Pathways to adolescent health sleep regulation and behavior

Longitudinal effects of insufficient sleep on psychological problems among adolescent bullies based on Korean Child and Youth Panel Survey

This study was performed to investigate longitudinal effects of insufficient sleep on psychological problems among bullies and neutral students using the Korean Child and Youth Panel Survey (KCYPS) collected from 8th to 10th graders. At the first wave, 6.4% of students reported that they had bullied other students two or more times. Bullies having insufficient sleep duration at the first wave exhibited significantly higher aggression levels than bullies with sufficient sleep over time. Among neutral students, sleep insufficiency showed no longitudinal relationship with aggression. Our findings confirm that insufficient sleep was an associated factor for chronically elevated aggression among bullies.

Family contexts and sleep during adolescence

Sleep deprivation among adolescents has received much attention from health researchers and policymakers. Recent research indicates that variation in sleep duration from night to night is associated with multiple health outcomes. While there is evidence that sleep deprivation is socially patterned, we know little about how social contexts are associated with nightly sleep variation during adolescence (a life course stage when nightly sleep variation is particularly high). Given the importance of family environments for influencing adolescents’ sleep patterns, we hypothesized that disadvantaged family contexts would be associated with higher intra-individual variation (IIV) in nightly sleep duration, in addition to lower average nightly sleep duration. We tested these hypotheses in a diverse, population-based sample of 11–17 year-olds (N = 1095) from the Adolescent Health and Development in Context Study. Using survey and ecological momentary assessment data and a novel form of multi-level regression modeling (location-scale mixed modeling), we found that adolescents living in unmarried-parent, low SES, economically insecure, and high caregiver stress families had higher IIV in sleep than adolescents in families with more resources and less caregiver stress. There were fewer family effects on average sleep duration. This suggests family social and economic contexts are associated with an under-researched aspect of adolescent sleep, nightly variation, and may contribute to adolescent sleep problems with implications for their health and health disparities.

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Consistency in nightly sleep duration is important for adolescent health.

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SES and family stress associated with variability in sleep duration in adolescents.

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Caregiver distress also associated with lower mean sleep duration among adolescents.

Prenatal and early life origins of adolescence sleep problems: evidence from a birth cohort

PURPOSE

This study aims to identify the prenatal and early life predictors of adolescence sleep problems.

METHODS

Sleep data (n = 5081) from the 14-year (13.92 ± 0.34 years) follow-up of a birth cohort were analyzed to explore the predictors of adolescence trouble sleeping, nightmares, snoring and sleep talking/walking. Data from the antenatal period till adolescence were explored for identifying predictors of adolescence sleep problems. Modified Poisson regression with a robust error variance was used to identify significant predictors.

RESULTS

Our results suggest that about a quarter of adolescents in our study sample had sleep maintenance problems (nightmares: 27.88%, snoring: 23.20%, sleepwalking/talking 27.72%). The prevalence rate of sleep initiation problems was even higher (trouble sleeping: 40.61%). Our results suggest that antenatal and early-life factors, e.g. maternal smoking, anxiety, sleep problems in childhood, attention deficit hyperactivity disorder (ADHD) symptoms, and poor health are significant predictors of adolescence sleep problems.

CONCLUSIONS

This study demonstrates the predictive role of prenatal and early life risk factors in adolescence sleep problems. It seems that exposure to prenatal and early life risk factors increase the vulnerability for sleep problems later in life, which is further supported by poor health and lifestyle choices in adolescence. Therefore, close observation and mitigation of factors associated with early life risk factors could be a potential strategy for preventing sleep problems later in life.

Young adolescent sleep is associated with parental monitoring

OBJECTIVES

Insufficient sleep can increase risk for adverse psychological and physical outcomes. Parental monitoring of daily activities is associated with youth health behaviors. We examined parental monitoring of waking and bedtime behaviors and sleep in a community sample of high-risk youth.

METHODS

One-hundred sixty-five 10- to 14-year-olds from low-socioeconomic status families participated (11.8 years ±1.16, 52% female; 78% Black/African American). Parents and youth evaluated parental monitoring of waking activities. Parent expectations about bedtime and parent knowledge about adolescent's bedtime and sleep routine were independently rated. Youth sleep was assessed via parent report and actigraphy over 7 days.

RESULTS

More parental knowledge about bedtime was associated with longer parent-reported sleep duration (β = .18, P < .05). Parental monitoring of waking activities (youth reported) was associated with more actigraph-assessed sleep over 7 days (B = 2.73, SE = .91), weekdays (B = 2.44, SE = .01), and weekends (B = 3.88, SE = .1.41, all Ps < .05), whereas parent reported monitoring was associated with more sleep on weekdays only (B = 2.10, SE = .87, P < .05). Parental knowledge and expectations about bedtime behaviors were not associated with actigraph-assessed sleep (P values > .05). Parental monitoring of waking and bedtime behaviors was not associated with sleep duration variability (P values > .05).

CONCLUSIONS

Parental monitoring of waking activities may indirectly influence adolescent sleep via increased structure and felt security in the parent-adolescent relationship. Youth perception of monitoring may be particularly relevant for youth sleep duration.

Children Sleep and Antisocial Behavior: Differential Association of Sleep with Aggression and Rule-Breaking

There is a strong relationship between sleep and behavioral problems. These findings are often interpreted via environmental explanations, such that poor sleep directly exacerbates or causes symptoms of aggression and behavior problems. However, there are other possible explanations, such that the genes predicting poor sleep also predict aggression or rule-breaking. The current study sought to elucidate the origin of this relationship. The sample was composed of 1030 twin pairs (426 monozygotic and 604 dizygotic). The sample was 51.3% male with a mean age of 8.06 years (range 6-11.96; SD = 1.45). Aggression, rule-breaking and sleep were assessed through the Child Behavior Checklist (CBCL). We fitted bivariate Cholesky genetic models to the data, decomposing the variance within, and the covariance among, aggression, rule-breaking, and sleep functioning into their genetic and environmental components. Genetic correlations between all sleep variables and aggression were significant and moderate to large in magnitude, but mostly small and non-significant between sleep and rule-breaking. We did not find evidence of a causal or environmental relationship between the majority of sleep variables and aggression, but rather clear evidence of genetic pleiotropy. However, the pattern of associations between rule-breaking and sleep measures was less consistent. Aggression and rule-breaking appear to be differentially associated with sleep.

Sleep in Teens With Type 1 Diabetes: Perspectives From Adolescents and Their Caregivers

PURPOSE

The purpose of this study is to identify barriers, facilitators, and consequences of obtaining sufficient sleep in adolescents with type 1 diabetes.

METHODS

Semistructured interviews were conducted with 25 adolescents (52% female, mean age = 15.6 years) and 25 caregivers. Interviews were transcribed and coded using Atlas.ti. A thematic analytic approach was used to identify and organize significant patterns of meaning (themes) and interpret themes across the data.

RESULTS

Several barriers were identified, with the most common being the use of electronics before bed and sleep disturbances related to diabetes management. Caregivers described strategies for helping adolescents achieve sufficient sleep, such as enforcing bedtimes and limiting distractions, but many adolescents could not identify facilitators of sleep. Weekday/weekend discrepancies in sleep timing were commonly disclosed.

CONCLUSIONS

This study is the first to examine the perceptions of barriers and facilitators to obtaining sufficient sleep in adolescents with T1D and their caregivers. Results have the potential to inform providers' recommendations regarding sleep, including possible interventions to promote sleep in this high-risk population.

Preschool executive control and sleep problems in early adolescence

OBJECTIVE

Although numerous studies have documented the effects of sleep loss on executive control (EC) and related abilities, research examining the impact of early EC on subsequent sleep problems is lacking. Therefore, the current study reports on a longitudinal investigation of EC in preschool as a predictor of sleep-wake problems and daytime sleepiness in early adolescence.

PARTICIPANTS

The participants were 141 children (48.6% female) recruited from the community for a longitudinal study spanning preschool through early adolescence, with an oversampling for high sociodemographic risk (34.1% based on eligibility for public medical insurance, free or reduced lunch status, or family income-to-needs below the federal poverty line).

METHODS

Participants completed a battery of developmentally appropriate tasks assessing major aspects of EC (working memory, inhibitory control, flexible shifting) during a laboratory visit at age 4 years, 6 months. Participants also completed a follow-up session in early adolescence (between ages 11 years and 13.5 years; mean age = 11.82 years, SD = .62 years), during which they completed self-report measures of sleep-wake problems and daytime sleepiness.

RESULTS

Structural equation modeling results indicate that preschool EC (represented by a single latent construct) significantly negatively predicted both sleep-wake problems and daytime sleepiness in early adolescence, with poorer EC predicting greater subsequent sleep problems.

CONCLUSIONS

Poorer EC abilities during the critical period of preschool may be a risk factor for later sleep problems in adolescence. Given that EC appears to be modifiable, early interventions to promote EC development may help prevent subsequent sleep problems and promote long-term health trajectories.

Perceived school safety, perceived neighborhood safety, and insufficient sleep among adolescents

OBJECTIVES

To examine whether perceptions of school safety and neighborhood safety are associated with insufficient sleep during adolescence.

DESIGN

The Florida Youth Substance Abuse Survey (FYSAS) is a cross-sectional study of adolescents.

SETTING

The state of Florida.

PARTICIPANTS

Middle-school and high-school students (n = 7,958) attending public schools in 2017.

MEASUREMENTS

Based on National Sleep Foundation recommendations, sleep was categorized as insufficient (less than 7 hours) or sufficient (7 or more hours) using self-reports of average sleep duration on school nights. Self-reports of perceived safety at school and perceived safety in one's neighborhood were modeled as predictors of insufficient sleep in logistic regression models when accounting for several covariates.

RESULTS

Adjusting for model covariates, the odds of insufficient sleep among adolescents who feel unsafe both at school and in their neighborhood are 129% greater relative to adolescents who feel safe in both contexts. In comparison, the odds of insufficient sleep among adolescents who feel unsafe only at school are 39% greater relative to adolescents who feel safe both at school and in their neighborhood, and the odds of insufficient sleep among adolescents who feel unsafe only in their neighborhood are 71% greater relative to adolescents who feel safe both at school and in their neighborhood.

CONCLUSIONS

The findings of this study indicate that efforts to improve the safety of salient social contexts in which adolescents develop may reduce the likelihood of insufficient sleep faced by a large portion of school-aged children.

Sleep Disturbances, Psychosocial Difficulties, and Health Risk Behavior in 16,781 Dutch Adolescents

OBJECTIVE

To investigate the prevalence of adolescent sleep disturbances and their relation to psychosocial difficulties and health risk behaviors with the use of data from a province-wide health survey (n = 16,781).

METHODS

Psychosocial difficulties were measured with the Strength and Difficulties Questionnaire. Additional assessments included self-reported sleep disturbances, suicidality, and health risk behaviors including current use of tobacco, alcohol, and drugs, physical inactivity, and compulsive use of multimedia. We used multilevel analyses to investigate the relationhips, including differences, between boys and girls, as well as the mediating role of emotional problems.

RESULTS

Just under 20% of adolescents reported sleep disturbances in the previous month. These sleep disturbances were associated with psychosocial problems (odds ratio [OR], 6.42; P < .001), suicidality (OR, 3.90-4.14; P < .001), and all health risk behaviors (OR, 1.62-2.66; P < .001), but not with physical inactivity. We found moderation by gender for the relations between sleep and suicide attempts (OR, 0.38; P < .002) and between sleep and cannabis use (OR, 0.52; P = .002), indicating attenuated relationships in girls compared with boys. Emotional problems partially mediated the relationships between sleep disturbances and multimedia use.

CONCLUSIONS

This study reiterates the high prevalence of sleep disturbances during adolescence. These sleep disturbances were strongly related to psychosocial problems and a wide range of health risk behaviors. Although the direction of causality cannot be inferred, this study emphasizes the need for awareness of impaired sleep in adolescents. Moreover, the gender differences in associated suicide attempts and cannabis use call for further research into tailored intervention strategies.

Insomnia mediates the longitudinal relationship between anxiety and depressive symptoms in a nationally representative sample of adolescents

BACKGROUND

Anxiety and depression are commonly comorbid with each other, with anxiety often temporally preceding the development of depression. Although increasingly research has begun to investigate the role of sleep problems in depression, no study has examined insomnia as a mediator in the longitudinal relationship between anxiety and subsequent depression.

METHODS

The current study utilizes data from Waves I, II, and IV of the National Longitudinal Study of Adolescent to Adult Health, a nationally representative prospective study conducted over a 14-year period (n = 20,745, 50.5% female, M age at Wave I = 16.20). Participants completed portions of the Center for Epidemiologic Studies Depression Scale at Waves I and IV to assess depressive symptoms, a six-item anxiety measure at Wave I, and three items assessing insomnia, sleep quality, and sleep duration at Wave II.

RESULTS

Structural equation modeling indicated that insomnia and unrestful sleep significantly mediated the relationship between anxiety and subsequent depression. The relationship between anxiety and depression was not significantly mediated by sleep duration.

CONCLUSIONS

Findings suggest that anxiety may increase risk for the development of later depression through insomnia.

Association of sleep with emotional and behavioral problems among abused children and adolescents admitted to residential care facilities in Japan

BACKGROUND

The psychological care of abused children in the child protection system is an urgent issue in Japan. Child abuse has a serious impact on children's emotion and behavior, but there is virtually no evidence about how child abuse affects sleep, which is closely related to behavioral and emotional control. In this study, we sought to identify sleep habits and suspected sleep disorders among abused children and adolescents admitted to residential care facilities in Japan and to investigate their association with emotional and behavioral problems.

METHODS

The study targeted 273 abused children and adolescents (age range: 4 to 15 years) who had been admitted to a residential care facility in Japan. They were assessed by physicians and other personnel at facilities with expertise in childcare and abuse. Respondents completed a brief sleep questionnaire on the incidence of problematic sleep habits and suspected sleep disorders as well as a questionnaire on emotional and behavioral issues.

RESULTS

Approximately 40% of the abused children and adolescents had some sleep-related symptoms at bedtime and waking, and 19% had suspected sleep disorder. Abused children with emotional and behavioral problems had a significantly higher incidence of suspected sleep disorders than abused children without such problems, and this incidence was particularly high among those with antisocial behavior and depressive behavior. Our predictive model also showed that antisocial behavior and depressive behavior were significant predictors of suspected sleep disorders.

CONCLUSION

Careful assessment and appropriate therapeutic intervention for sleep disorders are required in abused children and adolescents with emotional and behavioral problems.

Chronotype and Psychiatric Disorders

PURPOSE OF REVIEW

Chronotype, reflecting interindividual differences in daily activity patterns and sleep-wake cycles, is intrinsically connected with well-being. Research indicates increased risk of many adverse mental health outcomes for evening-type individuals. Here, we provide an overview of the current evidence available on the relationship between chronotype and psychiatric disorders.

RECENT FINDINGS

The association between eveningness and depression is well established cross-sectionally, with preliminary support from longitudinal studies. The mechanisms underlying this relationship warrant further research; deficient cognitive-emotional processes have recently been implicated. Eveningness is associated with unhealthy lifestyle habits, and the propensity of evening types to addiction has been recognized. Chronotype may also be implicated in disordered eating.

SUMMARY

Eveningness is associated with depression-including seasonal affective disorder (SAD)-and substance dependence, while support for a relation with anxiety disorders and psychosis is lacking. In bipolar disorder, chronotype is linked to depression but not mania. Eveningness is also related to sleep disturbances and poor lifestyle habits, which may increase risk for psychiatric disorders.

Neurophysiological differences in the adolescent brain following a single night of restricted sleep - A 7T fMRI study

Sleep deprivation in youth has garnered international attention in recent years, as correlational studies have demonstrated significant relationships between lack of sleep and detrimental behavioral and academic outcomes. However, no study to date has systematically examined the neurophysiological consequences of a single night of sleep restriction (i.e., 4 h) in adolescents using ultra-high field functional neuroimaging. Much of what we know regarding the neural consequences of sleep deprivation has come from the adult literature, and among those studies, the majority use region of interest (ROI) approaches, thus disregarding the dynamic mechanisms that may subserve the behavioral effects of sleep restriction. Leveraging a crossover within-subjects design, we demonstrate that pivotal brain regions involved in the default mode and limbic regulatory centers have disrupted functioning following a night of restricted sleep compared to a night of "normal sleep". Specifically, a normal night (i.e., 8 h) of sleep led to increased global and local efficiency of bilateral amygdala, and less efficiency in the posterior cingulate, as measured by graph theory, compared to a night of sleep restriction. Furthermore, aberrant functional connectivity patterns were identified in key fronto-limbic circuitry, suggesting a potential pathophysiological mechanism underlying the widespread effects of sleep deprivation in youth.

Girls' Sleep Trajectories Across the Pubertal Transition: Emerging Racial/Ethnic Differences

PURPOSE

This study aims to examine the longitudinal association between puberty and sleep in a diverse sample of girls and explore racial/ethnic differences in this association.

METHODS

Using latent growth curve modeling, the present study measured pubertal development (timing and rate) and sleep (wake time and bedtime) in 1,239 socioeconomically and ethnically diverse girls starting when they were 6-8 years old and followed longitudinally for up to 8 years. Pubertal assessment was conducted annually in clinic by physical examination, classified by sexual maturation stage for breast and pubic hair development by trained raters.

RESULTS

In line with previous research, black girls had the earliest pubertal development, followed by Hispanic, white, and Asian girls. Black girls, on average, reported significantly shorter sleep duration than Hispanic (β = -.20, p < .001), Asian (β = -.29, p = .002), and white (β = -.35, p < .001) girls. In a series of dual-process models, we found that early pubertal timing predicted shorter sleep duration for early-maturing black girls (breast development: β = .13, p = .005; pubic hair development: β = .14, p = .012). There was no evidence of any association between pubertal rate and sleep. All models controlled for family socioeconomic status and body mass index.

CONCLUSION

Sleep is essential for many aspects of youth development, including emotional, cognitive, and physical functioning. Developmental changes associated with puberty may put some early maturing girls at risk of shorter sleep duration in adolescence and exacerbate racial/ethnic disparities in health and well-being.

Adolescent Sleep Barriers: Profiles within a Diverse Sample of Urban Youth

Most adolescents face numerous obstacles to good sleep, which may undermine healthy development. In this study, we used latent class analysis and identified four categories of sleep barriers in a diverse sample of 553 urban youth (57% female). The majority profile, School/Screens Barriers, reported the most homework and extracurricular barriers, along with high screen time. The Home/Screens Barriers class (i.e., high environmental noise, light, screen use) and the High/Social Barriers class (i.e., high barriers across domains, particularly social) reported the poorest sleep quality and highest depressive/anxiety symptoms. The Minimal Barriers class-predominately male, with low depressive/anxiety symptoms-reported more sleep per night. We discuss implications of our findings for targeting interventions to address poor adolescent sleep among specific clusters of students.

Development of a University Campus Healthy Sleep Promotion Program

This article provides a preliminary evaluation of a campus sleep health program for undergraduate university students. In this study, 5 focus groups with 38 undergraduates assessed perceptions about sleep in relationship to college experiences. Additionally, 35 undergraduate students participated in campus sleep improvement workshops, and completed a brief self-report survey before and after the workshop. Results showed five themes emerged from focus groups: (a) Sleep and its impact on academics, (b) Understanding of the importance of sleep, (c) Procrastination and its impact on sleep, (d) Stress, and (e) Sleep and extracurricular/social activities. Based on self-report surveys, there was no improvement in perceived sleep importance, but perceived sleep confidence of undergraduate student-participants increased significantly after the workshop. The sleep health program for undergraduates showed promising results, and should be evaluated using a larger, more rigorous design in future studies.

Incorporating positive youth development into the therapeutic model for incarcerated young woman

Young women in the juvenile justice system have high rates of prior physical and sexual abuse, substance use and psychiatric disorders. Understandably services usually are based on a therapeutic model to address those needs. Positive Youth Development (PYD) is a complementary alternative format that aims to provide resilience, life competencies, and self efficacy for pro-social actions. We provide a narrative review of PYD programs with a focus on how those relate to youth in closed custody. Sleep and physical activity are two behaviors where incarcerated young women still have personal agency, and we present the additional relevance of those program aspects. We describe methods and findings from a feasibility trial of an existing evidence-based, peer-led program for young women high school athletes used with incarcerated young women. Findings are placed in the context of established models of behavior change. The program was feasible and acceptable, and in this small trial, results demonstrate the format's potential efficacy. PYD may provide a trajectory of success and assets that could durably assist these young women following incarceration.

Bi-directional association between sleep and outdoor active play among 10-13 year olds

BACKGROUND

The purpose of this study was to investigate whether there is a bi-directional relationship between sleep characteristics (time in bed, sleep duration, sleep chronology, and sleep efficiency) and time spent participating in outdoor active play among children.

METHODS

Participants consisted of 433 children aged 10-13 years from Kingston, ON, Canada. Time in bed, sleep duration, sleep chronology, and sleep efficiency were measured for 8 consecutive nights using data from a sleep log and Actical accelerometer. Outdoor active play was measured for the 7 days that fell in between these 8 nights using a combination of data from accelerometers, global positioning system loggers, and geographic information systems. Generalized estimating equation models were used to assess the relationships between sleep characteristics and outdoor active play. These models accounted for the repeated measures nested within participants and adjusted for several confounders (e.g., age, sex, family income, neighborhood traffic and green space).

RESULTS

Time in bed, sleep duration, sleep chronology, and sleep efficiency were not significantly associated with the following day's outdoor active play. There was a significant (p = 0.017) association between outdoor active play and the following night's time in bed, which suggested that each hour increase in outdoor active play was associated with a 4.0 min increase in time in bed. Outdoor active play was not significantly associated with sleep duration, sleep chronology, or sleep efficiency.

CONCLUSIONS

None of the sleep characteristics predicted the following day's outdoor active play. Increase time spent in outdoor active play predicted a longer time in bed, but not sleep duration, sleep chronology, or sleep efficiency.

Beyond Sleep Duration: Bidirectional Associations Among Chronotype, Social Jetlag, and Drinking Behaviors in a Longitudinal Sample of US High School Students

Inadequate sleep and problematic drinking are prevalent among high school students and are significant public health issues. Inadequate sleep may contribute to alcohol use through impairments in emotion regulation or cognitive functioning, whereas alcohol use may lead to inadequate sleep through the biological effects of alcohol or social influences. However, the directionality of the associations between sleep and drinking variables remains unclear as most prior studies were cross-sectional. This study utilizes longitudinal data from the NEXT Generation Health Study to examine bidirectional associations between alcohol use and sleep adequacy in a nationally representative sample across 3 years of high school. Students reported usual bedtimes and waketimes for scheduled- and free-days, alcohol use, and heavy episodic drinking. Estimates of sleep duration, chronotype, and social jetlag were calculated. Cross-lagged autoregressive models revealed evidence of alcohol use predicting subsequent sleep duration and timing, and sleep timing predicting subsequent alcohol use. Specifically, previous-wave alcohol use predicted shorter free-day sleep duration and later chronotype at 11th and 12th grade, and more social jetlag at 12th grade; similar results were obtained for heavy episodic drinking. Eleventh grade social jetlag predicted subsequent year current alcohol use; eleventh grade chronotype and social jetlag predicted subsequent year heavy episodic drinking. Bidirectional findings suggest that alcohol use and sleep may reflect mutually reinforcing life style choices. Understanding these bidirectional associations could inform risk prevention interventions. Given the implications of poor sleep for adolescents, further research on possible social influences on the alcohol-sleep relations is merited. Clinical Trial Registration: NCT01031160.

Maternal Sensitivity Predicts Fewer Sleep Problems at Early Adolescence for Toddlers with Negative Emotionality: A Case of Differential Susceptibility

Theory underscores the importance of parenting in sleep development, but few studies have examined whether links vary by temperament. To address this gap, we tested whether potential links between early maternal sensitivity and early adolescent sleep problems varied by child negative emotionality and delay of gratification. Using data from the National Institute of Child Health and Human Development Study of Early Child Care and Youth Development (N = 820), we found that high maternal sensitivity predicted fewer bedtime problems and longer sleep duration at 6th grade for toddlers with high negative emotionality, whereas low maternal sensitivity predicted the reverse. No differences were observed for low negative emotionality. Moreover, delay of gratification predicted fewer bedtime problems at 6th grade, but did not moderate associations between maternal sensitivity, negative emotionality, and sleep. Findings demonstrate that high, but not low, negative emotionality renders toddlers differentially susceptible and receptive to maternal sensitivity in relation to sleep.

Transitions in sleep problems from late adolescence to young adulthood: A longitudinal analysis of the effects of peer victimization

Adolescence is a developmental period with high vulnerability to sleep problems. However, research identifying distinct patterns and underlying determinants of sleep problems is scarce. This study investigated discrete subgroups of, changes in, and stability of sleep problems. We also examined whether peer victimization influenced sleep problem subgroups and transitions in patterns of sleep problems from late adolescence to young adulthood. Sex differences in the effects of peer victimization were also explored. In total, 1,455 male and 1,399 female adolescents from northern Taiwan participated in this longitudinal study. Latent transition analysis was used to examine changes in patterns of sleep problems and the effects of peer victimization on these changes. We identified three subgroups of sleep problems in males and two in females, and found that there was a certain level of instability in patterns of sleep problems during the study period. For both sexes, those with greater increases in peer victimization over time were more likely to change from being a good sleeper to a poor sleeper. The effects of peer victimization on baseline status of sleep problems, however, was only significant for males, with those exposed to higher levels of peer victimization more likely to be poor sleepers at baseline. Our findings reveal an important role of peer victimization in predicting transitions in patterns of sleep problems. Intervention programs aimed at decreasing peer victimization may help reduce the development and escalation of sleep problems among adolescents, especially in males.

Dim Light Melatonin Onset and Affect in Adolescents With an Evening Circadian Preference

PURPOSE

A shift toward an evening circadian preference and the onset of mood problems often occur during adolescence. Although these changes are linked to poorer outcomes, few studies have considered how positive and negative affect are related to the circadian rhythm during adolescence. This study examined the relationship between evening and morning affect ratings and dim light melatonin onset (DLMO), a measure of endogenous circadian rhythm. Age and sex were tested as moderators.

METHODS

This study is based on a subset of 163 (94 female, age = 14.7) adolescents with an evening circadian preference from a National Institute of Child Health and Human Development-funded study. Participants provided saliva for melatonin analysis and rated evening and morning affect.

RESULTS

Higher evening negative affect was related to a later DLMO. Evening positive affect was not significantly related to DLMO timing. Age but not sex was a significant moderator such that higher negative and lower positive affect were related to a later DLMO for 10- to 13-year-olds, whereas higher positive affect was related to a later DLMO for 17- to 18-year-olds. DLMO was not significantly related to morning affect ratings.

CONCLUSIONS

There is evidence that higher negative and lower positive affect may be related to the shift toward an evening circadian preference observed in adolescents, particularly for younger adolescents.

Discrimination and Sleep Difficulties during Adolescence: The Mediating Roles of Loneliness and Perceived Stress

Irregular and insufficient sleep place youth at risk for adverse psychological and physical health outcomes. Recent research indicates that discrimination constitutes a type of stressor that interferes with adolescent sleep; however, the mechanisms through which discrimination affects sleep are not well understood. This study examined whether ethnic and non-ethnic (i.e., gender, age, and height/weight) discrimination were associated with adolescents' sleep duration, variability, and quality, and whether loneliness and perceived stress mediated these associations. An ethnically-diverse sample (42% Latino, 29% European American, 23% Asian) of adolescents (N = 316; M age = 16.40 years, 57% girls) reported on their experiences of discrimination, perceived stress, and loneliness. Sleep duration and variability were assessed by actigraphy and sleep quality through self-reports. Ethnic discrimination was related to shorter sleep duration and both ethnic and non-ethnic discrimination were associated with worse sleep quality. Loneliness and perceived stress partially mediated the relation between discrimination and sleep quality. Discriminatory experiences can heighten feelings of loneliness and stress, which, in turn, may contribute to diminished sleep quality during adolescence.

Sleep Patterns and Quality Are Associated with Severity of Obesity and Weight-Related Behaviors in Adolescents with Overweight and Obesity

BACKGROUND

Inadequate sleep duration, sleep patterns, and sleep quality have been associated with metabolic, circadian, and behavioral changes that promote obesity. Adolescence is a period during which sleep habits change to include less sleep, later bedtimes, and greater bedtime shift (e.g., difference between weekend and weekday bedtime). Thus, sleep may play a role in adolescent obesity and weight-related behaviors. This study assesses sleep duration, quality, and schedules and their relationships to relative weight and body fat percentage as well as diet, physical activity, and screen time in adolescents with overweight/obesity.

METHODS

Adolescents between 12 and 17 years old (n = 186) were weighed and measured, reported typical sleep and wake times on weekdays and weekends, and responded to questionnaires assessing diet, physical activity, and screen time habits.

RESULTS

Controlling for sleep duration, later weekend bedtime and greater bedtime shift were associated with greater severity of overweight (β = 0.20; β = 0.16) and greater screen time use (β = 0.22; β = 0.2). Later bedtimes on the weekdays and weekends were associated with fewer healthy diet practices (β = -0.26; β = -0.27). In addition, poorer sleep quality was associated with fewer healthy diet habits (β = -0.21), greater unhealthy diet habits (β = 0.15), and less physical activity (β = -0.22). Sleep duration was not associated with any weight or weight-related behavior.

CONCLUSIONS

Sleep patterns and quality are associated with severity of overweight/obesity and various weight-related behaviors. Promoting a consistent sleep schedule throughout the week may be a worthwhile treatment target to optimize behavioral and weight outcomes in adolescent obesity treatment.

Validation of the Farsi version of the revised Adolescent Sleep Hygiene Scale (ASHSr): a cross-sectional study

BACKGROUND

Restoring sleep is associated with a broad variety of favorable cognitive, emotional, social and behavioral benefits during the day. This holds particularly true for adolescents, as maturational, social, cognitive, emotional and behavioral changes might unfavorably impact on adolescents' sleep. Among adolescents, poor sleep hygiene practices are a potentially modifiable risk factor that can be addressed via appropriate interventions. Accordingly, having reliable and valid self-report measures to assess sleep hygiene practices is essential to gauge individual responses to behavioral interventions and evaluate sleep hygiene recommendations. The aim of the present study therefore was to translate and to test the psychometric properties (internal consistency, test-retest reliability, factorial and concurrent validity) of the Farsi/Persian version of the revised version of the Adolescent Sleep Hygiene Scale (ASHSr).

METHOD

A total of 1013 adolescents (mean age: M = 15.4 years; SD = 1.2; range: 12-19 years; 42.9% females) completed the ASHSr and the Pittsburgh Sleep Quality Index (PSQI) in their classroom during an official school lesson. Further, 20% completed the ASHSr 6 weeks later to evaluate the test-retest reliability. Cronbach's alpha coefficients were calculated to examine internal consistency, confirmatory factor analysis (CFA) was used to test factorial validity, whereas concurrent validity and test-retest reliability were examined via correlation analyses.

RESULTS

A first-order confirmatory factor analysis (CFA) corroborated the six-factor structure of the ASHSr, including a physiological, behavioral arousal, cognitive/emotional, daytime sleep, sleep environment, and sleep stability factor. A second-order CFA showed that a higher-order sleep hygiene construct explained sufficient variance in each factor. Cronbach's alpha values ranged between .71 and .75, correlations for test-retest reliability between .82 and .87. Significant correlations were found between most ASHSr scales and the PSQI indices. However, the magnitude of these correlations was weak.

CONCLUSIONS

The Farsi/Persian version of the Adolescent Sleep Hygiene Scale can be used as a reliable and valid tool for evaluation of sleep hygiene practices among Farsi/Persian-speaking adolescents.

Behavioural correlates of energy drink consumption among adolescents: A review of the literature

Despite regulatory measures on the labelling of energy drinks (EDs), their consumption among adolescents continues to grow in popularity, but teachers increasingly report significant behavioural concerns among students who disclose habitual ED consumption. A review of papers published between January 2010 and October 2016 was undertaken to determine whether an association between adverse behaviour and consumption of ED exists. Findings indicate that ED consumption among adolescents is associated with alcohol and substance use, risky behaviours and psychological states including sensation seeking, depression and anxiety symptoms. ED consumption impacts negatively on executive functions and increases hyperactivity/inattention symptoms among adolescents. An inverse association between ED consumption and sleep duration exists. The findings highlight the need for greater awareness of the potential risk of ED consumption among adolescents.

A process-oriented model linking adolescents' sleep hygiene and psychological functioning: the moderating role of school start times

OBJECTIVE

To examine a mediational model linking sleep hygiene to better mental health in adolescents via the mechanism of improved sleep quality, and to test the moderating role of school start times (SST) (before 8:30 AM vs. 8:30 AM or later) on that mediation model.

DESIGN

Cross-sectional.

SETTING

Online survey for high school students across the United States.

PARTICIPANTS

A total of 197 adolescents aged 14-17 years old (M_age = 15.6 years, SD = 1.8; 53% female) completed a baseline survey and 7-day sleep diaries; their parents (M_age = 47.7 years, SD = 5.5; 79% female) reported on family socioeconomic status and high SST.

MEASUREMENT

Adolescents reported on their sleep hygiene, circadian chronotype, daily levels of sleep quality and duration (morning diaries) and their depressive/anxiety symptoms (evening diaries) for 7 days.

RESULTS

A moderated-mediation model suggested that baseline sleep hygiene was directly associated with lower average daily depressive/anxiety symptoms across all students, but that association was marginally stronger in students with later SST (8:30 AM or later). A mediated path emerged only for students with earlier start times, suggesting that, for those students, baseline sleep hygiene was indirectly associated with lower average daily psychological symptoms by improving average daily sleep quality.

CONCLUSIONS

The current study is one of the first to demonstrate that SST might serve as a critical moderator in models of adolescent sleep and daily functioning. The findings provide additional evidence in the debate on how SST may affect adolescent health.

Sleep Loss and Affective Functioning: More Than Just Mood

Empirical evidence supports an intimate link between sleep and affective functioning. While the bidirectional relationship between sleep duration and mood is well documented, limited research targets other aspects of affective functioning, such as emotion and emotion regulation, or considers their interrelationships. The present review summarizes research examining the relationship between sleep and emotion, emotion regulation, and mood, and presents a theoretical model representing the relationships between these constructs. Disruptions to sleep and mood may trigger and maintain a negative cascade, leading to more entrenched sleep problems and psychopathology. Given that insufficient sleep is a widespread phenomenon, understanding the interrelationships between sleep and affective functioning has implications for both public health and clinical practice.

Early Menarche and Menstrual Problems Are Associated with Sleep Disturbance in a Large Sample of Chinese Adolescent Girls

Study Objectives

Little is known about the association between menstruation and sleep disturbance in adolescent girls. This study examined sleep duration, insomnia symptoms, and sleep quality in relation to age at menarche and menstrual problems in a large sample of Chinese adolescent girls.

Methods

This report represents the baseline data of an ongoing longitudinal study of the Shandong Adolescent Behavior & Health Cohort in Shandong, China. A total of 5800 girls aged 12-18 years (mean age = 15.0, standard deviation = 1.4) participated in the baseline survey. A structured questionnaire was used to assess participants' age at menarche, menstrual cycle interval, menstrual flow length, period irregularity, period pain, body weight and height, and demographics. Internalizing and externalizing problems were measured by the Youth-Self Report of Child Behavioral Checklist. Sleep duration, insomnia symptoms, and sleep quality were assessed by the items adapted from the Pittsburgh Sleep Quality Index.

Results

After adjusting for age, school, body mass index, internalizing and externalizing problems, and family covariates, irregular periods (odds ratio [OR] = 1.46, 95% confidence interval [CI] = 1.06-2.02), period pain (OR = 1.99, 95% CI = 1.44-2.76), and menstrual flow length ≥7 days (OR = 1.21, 95% CI = 1.00-1.48) were significantly associated with insomnia symptoms. Irregular periods (OR = 1.72, 95% CI = 1.30-2.27) and period pain (OR = 1.78, 95% CI = 1.34-2.37) were significantly associated with poor sleep quality. Age at menarche ≤11 years (OR = 1.62, 95% CI = 1.05-2.50) was significantly associated with insomnia symptoms in 12- to 14-year-old girls.

Conclusions

Our results suggest that irregular periods and period pain appear to be associated with sleep disturbance and that early menarche may have short-term impact on sleep in adolescent girls.

Biobehavioral Approaches to Aggression Implicate Perceived Threat and Insufficient Sleep: Clinical Relevance and Policy Implications

Besides reducing the burden of aggression and violence on society, the biobehavioral study of aggression can inform our understanding of emotional problems and maladaptive behaviors more broadly, since aggression can often co-occur with psychological disorders (e.g., depression). This article reviews the neuroscience/psychophysiology literature to explain brain processes in aggression that can be targeted to reduce its scourge on society. In particular, the review implicates brain circuitry that is often triggered by feelings of threat, which in turn disrupt higher order cognitive processes and may prompt aggression. One potentially modifiable factor less frequently considered in the study of aggression is sleep insufficiency or problems. The neurophysiological impact of sleep insufficiency can parallel the brain-related risk factors of aggression. Policy recommendations span individual mental health innovations, community-based interventions, and public health campaigns promoting healthy lifestyles to reduce aggression and violence.

The Roles of Parental Support and Family Stress in Adolescent Sleep

The current study examines the association between parental support and adolescent sleep under varying levels of family stress. Participants included 316 adolescents (M_age  = 16.40 years, 43% male) and their parents (M_age  = 45.67 years, 91% mothers) from diverse ethnic backgrounds. Both adolescents and parents completed questionnaires and adolescents wore wrist actigraphs and completed self-reports on their sleep for 7 consecutive days. Results indicated that under contexts of family stress, more parental support was linked to longer sleep duration, less sleep variability, and less time spent awake during the night. Findings suggest that under contexts of family stress, cohesive family relationships may provide a sense of stability and security that is necessary for healthful sleep.

Predictors of insomnia onset in adolescents in Japan

OBJECTIVE

The objective of this study was to clarify the incidence rate and predictive factors of insomnia in Japanese junior and senior high school students.

METHODS

We conducted a baseline survey on first year junior and senior high school students (seventh and 10th graders) throughout the nation. A follow-up survey was then conducted two years later. For both surveys, we used self-administered questionnaires inquiring about sleep, mental health status, lifestyle, participation in club activities, and study hours.

RESULTS

A total of 3473 students (776 junior high and 2697 senior high) were suitable for analysis. During the two years leading to the follow-up study, the incidence rate of newly developed insomnia was 7.8% among junior high and 9.2% among senior high school students. Multiple logistic regression analyses revealed that factors associated with new insomnia onset were 'sleep paralysis experience' and 'poor mental health status' in junior high school students, and 'being woken by a nightmare', 'poor mental health status', '≥2 h of extracurricular learning per day' and 'mobile phone use for ≥2 h per day' in senior high school students.

CONCLUSIONS

In junior and senior high school students, parasomnias such as nightmares and sleep paralysis, and mental health status can be predictors of insomnia onset. For senior high school students, longer use of mobile phones can be a predictor of insomnia onset. The present findings suggest that sleep health must be promoted among junior and senior high school students in the future.

Family Functioning and Children's Sleep

Sleep is a pivotal correlate and predictor of many domains of child development, including socioemotional adjustment, physical health, and cognitive functioning. The family plays a major role in shaping children's sleep-wake behaviors, and developmental research on children's sleep in a family context is on the rise. As in any relatively young field, many gaps and questions remain. In this article, we aim to advance this literature by illustrating ways to examine the interconnections between family functioning and children's sleep. We also call for increasing conceptual developments and testing of transactional models, using well-established and psychometrically sound objective and subjective measures, and expanding both the family functioning domains and sleep parameters assessed.

Cancer-Related Fatigue in Adolescents and Young Adults After Cancer Treatment: Persistent and Poorly Managed

Cancer-related fatigue is the most prevalent and distressing symptom experienced by adolescents and young adults (AYAs). An electronic survey was undertaken to ascertain current fatigue management and perceptions of its effectiveness. Eighty-five percent of responders (68/80) experienced fatigue, and it was worse more than 1 year after cancer treatment ended, compared to <1 year (p = 0.007). Forty-one percent received no fatigue management. Although advice to exercise was the most frequent intervention, the greatest impact of fatigue was on the ability to exercise and most did not find exercise advice helpful. Early intervention is warranted, supporting AYAs to persevere with increasing activity.

Association between elder abuse and poor sleep: A cross-sectional study among rural older Malaysians

Objectives

To examine the association between elder abuse and poor sleep using a Malay validated version of Pittsburgh Sleep Quality Index (PSQI).

Design

This study was divided into two phases. Phase I tested the construct validity and reliability of the Malay version of PSQI. Phase II was a population-based, cross-sectional study with a multi-stage cluster sampling method. Home-based interviews were conducted by trained personnel using a structured questionnaire, to determine exposure and outcome.

Setting

Kuala Pilah, a district in Negeri Sembilan which is one of the fourteen states in Malaysia.

Participants

1648 community-dwelling older Malaysians.

Results

The Malay version of PSQI had significant test re-test reliability with intra-class correlation coefficients of 0.62. Confirmatory factor analyses revealed that one factor PSQI scale with three components (subjective sleep quality, sleep latency, and sleep disturbances) was most suitable. Cronbach’s Alpha was 0.60 and composite reliability was 0.63. PSQI scores were highest among neglect (4.11), followed by physical (4.10), psychological (3.96) and financial abuse (3.60). There was a dose-response relationship between clustering of abuse and PSQI scores; 3.41, 3.50 and 3.84 for “no abuse”, “1 type of abuse” and “2 types or more”. Generalized linear models revealed six variables as significant determinants of sleep quality–abuse, co-morbidities, self-rated health, income, social support and gait speed. Among abuse subtypes, only neglect was significantly associated with poor sleep.

Conclusion

The Malay PSQI was valid and reliable. Abuse was significantly associated with poor sleep. As sleep is essential for health and is a good predictor for mortality among older adults, management of abuse victims should entail sleep assessment. Interventions or treatment modalities which focus on improving sleep quality among abuse victims should be designed.

The impact of racial discrimination on the health of Australian Indigenous children aged 5-10 years: analysis of national longitudinal data

BACKGROUND

A growing body of literature highlights that racial discrimination has negative impacts on child health, although most studies have been limited to an examination of direct forms of racism using cross-sectional data. We aim to provide further insights on the impact of early exposure to racism on child health using longitudinal data among Indigenous children in Australia and multiple indicators of racial discrimination.

METHODS

We used data on 1239 Indigenous children aged 5-10 years from Waves 1-6 (2008-2013) of Footprints in Time, a longitudinal study of Indigenous children across Australia. We examined associations between three dimensions of carer-reported racial discrimination (measuring the direct experiences of children and vicarious exposure by their primary carer and family) and a range of physical and mental health outcomes. Analysis was conducted using multivariate logistic regression within a multilevel framework.

RESULTS

Two-fifths (40%) of primary carers, 45% of families and 14% of Indigenous children aged 5-10 years were reported to have experienced racial discrimination at some point in time, with 28-40% of these experiencing it persistently (reported at multiple time points). Primary carer and child experiences of racial discrimination were each associated with poor child mental health status (high risk of clinically significant emotional or behavioural difficulties), sleep difficulties, obesity and asthma, but not with child general health or injury. Children exposed to persistent vicarious racial discrimination were more likely to have sleep difficulties and asthma in multivariate models than those with a time-limited exposure.

CONCLUSIONS

The findings indicate that direct and persistent vicarious racial discrimination are detrimental to the physical and mental health of Indigenous children in Australia, and suggest that prolonged and more frequent exposure to racial discrimination that starts in the early lifecourse can impact on multiple domains of health in later life. Tackling and reducing racism should be an integral part of policy and intervention aimed at improving the health of Australian Indigenous children and thereby reducing health disparities between Indigenous and non-Indigenous children.

Characteristics of sleep in socially vulnerable adolescents

IMPORTANCE

This study may help understand the effects of an unfavorable environment in sleep quality of adolescents.

OBJECTIVE

To investigate sleep quality in socially vulnerable adolescents, correlating the results with cognitive problems and attention deficit/hyperactivity disorder, and assessing the effectiveness of sleep hygiene and an educational intervention.

DESIGN

Cross-sectional and interventional study.

SETTING

an educational charitable center supported by a Catholic institution, in Porto Alegre, southern Brazil.

PARTICIPANTS

125 male and female high school students.

INTERVENTIONS

As first step the subjects were administered specific questionnaires, the Pittsburgh Sleep Quality Index (PSQI) and the Epworth Sleepiness Scale (ESS), followed by an educational activity that was combined with an unblinded, randomized interventional study. Next, a cross-sectional study was conducted to determine the influence of cognition and ADHD on the sleep.

MAIN OUTCOME AND MEASURES

Sleep was evaluated using PSQI and ESS. Cognitive assessment was based on the Wechsler Abbreviated Scale of Intelligence and ADHD by a clinical interview the Multimodal Treatment Study for ADHD (MTA-SNAP-IV).

RESULTS

The average duration of sleep per night were 6 h 30 m. 80% of the sample presented sleep complains. Of these, 44% had excessive daytime sleepiness and 69.6% had poor sleep quality related to use of electronic media, environmental violence, and emotional issues. There were no significant associations between sleep problems and cognitive problems or ADHD. Sleep quality improved in 17% of the 53 students with previous sleep complains who participated in any of the two interventions.

CONCLUSIONS

A high prevalence of sleep deprivation and sleep complains was found in the study sample. The interventions showed some positive effects on the improvement of sleep quality.

Control Over Anxiety and Dispositional Coping Tendencies Are Associated With Presleep Arousal Among Children Referred for Anxiety Problems

Anxious youth typically experience sleep-related difficulties, but little is known about the role children's coping and perceived control over anxiety may play in these relations. We examined children's perceived levels of control over external anxiety-provoking events and internal anxious emotional reactions, as well as two dispositional coping tendencies (avoidant, support-seeking), and whether these were associated with anxious children's (N = 86) presleep arousal. Low perceived control over anxiety was significantly associated with high levels of presleep arousal. For children with low perceived control, higher avoidance was associated with greater presleep arousal, whereas lower avoidance was associated with lower presleep arousal levels. Findings suggest that efforts to avoid stressful life events may contribute to presleep arousal, especially under conditions where anxious arousal seems uncontrollable.

Behavioral and neural concordance in parent-child dyadic sleep patterns

Sleep habits developed in adolescence shape long-term trajectories of psychological, educational, and physiological well-being. Adolescents’ sleep behaviors are shaped by their parents’ sleep at both the behavioral and biological levels. In the current study, we sought to examine how neural concordance in resting-state functional connectivity between parent-child dyads is associated with dyadic concordance in sleep duration and adolescents’ sleep quality. To this end, we scanned both parents and their child (N = 28 parent-child dyads; parent M_age = 42.8 years; adolescent M_age = 14.9 years; 14.3% father; 46.4% female adolescent) as they each underwent a resting-state scan. Using daily diaries, we also assessed dyadic concordance in sleep duration across two weeks. Our results show that greater daily concordance in sleep behavior is associated with greater neural concordance in default-mode network connectivity between parents and children. Moreover, greater neural and behavioral concordances in sleep is associated with more optimal sleep quality in adolescents. The current findings expand our understanding of dyadic concordance by providing a neurobiological mechanism by which parents and children share daily sleep behaviors.

Relationships between school start time, sleep duration, and adolescent behaviors

OBJECTIVES

The objectives were 2-fold: (1) to examine how high school start times relate to adolescent sleep duration, and (2) to test associations between sleep duration and mental health- and substance use-related issues and behaviors in teens.

DESIGN

This study examines selected questions from survey data collected between 2010 and 2013 high school students.

SETTING

Respondents included more than 9000 students in grades 9 to 12 in 8 high schools in 5 school districts across the United States.

MEASUREMENTS

The survey instrument is the 97-item Teen Sleep Habits Survey. Logistic regression models were used to calculate adjusted odds ratios and 95% confidence intervals. Because of clustering within schools and the use of repeated measures, generalized estimating equations were used to account for variance inflation.

RESULTS

Greater sleep duration was associated with fewer reports of various mental health- and substance use-related issues and behaviors (all P values <.01). For instance, for each additional hour of sleep reported, there was a 28% reduction in the adjusted odds of a participant reporting that he or she felt "unhappy, sad, or depressed." Later wake-up times were associated with a reduction in risk for some, but not all factors. Later start times were significantly associated with greater sleep duration.

CONCLUSIONS

Given that later start times allow for greater sleep duration and that adequate sleep duration is associated with more favorable mental health- and substance use-related issues and behaviors, it is important that school districts prioritize exploring and implementing policies, such as delayed start times, that may increase the amount of sleep of adolescent students, which is needed for their optimal development.

Adolescent daytime sleepiness as a risk factor for adult crime

BACKGROUND

While recent cross-sectional research has documented a relationship between sleep problems and antisocial behavior, the longitudinal nature of this relationship is unknown. This study tests both the hypothesis that adolescent daytime sleepiness is associated with later adult criminal offending, and also tests a biopsychosocial mediation model in which social adversity predisposes to sleepiness, which in turn predisposes to attentional impairment, and to adult crime.

METHODS

Schoolboys aged 15 years rated themselves on self-report sleepiness. Age 15 antisocial behavior was assessed by teacher ratings and self-reports, while convictions for crime were assessed at age 29. Attentional capacity at age 15 was assessed by autonomic orienting, with arousal assessed by the electroencephalogram (EEG).

RESULTS

Sleepy adolescents were more likely to be antisocial during adolescence, and were 4.5 times more likely to commit crime by age 29. The sleepiness-adult crime relationship withstood control for adolescent antisocial behavior. Self-report sleepiness predicted to adult crime over and above objective measures of daytime sleepiness (EEG theta activity) and age 15 antisocial behavior. Poor daytime attention partly mediated the sleep-crime relationship. Mediation analyses also showed that social adversity predisposed to daytime sleepiness which was associated with reduced attention which in turn predisposed to adult crime.

CONCLUSIONS

Findings are the first to document a longitudinal association between sleepiness in adolescence and crime in adulthood. The longitudinal nature of this relationship, controlling for age 15 antisocial behavior, is consistent with the hypothesis that adolescent sleepiness predisposes to later antisociality. Findings are also consistent with the notion that the well-established link between social adversity and adult crime is partly explained by sleepiness. Results suggest that a very brief and simple assessment of subjective daytime sleepiness may have prognostic clinical value, and that interventions to reduced sleepiness could be a useful avenue for future crime prevention.