Advancing a biopsychosocial and contextual model of sleep in adolescence: a review and introduction to the special issue

Changes of adolescent sleep patterns during the COVID-19 pandemic

OBJECTIVE

The COVID-19 pandemic has raised numerous concerns regarding its effects on individuals' health and lifestyle. We aim to analyze potential changes in adolescent sleep patterns from before and during the pandemic and identify specific predictors of changes.

METHODS

A subgroup of adolescents from a population-based birth cohort from Pelotas, Brazil, was assessed pre-pandemic (T1, November-2019 to March-2020) and peri-pandemic (T2, August-2021 to December-2021) in in-person interviews (n = 1,949). Sleep parameters, including sleep duration and latency time on workdays and free days, as well as social jetlag (SJL), were assessed using the Munich ChronoType Questionnaire (MCTQ). Socio-demographic, pre-pandemic, and pandemic-related predictors were analyzed. Changes in sleep parameters from T1 to T2 were estimated by multivariate latent change score modeling.

RESULTS

The latent change factor shows a significant mean increase in workday sleep duration (M = 0.334, p < 0.001), workday sleep latency (M = 0.029, p = 0.002), and free day sleep latency (M = 0.021, p = 0.034), and a decreased in SJL (M = -0.758, p < 0.001) during the pandemic. Female adolescents presented higher increases in workday sleep duration. Adolescents who adopted a stricter social distancing level during the pandemic presented greater increases in workday sleep duration and smaller reductions in SJL. Self-evaluated insomnia during the pandemic predicted lower increases in workday and free day sleep duration and higher increases in workday and free day sleep latency.

CONCLUSION

The COVID-19 outbreak brought certain advantages regarding increased sleep duration and reduced SJL. However, the observed increase in sleep latency and the influence of self-reported insomnia could be related to psychological distress inherent to the pandemic.

Associations of 24-hour movement behaviors with emotional and behavioral problems among Chinese adolescents

PURPOSE

The role of adherence to the recommendations for 24-hour movement behaviors (24-HMB), including physical activity (PA), screen time (ST), and sleep duration (SLP), in relation to emotional and behavioral problems in Chinese adolescents remains uncertain. This study aimed to investigate these associations and explore potential sex differences.

METHODS

This school-based cross-sectional study included 15,071 Chinese adolescents with a mean age of 14.53 (SD: 1.65) years. Data on emotional and behavioral problems and 24-HMB (including PA, ST, and SLP) were collected. Analysis was performed using general linear mixed models, with additional sex-stratified analyses conducted.

RESULTS

The number of 24-HMB recommendations met was negatively associated with total difficulties (β estimate=-0.96, 95% CI: -1.07 to -0.85) and positively related to prosocial behavior (β estimate = 0.41, 95% CI: 0.37 to 0.46) among adolescents. Compared with none of the recommendations met, meeting all recommendations (total difficulties: β estimate=-2.98, 95% CI: -3.41 to -2.55; prosocial behaviors: β estimate = 1.05, 95%CI: 0.87 to 1.24) demonstrated the strongest association with both difficulties and prosocial behaviors, followed by meeting recommendations for PA + ST (total difficulties: β estimate=-2.15, 95% CI: -2.41 to -1.90; prosocial behaviors: β estimate = 0.98, 95% CI: 0.87 to 1.09). These associations were consistently significant in both boys and girls.

CONCLUSION

Adherence to more 24-HMB recommendations, particularly meeting all recommendations or combined PA + ST recommendations, could improve emotional and behavioral well-being among adolescent girls and boys. The significance of balanced movement behaviors for promoting adolescent mental health merits increased attention.

Mobile-based mindfulness meditation intervention's impact on mental health among young male judo athletes in South Korea: a quasi-experimental study

Young athletes commonly encounter various mental health challenges due to the distinct pressures inherent in sports environments. This study investigates the effectiveness of mobile-delivered mindfulness meditation interventions in alleviating mental health indicators of depression, perceived stress, and anxiety, and enhancing self-esteem and resilience among young male judo athletes in South Korea. Pre- and post-test questionnaires were completed by 53 judo athletes. Participants were then allocated to the intervention group (N = 27; Mage = 13.77 [SD = 1.11]), which used a mobile meditation software program, or the control group (N = 27; Mage = 13.56 [SD = 1.05]). Data analysis compared intervention and control group scores using multiple statistical methods, including independent sample t-tests, paired sample t-tests, and 2 (time) × 2 (group) repeated measures analysis of variance. Following the intervention, the mindfulness group exhibited significant enhancements in the mental health indicators of depression (GMD = 2.74 [95% CI 0.90-4.56], Cohen's D = 0.84), perceived stress (GMD = 0.35 [95% CI 0.002-0.70], Cohen's D = 0.56), and anxiety (GMD = 0.2 [95% CI 0.001-0.40, Cohen's D = 0.56]. Self-esteem also had a significant increase (GMD = 0.55 [95% CI - 0.22 to - 0.88], Cohen's D = 0.95). The findings of this study underscore the potential benefits of mobile-delivered mindfulness meditation interventions in addressing mental health challenges among young male judo athletes. The significant enhancements observed in scores on measures of depression, perceived stress, anxiety, and self-esteem among participants in the mindfulness group highlight the effectiveness of such interventions in promoting mental health in sports settings.

Adolescents' Suggestions on how to Support Their Sleep: A Focus Group Study

Sleeping difficulties among adolescents constitute a pressing public health issue, and it is of the utmost importance that these are approached from a health-promotion perspective. This study explores adolescents' suggestions on how their sleep could be supported. Data were collected via eight focus group interviews with 43 adolescents aged 15-16, in Sweden, and analyzed using qualitative content analysis. The results describe the adolescents' suggestions on how their sleep could be supported in three themes: being supported by involved parents- routines, engagement, and warmth are vital; being supported to achieve knowledge on the "whys" and "hows" of sleep-increased knowledge gives the ability to make well-grounded sleep choices; and being guided into finding balance-balance in life is difficult to achieve and adolescents desire support. Parents, school nurses, health professionals, and anyone who has the opportunity to improve and promote sleep should consider adolescents' suggestions.

Bidirectional associations between sleep problems and suicidal thought/attempt in adolescents: A 3-wave data path analysis

PURPOSE

This longitudinal data analysis examined the bidirectional relationships between sleep problems and suicidal thought (ST)/attempt (SA) in a large sample of Chinese adolescents.

METHODS

A total of 6995 adolescents (mean age = 14.86 years and 51.4% males) participated in a 3-wave longitudinal study of behavior and health in Shandong, China. A self-administered questionnaire and standardized scales were used to assess ST, SA, sleep duration, insomnia, daytime sleepiness, and behavioral/emotional problems in 2015 (T1), 1 year later (T2), and 2 years later (T3). Path analyses were performed without and with adjustment for covariates, including gender, grade level, chronic diseases, cigarette smoking, alcohol use, anxiety/depressive symptoms, paternal education, and family economic status.

RESULTS

The prevalence rates of short sleep (<7 h/night), insomnia symptoms, and daytime sleepiness were 46.9-58.8%, 16.0-19.4%, and 25.1-25.3% at T1, T2, and T3, respectively. The rates of past-year ST and SA were 9.1-12.4% and 1.6-2.4% at T1, T2, and T3, respectively. Path analyses showed that short sleep, insomnia, and daytime sleepiness predicted subsequent ST, and vice versa. Daytime sleepiness and SA predicted each other 1 year later. Sleep problems and ST/SA in the previous year significantly predicted themselves in the follow-up year.

STUDY LIMITATION

All data were based on self-report.

CONCLUSION

Short sleep, insomnia, and daytime sleepiness all had bidirectional relationships with ST. Daytime sleepiness and SA were bidirectionally linked. Our findings suggest that interventions should be taken for both night sleep disturbances and daytime sleepiness to prevent suicide. Adverse sleep outcomes in suicidal adolescents should be assessed, which can in turn increase suicide risk.

A multidimensional investigation of sleep and biopsychosocialprofiles with associated neural signatures

Sleep is essential for optimal functioning and health. Interconnected to multiple biological, psychological and socio-environmental factors (i.e., biopsychosocial factors), the multidimensional nature of sleep is rarely capitalized on in research. Here, we deployed a data-driven approach to identify sleep-biopsychosocial profiles that linked self-reported sleep patterns to inter-individual variability in health, cognition, and lifestyle factors in 770 healthy young adults. We uncovered five profiles, including two profiles reflecting general psychopathology associated with either reports of general poor sleep or an absence of sleep complaints (i.e., sleep resilience) respectively. The three other profiles were driven by sedative-hypnotics-use and social satisfaction, sleep duration and cognitive performance, and sleep disturbance linked to cognition and mental health. Furthermore, identified sleep-biopsychosocial profiles displayed unique patterns of brain network organization. In particular, somatomotor network connectivity alterations were involved in the relationships between sleep and biopsychosocial factors. These profiles can potentially untangle the interplay between individuals' variability in sleep, health, cognition and lifestyle - equipping research and clinical settings to better support individual's well-being.

Life stress and suicidality mediated by insomnia and depressive symptoms in adolescents: a three-wave longitudinal study

STUDY OBJECTIVES

Little empirical work has investigated the associations between life stress (LS), insomnia, depression, and suicidality in multi-wave longitudinal studies. With three waves of data collection 1-year apart, this longitudinal study with a large sample of adolescents examined the predicting effects of LS on suicidality 1-year later and 2 years later and the mediating roles of insomnia and depression in the LS-suicidality link.

METHODS

A total of 6995 adolescents (mean age = 14.86 years, 51.4% male) participated in a three-wave longitudinal study of behavior and health in Shandong, China. A self-administered structured questionnaire and standardized scales were used to assess suicidality (including suicidal thought [ST], suicide plan [SP], and suicide attempt [SA]), LS, insomnia, and depression in 2015 (T1), 1-year later (T2), and 2 years later (T3). Mediation effects were examined with path models.

RESULTS

The overall prevalence rates of past-year suicidality were 13.4% at T1, 10.0% at T2, and 9.5% at T3, respectively. The prevalence rates of suicidality across T1-T3 significantly increased with elevated levels of baseline LS, insomnia, and depression (p < .001). Path models indicated that the relationship between baseline LS and suicidal ideation (i.e., ST/SP) 2 years later was significantly mediated by both insomnia and depression. Depression was also a significant mediator between LS and SA.

CONCLUSIONS

LS is a significant predictor of suicidality 1-2 years later in adolescents. Depression mediates the association between LS and suicidal ideation and suicide attempt while insomnia appears to be a mediator for suicidal ideation rather than suicide attempt.

Starting a Romantic Relationship, Breakups, and Sleep: A Longitudinal Study of Chinese Adolescents

BACKGROUND

Epidemiological data on the association between romantic experiences and sleep in adolescents are limited. This study examined the associations of starting a romantic relationship (SRR) and romantic breakups with insomnia symptoms and sleep duration in adolescents.

METHODS

A total of 7,072 Chinese adolescents were surveyed in November-December 2015 and 1 year later. A self-administered questionnaire was used to assess SRR, romantic breakups, sleep duration, insomnia symptoms, depressive symptoms, substance use, and demographics.

RESULTS

The mean age of the sample was 14.58 (SD = 1.46) years and half were female. SRR only, breakups only, and both (SRR + breakups) in the past year were reported by 7.0%, 8.4%, and 15.4% of the sample, respectively. At the baseline and 1-year follow-up, 15.2% and 14.7% of the sample had insomnia symptoms and 47.7% and 42.1% reported short sleep duration (<7 h/night), respectively. After adjusting for depressive symptoms, substance use, and demographics, SRR and breakups were significantly associated with 35-45% increased odds of insomnia symptoms at baseline. SRR + breakups were significantly associated with short sleep duration (OR = 1.28, 95%CI = 1.05-1.56). SRR (OR = 1.61, 95%CI = 1.16-2.23) and breakups (OR = 1.43, 95%CI = 1.04-1.96) were significantly associated with increased odds of incident insomnia symptoms at 1-year follow-up. These associations were stronger in younger adolescents (<15 years) than in older adolescents (≥15 years), especially in girls.

CONCLUSIONS

The findings suggest that SRR and breakups are associated with insomnia symptoms and short sleep duration, underscoring the importance of romantic relationships education and management of romantic stress for healthy sleep especially in early adolescent girls.

Optimizing Concussion Care Seeking: Connecting Care-Seeking Behaviors and Neurophysiological States Through Blood Biomarkers

BACKGROUND

Timely and appropriate medical care after concussion presents a difficult public health problem. Concussion identification and treatment rely heavily on self-report, but more than half of concussions go unreported or are reported after a delay. If incomplete self-report increases exposure to harm, blood biomarkers may objectively indicate this neurobiological dysfunction.

PURPOSE/HYPOTHESIS

The purpose of this study was to compare postconcussion biomarker levels between individuals with different previous concussion diagnosis statuses and care-seeking statuses. It was hypothesized that individuals with undiagnosed concussions and poorer care seeking would show altered biomarker profiles.

STUDY DESIGN

Cohort study; Level of evidence, 3.

METHODS

Blood samples were collected from 287 military academy cadets and collegiate athletes diagnosed with concussion in the Advanced Research Core of the Concussion Assessment, Research and Education Consortium. The authors extracted each participant's self-reported previous concussion diagnosis status (no history, all diagnosed, ≥1 undiagnosed) and whether they had delayed or immediate symptom onset, symptom reporting, and removal from activity after the incident concussion. The authors compared the following blood biomarkers associated with neural injury between previous concussion diagnosis status groups and care-seeking groups: glial fibrillary acidic protein, ubiquitin c-terminal hydrolase-L1 (UCH-L1), neurofilament light chain (NF-L), and tau protein, captured at baseline, 24 to 48 hours, asymptomatic, and 7 days after unrestricted return to activity using tests of parallel profiles.

RESULTS

The undiagnosed previous concussion group (n = 21) had higher levels of NF-L at 24- to 48-hour and asymptomatic time points relative to all diagnosed (n = 72) or no previous concussion (n = 194) groups. For those with delayed removal from activity (n = 127), UCH-L1 was lower at 7 days after return to activity than that for athletes immediately removed from activity (n = 131). No other biomarker differences were observed.

CONCLUSION

Individuals with previous undiagnosed concussions or delayed removal from activity showed some different biomarker levels after concussion and after clinical recovery, despite a lack of baseline differences. This may indicate that poorer care seeking can create neurobiological differences in the concussed brain.

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.

Caffeine intake and its association with nutrition, sleep, and physical activity among schoolchildren in the United Arab Emirates: a national cross-sectional study

PURPOSE

Recent surveys indicate a significant increase in total caffeine intake among schoolchildren. Limited research has been published concerning the total intake of caffeine among schoolchildren in the Middle East and Gulf Cooperation Council (GCC) countries, including the UAE.

METHODS

This cross-sectional survey estimated the total caffeine intake from foods and beverages among 10,275 schoolchildren in the UAE. Caffeine intakes were related to the European Food Safety Authority's level of no safety concern (3.0 mg/kg BW) and level of effects on sleep (1.4 mg/kg BW).

RESULTS

More than half (56.2%) of the students consumed more than 100 mg (the upper limit allowed) of caffeine from dietary sources. High intake of caffeine (> 100 mg/day) was significantly associated (p = 0.001) with reduced sleep duration, difficulty falling asleep, infrequent exercising, using smart devices for more than 2 h a day, getting a lower GPA, skipping breakfast, eating fewer servings of vegetables than recommended, frequent consumption of fast food and more frequent snack consumption.

CONCLUSION

Excessive intake of caffeine from different dietary sources coexists with unhealthy dietary and lifestyle behaviors and sleep problems. Tailoring educational programs and intervention strategies is warranted to correct the unhealthy intake of caffeine and the associated unhealthy dietary and lifestyle behaviors among schoolchildren in the UAE.

Psychosocial Determinants of Sleep Behavior and Healthy Sleep Among Adolescents: A Two-Wave Panel Study

To date, it remains unknown which psychosocial determinants identified by several leading behavior change theories are associated with different sleep parameters among adolescents. Therefore, this study investigates whether changes in knowledge about healthy sleep, attitude toward healthy sleep and going to bed on time, self-efficacy to engage in healthy sleep behavior, perceived parental and peer norms, perceived barriers (e.g., worrying, fear of missing out), and perceived support (e.g., bedtime rules, encouragement) related to healthy sleep are associated with changes in adolescents' sleep duration on school days and free days and sleep quality over a period of 1 year. Two-wave data of 1648 Flemish adolescents (mean age = 15.01, SD = 0.65, 46.3% female) were analyzed using linear models. Increased levels of parental social support, positive attitude towards and perceived advantages of healthy sleep, norm-knowledge, and perceived peer behavior were associated with sleep duration, with parental social support having the strongest association. Increased levels of perceived barriers were associated with decreased levels of sleep quality parameters, and increased levels of self-efficacy, positive attitude, and parental modeling were associated with improved sleep quality parameters, with perceived barriers having the strongest association. The current results indicate that behavior change theories are useful in the context of adolescent sleep behavior and suggest that perceived parental support (i.e., bedtime rules) and perceived barriers are most strongly associated with adolescents' sleep duration and/or quality.

Childhood sleep: assessments, risk factors, and potential mechanisms

BACKGROUND

Sleep problem is a highly prevalent health issue among pediatric populations across the world. In this review, we aimed to identify risk factors contributing to sleep deficiency and poor sleep hygiene in children. Potential biological, psychosocial, and environmental mechanisms as well as research gaps in the literature are also discussed.

DATA SOURCES

A comprehensive search for relevant English language full-text, peer-reviewed publications was performed focusing on pediatric sleep studies from prenatal to childhood and adolescence in a variety of indexes in PubMed, SCOPUS, and Psych Info. Both relevant data based and systematic reviews are included.

RESULTS

This paper summarizes many risk factors for childhood sleep problems, including biological (e.g., genetics, gender, age and puberty, prenatal factors, postnatal factors); nutritional (e.g., macronutrients, micronutrients, omega-3 fatty acids, obesity); environmental (e.g., heavy metals, noise, light, air pollution); interpersonal (e.g., family, exposure to violence, screen media use, physical injury); and community/socioeconomic variables (e.g., racial/ethnicity and cultural factors, neighborhood conditions and socioeconomic status, school factors, public health disasters/emergencies), to better understand the development of sleep problems in children.

CONCLUSIONS

Poor childhood sleep is a multifactorial issue affected by a wide range of prenatal and early-life biological, environmental, and psychosocial risk factors and contributors. A better understanding of these risk factors and their mechanisms is an important first step to develop future research and prevention programs focusing on pediatric sleep problems.

Associations between social jetlag trajectories and body mass index among young adults

STUDY OBJECTIVES

This study employed longitudinal data collected repeatedly from individuals over the course of several years to examine the trajectories of social jetlag from ages 11 to 22 years and their associations with subsequent body mass index (BMI). Potential sex differences were also investigated.

METHODS

Data were obtained from two longitudinal studies conducted in Taiwan (N = 4287). Social jetlag was defined as ≥ 2 hours of absolute difference in sleep midpoint between weekdays and weekends. BMI was calculated using weight (kg)/height(m)2 and categorized as underweight (<18 kg/m2), normal weight (18 kg/m2 ≤ BMI < 24 kg/m2), overweight (24 kg/m2 ≤ BMI < 27 kg/m2), and obese (≥27 kg/m2). Group-based trajectory modeling and multinomial logistic regression were applied to investigate study objectives.

RESULTS

Four distinct trajectories of social jetlag throughout the adolescent years were identified, with corresponding proportions as follows: low-stable (42%), moderate-decreasing (19%), low-increasing (22%), and chronic (17%) trajectories. Among males, the risk of being underweight (aOR, 1.96; 95% CI: 1.35 to 2.84) or obese (aOR, 1.40; 95% CI: 1.02 to 1.92) was higher in individuals with a low-increasing trajectory than in those with a low-stable trajectory. Among females, those with a low-increasing (aOR, 1.61; 95% CI: 1.02 to 2.54) or chronic (aOR, 2.04; 95% CI: 1.27 to 3.25) trajectory were at a higher risk of being obese relative to those with a low-stable trajectory.

CONCLUSIONS

Addressing the development of increasing or chronic social jetlag during adolescence can help prevent abnormal BMI in young adulthood. Practitioners should consider sex differences in treatment or consultation.

A meta-analysis of longitudinal studies on the interplay between sleep, mental health, and positive well-being in adolescents

Objective

This review aimed to summarize longitudinal research about the interplay between sleep, mental health, and positive well-being in adolescents.

Method

Multiple search strategies were applied until 28th January 2023 to identify relevant research published in peer-reviewed journal articles or available grey literature. A final set of 63 studies were included in the systematic review and 42 in the meta-analysis.

Results

Results highlighted that long sleep duration, good sleep quality, and low insomnia symptoms were bidirectionally related to lower internalizing (Sleep T1 → Internalizing symptoms T2: r = -.20, p < .001; Internalizing symptoms T1 → Sleep T2: r = -.21, p < .001) and externalizing (Sleep T1 → Externalizing symptoms T2: r = -.15, p < .001; Externalizing symptoms T1→ Sleep T2: r = -.17, p < .001) symptoms, and to higher levels of psychological well-being (Sleep T1 → Psychological well-being T2: r = .15, p < .001; Psychological well-being T1 → Sleep T2: r = .15, p < .05). Moreover, good sleep was positively related to higher subjective well-being at a later time point (r = .18, p < .001).

Conclusions

Overall, these findings suggest a bidirectional relation between different aspects of sleep, mental health, and positive well-being.

Latent Profiles of Sleep Patterns in Early Adolescence: Associations With Behavioral Health Risk

PURPOSE

The present study characterized sleep profiles in a national longitudinal sample of early adolescents and examined whether profiles predicted later behavioral problems.

METHODS

Three waves of data (2016-2021) were obtained from the Adolescent Behavior and Cognitive Development study, including 3,326 participants with both weekday and weekend sleep data measured by Fitbit wearables (age range 10.58-13.67 years; 49.3% female). Latent profile analysis was utilized to identify sleep profiles using multiple sleep indicators (duration, latency, efficiency, wake minutes, wake counts, and midpoint). We then explored whether demographic predictors predicted profile membership and tested the latent sleep profiles' predictive utility of internalizing and externalizing symptoms.

RESULTS

Four profiles were identified: average sleep (40.39%), high duration & high wakefulness (28.58%), high efficiency, low duration &low wakefulness (16.86%), and low duration & low efficiency (14.17%). Participants with older age, males, higher body mass index, and advanced pubertal status were more likely to be classified in the low duration & low efficiency profile than the average group. Participants with lower income, minority identification, older age, and higher body mass index were more likely to be classified in the high efficiency, low duration &low wakefulness than the average group. Participants with lower parental education and males were more likely to be in the high sleep duration & high wakefulness than the average group. The low duration & low efficiency group had the highest attention problems, social problems, and rule-breaking behaviors.

DISCUSSION

Our findings highlight unique sleep patterns in early adolescence and their prospective links with internalizing and externalizing problems.

Changes in sleep disturbance among Chinese adolescents: A population-based online survey

OBJECTIVE

Sleep disturbance is prevalent among adolescents but little is known about the short-term changes among Chinese adolescents. The study aimed to explore the prevalence and change patterns of sleep disturbance and identify its risk and protective factors.

METHODS

Data were collected online from April 21st to May 12th, 2021 (Time 1, T1) and December 17th to 26th, 2021 (Time 2, T2). The final sample comprised 34,260 adolescents. Self-administrated questionnaires were used to assess socio-demographic variables, sleep disturbance, depression, anxiety, life events, family function, and resilience.

RESULTS

The prevalence of sleep disturbance was 12.0% at T1 and 11.8% at T2, with higher rates in females than males. Four groups of sleep disturbance change patterns were identified: non-sleep disturbance group (80.4%), persistent group (4.2%), new-onset group (7.6%), and remission group (7.8%). Risk factors for new-onset sleep disturbance included being in junior high school (AOR = 1.26, 95%CI = 1.15-1.38), family history of mental disorders (AOR = 1.49, 95%CI = 1.03-2.15), and moderate (AOR = 1.24, 95%CI = 1.13-1.36) and severe (AOR = 1.48, 95%CI = 1.27-1.72) family dysfunction. Risk factors for persistent sleep disturbance included being in junior (AOR = 1.25, 95%CI = 1.08-1.45) and senior (AOR = 1.53, 95%CI = 1.15-2.03) high school, parental currently unmarried status (AOR = 1.34, 95%CI = 1.05-1.73), moderate (AOR = 1.19, 95%CI = 1.02-1.39) and severe (AOR = 1.28, 95%CI = 1.06-1.55) family dysfunction. Medium (AOR = 0.48, 95%CI = 0.43-0.53) and high (AOR = 0.34, 95%CI = 0.29-0.40) levels of resilience were protective factors against new-onset sleep disturbance, as well as against persistent sleep disturbance (medium level: AOR = 0.51, 95%CI = 0.43-0.60; high level: AOR = 0.32, 95%CI = 0.25-0.43).

CONCLUSIONS

Interventions aimed at promoting family functions and enhancing resilience may improve sleep disturbance among adolescents.

Concordance in parent-child and sibling actigraphy-measured sleep: Evidence among early adolescent twins and primary caregivers

STUDY OBJECTIVES

Growing evidence suggests concordance between parent and youth sleep. However, no known study has simultaneously examined concordance among siblings' sleep patterns. This study investigated daily and average concordance in (1) parent-youth and (2) sibling actigraphy-measured sleep, as well as the degree to which sibling concordance varied by sleeping arrangements.

METHODS

516 twin siblings (Mage = 10.74, 51% female; 30% monozygotic (MZ) twin pairs, 37% same-sex dizygotic pairs (DZ-ss), 33% opposite-sex DZ pairs (DZ-os)) and their primary caregivers (Mage = 40.59, 95% female) wore wrist-based accelerometers for 7 consecutive nights to measure sleep duration, efficiency, midpoint time, and latency. Primary caregivers also reported on demographics, youth pubertal status, and room-sharing. Two-level multilevel models were estimated to examine daily and average concordance in parent-youth and sibling sleep.

RESULTS

Daily concordance was observed between parent and youth sleep duration and midpoint; average concordance was found for sleep duration, midpoint, and latency. Within sibling dyads, daily and average concordance was evident across all sleep parameters (duration, efficiency, midpoint, latency), with generally stronger concordance patterns for MZ than DZ twin pairs, and for twins who shared a room with their co-twin.

CONCLUSIONS

This is the first known study to document concordance among parent-youth and siblings' actigraphy-measured sleep within the same study (i.e., triad). Our findings can help inform the development of family-level interventions targeting daily and overall sleep hygiene.

Pediatric sleep: current knowledge, gaps, and opportunities for the future

This White Paper addresses the current gaps in knowledge, as well as opportunities for future studies in pediatric sleep. The Sleep Research Society's Pipeline Development Committee assembled a panel of experts tasked to provide information to those interested in learning more about the field of pediatric sleep, including trainees. We cover the scope of pediatric sleep, including epidemiological studies and the development of sleep and circadian rhythms in early childhood and adolescence. Additionally, we discuss current knowledge of insufficient sleep and circadian disruption, addressing the neuropsychological impact (affective functioning) and cardiometabolic consequences. A significant portion of this White Paper explores pediatric sleep disorders (including circadian rhythm disorders, insomnia, restless leg and periodic limb movement disorder, narcolepsy, and sleep apnea), as well as sleep and neurodevelopment disorders (e.g. autism and attention deficit hyperactivity disorder). Finally, we end with a discussion on sleep and public health policy. Although we have made strides in our knowledge of pediatric sleep, it is imperative that we address the gaps to the best of our knowledge and the pitfalls of our methodologies. For example, more work needs to be done to assess pediatric sleep using objective methodologies (i.e. actigraphy and polysomnography), to explore sleep disparities, to improve accessibility to evidence-based treatments, and to identify potential risks and protective markers of disorders in children. Expanding trainee exposure to pediatric sleep and elucidating future directions for study will significantly improve the future of the field.

Evening chronotype, insufficient weekday sleep, and weekday-weekend gap in sleep times: What is really to blame for a reduction in self-perceived health among university students?

The association of insufficient sleep with reduced self-perceived health was previously well established. Moreover, it was sometimes shown that the indicators of poorer health were significantly related to chronotype and weekday-weekend gaps in sleep timing and duration. It remains to be elucidated, however, whether chronotype and these gaps can contribute to the reduced health self-ratings independently from shortened sleep duration or, alternatively, their relationship with health can be simply explained by their association with insufficient sleep on weekdays. In an online survey, we tested whether the self-rated health of university students can be predicted by several individual characteristics of the sleep-wake cycles, such as chronotype, weekday and weekend sleep times, weekday-weekend gap in sleep times, sleepability and wakeability at different times of the day, etc. Responses to a question about general health and to items of several questionnaires for chronobiological assessment were collected from smartphones of 1582 university students (mean age ± standard deviation was 19.5 ± 1.7 y). The results of regression analyses suggested that lower odds of having good self-rated health were significantly associated with an earlier weekday risetime, a later weekday bedtime, and, consequently, a shorter weekday time in bed. After accounting for weekday sleep, self-rated health showed significant association with neither chronotype nor weekday-weekend differences in sleep duration and timing. Besides, the adverse health effects of reduced weekday sleep were independent from the significant adverse effects of several other individual sleep-wake characteristics including poorer nighttime sleepability and lower daytime wakeability. We concluded that university students perceive the negative health impacts of losing sleep by waking up early on weekdays irrespective of their night sleep quality and daytime level of alertness. Their chronotype and weekday-weekend difference in sleep times might not be among significant contributors to this perception. It is of practical importance to consider the reduction of weekday sleep losses among the interventions aimed at preventing sleep and health problems.

Exploring the associations between the Morningness-Eveningness-Stability-Scale improved (MESSi) and the higher-order personality factors

Morningness-eveningness refers to individual differences in the sleep-wake cycle. Research indicates that morningness-eveningness is associated with the Big Five (neuroticism, extraversion, openness to experience, agreeableness, conscientiousness) and the Big Two (alpha-stability, beta-plasticity) personality factors. However, the latter has not yet been tested within the multidimensional approach to morningness-eveningness. In the present study, we have adapted the Morningness-Eveningness-Stability-Scale improved (MESSi) to Polish (https://osf.io/rcxb5) to explore the associations between its subscales (morning affect, eveningness, distinctness) and the Big Two personality traits in a sample of 1106 participants (559 women and 547 men) aged 18 to 55 (M = 36.26, SD = 9.90). In bivariate correlations, morning affect was positively related to alpha-stability and beta-plasticity, distinctness was correlated negatively with alpha-stability and beta-plasticity, while eveningness was positively correlated only with beta-plasticity. Furthermore, the confirmatory factor analysis supported the original three-factor structure of the Polish version of MESSi, while the associations with affect and the symptoms of depression and anxiety attested to its validity. Overall, the present study provides the first evidence for the associations between MESSi subscales and the Big Two personality traits, as well as shows a good fit of the three-factor structure of MESSi in the Polish population.

Sleep IntervEntion as Symptom Treatment for ADHD (SIESTA)-Blended CBT sleep intervention to improve sleep, ADHD symptoms and related problems in adolescents with ADHD: Protocol for a randomised controlled trial

INTRODUCTION

Adolescents with attention deficit hyperactivity disorder (ADHD) experience a more disrupted sleep and more sleep problems compared with typically developing adolescents. This is particularly concerning, because disrupted sleep is related to worsened clinical, neurocognitive and functional outcomes and leads to increased ADHD symptom impairment. Due to the specific difficulties adolescents with ADHD experience, a tailored sleep treatment is needed. Therefore, our lab developed a cognitive behavioural treatment-Sleep IntervEntion as Sympom Treatment for ADHD (SIESTA)-that integrates sleep training with motivational interviewing, and planning/organisational skills training with the aim of improving sleep problems in adolescents with ADHD.

METHODS AND ANALYSIS

A randomised, controlled, investigator-blinded monocentre trial is used to test whether SIESTA in combination with treatment as usual (TAU) for ADHD results in greater improvement in sleep problems than TAU only. Adolescents (aged 13-17 years) with ADHD and sleep problems are included. They complete measurements before treatment (pre-test), approximately 7 weeks after the pre-test (post-test), and approximately 3 months after the post-test (follow-up). The assessment includes questionnaires filled out by adolescents, parents and teachers. Additionally, sleep is assessed by actigraphy and sleep diaries at all time-points. Primary outcomes include objectively and subjectively measured sleep architecture (specified as total sleep time, sleep onset latency, sleep efficiency and number of awakenings), subjectively measured sleep problems and sleep hygiene. Secondary outcomes include ADHD symptoms, comorbidities and functional outcomes. To analyse the data, a linear mixed effects model will be used with an intent-to-treat approach.

ETHICS AND DISSEMINATION

The study activities, informed consent and assent forms have been approved by the Ethical Committee Research UZ/KU Leuven (study ID S64197). If proven effective, the intervention will be implemented throughout Flanders. Therefore, an advisory board consisting of societal partners in healthcare is appointed at the start of the project, giving advice throughout the project and assistance with implementation afterwards.

TRIAL REGISTRATION NUMBER

NCT04723719.

Prevalence of insomnia in a sample of Internet addicts in different age groups in Abu Dhabi, UAE

Background

Internet addiction, insomnia, and depression have a major health concern. The association of these problems can severely affect education, work productivity with negative outcomes for society. Internet addiction has been reported to be associated with insomnia and depression that may differ by age. The aim of the study is to assess the prevalence of insomnia and depression and their correlation with Internet addiction in all age groups and to detect age differences. A total of 386 participants were recruited. Data were collected using an online survey that contains questions about sociodemographic, Insomnia Severity Index (ISI), Internet Addiction Test (IAT), and Patient Health Questionnaire (PHQ9) to measure insomnia, Internet addiction, and depression, respectively.

Results

The overall prevalence of clinically significant insomnia was 22.5% while subthreshold insomnia was present in 38.5%. There was a significant negative correlation of age with IAT and PHQ9. Also, a highly significant positive correlation was found between ISI, IAT, and PHQ9 within the total sample and each age group (p = 0.000).

Conclusions

A great proportion of the general population suffers from insomnia, Internet addiction, and depression, and their prevalence rates differ by age. Also, there is a strong association between them. Identifying these problems is important, and interventions should include the three problems.

Sleep Is a Family Affair: A Systematic Review and Meta-Analysis of Longitudinal Studies on the Interplay between Adolescents' Sleep and Family Factors

Family is one of the primary socialization contexts influencing adolescents' psychological health. In this regard, a crucial indicator of adolescents' health is their sleep quality. Nevertheless, it is still unclear how multiple family factors (i.e., demographic and relational) are intertwined with adolescents' sleep quality. For this reason, this systematic review with meta-analysis aims to comprehensively summarize and integrate previous longitudinal research investigating the reciprocal relation between demographics (e.g., family structure) and positive (e.g., family support) and negative (e.g., family chaos) relational family factors and adolescents' sleep quality. Several search strategies were applied, and a final set of 23 longitudinal studies that matched the eligibility criteria were included in this review. The total number of participants was 38,010, with an average age at baseline of 14.7 years (SD = 1.6, range: 11-18 years). On the one hand, the meta-analytic results showed that demographic factors (e.g., low socio-economic status) were not related to adolescents' sleep quality at a later time point. On the other hand, positive and negative family relational factors were positively and negatively related to adolescents' sleep, respectively. Furthermore, the results suggested that this association could be bidirectional. Practical implications and suggestions for future research are discussed.

Factors Underpinning the Shift to Eveningness during Early Adolescence: Pubertal Development and Family Conflicts

Biological and psychosocial factors have been related to the shift to eveningness during early adolescence but it is necessary to study them from a longitudinal perspective. This longitudinal study examined the contribution of these factors to the onset of a shift towards eveningness in early adolescence. A sample of 440 (49.9% boys) Spanish adolescents were assessed for pubertal development, family conflicts, and morningness/eveningness. The same measures were taken twice at the age of 12 and one year later (T1: M = 12.47, SD = 0.75 and T2: M = 13.64, SD = 0.78). Pubertal development and family conflicts were considered predictors of morningness/eveningness in a mixed-effects multilevel model. The developmental shift towards eveningness appeared in girls but not in boys. The shift was related to more advanced pubertal development and more conflicts in the family. This study has implications for shaping healthy sleep habits in adolescents and possible interventions focused on family dynamics.

Wearable and mobile technology to characterize daily patterns of sleep, stress, presleep worry, and mood in adolescent insomnia

OBJECTIVES

Characterizing daily patterns of sleep, stress, presleep worry, and mood in adolescents with and without insomnia symptomatology.

DESIGN

Two months of continuous wearable tracking and daily diary ratings.

SETTING

Free-living conditions.

PARTICIPANTS

Ninety-three adolescents (59 girls; 16-19 years old) with (N = 47; 26 with clinical and 21 with sub-clinical) and without (N = 46; control) DSM-5 insomnia symptomatology.

MEASUREMENTS

Fitbit Charge 3 tracked sleep, heart rate, and steps. Evening electronic diaries collected ratings of daily stress, presleep worry, and mood.

RESULTS

While sleep duration (control: 6.88 ± 1.41 hours; insomnia: 6.92 ± 1.28 hours), architecture, timing, and night-to-night variability were similar between groups, the insomnia group reported higher levels of stress and worry, being mainly related to "school". At the intraindividual level, stress and worry predicted shorter sleep duration and earlier wake up times, which, in turn, predicted higher stress the following day. Moreover, higher-than-usual stress predicted higher sleep-time heart rate, with a more consistent effect in adolescents with insomnia. Results were overall consistent after controlling for covariates and several robustness checks.

CONCLUSIONS

There is a bidirectional relationship between daily stress and sleep, with daily stress negatively impacting sleep, which in turn leads to more stress in adolescents with and without insomnia symptoms. Findings also highlight the complexity of insomnia in adolescence, in which the core clinical features (perceived sleep difficulties) and the critical factors (stress/worry) implicated in the pathophysiology of the disorder are not necessarily reflected in objective sleep indicators.

Life stress, insomnia, and anxiety/depressive symptoms in adolescents: A three-wave longitudinal study

PURPOSE

Life stress has negative impacts on sleep and mental health. Little empirical work has investigated the associations between life stress, insomnia, and anxiety/depressive symptoms (ADS) in multi-wave longitudinal studies. This longitudinal study examined these associations in a large sample of adolescents.

METHODS

A total of 6995 adolescents (mean age = 14.86 years, 51.4 % male) participated in a 3-wave longitudinal study of behavior and health in Shandong, China. Standardized rating scales were used to assess life stress, insomnia, and ADS in 2015 (T1), 1 year later (T2), and 2 years later (T3). Three-wave longitudinal panel models were conducted to examine the prospective relationships between life stress, insomnia, and ADS.

RESULTS

The prevalence and persistence rates of insomnia and ADS across T1-T3 significantly increased with elevated life stress score (p < .001). Cross-lagged panel analysis showed that life stress, insomnia, and ADS at a later time point were significantly predicted by the same variable at earlier time points (all p < .01). Life stress, insomnia, and ADS significantly predicted each other bidirectionally over time (all p < .01). The relationship between life stress and ADS was partially mediated by insomnia. The relationship between life stress and insomnia was partially mediated by ADS.

STUDY LIMITATION

Life stress, insomnia, and ADS were all self-reports.

CONCLUSIONS

Life stress, insomnia, and ADS are prospectively bidirectionally related to one another. Insomnia was a mediator of life stress and subsequent ADS and vice versa. These findings underscore the importance of sleep and mental health assessment and intervention in adolescents following life stress.

A developmental perspective on sleep consistency: Preschool age through emerging adulthood

OBJECTIVE/BACKGROUND

Beyond sleep duration, the regularity of sleep patterns (e.g., sleep consistency), including variability in sleep timing (e.g., bedtime, wake time) and duration, is a critical marker of sleep health. Sleep consistency is captured using a variety of methods within the literature (e.g., sleep intraindividual variability, social jetlag), but most of the research focuses on adolescents.

METHODS

Drawing on a developmental perspective, this narrative review highlights how normative changes at the individual (e.g., biological, cognitive, and social) and contextual (e.g., home, school, sociocultural) levels may contribute to inconsistent sleep patterns across development.

RESULTS AND CONCLUSIONS

This review emphasizes how inconsistent sleep may increase across pivotal transitions throughout development (e.g., elimination of naps, puberty, summertime, entering college). Finally, recommendations for measuring sleep consistency and areas to address in future research are discussed.

Addictive smartphone use in the elderly: relationship with depression, anxiety and sleep quality

BACKGROUND

The aim of the present study was to explore the relationship between addictive smartphone use (ASU) and depressive symptoms, anxiety and sleep quality in elderly adults.

METHODS

The study sample included smartphone users over the age of 65 years. The research data were obtained from social networking sites via a Google survey link. In addition to filling out a sociodemographic data form, the participants were also assessed with Smartphone Addiction Scale (SAS), Geriatric Depression Scale, Beck Anxiety Inventory and Pittsburgh Sleep Quality Index tools.

RESULTS

The correlation analysis revealed the SAS score to be positively correlated with depression and anxiety, and negatively correlated with sleep quality. In the regression analysis, depressive symptoms, anxiety level and sleep quality were all found to have an effect on the SAS total score. Furthermore, the SAS score was found to have an effect on depressive symptoms, anxiety and sleep quality.

CONCLUSIONS

Our findings reveal a bidirectional relationship between ASU and depressive, anxiety symptoms and impaired sleep quality in elderly adults. It is important to question smartphone use patterns in people with sleep problems, symptoms of depression or anxiety.

Prospective association between evening circadian preference and academic functioning in adolescents: the role of daytime sleepiness

BACKGROUND

There is growing evidence for the role of circadian factors in adolescents' sleep and academic adjustment, with greater evening preference being linked to poorer academic functioning. However, studies have yet to evaluate this association prospectively in adolescence, nor have studies examined daytime sleepiness as a putative mechanism linking evening preference to poor academic functioning. The current study used a multi-informant design to test the prospective association of evening circadian preference, daytime sleepiness, and academic functioning (e.g., global academic impairment and grades) across 2 years in adolescence. As evening circadian preference, sleepiness, and academic problems are elevated in adolescents with ADHD, we used a sample enriched for adolescents with ADHD and explored whether ADHD moderated effects.

METHOD

Participants were 302 adolescents (M_age  = 13.17 years; 44.7% female; 81.8% White; 52% with ADHD). In the fall of eighth grade, adolescents reported on their circadian preference, and in the fall of ninth grade, adolescents and parents completed ratings of daytime sleepiness. In the middle of 10th grade, parents and teachers reported on adolescents' academic impairment and at the end of 10th grade, adolescents' grade point average (GPA) was obtained from school records.

RESULTS

Above and beyond covariates (e.g., adolescent sex, ADHD status, medication, sleep duration) and baseline academic impairment, greater self-reported evening preference in 8th grade predicted increased parent ratings of academic impairment in 10th grade indirectly via adolescent and parent ratings of daytime sleepiness in 9th grade. Furthermore, evening preference in 8th grade predicted greater teacher ratings of academic impairment and lower average GPA in 10th grade via parent ratings of daytime sleepiness in 9th grade, controlling for covariates and baseline GPA. ADHD status did not moderate indirect effects.

CONCLUSION

Findings underscore daytime sleepiness as a possible intervening mechanism linking evening preference to poor academic functioning across adolescence. Intervention studies are needed to evaluate whether targeting circadian preference and sleepiness improves academic functioning in adolescents.

Associations between Insomnia, Daytime Sleepiness, and Depressive Symptoms in Adolescents: A Three-Wave Longitudinal Study

BACKGROUND

Insomnia, daytime sleepiness, and depressive symptoms are prevalent in adolescents. This three-wave prospective study examined the associations between the three symptoms in adolescents.

METHODS

A total of 6995 schoolchildren in 7th and 10th grades (Mean age = 14.86 years) participated in a longitudinal study of behavior and health in Shandong, China. Standardized rating scales were used to assess symptoms of insomnia, daytime sleepiness, and depression in November-December in 2015, 1 year later, and 2 years later.

RESULTS

Insomnia was cross-sectionally associated with 10-14-fold increased odds of daytime sleepiness and 5-9-fold increased odds of depression. Daytime sleepiness was associated with 4-5-fold increased odds of depression. Insomnia, daytime sleepiness, or depression at a later time point was significantly predicted by itself at earlier time points. Insomnia was a significant predictor of daytime sleepiness and depression and a mediator between depression and daytime sleepiness. Daytime sleepiness was a significant predictor of insomnia and a mediator between depression and insomnia. Depression was a significant predictor of insomnia and daytime sleepiness and a mediator between insomnia and daytime sleepiness.

CONCLUSIONS

Insomnia, daytime sleepiness, and depressive symptoms were highly comorbid in adolescents. The associations of insomnia with daytime sleepiness and depression were bidirectional. Depression predicted daytime sleepiness, but not vice versa. Further research is needed to understand the underlying neurobiological mechanisms between insomnia, daytime sleepiness, and depression during adolescence.

The longitudinal relationship between sleep length and psychotic-like experiences in adolescents

The longitudinal relationship between psychotic-like experiences (PLEs) and short habitual sleep in adolescents remains to be investigated. We examined the effect of habitual sleep length (time-in-bed: TIB) on the risk of subsequent year PLEs and vice versa, in grade 7-12 students (ages: 12-18, n = 1,685) followed over 6 years. Yearly longitudinal data were analyzed using cross-lagged panel models. Shorter weekday TIB was associated with a higher risk of subsequent year PLEs; PLEs did not affect subsequent year TIB. Compared to a TIB of 8-9 h, 5-6 h increased PLEs likelihood 1.8 times; <5 h increased this 6-fold.

A 28-day, 2-year study reveals that adolescents are more fatigued and distressed on days with greater NO2 and CO air pollution

This 2-year, 28-day study examined whether adolescents felt greater fatigue and emotional distress the same day and the day after air quality was worse. We linked objective daily air quality measurements to daily self-reports from 422 Mexican-American adolescents in Los Angeles County, California from 2009 to 2011 (50% girls, M_Age = 15 years). A robust, within-subject analysis of 9696 observations revealed that adolescents with ongoing physical complaints reported greater fatigue and emotional distress on days that the air contained higher levels of nitrogen dioxide (NO₂) and carbon monoxide (CO). Regardless of physical complaints, adolescents on average also reported greater fatigue the day after NO₂ levels were higher. The same-day and next-day associations between air pollution and distress were mediated via daily increases in fatigue. Results were robust when controlling for day of the week, and daily temperature and humidity. Sulfur dioxide (SO₂), ozone (O₃), PM_2.5 and PM₁₀ were not related to daily fatigue or distress.

Changes in sleeping habits during the pubertal years; A descriptive study conducted in Jordan

Background:

There is limited information about changes in sleeping habits during the pubertal years of development among adolescents in Jordan.

Objective:

This study examined sleeping habits at the onset and end of puberty.

Methods:

This study utilized data from a nationwide survey in Jordan.

Participants: Sleeping habits were obtained from 3,661 adolescents aged 11(onset of puberty) and 15 years (end of puberty) and their mothers using a self-reported questionnaire. The number of hours slept and bedtimes and wake-up times on both school and non-school days were examined.

Results:

On school days, 60% of 11-year-old and 34% of 15-year-old adolescents slept between 8:00-10:00 pm. On school days, the 11-year-old adolescent group reported sleeping significantly longer than the 15-year-old adolescent group, and the proportions of adolescents who met the minimal recommended sleeping hours were 64% and 54%, respectively. Sleeping hours were long for both groups attending government schools; for the 15-year-old adolescent group, sleeping hours varied with family income and maternal education. In the case of both groups, on non-school days sleeping hours varied with gender, family income, and type of school.

Conclusion:

At the end of pubertal years, adolescent sleeping habits differ significantly from those of adolescents at the onset of puberty. On school days, insufficient sleep is much evident in the case of both 11 and 15-year-old adolescent groups, but more pronounced in the latter. Nursing initiatives to address poor sleeping habits among adolescents are warranted, given their efficacy in promoting healthy growth and development within this age group.

What time do you plan to sleep tonight? An intense longitudinal study of adolescent daily sleep self-regulation via planning and its associations with sleep opportunity

BACKGROUND

Most adolescents are sleep deprived on school days, yet how they self-regulate their sleep-wake behaviours is poorly understood. Using ecological momentary assessment, this intense longitudinal study explored patterns of adolescents' daily bedtime and risetime planning and execution, and whether these behaviours predicted sleep opportunity.

METHODS

Every afternoon, for 2 school weeks and the subsequent 2 vacation weeks, 205 (54.1% female, 64.4% non-White) adolescents from year 10 to 12 (M ± SD_age  = 16.9 ± 0.9) reported their plans for bedtime (BT) that evening, and for risetimes (RT) the following day. Actual daily sleep was measured via actigraphy and sleep diary.

RESULTS

Some adolescents never planned bedtime (school 19.5%, non-school 53.2%) or risetime (school 1.5%, non-school 24.4%). More adolescents planned consistently (≥75% of days) on school (BT = 29.9%, RT = 61.3%) compared to non-school nights (BT = 3.5%, RT = 2.5%). On average, adolescents went to bed later than planned, with longer delays on non-school (71 min) compared to school nights (46 min). Of those who executed their plans within ≤15 min, more did it consistently (≥75% of days) on school (BT = 40.9%, RT = 67.7%) than on non-school nights/days (BT = 29.7%, RT = 58.6%). Mixed effects models utilizing daily data, controlling for sex, race, and study day, showed that bedtime planning predicted longer time in bed (TIB; p < .01) on school and shorter TIB on non-school nights (p < .01); and greater delay in actual (compared to planned) BT predicted shorter TIB (p < .001).

CONCLUSIONS

Adolescents may require support during the transition from parent-controlled to autonomous sleep self-regulation. Bedtime planning on school nights and going to bed as planned are two modifiable sleep regulatory behaviours that are protective and potential therapeutic targets for increasing sleep opportunity in adolescents.

Contributory Factors for Teen Insomnia Symptoms: A Prospective Cohort Study in Sweden

Objectives

Insufficient sleep is a public health problem that impacts the mental and physical health of children and adolescents. Complaints of insomnia are particularly pervasive among adolescents. This longitudinal study investigates factors that contribute to teen insomnia symptoms.

Design

Five-year prospective follow-up study.

Setting

School-based.

Participants

A total of 522 children (49.8% girls) aged 9.4 ± 1.3 years at baseline; 14.4 ± 0.7 years at follow-up.

Measurements

The dependent variable of insomnia symptoms at follow-up was assessed with the Minimal Insomnia Symptom Scale-Revised. The independent variables at baseline were the perceived family financial situation, tiredness at school, problems waking up, short sleep duration, sleeping difficulties, having a bedroom Television (TV), and time spent with a TV/computer. Multivariate binary logistic regression analyses were used to examine whether the independent variables at baseline predicted insomnia symptoms at follow-up.

Results

Perceived quite bad/very bad family financial situation (OR 3.1; CI 1.4–6.7) and short sleep duration (<10 h) (OR 2.3; CI 1.0–5.3) among girls at baseline were associated with insomnia symptoms at follow-up. Having problems waking up among boys at baseline was associated with insomnia symptoms at follow-up (OR 4.9; CI 1.6–14.4).

Conclusion

Short sleep duration, problems waking up, and perceived bad family financial situation during childhood were linked with adolescent insomnia symptoms. The sex-based differences in these associations warrant further investigation to effectively mitigate adolescent insomnia.

The onset of pubertal development and actigraphy-assessed sleep during middle childhood: Racial, gender, and genetic effects

OBJECTIVE

This study (1) examined pubertal development in relation to actigraphy-assessed sleep in twin children, and tested whether associations differed by child race and gender, (2) modeled genetic and environmental influences on pubertal development and sleep indicators, and (3) examined genetic and environmental influences on the covariation of puberty and sleep.

DESIGN

The classic twin design was used to examine genetic and environmental contributions to puberty and sleep and their associations.

SETTING

Data were collected from community-dwelling urban and rural families of twins in the southwestern U.S.

PARTICIPANTS

The racially and socioeconomically diverse sample included 596 twin children (M_age = 8.41, SD = 0.69; 51.7% female; 66.3% white; 33.7% Hispanic; 170 monozygotic, 236 same-sex dizygotic, 188 opposite-sex dizygotic).

MEASUREMENTS

Pubertal development was assessed via parent report. Children wore actigraph watches for 7 nights (M = 6.81, SD = 0.67) to capture sleep duration, efficiency, midpoint, onset latency, and duration variability.

RESULTS

In contrast to extant literature with older youth, more advanced pubertal development was associated with longer sleep durations in Hispanic and white girls and higher sleep efficiency in white girls, though Hispanic girls demonstrated later sleep midpoints. Pubertal development was moderately heritable and there was a genetic influence on the covariance between puberty and sleep indicators.

CONCLUSIONS

This was the first study to examine the genetic and environmental influences on the covariation between puberty and sleep, and found genetic underpinnings between pubertal development and actigraphy-assessed sleep duration and efficiency, though sleep and puberty were almost entirely independent in twins at this age.

Mental health, family functioning, and sleep in cultural context among American Indian/Alaska Native urban youth: A mixed methods analysis

Mental health problems contribute significantly to the global burden of disease. Driven in part by family stressors and insufficient sleep, mental health disproportionately affects low SES urban adolescents. In the United States, American Indian/Alaska Native (AI/AN) youth exhibit excessively high rates of mental health problems. Family functioning is strongly associated with adolescent mental health, and sleep problems may serve as a pathway between family functioning and mental health. Using mixed methods we examine the associations among family functioning, subjective- and actigraphy-measured sleep, mental health (depressive and anxiety symptoms), and cultural identity in a sample of urban AI/AN youth. All participants (N = 142) completed surveys; a random subsample (n = 26) completed qualitative interviews to assess family and cultural dynamics related to sleep, which informed hypothesized direct and indirect effects that were tested using survey data. Narratives identified mechanisms of family cohesion (e.g., daily interactions that build perceived family togetherness and family-centered traditional activities) and the role that family cohesion plays in sleep (e.g., ensuring stability of sleep environments). Path analysis showed direct effects of improved family functioning on fewer depressive and anxiety symptoms, and indirect effects through lower self-reported sleep disturbance (but not through greater actigraphy-measured sleep duration or efficiency). Cultural identity did not moderate effects in quantitative tests. Our findings illustrate the complex associations among family functioning, sleep, and mental health in AI/AN youth. Family-based interventions to improve adolescent mental health should address modifiable intervention targets such as sleep, and address sources of both risk and resilience relevant to urban AI/AN families, including extended family and cultural practices.

Adolescent sleep - lessons from COVID-19

Sleep in adolescents was significantly impacted by the COVID-19 pandemic. We present a commentary on a range of articles exploring COVID-19's impact on sleep in teenagers, exploring the variety of effects internationally, interactions with sleep biology and the environment, mental health, online learning and Long COVID. We conclude with vicious and virtuous flowers suggesting ways to mitigate the impacts of COVID-19 on adolescent sleep.

Food Insecurity and Sleep Disturbance Among 223,561 Adolescents: A Multi-Country Analysis of Cross-Sectional Surveys

This study was to investigate the association between food insecurity (FI) and sleep disturbance among adolescents. Based on the cross-sectional data of the Global School-based Student Health Survey, this study analyzed self-reported data from adolescents in 68 countries. Multivariate logistic regression and meta-analysis were used to evaluate the association between FI and sleep disturbance. The final sample included 223,561 adolescents. The prevalence of severe FI and sleep disturbance was 6.4% and 8.0%, respectively. Severe FI was significantly associated with a higher risk of sleep disturbance in 48 of the 68 countries after adjusting for covariates, with a pooled OR (95% CI) of 1.94 (1.79–2.09). Overall, the association between FI and sleep disturbance was similar across countries and gender, though a large level of heterogeneity existed across upper- and middle-income countries. Identifying adolescents suffering from FI and remedying the FI severity may be important to improve sleep quality in global adolescents.

Bidirectional spillover across days between family assistance and physical health experiences during adolescence

Helping the family may either promote or undermine adolescents' physical health and well-being. Adolescents (N = 396, 58% female, Mage = 14.57 years) completed diary checklists for 14 days, reporting whether they provided instrumental assistance (e.g., tangible tasks) and emotional support (e.g., listening, giving advice) to family, as well as their amount of physical activity, sleep, and physical symptoms (e.g., headache, backpain) each day. After providing emotional support, adolescents slept more that night and experienced fewer physical symptoms the next day, over and above prior day levels. When adolescents provided instrumental assistance on school days (but not nonschool days), they engaged in less physical activity that day. These results were consistent across individual differences in gender, age, socioeconomic status, and ethnicity. In addition, bidirectional associations emerged such that adolescents were more likely to provide instrumental assistance on days after they slept more. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Designing adolescent sleep interventions with stakeholder input

OBJECTIVE

Few sleep promotion programs for adolescents have involved stakeholders as part of the intervention development, which may contribute to their limited accessibility, scalability, acceptability, and feasibility. Specifically asking stakeholders for their input on how to modify factors impacting sleep is critical, as is identifying strategies for motivating sleep behavior change. We report qualitative feedback from stakeholders interested in improving adolescent sleep, data collected specifically to inform the development of an adolescent sleep promotion program.

PARTICIPANTS

We conducted 9 focus groups (3 each for young adults (n = 8, ages 21-25), parents of adolescents (n = 12), and healthcare providers working with adolescents (n = 29) following a semistructured approach.

DESIGN

Participants reported on contributors to good and poor sleep; motivators for improving sleep; strategies for promoting and sustaining behavior change; and feasibility of a proposed sleep promotion program. We coded and thematically analyzed focus group transcripts using inductive and deductive approaches.

RESULTS

Moderate engagement in activities (eg, a job, sports) was seen as a contributor to good sleep, while having too many or too few activities was thought to contribute to poor sleep. Linking improved sleep with personalized outcomes of interest can enhance motivation for changing sleep. Strategies for behavior change should rely on increasing internal motivation, personalizing intervention content, and having parents model desired behaviors.

CONCLUSIONS

Key stakeholders are critical to the development of acceptable interventions that can be implemented effectively in real-world settings. Future work should test whether the identified themes contribute to increased feasibility, scalability, and effectiveness of sleep programs.

Stress and Sleep Across the Onset of the COVID-19 Pandemic: Impact of Distance Learning on U.S. College Students' Health Trajectories

Study Objectives

This study examined associations between average and intraindividual trajectories of stress, sleep duration, and sleep quality in college students before, during, and after transitioning to online learning due to the COVID-19 pandemic.

Methods

One hundred and sixty-four first-year college students answered twice-weekly questionnaires assessing stress exposure and perception, sleep duration, and sleep quality from January until May, 2020 (N=4,269 unique observations).

Results

Multilevel growth modeling revealed that prior to distance learning, student stress was increasing and sleep duration and quality were decreasing. After transitioning online, students’ stress exposure and perception trajectories immediately and continuously decreased; sleep quality initially increased but decreased over time; and sleep duration increased but then plateaued for the remainder of the semester. Days with higher stress exposure than typical for that student were associated with lower sleep quality, and both higher stress exposure and perception at the transition were linked with simultaneous lower sleep quality. Specific groups (e.g., females) were identified as at-risk for stress and sleep problems.

Conclusion

Although transitioning to remote learning initially alleviated college students’ stress and improved sleep, these effects plateaued, and greater exposure to academic, financial, and interpersonal stressors predicted worse sleep quality on both daily and average levels. Environmental stressors may particularly dictate sleep quality during times of transition, but adaptations in learning modalities may help mitigate short-term detrimental health outcomes during global emergencies, even during a developmental period with considerable stress vulnerability. Future studies should examine longer-term implications of these trajectories on mental and physical health.

Modelling Health in University Students: Are Young Women More Complicated Than Men?

The biopsychosocial model of health in a limited life course perspective was tested among students in higher education using data from a nationwide cross-sectional survey of students on track to become teachers in Hungary. Health determinants were grouped into categories of biological, psychological, and social determinants and arranged in a temporal manner from childhood to the present. The model was tested by canonical correlation analysis followed by multivariate analysis of covariance. One composite outcome of health and six determinant groups were examined out of a total of 24 variables in both genders. Separate sets of health determinants were identified for men and women. The health of men was determined by fewer variables that were more proximal in time, more centred around physical activity, and less influenced by social relations. As opposed to that of men, women’s health was influenced by age; determinants were grouped around the ingestion of various substances and social support. In contrast to men, the health of women seemed to be more obviously multifactorial. The study supports the usefulness of the biopsychosocial model of health in research. The best fit models provided evidence for the importance of gender awareness when designing public health interventions aimed at students.