a determinant of sleep time, sleep quality, and mental health level. Although the MEQ score directly affected sleep quality, bedtime had a partial mediation role between MEQ score and sleep quality. Sleep quality had a full mediation role between MEQ score and mental health score. School health workers, especially nurses, should consider chronotype-focused measures to improve adolescents' sleep quality and psychosocial health.

Sleep duration and mood in adolescents: an experimental study

STUDY OBJECTIVES

This study examines the relationship between experimentally manipulated sleep duration and mood in adolescents.

METHODS

Thirty-four adolescents (20 male), aged 15-17 years, lived in a sleep laboratory for 10 days and 9 nights. They were allocated to one of three sleep "doses" for five consecutive nights for 5, 7.5, or 10 h sleep opportunity per night. Two baseline nights and two recovery nights entailed 10 h sleep opportunity per night. Mood was measured every 3 h during wake using unipolar visual analogue scales measuring the mood states "depressed," "afraid," "angry," "confused," "anxious," "happy," and "energetic."

RESULTS

Mixed models analyses with post hoc comparisons revealed that participants in the 5-h group, but not the 7.5- or 10-h groups, reported being significantly more depressed, angry, and confused during sleep restriction than at baseline. Adolescents were significantly less happy and energetic during sleep restricted to 5 h and significantly less energetic during sleep restricted to 7.5 h. When adolescents had 10 h sleep opportunities their happiness significantly increased. No statistically significant effects of sleep restriction were found for fear or anxiety, although small-to-moderate effects of sleep restricted to 5 or 7.5 h were found. Two nights of recovery sleep was not sufficient to recover from increased negative mood states for the 5-h group, although recovery occurred for positive mood states.

CONCLUSIONS

Given the prevalence of insufficient sleep and the rising incidence of mood disorders and dysregulation in adolescents, these findings highlight the importance of sufficient sleep to mitigate these risks.

The association of sleep problem, dietary habits and physical activity with weight status of adolescents in Nepal

BACKGROUND

Overweight/obesity among adolescents is an emerging public health issue worldwide. However, the evidence on the determinants of body weight status and lifestyle behaviors among Nepalese adolescents is limited. This study aims to explore the sleep characteristics, dietary habits, and physical activity and its association with body mass index (BMI) among Nepalese adolescents.

METHODS

A cross-sectional study was conducted between July and November 2019 among 627 randomly selected adolescents from eight schools located in Kathmandu Metropolitan City, Nepal. A self-administrated structure questionnaire was used to collect the data. Anthropometric measurements (adolescent's BMI), sleep characteristics, dietary habits, and physical activity were assessed using validated tools. Multinomial logistic regression analyses assessed the association between covariates and BMI categories. The statistical significance was considered at p-value < 0.05 and 95% confidence intervals (CIs).

RESULTS

The overall prevalence of underweight and overweight/obesity among adolescents was 9.1% (95% CI: 7.1-11.6) and 23.7% (95% CI: 20.6-27.7) respectively. In multinomial logistic regression, adolescents who reported sleep problem compared to those with no such problem (Relative risk ratio (RRR) = 13.37, 95% CI: 7.14-25.05), adolescents who had obstructive sleep apnea (OSA) symptoms (RRR = 3.21, 95% CI:1.31-7.86), who consumed soft drink ≥1 time/day in past 1 months (RRR = 5.44, 95% CI: 2.93-10.10), consumed high-fat dietary ≥2 times/day (RRR = 2.17, 95% CI: 1.18-3.99), and had a habit of junk food consumptions (RRR = 5.71, 95% CI:2.55-12.82), adolescents who had 5-6 h/day sedentary behavior (RRR = 3.21, 95% CI: 1.14-9.09), adolescents from Terai/Madhesi castes (RRR = 2.81, 95% CI: 1.19-6.64) and adolescents whose father was employed (RRR = 2.04, 95% CI: 1.04-3.98) were at increased risk of being overweight/obesity. In contrast, adolescents aged 14-16 years had 71% lower (RRR = 0.29, 95% CI: 0.16-0.52), and adolescents who consumed less than five food groups had 45% lower (RRR = 0.55, 95% CI: 0.31-0.97) risk of being overweight/obesity compared to 12-14 years age groups and consumed more than five food groups respectively.

CONCLUSIONS

The findings of this study warrant immediate interventions to improve the lifestyle to reduce overweight/obesity among Nepalese adolescents. Creating a conducive environment, both at school and home is essential to encourage adolescents for the adoption of healthy lifestyle behaviors.

Prevalence, patterns and socio-demographic correlates of sleep duration in adolescents: results from the LabMed study

OBJECTIVE

The aim of this study was to report the prevalence of adequate sleep and the correlates of sleep duration in Portuguese adolescents aged 12-18 years.

METHODS

Cross-sectional analysis with 1017 adolescents (471 girls) aged 14.6 ± 1.8 years. Adolescents self-reported their sleep duration.

RESULTS

The percentage of adolescents meeting the guidelines was 72.7%, 60.7% and 51.3%, during a whole week, on weekdays and on weekends, respectively. Boys were always more compliant with the guidelines than girls, for all week categories. A significant difference was found on sleep duration on weekends, between boys and girls (p < 0.001). During weekdays, more adolescents were classified as short sleepers when compared to long sleepers. Younger adolescents were more likely to meet the guidelines over the whole week and on weekdays (OR = 2.23, OR = 2.13, respectively; p < 0.05) and being long sleepers on weekends (OR = 1.49, p < 0.05). Those of medium and low SES were less likely to meet the sleep guidelines for all week categories (p_trend<0.001). Girls were more likely than boys to meet the guidelines or being long sleepers on weekends (OR = 1.78, OR = 2.85, respectively; p < 0.05).

CONCLUSIONS

During weekends, the percentage of girls sleeping more than recommended is high, indicating a clear compensation of low sleep duration during weekdays. Those of low SES and older adolescents were less likely to meet the sleep guidelines. Policy makers and researchers should consider the potential effects that SES, gender and age might have on sleep duration, when designing targeted interventions to promote adequate sleep duration.

Association between sleep habits and symptoms of oral disease in adolescents: the 2017 Korea Youth Risk Behavior Web-based Survey

BACKGROUND

This cross-sectional study aimed to examine the relationship between sleep habits and oral disease symptoms in adolescents.

METHODS

Among 62,276 adolescents who participated in the 13th Korea Youth Risk Behavior Web-based Survey (2017), we selected a total of 54,766 adolescents (age, 12-18 years; male, 49.9%) for the final analysis, after excluding those who did not report their sleep duration. The 13th Korea Youth Risk Behavior Web-based Survey data were obtained from a stratified, multistage, clustered sample. Independent variables included general characteristics, oral health behavior, sleep types, sleep duration, and sleep quality; dependent variables comprised oral disease symptoms. Sleep was categorized according to bedtime astype A (bedtime < 1 a.m.) and type B (bedtime ≥ 1 a.m.). Data were analyzed using logistic regression analysis. Statistical significance was set at p < 0.05.

RESULTS

After adjusting for all covariates, adolescents with type A sleep had a higher risk of toothache on chewing (OR = 1.08, 95% CI 1.02-1.15) than adolescents with type B. Adolescents who slept for 6 h or less each night had a higher risk of pain in the tongue and buccal mucosa (OR = 1.35, 95% CI 1.18-1.54), gingival pain, and bleeding (OR = 1.31, 95% CI 1.19-1.45) than those who slept for more than 8 h. Adolescents with low quality of sleep had a higher risk of toothache or throbbing (OR = 1.70, 95% CI 1.60-1.81), toothache on chewing (OR = 1.73, 95% CI 1.65-1.82), and halitosis (OR = 1.51, 95% CI 1.41-1.59) than those with high quality of sleep.

CONCLUSIONS

Our findings indicate that some oral symptoms are related to sleep duration and quality. It is essential to inculcate good sleeping habits in adolescents by emphasizing the effects of inadequate sleep duration and quality.

Does a delayed school start time cause students to exercise less? Evidence from South Korea

A delayed school start time (DSST), achieved by removing zero period, could change students' other time use during school as well as other forms of human capital accumulation. Using difference-in-differences, we find evidence that a DSST in South Korea reduced the time students spent in gym class without worsening students' health status. Combined with previous studies that provided evidence that DSSTs increased students' test scores, our results imply that a DSST can increase students' academic achievement without reducing other forms of human capital accumulation, although schools might change students' other time use.

Sleep duration, insomnia, and stuttering: The relationship in adolescents and young adults

PURPOSE

Evidence of a linkage between neurodevelopmental stuttering and sleep difficulties has been suggested in studies involving children and adolescents. To further examine the relationship between stuttering and sleep, the current study explored both hours of sleep and insomnia in a longitudinal sample of adolescents and young adults living with stuttering.

METHOD

The data for this study came from the National Longitudinal Study of Adolescent to Adult Health (Add Health), a nationally representative survey study following 13,564 US respondents over the course of 20 years. In each of the five survey waves, respondents noted their average hours of sleep. In addition, Wave IV, respondents indicated whether they suffered from insomnia (i.e., difficulty falling or staying asleep). Respondents who indicated stuttering at ages 18-26 (Wave III) and 24-32 (Wave IV) are considered as those with persistent stuttering-the focus of this analysis. Regression analysis assessed the association between stuttering, hours of sleep and insomnia controlling for sex, age, race, education and other demographic characteristics.

RESULTS

The sample included 261 participants (1.7% of total respondents) who identified themselves as people who stutter, comprised of 169 males and 92 females. Compared to their fluent counterparts, individuals who stutter reported to sleep, on average, 20 min less per night. Additionally, 15% of those who stutter reported difficulties falling or staying asleep almost every day or every day, which is twice as likely as controls. Results were robust to demographic characteristics and co-occurring conditions.

CONCLUSIONS

Speech-language pathologists should be aware of the association between stuttering and insomnia, as well as the lower average hours of sleep among adolescents and young adults who stutter. The possibility that lower sleep duration and insomnia may affect stuttering daily variability and impair improvement from stuttering are discussed.

Psychosocial stress, sleep quality and interest in mind-body integrative health sleep intervention among urban adolescents in the school-based health setting

BACKGROUND

Mind-body integrative health (MBIH) interventions to improve adolescent sleep are lacking. The study characterized sleep quality and bedtime-related psychosocial stressors among urban minority adolescents, explored associations between demographics factors, stressors and sleep quality, and gauged interest in a MBIH sleep intervention.

MATERIALS AND METHODS

167 school-based health center (SBHC) patients (mean age = 16.3; 64 % female; 68 % Latino) participated in a needs assessment as part of a quality improvement project. They reported bedtime-related psychosocial stressors using items from the Adolescent Sleep Hygiene Scale (ASHS), sleep quality using the Pittsburgh Sleep Quality Index (PSQI), and interest in a MBIH-based sleep intervention. Chi-square and logistic regression examined associations between demographics, stressors, sleep quality, and interest in the intervention.

RESULTS

67 % had poor sleep quality. Females, compared to males, had 2.23 higher odds (95 % Confidence Interval [CI]: 1.12, 4.42) of having poor sleep quality. Nearly 80 % experienced bedtime-related stressors (25 % experienced one stressor, 17 % two stressors and 37 % three or more stressors); relative to those reporting no stressors, those reporting 3+ stressors had 3.15 higher odds (95 % CI: 1.27, 7.84) of having poor sleep quality. Most (77 %) reported they would participate in an SBHC-based intervention that utilized MBIH modalities preferring both one-on-one and group sessions.

CONCLUSIONS

Urban, predominantly Hispanic and Black, SBHC adolescent patients have poor sleep quality and report bedtime-related psychosocial stressors. Their interest in MBIH interventions to address sleep problems represents a unique opportunity for practitioners and complementary therapists to offer MBIH interventions to a population at high-risk for poor sleep quality.

Role of Sleep Duration in the Association Between Socioecological Protective Factors and Health Risk Behaviors in Adolescents

OBJECTIVE

The purpose of this study was to examine the associations of sleep duration and socioecological protective factors with patterns of adolescent risk behaviors in Fairfax County, VA-one of the largest public school districts in the United States.

METHODS

A total of 21,360 and 20,330 students in 10th and 12th grades who completed the Youth Risk Behavior Survey were included in this cross-sectional analysis. Sleep duration was measured by self-report of the average number of hours of sleep on a school night. Ten socioecological protective factors included peer-individual, family, school, and community domains. Latent class analysis was used to classify 7 risk behaviors (alcohol use, cigarette use, illicit drug use, inappropriate prescription drug use, risky sexual behavior, deviant behavior, and academic failure) into 4 class memberships (low, some, moderate, and high). Multinomial regression models were adjusted for age, sex, and race.

RESULTS

Adolescents who reported sleeping the recommended 8 to 9 hours were significantly less likely to belong to the class memberships of greater risk behaviors compared with those who reported short and long sleep duration after controlling for age, sex, race, and survey year. There was a significant inverse relationship between the number of socioecological protective factors and risk behaviors for both 10th and 12th graders. Potential risks of age, sex, and race on risk behaviors were observed. No significant interaction between sleep duration and protective factors was found in either grade.

CONCLUSION

This study highlights the significant associations between sleep duration and risk behaviors in adolescents with diverse socioecological protective factors. Prioritization of prevention-focused resources should consider sleep duration in addition to the socioecological protective factors commonly cited in the literature when addressing adolescent risk behaviors.

Trajectories of sleep problems in childhood: associations with mental health in adolescence

STUDY OBJECTIVES

We examined initial levels (intercepts) of sleep-wake problems in childhood and changes in sleep-wake problems across late childhood (slopes) as predictors of externalizing behavior problems, depressive symptoms, and anxiety in adolescence. To ascertain the unique effects of childhood sleep problems on adolescent mental health, we controlled for both childhood mental health and adolescent sleep problems.

METHODS

Participants were 199 youth (52% boys; 65% White/European American, 35% Black/African American). Sleep-wake problems (e.g. difficulty sleeping and waking up in the morning) were assessed during three time points in late childhood (ages 9, 10, and 11) with self-reports on the well-established School Sleep Habits Survey. At age 18, multiple domains of mental health (externalizing behavior problems, depressive symptoms, and anxiety) and sleep-wake problems were assessed.

RESULTS

Latent growth curve modeling revealed that children with higher levels of sleep-wake problems at age 9 had consistently higher levels of such problems between ages 9 and 11. The initial level of sleep-wake problems at age 9 predicted externalizing behaviors, depressive symptoms, and anxiety at age 18, controlling for mental health in childhood and concurrent sleep-wake problems in adolescence. The slope of sleep-wake problems from ages 9 to 11 did not predict age 18 mental health.

CONCLUSIONS

Youth who had higher sleep-wake problems during late childhood had higher levels of mental health problems in adolescence even after controlling for childhood mental health and concurrent sleep-wake problems. Findings illustrate that childhood sleep problems may persist and predict adolescent mental health even when potentially confounding variables are rigorously controlled.

Self-reported daily sleep quality modulates the impact of the framing effect on outcome evaluation in decision-making under uncertainty: An ERP study

A growing body of research has largely confirmed and supported the idea that experimental sleep loss, such as sleep deprivation or sleep restriction, could affect individuals' risk-taking behavior and brain activity. However, whether self-reported sleep quality resulting from daily life modulates how feedback is evaluated during decision-making is still unclear. In this study, we used event-related potentials (ERPs) with a Balloon Analogue Risk Task (BART) to investigate how self-reported daily sleep quality modulates the brain's response to feedback from decision-making in the gain and loss frames. Behavioral data showed an increased aversion to uncertainty in the gain frame relative to the loss frame for individuals with higher sleep quality. However, this was not true for individuals with lower voluntary sleep quality. Similarly, the ERP data demonstrated that individuals with lower self-reported daily sleep quality displayed no changes in feedback-related negativity (FRN) in response to outcomes from decision-making in the gain and loss frames; however, individuals with higher self-reported daily sleep quality showed a greater FRN in response to decision-making in the gain frame than that in the loss frame. A Pearson correlation analysis showed that self-reported daily sleep quality was positively related to the variance of the FRN amplitude in response to the gain and loss frames. These findings suggest that framing effects on decision-making under uncertainty may depend on self-reported daily sleep quality and that the effects disappear when the sleep quality declines.

Bullying Victimization and Friendship as Influences on Sleep Difficulty among Brazilian Adolescents

Bullying victimization is associated with poor health-related outcomes, including sleeping problems. The present study aimed to investigate the impact of bullying victimization on sleep difficulty, and the moderating effect of the number of close friends on this association, also exploring differences across genders. The study was based on a nationally-representative survey on adolescent health conducted in Brazilian schools, involving a total of 109,104 participants, enrolled at the 9th year in 2012. The measures used in the analysis included socio-demographic characteristics, bullying victimization, sleep difficulty, and number of close friends. In the multilevel models, reporting more peer victimization was associated with more sleep difficulties (b = .18, t = 50.17, p < .05), with girls reporting more sleep difficulties in association with peer victimization than boys. Reporting having more friends was inversely linked to sleep difficulties (b = -.08, t = -15.26, p < .05), and the association between peer victimization and sleep difficulties was significantly buffered by the number of friends. Moreover, in a three way interaction, there was a marginally significant difference in the effect of friends on the link between victimization and sleep difficulties between boys and girls (b = .02, t = 1.86, p = .06), with the buffering effect of friendships being negligible among girls as opposed to boys. The results indicate a significant association between bullying victimization and sleep difficulties, which seems to be more pronounced among girls, also suggesting that the number of close friends may buffer this association, mainly for boys.

Racial disparities in sleep health between Black and White young adults: The role of neighborhood safety in childhood

OBJECTIVES

Black adults in the United States have shorter sleep durations and poorer sleep efficiency relative to White adults, yet reasons for these disparities are not well explicated. The objective of this study was to examine neighborhood safety in childhood as a mediator of subsequent racial disparities in sleep.

METHODS

Data were from Black and White young adults attending a large, predominantly White university in the Southeastern United States (N = 263; 52% Black, 53% female; Mean age = 19.21 years, SD = 1.01). Sleep parameters were assessed from eight nights of wrist actigraphy (time in bed, sleep duration, and efficiency) and an established self-report measure of daytime sleepiness. Residential histories from birth through age 18 were documented, and retrospective self-reports of neighborhood safety in childhood were assessed.

RESULTS

Black participants had less time in bed (p < 0.001), shorter sleep duration (p < 0.001), poorer sleep efficiency (p < 0.001), and more daytime sleepiness (p = 0.009) than White participants. Neighborhood safety mediated race differences in time in bed (p = 0.028), sleep duration (p = 0.033), and daytime sleepiness (p = 0.048), but not sleep efficiency. Findings were substantively unchanged after adjustment for family socioeconomic status, BMI, and substance use.

CONCLUSIONS

Findings support the hypothesis that neighborhood safety in childhood may partially account for race differences in subsequent sleep duration and daytime sleepiness. Addressing racial inequities in childhood neighborhood safety may be an important step toward reducing racial disparities in sleep health.

Impact of pre-sleep habits on adolescent sleep: an Italian population-based study

OBJECTIVE

Several evidences demonstrate that pre-sleep habits may negatively impact adolescent sleep, yet few data exist on Italian population. This study aimed to investigate the relationship between pre-sleep habits, use of technology/activity and sleep in Italian adolescents.

METHODS

Self-report questionnaires including Italian version of School Sleep Habits Survey and use of technology/activity (eg smartphone, PC) at bedtime were administered to 972 adolescents (13-19 years) from Lombardia. We stratified the sample in five groups according to the age: Group I (13-14 years), Group II (15 years), Group III (16 years), Group IV (17 years), Group V (18-19 years).

RESULTS

Our descriptive analysis reveals a different sleep profile across age-groups: Group III showed highest percentage of bad sleep (26.7%) and frequent nocturnal awakenings (24.1%), Group V had the highest percentage of insufficient sleep (40,4%) and difficulty falling asleep (42.7%) and Group IV presented an elevated difficulty in waking up in the morning (70.1%). A significant negative correlation was found in total group between use of smartphone, internet and studying/doing homework and total sleep time. The use of smartphone, internet videogames, listening to music and studying/doing homework was positively associated with delayed bedtime.

CONCLUSIONS

This study confirms the great impact of pre-sleep habits, and in particular the use of technology on adolescent sleep. Our results demonstrate that sleep is strongly altered among Italian adolescents using electronic devices in evening. The type of technology may be related to specific sleep profile, emphasizing the importance of stratification analyses to identify associated factors to sleep problems.

Sleep Quality and Duration in European Adolescents (The AdolesHealth Study): A Cross-Sectional, Quantitative Study

Sleep is a vital element of adolescents' overall health; it influences their body and mind and thus affects their quality of life. Adequate sleep quality and duration are essential for maintaining optimal metabolic health and lowering the risk of developing several medical conditions, such as cardiovascular disease. The current study aimed to assess the perceived sleep quality and duration of 1717 European adolescents from three different European countries (Spain, Iceland and Estonia) aged 13- to 16-years (900 boys, 817 girls) using the Pittsburgh Sleep Quality Index (PSQI). A multivariate analysis of variance (MANOVA) was performed to examine differences between groups and two-factor analysis of variance (ANOVA) was used to analyze city and age differences. The probability of having poor sleep quality and duration was calculated by Odd-Ratio (OR). Our study found poor sleep quality in 44% of the boys and 53% of the girls, whereas 68% and 69%, respectively did not get the recommended hours of sleep (i.e., 8-10 h). No difference was found between adolescents from Estonia, Iceland and Spain regarding sleep duration. In contrast, Spanish and Estonian adolescents reported higher probabilities of having poor sleep quality. Finally, girls had a significantly higher probability of poor sleep quality than boys.

Magnitude and correlates of sleep quality among undergraduate medical students in Ethiopia: cross –sectional study

Purpose

Poor quality of sleep has a negative effect on academic performance of medical students. Quantity and quality of sleep in addition to average sleep time are strongly linked with students’ learning abilities, poor academic performance and poor interpersonal relationship which predispose them to mental illnesses. This study is aimed to assess magnitude and correlates of sleep quality among medical students in Ethiopia.

Method

An institutional based cross-sectional study was conducted among 576 undergraduate medical students. Data was collected by using interviewer administered structured questionnaires. Pittsburgh Sleep Quality Index (PSQI) was used to assess sleep quality. The collected data were entered in to Epi-data version 3.1and analyzed using SPSS version 20. Logistic regression was used to identify the potential determinants of quality of sleep among undergraduate medical students. P-values less than 0.05 were considered statistically significant and strength of the association was presented by adjusted odds ratio with 95% C.I.

Result

The prevalence of poor sleep quality among undergraduate medical students was 62% (95%CI, 57.9, 65.3). The mean age (±SD) of the respondents was 21.5(±2.4), with age ranging from 18 to 28 and about 310 (53.8%) were males. Factors like, being depressed (AOR = 1.92,95%CI 1.16,3.19), poor social support (AOR = 5.39,95%CI 2.33,2.49), being stressed (AOR = 2.04,95%CI 1.26,3.31), and poor sleep hygiene (AOR = 3.01,95%CI 1.75,5.18) were associated with poor sleep quality at p-value < 0.05. Findings also showed that, one unit increase in grade point average was associated with 81.5% decrease (AOR = 0.185, 95%CI 0.13, 0.28) in poor sleep quality.

Conclusion

A substantial proportion of medical students are affected by poor sleep quality. Routine screening of sleep quality, sleep hygiene, depression and stress is warranted. Moreover, it is better to educating medical students about proper sleep hygiene and the consequences of poor sleep.

Sleep problems in children and adolescents following traumatic life events

Rates of childhood trauma exposure are extremely high, with approximately 70% of children and adolescents experiencing at least one traumatic event. Among the most common non-specific consequences of stress and trauma are disruptions of sleep. Sleep problems, such as shorter sleep duration, difficulty falling asleep, frequent awakenings, nightmares, sleepless nights, and early-morning wakefulness appear to have a higher prevalence among children and adolescents following traumatic events. This review will illustrate the role of sleep problems in traumatized children and adolescents, and emphasize the need to consider a wide range of etiological mechanisms for these symptoms. However, the relationship of trauma exposure to sleep problems among children and adolescents needs further investigation in future research. Moreover, in view of the adverse consequences of long-term disrupted sleep on mental health outcomes following trauma, the need to effectively address sleep disturbances in traumatized children and adolescents is crucial.

Social Media Use and Adolescents' Sleep: A Longitudinal Study on the Protective Role of Parental Rules Regarding Internet Use before Sleep

The popularity of social media use among adolescents has raised concerns about the potentially harmful effects of social media use on adolescents' sleep. Since longitudinal research considering this relationship is scarce, the present two-wave longitudinal study of 2021 secondary school students (Mage = 13.86, SD = 1.25) examined whether frequency of social media use and problematic social media use predicted adolescents' bedtime and quality of sleep. Moreover, the protective role of parental rules regarding Internet and smartphone use one hour before sleep was examined. The findings indicated that strict parental rules about Internet and smartphone use before sleep might prevent negative consequences of social media use on bedtime and sleep quality, but only among less engaged social media users. Once adolescents are highly engaged social media users, strict parental rules do not seem to prevent negative media influences on sleep. This implies that limiting Internet accessibility before bedtime can help prevent adolescents' sleep problems, but that regulation is less effective for adolescents who are already highly involved in social media use.

Sleep Characteristics in Italian Children During Home Confinement Due to Covid-19 Outbreak

OBJECTIVE

Italy faced one of the first large clusters of COVID-19 infections worldwide. Home confinement and social distancing could have negatively impacted sleep habits and prevalence of sleep disorders in children, which may be also linked with altered emotional processes. The present study focused on clinical aspects related to sleep, insomnia and emotions in Italian children aged 0-to-12 years during home confinement due to COVID-19 outbreak.

METHOD

An online survey was systematically distributed in all Italian territories by contacting regional offices of the Italian Ministry of Instruction, University and Research (MIUR) and schools with available contact. All respondents had to be parents of at least one child aged 0 to 12 years old. Information on sociodemographic variables, sleep habits, sleep health behaviors, sleep disorders and mood were collected.

RESULTS

Parents of 2361 children (mean age: 8.1 ± 2.62 years; 1148 females; 1213 males) answered the survey. 1.2% of children was between 0 and 2 years old; 15.3% within 3 to 5 years and 83.3% within 6 and 12 years. In all group ages, late bedtime was observed (most of them after 9 p.m.). 59.4% of all children presented at least one clinical diagnostic criterion for childhood insomnia. Logistic regression model showed that presence of at least one criterion for childhood insomnia was associated to younger age, negative mood, current parental insomnia, being the only child, presence of any other sleep disorder, and sleep hygiene behaviors.

CONCLUSIONS

Data indicate an alarming increase of prevalence of insomnia related problems in Italian children during home confinement with respect to previous data. This was found to be associated with poor sleep hygiene and negative mood. Clinical programs targeting insomnia, sleep health behaviors and emotional processes should be implemented in pediatric primary care in order to prevent the development of sleep problems in a post-pandemic situation.

Neurobiological and Hormonal Mechanisms Regulating Women's Sleep

Sleep is crucial for optimal well-being, and sex differences in sleep quality have significant implications for women's health. We review the current literature on sex differences in sleep, such as differences in objective and subjective sleep measures and their relationship with aging. We then discuss the convincing evidence for the role of ovarian hormones in regulating female sleep, and survey how these hormones act on a multitude of brain regions and neurochemicals to impact sleep. Lastly, we identify several important areas in need of future research to narrow the knowledge gap and improve the health of women and other understudied populations.

A chrononutrition perspective of diet quality and eating behaviors of Brazilian adolescents in associated with sleep duration

It is well recognized that sleep and food intake exhibit 24-h patterns and disturbances of these patterns can lead to health problems. Cross-sectional and prospective studies suggest that diet quality and eating behaviors are negatively affected by short sleep duration. Adolescence is a particularly vulnerable period for the emergence of inadequate sleep and diet patterns. The aim of the study was to investigate associations, from a chrononutrition perspective, of diet quality, nutrients intake, and eating behaviors (eating frequency, eating period, and time-interval between eating occasions) in relation to sleep duration among a multi-ethnic cohort of Brazilian adolescents. Data were collected by the 2015 ISA-Capital survey, a population-based cross-sectional study comprising 419 adolescents of both sexes (12-19 years old) of São Paulo, Brazil. Demographic, socioeconomic, anthropometric, and lifestyle, including sleep duration, data were obtained from an interviewer-administered structured questionnaire. Dietary data were obtained by 24-h dietary recall (24-HDR), and diet quality was assessed by the Brazilian Healthy Eating Index - Revised (BHEI-R), validated for the Brazilian population. The independent associations between sleep duration categories (i.e., <8 h as short sleep and 8-10 h as adequate sleep), and dietary variables were assessed after adjustments for covariates. Multiple linear, logistic, and Poison regression models were used, depending on the variable. Diet quality, nutrients intake, and eating behaviors differed according to adolescents' sleep duration. Approximately 36% of adolescents were sleep deprived. They presented poorer diet quality (53 points, p = .034) and eating behaviors characterized by lower probability of having lunch (88%, p < .001) and dinner (71%, p < .001) and higher probabilities of eating breakfast (87%, p < .001) and morning snack (26%, p = .001). These adolescents compared to those with adequate sleep duration also had, from snacks and in the 24-h cycle, higher contribution of available carbohydrates (8%, p < .001; 50%, p = .024) and total sugar (6%, p < .001; 21%, p < .001) and added sugar (3%, p < .001; 15%, p < .001). The chrononutrition characteristics of sleep-deprived adolescents were marked by longer eating periods (12 h, p < .001) and time-interval between eating occasions (3 h, p < .001) than adolescents with adequate sleep duration. These differences point to the relevance of the interrelation between sleep and diet, i.e., disruption of circadian cycles and consequent metabolic health problems, to inform public health policies and clinical interventions.

Nightly sleep-wake concordance and daily marital interactions

OBJECTIVE

We and others have found that couples' sleep is a shared and dyadic process. Couples' sleep-wake concordance (whether couples are awake or asleep at the same time) is associated with couples' relationship factors; however, we know little of the temporal associations between concordance and daily relationship characteristics. The purpose of this study was to examine daily positive and negative interpersonal interactions to determine how they predict, and are predicted by, nightly sleep-wake concordance.

METHOD

Participants were 48 heterosexual couples between 18 and 45 years of age who shared a bed with their spouse. Couples completed questionnaires and daily assessments of positive and negative interactions. Each member of the dyad wore wrist actigraphs for 10 days. Sleep-wake concordance was calculated as the percentage of time couples were awake or asleep throughout the night at one-minute intervals. Multilevel modeling with lagged effects determined bidirectional and lagged associations between concordance and couples' daily interactions.

RESULTS

Couples had more negative interactions than their usual following nights with higher concordance than their usual (but not vice versa) and this was more pronounced for well-adjusted couples. In contrast, across all couples, more positive interactions and perceived warmth and support from partners were associated with higher concordance.

CONCLUSIONS

Our findings demonstrate that the valence of sleep-wake concordance depends on relationship quality characteristics (eg, marital adjustment). Future research on relationships, sleep, and health should consider couples' shared sleep behaviors as one mechanism by which relationships are associated with long-term health outcomes.

Afraid and Awake: The Interaction Between Trauma and Sleep in Children and Adolescents

Traumatic experiences and sleep disturbances are both common in children and adolescents. Because of the reciprocal relationship between sleep complaints and trauma, a mental health evaluation should include not only an assessment of posttraumatic stress disorder and other trauma symptoms but also a specific evaluation of sleep-related complaints. Similarly, if a history of both trauma and sleep complaints is identified, an effective trauma-informed intervention, whether psychological, psychopharmacologic, or a combination of the two, should directly address sleep issues.

Normal Sleep in Children and Adolescence

Adequate sleep is essential for healthy development in childhood and adolescence. Healthy sleep contributes to good physical health, immune function, mental health, and academic performance. The regulation and architecture of sleep change greatly across childhood and adolescence, and the ability to obtain sufficient sleep is impacted by a range of factors that change with maturation. This article describes normal sleep across childhood and adolescence and discusses some of the most common barriers to adequate sleep, including early school start times, technology use, and changes to circadian rhythms, and sleep homeostasis across puberty.

Resilience and lifestyle-related factors as predictors for health-related quality of life among early adolescents: a cross-sectional study

Objective

To examine whether lifestyle-related factors and resilience predict health-related quality of life (HRQoL) in a sample of early adolescents.

Methods

A total of 611 eighth grade pupils (response rate: 79%) participated in this cross-sectional study. The variables measured were physical activity (accelerometer), cardiorespiratory fitness (Andersen test) and a questionnaire assessing dietary habits, sleep disturbance, resilience (Resilience Scale for Adolescents) and HRQoL (KIDSCREEN-27).

Results

A total of 36% of the sample met the official recommendations of 60 minutes of daily physical activity. Univariate analysis identified physical activity, dietary habits, sleep disturbances, body mass index (BMI), cardiorespiratory fitness and resilience, but not sedentary time, as predictors of HRQoL. Multivariate regression analysis identified resilience as a positive predictor (β 0.18 to 0.27) of all HRQoL domains and sleep disturbance as a negative predictor (β −0.65 to −0.24) of four HRQoL domains. BMI (β = −0.27) and cardiorespiratory fitness (β = 0.021) were predictors of the HRQoL domain physical well-being. Adherence to dietary recommendations was both a positive and a negative predictor of HRQoL (β −0.45 to 0.59).

Conclusion

Resilience and sleep disturbances were the main predictors of HRQoL.

The Teensleep study: the effectiveness of a school-based sleep education programme at improving early adolescent sleep

Objective

To evaluate the impact of a school-based sleep education programme on adolescent sleep and sleep knowledge.

Methods

This is the first outcome report on ‘Teensleep’: a novel, teacher-led programme, comprising ten lessons that can be delivered flexibly. Students in Year 10 (n = 1504; mean age = 14.14 ± 0.35 years) from ten UK state (non-fee-paying) secondary schools received the lessons and parents received a leaflet. Effectiveness was assessed using measures across two time points (pre- and post-intervention). Students completed questionnaires on sleep knowledge, sleep quality, sleep behaviour, sleep hygiene, daytime sleepiness and health-related quality of life. A sub-sample provided objective (actigraphy, n = 84) and subjective (sleep diary, n = 74) sleep measures.

Results

Large improvements in sleep knowledge (d = 0.78), and smaller improvements in sleep quality (d = 0.15) and sleep hygiene (d = 0.11) were observed, but not in daytime sleepiness or health-related quality of life. Small and limited changes in subjective and objective sleep patterns were found. Baseline sleep quality was differentially associated with key outcomes, with those initially self-reporting poor sleep demonstrating an improvement in sleep quality, sleep hygiene and sleepiness.

Conclusion

Teensleep was effective at improving sleep knowledge but sleep changes were small. Such interventions have traditionally focused on gains for all students, but this study suggests that poor sleepers may be the most likely to experience immediate direct sleep benefits. Follow-up studies are required to investigate whether or not sleep education provides long-term benefits as a step towards preventative sleep medicine.

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‘Teensleep’ is a teacher-led, school-based sleep education programme for adolescents.

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Large-scale study: students received lessons in ten UK schools.

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Programme effectiveness was evaluated using questionnaires and actigraphy.

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Sleep knowledge, self-reported sleep quality and sleep hygiene improved after lessons.

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Study suggests poor sleepers may be most likely to experience immediate benefits.

Relationships between sleep and internalizing problems in early adolescence: Results from Canadian National Longitudinal Survey of Children and Youth

BACKGROUND

Both inadequate sleep and internalizing problems, such as symptoms of anxiety and depression, are prevalent among adolescents with sparse epidemiological literature outlining sex-specific relationships at this critical age.

OBJECTIVE

To examine cross-sectional and prospective relationships between self-reported sleep problems, indicated by sleep duration, difficulties getting to sleep and changes in difficulties getting to sleep with internalizing problems in early adolescence.

METHODS

This study was a secondary analysis of data from the Canadian National Longitudinal Survey of Children and Youth. Multivariable linear regression was used to estimate cross-sectional and longitudinal associations. Relevant family and social context variables were controlled for in multivariable analyses. Family functioning was assessed as a potential effect modifier.

RESULTS

There were 993 and 736 participants [longitudinal cohort entry age of 10 or 11 years; 49% male] in longitudinal and cross-sectional analyses, respectively. Most cross-sectional multivariable analyses of sleep duration and internalizing problems revealed no statistical associations. Difficulties sleeping and concurrent internalizing problems were positively associated in 12/13 year old females (β = 1.77 [0.94, 2.61], R² = 17%) and males (β = 1.18 [0.36, 2.01], R² = 16%). High persistent difficulties sleeping in females aged 12/13 to 14/15 years also positively predicted internalizing problems in females age 14/15 years (β = 1.90 [0.52, 3.29], R² = 21%) while controlling for initial internalizing symptoms. Family functioning was not found to be an effect modifier.

CONCLUSION

Findings highlight the potential role of difficulties sleeping for adolescents' mental health. Public health initiatives to promote sleep hygiene in this population subgroup are critical to prevent the potential long-term health impact of sleep problems.

Affective recovery from stress and its associations with sleep

Good sleep habits are important for emotional well-being. Studies have linked sleep with people's ability to regulate their emotions in response to stressful events, yet little is known specifically about how sleep is related to a person's ability to recover affectively from a stressful experience. The current study examined self-reported sleep habits and their associations with both positive and negative affective recovery from a laboratory-induced stressor. Participants (N = 120) reported their sleep habits over the previous month and then engaged in a laboratory psychosocial stress task. Affect was measured before, during, and 6 minutes after the task. Different aspects of sleep were related to poorer positive and negative affective recovery. Worse sleep quality was associated with higher post-recovery negative affect, whereas worse sleep efficiency was associated with lower post-recovery positive affect. Findings suggest that poor sleep is associated with prolonged affective recovery from a stressful event. Implications for health and well-being are discussed.

Association of Parent-Reported Sleep Problems in Early Childhood With Psychotic and Borderline Personality Disorder Symptoms in Adolescence

IMPORTANCE

Persistent nightmares in childhood have been prospectively associated with psychosis and borderline personality disorder (BPD) in adolescence. However, the extent to which this association is also true for behavioral sleep problems is still unknown, and the potential mechanisms are unexplored.

OBJECTIVE

To examine the prospective associations between several parent-reported sleep problems in early childhood and psychotic and BPD symptoms at 11 to 13 years of age and the potential mediation of the associations by depression at 10 years of age.

DESIGN, SETTING, AND PARTICIPANTS

This cohort study assessed 13 488 participants in the Avon Longitudinal Study of Parents and Children birth cohort who were followed up for more than 13 years. Pregnant women from Avon, United Kingdom, with expected dates of delivery from April 1, 1991, to December 31, 1992, were invited to take part in the study. Data analysis was conducted from May 1 to December 31, 2019.

MAIN OUTCOMES AND MEASURES

Psychotic experiences at 12 to 13 years of age were assessed using the Psychosis-Like Symptom Interview, and BPD symptoms at 11 to 12 years of age were tested using the UK Childhood Interview for DSM-IV Borderline Personality Disorder. Parent-reported nighttime sleep duration, night awakening frequency, bedtime, and regularity of sleep routines were assessed when the child was 6, 18, and 30 months and 3.5, 4.8, and 5.8 years of age.

RESULTS

Data were available on 7155 participants (3718 girls [52%]) who reported on BPD symptoms and 6333 (3280 boys [52%]) who reported on BPD symptoms. Higher night awakening frequency at 18 months of age (odds ratio [OR], 1.13; 95% CI, 1.01-1.26) and less regular sleep routines at 6 months (OR, 0.68; 95% CI, 0.50-0.93), 30 months (OR, 0.64; 95% CI, 0.44-0.95), and 5.8 years (OR, 0.32; 95% CI, 0.19-0.53) of age were significantly associated with psychotic experiences in adolescence, whereas shorter nighttime sleep duration (OR, 0.78; 95% CI, 0.66-0.92) and later bedtime at 3.5 years of age (OR, 1.32; 95% CI, 1.09-1.60) were significantly associated with BPD symptoms. Results of mediation analysis were consistent with all these associations, except for later bedtime at 3.5 years and BPD in adolescence, which had no association. Depression at 10 years of age mediated the associations between frequent night awakenings at 18 months of age (bias-corrected estimate, -0.005; 95% CI, -0.008 to -0.002; P = .002) and irregular sleep routines at 5.8 years of age (bias-corrected estimate, -0.006; 95% CI, -0.010 to -0.003; P = .003) with psychosis.

CONCLUSIONS AND RELEVANCE

The findings suggest that some behavioral sleep problems in childhood are distinctively associated with the onset of psychosis and BPD in adolescence, following different pathways. Furthermore, depression at 10 years of age may mediate only the association with psychosis. These findings contribute to the design of more personalized interventions in psychosis and BPD.

Sleep in youth with repeated self-harm and high suicidality: Does sleep predict self-harm risk?

OBJECTIVE

To elucidate processes contributing to continuing self-harm in youth at very high risk for suicide, focusing on sleep disturbance, a putative warning sign of imminent suicide risk.

METHOD

101 youth (ages 12-18) selected for high risk of suicide/suicide attempts based on suicidal episodes plus repeated self-harm (suicide attempts and/or nonsuicidal self-injury [NSSI]). Youth were assessed at baseline, 6-, and 12-month follow-ups on measures of self-harm, suicidality, sleep, and depression.

RESULTS

Youth showed high rates of baseline sleep disturbance: 81.2% scored in the clinical range on the Pittsburgh Sleep Quality Index (PSQI); 81.2% reported an evening (night owl) circadian preference. PSQI score was associated with elevated levels of self-harm (suicide attempts and NSSI) contemporaneously and predicted future self-harm within 30 days. Rates of self-harm were high during follow-up: 45.0% and 33.7% at 6 and 12 months, respectively.

CONCLUSIONS

Results underscore the need to move beyond an acute treatment model to prevent recurrent and potentially deadly self-harm, the importance of clarifying mechanisms contributing to elevated suicide/self-harm risk, and the potential promise of engaging sleep as a therapeutic target for optimizing treatment and elucidating mechanistic processes.

The contribution of good sleep to working memory in preschool: A matter of sleep quality or duration?

Good sleep is essential for efficient cognitive performance. The present research examined the link between sleep and working memory (WM) during early childhood, a period of major advances in neurodevelopment. The sample included 80 healthy children, 40 3-year-olds and 40 4-year-olds, attending childcare settings. The children were individually tested using WM tasks; parents completed sleep questionnaires. On a group level, WM improved with age. Process model analysis demonstrated the effect of age on WM (P=0.001) and indicated an age-specific involvement of sleep quality (P=0.01). Whereas sleep duration was not associated with WM, at 4years of age, sleep disturbance with physical symptoms (e.g., breathing, motor) was associated with poor WM performance. Among 3-year-old girls, fear-related sleep disruption was associated with better WM performance. Together, the results suggest that the association between sleep and WM is dependent on: (a) specific aspects of sleep, (b) age, and (c) gender. More research is essential for unraveling the underlying neuro-maturational processes and mechanisms.

Sleep Quality of Students from Elementary School to University: A Cross-Sectional Study

BACKGROUND

Sleep affects a wide array of health outcomes and is associated with the quality of life. Among students, sleep quality is affected by school stage and grade; however, data regarding the different sleep-related problems students experience at different school stages are limited. In this study, we aimed to explore sleep quality among a student sample ranging from elementary school to university level.

METHODS

Overall, data were examined for 9392 subjects aged 9-22 years. Information on sociodemographic characteristics and other variables were collected through self-administered questionnaires. Sleep quality on school nights was evaluated using the standard Pittsburgh Sleep Quality Index; global score >5 was classified as poor sleep quality. For the high school sample, logistic regression analysis was used to estimate associations between sleep quality and certain factors.

RESULTS

Of the elementary school, middle school, vocational high school, senior high school, and university students, 7.5%, 19.2%, 28.6%, 41.9%, and 28.5%, respectively, showed poor sleep quality. The high school students reported the highest prevalence of shorter sleep duration (70.8%), day dysfunction (84.7%), and subjective poor sleep quality (17.2%). The elementary school students showed the highest prevalence of poor sleep efficiency (17.9%). The university students showed the highest prevalence of sleep medication use (6.4%). The vocational high school students reported the highest prevalence of sleep latency (6.3%) and sleep disturbance (7.4%). Logistic regression modeling indicated that sleep quality is positively associated with school stage, grade, family atmosphere, academic pressure, and number of friends.

CONCLUSION

Sleep quality and sleep features change greatly from elementary school to university. Interventions to improve sleep quality should consider targeting the specific issues students experience at each school stage. Alarmed by the high prevalence of poor sleep quality among high school students, it is recommended that high school students should be informed of their sleep matter and the consequences.

A Qualitative Study of a Mindfulness-Based Intervention in Educational Contexts in Chile: An Approach Based on Adolescents' Voices

The application of mindfulness-based interventions in school settings has increased considerably in recent years, showing that differences between the characteristics of programmes can impact on the receptivity and effectiveness of mindfulness training. However, few studies have explored the learning process from the perspective of the children and adolescents who participate in mindfulness practice. The goal of this paper is to analyse the subjective experience of a group of adolescents following the completion of a mindfulness-based intervention developed for schools in Chile. The intervention studied is the “.b curriculum”, which is part of the Mindfulness in School Project (MiSP) developed in the UK. Twenty adolescents participated in semi-structured interviews within their school, in which three key areas were explored: pedagogy, perceived effects, and mechanisms of action, each of them being analysed from the perspective of thematic analysis. The results support the view that pedagogy is a very relevant consideration in the implementation, development, and efficacy of mindfulness-based interventions within the school context. We propose that the inclusion of structure, contents, process/mindful practices, and teachers’ expertise provides the pedagogical-relational framework required for students to successfully develop mindfulness skills, which enables them to experience their cognitive, emotional, and somatic effects. These effects are linked to self-regulation strategies, based on paying attention to one’s somatic experience with kindness and curiosity, which works as an attentional anchor. It is hoped that these results will contribute to the spread of mindfulness research in adolescents in Latin America, thus facilitating cross-cultural and international comparisons.

Material hardship, perceived stress, and health in early adulthood

Purpose

We examined the associations between material hardship and health outcomes in early adulthood and the extent to which these associations are mediated by perceived stress.

Methods

We used wave I and IV of the National Longitudinal Study of Adolescent Health, a nationally representative survey of young adults aged 18–34 years old (n = 13,313). Multivariate logistic regression and decomposition methods were used to evaluate the associations between types and depth of material hardship (food, bill-paying, and health resource hardship), health outcomes (self-rated health, depression, sleep problems, and suicidal thoughts) in early adulthood, and the extent to which these associations were mediated by perceived stress.

Results

The adjusted odds of fair or poor health status, depression, sleep problems, and suicidal thoughts were higher among individuals with material hardship than counterparts without. A considerable proportion of the association between material hardship and health outcomes was attributable to perceived stress.

Conclusions

Material hardship is associated with adverse health outcomes in early adulthood, and these relationships are robust after accounting for various sociodemographic characteristics and family background. Perceived stress accounted for a sizable portion of the effects of material hardship on health.

Public Health Implications

Efforts to promote health equity in young adults should focus on material hardship and associated stressful conditions.

Internet-delivered insomnia intervention improves sleep and quality of life for adolescent and young adult cancer survivors

BACKGROUND

Insomnia is common among adolescent and young adult (AYA) cancer survivors. Cognitive-behavioral therapy for insomnia (CBT-I) is considered the gold standard treatment. Standard CBT-I was designed for adults and not adapted to the unique medical, psychosocial, and developmental needs of AYA cancer survivors, which can exacerbate their insomnia. Further, the vast majority of cancer centers do not have a behavioral sleep medicine expert on staff. Our study objective was to examine the efficacy of an Internet-delivered CBT-I program that was tailored for AYA cancer survivors (NCT03279055).

PROCEDURE

Twenty-two AYA cancer survivors (mean age 20.4; range 14-25) with insomnia enrolled in an automated CBT-I program modified for AYA cancer survivors following stakeholder feedback. Participants were blood cancer (54.5%) and solid tumor (45.5%) survivors, an average of 9.7 years postdiagnosis. Sleep health, fatigue, and quality of life were assessed at baseline and at two follow up timepoints (8 and 16 weeks postbaseline).

RESULTS

Significant improvements in insomnia severity, daytime sleepiness, fatigue, and quality of life were reported at both follow up timepoints. However, most participants (72.7%) did not complete all of the six study sessions, with a mean completion rate of 3.2 sessions. Participants who completed at least two sessions reported better sleep (insomnia severity index total score) than those who did not.

CONCLUSIONS

An Internet-delivered insomnia intervention adapted for AYA cancer survivors was efficacious. This has important implications for access to evidence-based clinical care for this growing population. Future efforts should study stepped care models of care and ways to improve treatment adherence.

An Exploratory Study on Sleep Procrastination: Bedtime vs. While-in-Bed Procrastination

Sleep Procrastination literature has focused on the behaviors individuals engage in before going to bed (Bedtime Procrastination) but not on the behaviors individuals engage in after going to bed (While-in-Bed Procrastination). The main goal of this study is to explore whether this While-in-Bed procrastination is a novel phenomenon that adds to the Sleep Procrastination literature. The study was conducted online with 400 high school students (M_age = 16.56; 139 males) recruited through personal contacts and social media. The Bedtime procrastination scale was adapted and validated for this sample, whereas the While-in-Bed Procrastination scale was developed for this study. Data show a low correlation (r = 0.158 **) between Bedtime and While-in-Bed Procrastination scales, suggesting that Sleep Procrastination may be composed of the two facets. Additionally, results showed that more Bedtime Procrastination was related to later waking time and later dinnertime hours, whereas more While-in-Bed Procrastination was linked to being male, later desired time to sleep, and earlier dinnertime hour. Findings indicate that solely assessing Bedtime Procrastination as representing the procrastination of Sleep is limited and overlooks a significant part of this behavior. This exploratory study adds a new perspective to the literature by stressing the role of While-in-Bed Procrastination, thus opening new research pathways.

Relationship between internet addiction and sleep disturbance in high school students: a cross-sectional study

BACKGROUND

The increase in the number of Internet users has increased Internet dependence worldwide. In adolescents, this dependence may interfere with sleep, which is important for the development of psychophysiological capabilities. However, few large-scale surveys have described the relationship between Internet addiction (IA) and sleep disturbance using standardized questionnaires. We conducted a survey in one prefecture in Japan to determine the relationship between sleep disturbance and IA in adolescents based on the categories of the Young Diagnostic Questionnaire (YDQ).

METHODS

In 2016, high school students (N = 10,405, age range: 15-16 years) in all 54 daytime high schools in the selected prefecture were surveyed using a self-administered questionnaire. Participants with scores > 5.5 points on the Japanese version of the Pittsburgh Sleep Quality Index were defined as having a sleep disturbance. IA was evaluated using the YDQ: Participants with five to eight YDQ items present were classified as having IA; those with three or four items present were classified as "at risk of IA"; and those with two or less YDQ items were classified as "non-IA". Multiple logistic regression analysis was performed with sleep disturbance as the dependent variable, IA as the explanatory variable, and adjustments for eight other variables.

RESULTS

High YDQ scores were associated with a high prevalence of sleep disturbance in boys and girls. These findings persisted after controlling for other factors in the multiple regression model.

CONCLUSIONS

Among Japanese adolescents, there was a significant independent relationship between IA and sleep disturbance.

Social media use predicts later sleep timing and greater sleep variability: An ecological momentary assessment study of youth at high and low familial risk for depression

INTRODUCTION

Social media (SM) use has been increasingly recognized as a potential contributor to poor sleep. Few studies have examined SM use and sleep using ecological momentary assessment (EMA), compared different types of media use (SM, television, gaming), or examined whether youth at high and low familial risk for depression are differentially affected by SM use.

METHODS

The current study included 76 youth (46% female; Mean age = 11.28 years) who were recruited based on parental history of recurrent depression (N = 35 high risk; N = 41 low risk) in the United States. Youth completed a 9-day EMA protocol, which included current activity at time of prompt and daily sleep onset and offset times. Regression and multilevel models were conducted to examine the effects of media use on sleep.

RESULTS

Results indicated that youth who used more SM (mean and number of days) went to sleep later, but did not have shorter sleep duration. Youth with more SM use also had higher levels of variability of both sleep timing and sleep duration across the 9-day period. There were no effects of gaming or TV on sleep, and youth at high risk for depression did not have differences in SM use or its effects on sleep compared to low-risk youth.

CONCLUSIONS

These findings indicate a unique impact of SM use on sleep timing and variability for youth (regardless of risk status), which may suggest a unique and modifiable pathway through which SM use contributes to poor health.

Leveraging Technology to Improve Health in Adolescence: A Developmental Science Perspective

As technologies continue to evolve at exponential rates, online platforms are becoming an increasingly salient social context for adolescents. Adolescents are often early adopters, savvy users, and innovators of technology use. This not only creates new vulnerabilities but also presents new opportunities for positive impact-particularly, the use of technology to promote healthy learning and adaptation during developmental windows of opportunity. For example, early adolescence appears to represent a developmental inflection point in health trajectories and in technology use in ways that may be strategically targeted for prevention and intervention. The field of adolescent health can capitalize on technology use during developmental windows of opportunity to promote well-being and behavior change in the following ways: (1) through a deeper understanding of the specific ways that developmental changes create new opportunities for motivation and engagement with technologies; (2) by leveraging these insights for more effective use of technology in intervention and prevention efforts; and (3) by combining developmental science-informed targeting with broader-reach technologic approaches to health behavior change at the population level (e.g., leveraging and changing social norms). Collaboration across disciplines-including developmental science, medicine, psychology, public health, and computer science-can create compelling innovations to use digital technology to promote health in adolescents.

Sleep and development in adolescence in the context of socioeconomic disadvantage

INTRODUCTION

Sleep problems are associated with negative developmental outcomes in youth, and identification of vulnerability and protective factors is needed to explicate for whom and under which conditions adolescents may be most at risk. Towards this end, we examined socio-economic status (SES) as a moderator of associations between multiple sleep parameters and adolescents' socio-emotional adjustment and cognitive functioning.

METHODS

Participants were 272 adolescents (M age = 17.3 years; 49% girls) and their parents, residing in the Southeastern U.S.A. The sample was socioeconomically diverse and included 41% Black/African American and 59% White/European American youth. Using a cross-sectional design, adolescents' sleep was assessed with actigraphy (total sleep minutes; efficiency indicated by % of time asleep from sleep onset to wake time) and self-reports of sleep quality (sleep-wake problems). Mothers reported on youths' internalizing and externalizing symptoms, and cognitive functioning was assessed with a standardized test battery.

RESULTS

Moderation effects were found and illustrated that, for youth from families with lower SES, shorter and less efficient sleep and subjective sleep problems were associated with higher levels of internalizing and externalizing symptoms as well as lower cognitive performance. Conversely, longer and better-quality sleep protected against socio-emotional and cognitive difficulties otherwise observed for socioeconomically disadvantaged youth. Fewer relations between sleep and adjustment emerged for adolescents from families with higher SES.

CONCLUSIONS

Results reinforce a growing literature indicating that the relation between sleep and adjustment is stronger for youth from families with lower SES, who may especially benefit from better sleep.

The Montgomery and Åsberg Depression Rating Scale - self-assessment for use in adolescents: an evaluation of psychometric and diagnostic accuracy

Background: The Montgomery-Åsberg Depression Rating Scale - Self Assessment (MADRS-S) is used to assess symptom severity in major depressive disorder (MDD) among adolescents, but its psychometric properties and diagnostic accuracy are unclear.Aim: The aim of this study was to explore psychometric properties, including diagnostic accuracy, of the MADRS-S in adolescent psychiatric outpatients.Method: Adolescent psychiatric outpatients (N = 105, mean age 16 years, 46 boys) completed the MADRS-S and were interviewed using the Kiddie Schedule for Affective Disorders and Schizophrenia for School-Age Children (K-SADS).Results: In principal component analysis, two components with eigenvalues of 4.6 and 1.3 explained 51.1% and 14.4% of the variance, respectively. On the first component loaded items assessing Mood, Feelings of unease, Appetite, Initiative, Pessimism, and Zest for life. On the second component loaded items assessing Sleep, Ability to concentrate, and Emotional involvement. Cronbach's alpha (internal consistency) for all items was 0.87. Spearman's rho was 0.68 for concurrent validity (correlation between total MADRS-S-score and K-SADS MDD severity score). In receiver-operating characteristic analysis, the area under the curve was 0.86 (95% confidence interval 0.78-0.93, p < .001). For all the participants, the highest combined sensitivity and specificity were reached using cut-offs of 15 and 16 (sensitivity 0.82, specificity 0.86). Optimizing sensitivity for MDD, with specificity still ≥0.5, cut off for all was 9, for boys 7 and for girls 10.Conclusion: Psychometric properties of MADRS-S showed good reliability and validity as well as satisfying diagnostic accuracy, indicating good to excellent properties for MDD screening of adolescent psychiatric patients.

Gender Discrimination, Perceived School Unfairness, Depressive Symptoms, and Sleep Duration Among Middle School Girls

The current study examines how gender discrimination by adults in school is linked with depressive symptoms and sleep duration over time in middle school. The main goal is to test one psychological mechanism that can account for such associations: perceived school unfairness. Relying on a racially-ethnically diverse sample of girls (N = 2,718, M_age  = 13.01, SD_age  = 0.39) from 26 middle schools, multilevel mediation analyses revealed that girls who experienced school-based gender discrimination by an adult in seventh grade reported higher levels of perceived school unfairness in eighth grade. Moreover, perceived unfairness, in turn, was associated with more depressive symptoms and shorter sleep durations by eighth grade. Implications of changes in adolescent girls' sleep and mood related to their experiences of gender discrimination are discussed.