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De Pieri M, Bueltemann L, Tedone F, Riccardi S, Castelnovo A, Miano S, Manconi M. Clinical and instrumental features in 82 patients with insufficient sleep syndrome. J Sleep Res 2024; 33:e14076. [PMID: 37909272 DOI: 10.1111/jsr.14076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 09/18/2023] [Accepted: 10/09/2023] [Indexed: 11/03/2023]
Abstract
Insufficient sleep syndrome possibly represents the worldwide leading cause of daytime sleepiness, but remains poorly recognised and studied. The aim of this case series is to comprehensively describe a cohort of patients with insufficient sleep syndrome. Eighty-two patients were studied concerning demographic and socio-economic features, medical, psychiatric and sleep comorbidities, substance use, sleep symptoms, actigraphy, video-polysomnography, multiple sleep latency tests and treatment. The typical patient with insufficient sleep syndrome is a middle-aged adult (with no difference of gender), employed, who has a family, often carrying psychiatric and neurological comorbidities, in particular headache, anxiety and depression. Other sleep disorders, especially mild sleep apnea and bruxism, were common as well. Actigraphy was a valuable tool in the characterisation of insufficient sleep syndrome, showing a sleep restriction during weekdays, associated with a recovery rebound of night sleep during weekends and a high amount of daytime sleep. An over- or underestimation of sleeping was common, concerning both the duration of night sleep and daytime napping. The average daily sleep considering both daytime and night-time, weekdays and weekends corresponds to the recommended minimal normal duration, meaning that the burden of insufficient sleep syndrome could mainly depend on sleep fragmentation and low quality. Sleep efficiency was elevated both in actigraphy and video-polysomnography. Multiple sleep latency tests evidenced a tendency toward sleep-onset rapid eye movement periods. Our study offers a comprehensive characterisation of patients with insufficient sleep syndrome, and clarifies their sleeping pattern, opening avenues for management and treatment of the disorder. Current options seem not adapted, and in our opinion a cognitive-behavioural psychotherapy protocol should be developed.
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Affiliation(s)
- Marco De Pieri
- Sleep Medicine Unit, Neurocenter of Southern Switzerland, Ente Ospedaliero Cantonale (EOC), Lugano, Switzerland
- Service de psychiatrie adulte, Département de psychiatrie, Hôpitaux universitaires de Genève, Genève, Switzerland
| | - Linda Bueltemann
- Sleep Medicine Unit, Neurocenter of Southern Switzerland, Ente Ospedaliero Cantonale (EOC), Lugano, Switzerland
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
| | - Francesco Tedone
- Sleep Medicine Unit, Neurocenter of Southern Switzerland, Ente Ospedaliero Cantonale (EOC), Lugano, Switzerland
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
| | - Silvia Riccardi
- Sleep Medicine Unit, Neurocenter of Southern Switzerland, Ente Ospedaliero Cantonale (EOC), Lugano, Switzerland
| | - Anna Castelnovo
- Sleep Medicine Unit, Neurocenter of Southern Switzerland, Ente Ospedaliero Cantonale (EOC), Lugano, Switzerland
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
| | - Silvia Miano
- Sleep Medicine Unit, Neurocenter of Southern Switzerland, Ente Ospedaliero Cantonale (EOC), Lugano, Switzerland
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
| | - Mauro Manconi
- Sleep Medicine Unit, Neurocenter of Southern Switzerland, Ente Ospedaliero Cantonale (EOC), Lugano, Switzerland
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
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Lukowski AF, Kamliot DZ, Schlaupitz CA. Insomnia and behaviorally induced sleep syndrome in undergraduates tested during the COVID-19 pandemic: associations with health, stress, and GPA. J Clin Sleep Med 2024; 20:261-269. [PMID: 37858288 PMCID: PMC10835785 DOI: 10.5664/jcsm.10844] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 09/27/2023] [Accepted: 09/27/2023] [Indexed: 10/21/2023]
Abstract
STUDY OBJECTIVES This study was conducted to determine (1) whether the distribution of undergraduates who endorse insomnia or behaviorally induced insufficient sleep syndrome (BIISS) varied during the coronavirus disease 2019 (COVID-19) pandemic relative to normal sleepers and in comparison to values reported pre-pandemic and (2) whether group (insomnia, BIISS, and normal sleepers) was differentially associated with health, stress, and academic achievement mid-pandemic. METHODS Two hundred ninety-three undergraduates completed online questionnaires assessing demographics, global sleep quality, insomnia severity, health, and perceived stress; cumulative grade point averages (GPAs) were also collected for each participant. RESULTS The proportion of participants in each group did not differ from the pre-pandemic values reported in Williams et al (2020). Relative to the normal-sleepers group, the insomnia group reported poorer sleep quality, greater insomnia severity, poorer functioning on measures of physical health, and increased stress; only 1 significant difference was found concerning the BIISS group. Group differences were not found on GPA. CONCLUSIONS Despite the various challenges brought about by the COVID-19 pandemic, the distribution of participants by group was similar to those reported pre-pandemic. The insomnia group fared most poorly in terms of sleep quality, insomnia severity, physical health, and stress. As such, additional effort should be devoted to identifying undergraduates with insomnia to provide treatment that may improve their sleep and their health. CITATION Lukowski AF, Kamliot DZ, Schlaupitz CA. Insomnia and behaviorally induced sleep syndrome in undergraduates tested during the COVID-19 pandemic: associations with health, stress, and GPA. J Clin Sleep Med. 2024;20(2):261-269.
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Affiliation(s)
- Angela F. Lukowski
- Department of Psychological Science, University of California Irvine, Irvine, California
| | - Deborah Z. Kamliot
- Department of Psychological Science, University of California Irvine, Irvine, California
| | - Caleb A. Schlaupitz
- Department of Psychological Science, University of California Irvine, Irvine, California
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Grasaas E, Rohde G, Haraldstad K, Helseth S, Småstuen MC, Skarstein S, Mikkelsen HT. Sleep duration in schooldays is associated with health-related quality of life in norwegian adolescents: a cross-sectional study. BMC Pediatr 2023; 23:473. [PMID: 37726691 PMCID: PMC10507926 DOI: 10.1186/s12887-023-04306-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 09/11/2023] [Indexed: 09/21/2023] Open
Abstract
BACKGROUND Insufficient sleep is commonly reported in adolescence and is negatively associated with a wide range of health outcomes. A way to grasp the complicated challenge of how sleep impact different aspects of the adolescents´ everyday life is by examining the relationship between sleep duration in schooldays and weekends on different health-related quality of life (HRQOL) subscales. Furthermore, to expand the understanding of possible underlying mechanisms between sleep and HRQOL, testing for self-efficacy as a possible mediator is of importance. METHODS A cross-sectional study was performed among 696 adolescents aged 13-15 years from a school-based setting. All participants completed an electronic survey in their respective classrooms. The survey included demographic data, the School Sleep Habits Survey, the KIDSCREEN-27 questionnaire measuring HRQOL, and the General Perceived Self-Efficacy Scale. Statistical analyses were conducted using SPSS Statistics software including PROCESS macro by Andrew Hayes. RESULTS Our findings revealed overall similar sleep patterns in boys and girls including longer sleep duration in the study sample during weekends (10:09 h) than in schooldays (08:36 h). Regression analyses revealed that sleep duration in schooldays was positively and statistically associated with HRQOL subscales psychological well-being (95% CI [0.44 to 1.33]), autonomy and parents (95% CI [0.12 to 1.06]), school environment (95% CI [0.47 to 1.40]), and self-efficacy (95% CI [0.01 to 0.47]). Sleep duration in weekends revealed no associations with the HRQOL subscales, except for the HRQOL subscale psychological well-being (95% CI [0.09 to 0.85]). Mediation analyses revealed that sleep duration in schooldays explained most of the associations (64 - 75%) in 4 out 5 HRQOL subscales, except in the association with the HRQOL subscale physical well-being revealing an indirect effect of 71.9%. CONCLUSIONS This cross-sectional study described sleep among Norwegian adolescents and demonstrated that sleep durations in weekends and schooldays impact HRQOL and self-efficacy, revealing overall better outcome in HRQOL and self-efficacy with sufficient sleep during schooldays. These findings support the regularity of sleep and highlight the importance of sufficient sleep during schooldays, especially in a school-based sample of adolescents.
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Affiliation(s)
- Erik Grasaas
- Department of Health and Nursing Science, Faculty of Health and Sport Sciences, University in Agder, Kristiansand, Norway.
| | - Gudrun Rohde
- Department of Health and Nursing Science, Faculty of Health and Sport Sciences, University in Agder, Kristiansand, Norway
- Department of Clinical Research, Sorlandet Hospital, Kristiansand, Norway
| | - Kristin Haraldstad
- Department of Health and Nursing Science, Faculty of Health and Sport Sciences, University in Agder, Kristiansand, Norway
| | - Sølvi Helseth
- Department of Health and Nursing Science, Faculty of Health and Sport Sciences, University in Agder, Kristiansand, Norway
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Milada Cvancarova Småstuen
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Siv Skarstein
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Hilde Timenes Mikkelsen
- Department of Health and Nursing Science, Faculty of Health and Sport Sciences, University in Agder, Kristiansand, Norway
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Han CH, Lee S, Chung JH. Association between COVID-19 lockdown and sleep behaviors in Korean adolescents. Medicine (Baltimore) 2023; 102:e33809. [PMID: 37233444 PMCID: PMC10219643 DOI: 10.1097/md.0000000000033809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 04/27/2023] [Indexed: 05/27/2023] Open
Abstract
To find the effect of coronavirus disease 2019 (COVID-19)-related sleep behavior changes using school-based self-reported data from a nationally representative Korean adolescent population. We analyzed web-based self-reported data from the Korean Youth Risk Behavior Web-based Survey in 98,126 participants (51,651 in 2019 [before the COVID-19 pandemic]; 46,475 in 2020 [during COVID-19 pandemic] 12 through 18 years old were included in this study. Self-report questionnaires were used to assess socioeconomic status, health behaviors, psychological factors, and sleep patterns. During the COVID-19 pandemic, Korean adolescents had a later weekend bedtime (≥1:00 am: 68.2% vs 71.5%, P < .001) and late weekend wake time (≤7:00 am: 13.3% vs 10.7%, P < .001) compared to before COVID-19 pandemic. Average sleep duration (434.7 ± 102.6 vs 428.2 ± 100.4 minutes; P < .001) was significantly lower during the COVID-19 pandemic and weekend catch-up sleep >2 hours (42.1% vs 43.7%; P < .001), late chronotype (17.1% vs 22.9%, P < .001) were significantly higher during COVID-19 pandemic. After adjusting for multiple confounding variables, short sleep duration (≦5 hours, odds ratio [OR] 1.14; 95% confidence interval [CI] 1.10-1.19), 6 hours, OR 1.07; 95% CI 1.03-1.12), long weekend catch-up sleep (OR, 1.08; 95% CI, 1.06-1.11) and late chronotype (OR, 1.43; 95% CI, 1.38-1.47) were significantly associated with COVID-19 pandemic. The COVID-19 pandemic was associated with changes in sleep behavior among Korean adolescents, resulting in later bed and wake-up times, increased weekend catch-up sleep, and a shift of chronotype toward eveningness.
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Affiliation(s)
- Chang Hoon Han
- Department of Internal Medicine, National Health Insurance Service Ilsan Hospital, Goyang, Republic of Korea
| | | | - Jae Ho Chung
- Department of Internal Medicine, International St. Mary`s Hospital, Catholic Kwandong University College of Medicine, Incheon, Republic of Korea
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Langholm C, Byun AJS, Mullington J, Torous J. Monitoring sleep using smartphone data in a population of college students. NPJ MENTAL HEALTH RESEARCH 2023; 2:3. [PMID: 38609478 PMCID: PMC10955805 DOI: 10.1038/s44184-023-00023-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 02/20/2023] [Indexed: 04/14/2024]
Abstract
Sleep is fundamental to all health, especially mental health. Monitoring sleep is thus critical to delivering effective healthcare. However, measuring sleep in a scalable way remains a clinical challenge because wearable sleep-monitoring devices are not affordable or accessible to the majority of the population. However, as consumer devices like smartphones become increasingly powerful and accessible in the United States, monitoring sleep using smartphone patterns offers a feasible and scalable alternative to wearable devices. In this study, we analyze the sleep behavior of 67 college students with elevated levels of stress over 28 days. While using the open-source mindLAMP smartphone app to complete daily and weekly sleep and mental health surveys, these participants also passively collected phone sensor data. We used these passive sensor data streams to estimate sleep duration. These sensor-based sleep duration estimates, when averaged for each participant, were correlated with self-reported sleep duration (r = 0.83). We later constructed a simple predictive model using both sensor-based sleep duration estimates and surveys as predictor variables. This model demonstrated the ability to predict survey-reported Pittsburgh Sleep Quality Index (PSQI) scores within 1 point. Overall, our results suggest that smartphone-derived sleep duration estimates offer practical results for estimating sleep duration and can also serve useful functions in the process of digital phenotyping.
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Affiliation(s)
- Carsten Langholm
- Division of Digital Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, 02215, USA
| | - Andrew Jin Soo Byun
- Division of Digital Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, 02215, USA
- John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, MA, 02138, USA
| | - Janet Mullington
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, 02215, USA
| | - John Torous
- Division of Digital Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, 02215, USA.
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Papadopoulos D, Sosso FAE. Socioeconomic status and sleep health: a narrative synthesis of 3 decades of empirical research. J Clin Sleep Med 2023; 19:605-620. [PMID: 36239056 PMCID: PMC9978435 DOI: 10.5664/jcsm.10336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 10/03/2022] [Accepted: 10/04/2022] [Indexed: 12/24/2022]
Abstract
STUDY OBJECTIVES This review aims to assess the association between socioeconomic status (SES) and sleep health in the general population and the mediating effects of lifestyle and mental and physical health in this relationship. METHODS Observational studies testing the independent association between objective or subjective SES indicators and behavioral/physiological or clinical sleep health variables in the general population were included. PubMed/MEDLINE was searched for reports published from January 1990 to December 2019. The direction of effect was used as the primary effect measure, testing the hypothesis that low SES is associated with poor sleep health outcomes. Results are presented in the form of direction effect plots and synthesized as binomial proportions. RESULTS Overall, 336 studies were identified. A high proportion of effects at the expected direction was noted for measures of sleep continuity (100% for sleep latency, 50-100% for awakenings, 66.7-100% for sleep efficiency), symptoms of disturbed sleep (75-94.1% for insomnia, 66.7-100% for sleep-disordered breathing, 60-100% for hypersomnia), and general sleep satisfaction (62.5-100%), while the effect on sleep duration was inconsistent and depended on the specific SES variable (92.3% for subjective SES, 31.7% for employment status). Lifestyle habits, chronic illnesses, and psychological factors were identified as key mediators of the SES-sleep relationship. CONCLUSIONS Unhealthy behaviors, increased stress levels, and limited access to health care in low-SES individuals may explain the SES-sleep health gradient. However, the cross-sectional design of most studies and the high heterogeneity in employed measures of SES and sleep limit the quality of evidence. Further research is warranted due to important implications for health issues and policy changes. CITATION Papadopoulos D, Etindele Sosso FA. Socioeconomic status and sleep health: a narrative synthesis of 3 decades of empirical research. J Clin Sleep Med. 2023;19(3):605-620.
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Crowley SJ, Velez SL, Killen LG, Cvengros JA, Fogg LF, Eastman CI. Extending weeknight sleep of delayed adolescents using weekend morning bright light and evening time management. Sleep 2023; 46:zsac202. [PMID: 36006948 PMCID: PMC9832518 DOI: 10.1093/sleep/zsac202] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 07/13/2022] [Indexed: 01/14/2023] Open
Abstract
STUDY OBJECTIVES Shift sleep onset earlier and extend school-night sleep duration of adolescents. METHODS Forty-six adolescents (14.5-17.9 years; 24 females) with habitual short sleep (≤7 h) and late bedtimes (≥23:00) on school nights slept as usual for 2 weeks (baseline). Then, there were three weekends and two sets of five weekdays in between. Circadian phase (Dim Light Melatonin Onset, DLMO) was measured in the laboratory on the first and third weekend. On weekdays, the "Intervention" group gradually advanced school-night bedtime (1 h earlier than baseline during week 1; 2 h earlier than baseline during week 2). Individualized evening time management plans ("Sleep RouTeen") were developed to facilitate earlier bedtimes. On the second weekend, Intervention participants received bright light (~6000 lux; 2.5 h) on both mornings. A control group completed the first and third weekend but not the second. They slept as usual and had no evening time management plan. Weekday sleep onset time and duration were derived from actigraphy. RESULTS Dim light melatonin onset (DLMO) advanced more in the Intervention (0.6 ± 0.8 h) compared to the Control (-0.1 ± 0.8 h) group. By week 2, the Intervention group fell asleep 1.5 ± 0.7 h earlier and sleep duration increased by 1.2 ± 0.7 h; sleep did not systematically change in the Control group. CONCLUSIONS This multi-pronged circadian-based intervention effectively increased school-night sleep duration for adolescents reporting chronic sleep restriction. Adolescents with early circadian phases may only need a time management plan, whereas those with later phases probably need both time management and morning bright light. CLINICAL TRIALS Teen School-Night Sleep Extension: An Intervention Targeting the Circadian System (#NCT04087603): https://clinicaltrials.gov/ct2/show/NCT04087603.
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Affiliation(s)
- Stephanie J Crowley
- Biological Rhythms Research Laboratory, Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago IL, USA
| | - Sabrina L Velez
- Biological Rhythms Research Laboratory, Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago IL, USA
| | - Logan G Killen
- Biological Rhythms Research Laboratory, Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago IL, USA
| | - Jamie A Cvengros
- Biological Rhythms Research Laboratory, Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago IL, USA
| | - Louis F Fogg
- Biological Rhythms Research Laboratory, Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago IL, USA
| | - Charmane I Eastman
- Biological Rhythms Research Laboratory, Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago IL, USA
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Bruni O. Approach to a sleepy child: Diagnosis and treatment of excessive daytime sleepiness in children and adolescents. Eur J Paediatr Neurol 2023; 42:97-109. [PMID: 36608412 DOI: 10.1016/j.ejpn.2022.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Revised: 12/08/2022] [Accepted: 12/27/2022] [Indexed: 01/01/2023]
Abstract
The aim of this review is to give updated information to pediatric neurologists on the correct diagnostic approach and treatment of excessive daytime sleepiness (EDS) in children and adolescents. Due to the change in the society habits, EDS is becoming an emerging problem for the health system. At the present there are few articles specifically devoted to the evaluation of EDS. EDS is often reported in several manuscripts as a side effect of other sleep disorders (obstructive sleep apnea, circadian disorders, etc.) or of the use of drugs or of the substance abuse or as a consequence of bad sleep habits and poor sleep hygiene. EDS, especially in children, may manifest with paradoxical symptoms like hyperactivity, inattention, and impulsiveness. However, common sign of EDS in children are the propensity to sleep longer than usual, the difficulty waking up in the morning, and falling asleep frequently during the day in monotonous situation. The diagnosis should include subjective (sleep diaries, questionnaires) and objective (polysomnography, multiple sleep latency test, etc.) instruments to avoid misdiagnosis. Narcolepsy is the most studied central disorder of hypersomnolence, and it is a predominantly pediatric disease with a peak age of onset in prepuberty but the diagnosis is often delayed especially in mild forms. The early and correct treatment of narcolepsy and of other form of EDS is extremely important since late and inappropriate treatments can affect the psychosocial development of the children and adolescents.
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Affiliation(s)
- Oliviero Bruni
- Department of Developmental and Social Psychology, Sapienza University, Via dei Marsi, 78-00185, Rome, Italy.
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Klaus S, Carolan A, O'Rourke D, Kennedy B. What respiratory physicians should know about narcolepsy and other hypersomnias. Breathe (Sheff) 2022; 18:220157. [PMID: 36865656 PMCID: PMC9973529 DOI: 10.1183/20734735.0157-2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 09/22/2022] [Indexed: 11/16/2022] Open
Abstract
Narcolepsy and related central disorders of hypersomnolence may present to the sleep clinic with excessive daytime sleepiness. A strong clinical suspicion and awareness of the diagnostic clues, such as cataplexy, are essential to avoid unnecessary diagnostic delay. This review provides an overview of the epidemiology, pathophysiology, clinical features, diagnostic criteria and management of narcolepsy and related disorders, including idiopathic hypersomnia, Kleine-Levin syndrome (recurrent episodic hypersomnia) and secondary central disorders of hypersomnolence.
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Affiliation(s)
- Stephen Klaus
- Department of Sleep Medicine, St James's Hospital, Dublin, Ireland
| | - Aoife Carolan
- Department of Sleep Medicine, St James's Hospital, Dublin, Ireland
| | - Deirdre O'Rourke
- Department of Sleep Medicine, St James's Hospital, Dublin, Ireland
| | - Barry Kennedy
- Department of Sleep Medicine, St James's Hospital, Dublin, Ireland,Corresponding author: Barry Kennedy ()
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Konsensus-Statement der Österreichischen Gesellschaft für Schlafmedizin (ÖGSM/ASRA) zum Management der residualen exzessiven Tagesschläfrigkeit (rETS) bei obstruktiver Schlafapnoe. SOMNOLOGIE 2022; 26:264-271. [DOI: 10.1007/s11818-022-00359-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/13/2022] [Indexed: 10/17/2022]
Abstract
Zusammenfassung
Hintergrund
Sechs bis zehn Prozent aller Patienten mit einer obstruktiven Schlafapnoe leiden trotz adäquater nächtlicher Überdrucktherapie oder einer effektiven Alternativtherapie an einer residualen exzessiven Tagesschläfrigkeit (rETS). Die Differentialdiagnose der rETS stellt im klinischen Alltag eine interdisziplinäre Herausforderung dar.
Fragestellung
Entwicklung eines übersichtlichen Leitfadens für die Erkennung, die differentialdiagnostischen Abwägungen und die Möglichkeiten der weiterführenden Behandlung der rETS in der klinischen Praxis.
Material und Methode
MeSH-Analyse basierte Recherche und interdisziplinäre Abstimmung von Fachvertreter:innen der Inneren Medizin und Pneumologie, Neurologie sowie Psychiatrie und Psychotherapie.
Ergebnisse
SPAIN-Checkliste zur systematischen differentialdiagnostischen Exploration der rETS mit den Parametern: S chlafverhalten, P sychische Ursachen, A namnese der Medikation, I nternistische Ursachen und N eurologische Ursachen.
Schlussfolgerungen
Die rETS sollte als behandlungswürdiges Symptom erkannt werden. Sie verlangt nach einer interdisziplinären Abklärung und der individuellen Abstimmung der Behandlung auf die Bedürfnisse der Betroffenen.
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Bendaoud I, Etindele Sosso FA. Socioeconomic Position and Excessive Daytime Sleepiness: A Systematic Review of Social Epidemiological Studies. Clocks Sleep 2022; 4:240-259. [PMID: 35645243 PMCID: PMC9149899 DOI: 10.3390/clockssleep4020022] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 04/01/2022] [Accepted: 05/05/2022] [Indexed: 11/30/2022] Open
Abstract
The objectives of this empirical study are to describe and discuss the current literature available on the relationship between excessive daytime sleepiness (EDS) and the socioeconomic position (SEP) as well as to provide recommendations for consideration of SEP in sleep medicine and biomedical research. Databases Medline/PubMed, Web of Science, Google scholar and Scopus were screened from January 1990 to December 2020 using PRISMA guidelines and 20 articles were included in the final synthesis. Nineteen studies were cross-sectional and one study was longitudinal. Among these studies, 25.00% (n = 5) are focused on children and adolescent and the remaining 75.00% (n = 15) focused on adults and seniors. Ages ranged from 8 to 18 years old for children/adolescent and ranged from 18 to 102 years old for adults. Main SEP measures presented in these studies were education, income, perceived socioeconomic status and employment. The sample size in these studies varied from N = 90 participants to N = 33,865 participants. Overall, a lower educational level, a lower income and full-time employment were associated with EDS. Symptoms of EDS are prevalent in women, especially those with a low income or no job; and children and adolescents with difficult living conditions or working part time reported more sleep disturbances. SEP is already considered as an important determinant for many health outcomes, but if SEP is embedded in the experimental design in psychosomatic research, biomedical research and clinical practice as a constant variable regardless of outcome; it will move forward future investigations.
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Affiliation(s)
- Imene Bendaoud
- Clinical Pharmacology, Faculty of Medicine, University of Montreal, Montreal, QC H3T 1J4, Canada
- Global Health and Ecoepidemiology, Redavis Institute, Montreal, QC H3S 1X5, Canada;
- Correspondence:
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Mikkelsen HT, Haraldstad K, Helseth S, Skarstein S, Småstuen MC, Rohde G. Pain and health-related quality of life in adolescents and the mediating role of self-esteem and self-efficacy: a cross-sectional study including adolescents and parents. BMC Psychol 2021; 9:128. [PMID: 34462000 PMCID: PMC8404017 DOI: 10.1186/s40359-021-00629-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 08/16/2021] [Indexed: 12/20/2022] Open
Abstract
Background To promote health-related quality of life (HRQOL) in adolescents with pain, it is important to study factors associated with pain. This study aimed to describe selected factors and pain in 14–15-year-old adolescents and their parents, to assess how these factors are associated with adolescent pain groups, and to explore whether the relationship between pain intensity and HRQOL in adolescents with persistent pain is mediated by self-esteem and self-efficacy. Methods A cross-sectional study was performed among 508 dyads of adolescents (14–15 years) and parents in a school-based setting. Among these, 148 adolescents had persistent pain. We explored the following variables: HRQOL, pain, self-efficacy, self-esteem, sleep, loneliness, stress and sociodemographic variables. All variables were assessed with well-validated instruments. HRQOL was measured with KIDSCREEN-27. Analyses included Chi-square, ANOVA, Mann–Whitney U tests, Kruskal–Wallis and the PROCESS macro method for mediation analyses. Results Adolescents with pain reported significantly higher levels of stress, loneliness and lack of sleep and lower levels of self-efficacy, self-esteem and HRQOL compared to adolescents without pain. More girls than boys reported pain. Adolescents with persistent pain scored significantly worse on self-esteem, stress, loneliness, lack of sleep, school absence, pain and HRQOL compared to adolescents with shorter pain duration. Adolescent pain groups did not differ significantly considering parental factors. However, more adolescents with persistent pain reported that someone in their family had pain. The associations between pain intensity and the HRQOL subscales in adolescents with persistent pain were completely mediated by self-esteem, but not by self-efficacy. The highest degree of mediation was estimated for the HRQOL subscale school environment (indirect effect = 73.5%). Conclusions Our findings highlight the complexity within adolescent pain, demonstrating that adolescents with pain differ from adolescents without pain when it comes to gender, school absence, factors within-person and between-persons. Longer pain duration makes adolescents more vulnerable. We confirm the importance of resilience factors for HRQOL but indicate that self-esteem is more important than self-efficacy. To promote HRQOL in adolescents with persistent pain, a strengthening of both their self-esteem and self-efficacy is recommended. We highlight the need for an individual, holistic approach to adolescent pain. Supplementary Information The online version contains supplementary material available at 10.1186/s40359-021-00629-z.
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Affiliation(s)
- Hilde Timenes Mikkelsen
- Department of Health and Nursing, Faculty of Health and Sport Sciences, University of Agder, PO Box 422, 4604, Kristiansand, Norway.
| | - Kristin Haraldstad
- Department of Health and Nursing, Faculty of Health and Sport Sciences, University of Agder, PO Box 422, 4604, Kristiansand, Norway
| | - Sølvi Helseth
- Department of Health and Nursing, Faculty of Health and Sport Sciences, University of Agder, PO Box 422, 4604, Kristiansand, Norway.,Department of Nursing and Health Promotion, Faculty of Health Sciences, Metropolitan University, Oslo, Norway
| | - Siv Skarstein
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Metropolitan University, Oslo, Norway
| | - Milada Cvancarova Småstuen
- Department of Health and Nursing, Faculty of Health and Sport Sciences, University of Agder, PO Box 422, 4604, Kristiansand, Norway.,Department of Nursing and Health Promotion, Faculty of Health Sciences, Metropolitan University, Oslo, Norway
| | - Gudrun Rohde
- Department of Health and Nursing, Faculty of Health and Sport Sciences, University of Agder, PO Box 422, 4604, Kristiansand, Norway.,Department of Clinical Research, Sorlandet Hospital, Kristiansand, Norway
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13
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Sosso FAE, Khoury T. Socioeconomic status and sleep disturbances among pediatric population: a continental systematic review of empirical research. Sleep Sci 2021; 14:245-256. [PMID: 35186203 PMCID: PMC8848532 DOI: 10.5935/1984-0063.20200082] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 11/24/2020] [Indexed: 11/20/2022] Open
Abstract
To this day, no consensus has been established on the definition and the conceptualization of the socioeconomic status (SES), since all the available studies on the relation between SES and health did not use the same conceptual framework and operationalization to assess SES. While literature reported that SES markers (such as income, social support networks, education, employment or occupation) influence the health of populations by shaping living conditions; empirical research does not tell us which SES markers affect more strongly the sleep components of the individuals, as well as which sleep disorders (SD) are affected and how. Even though several original studies have tried to assess how changes in socioeconomic status of parents may affect the psychosocial environment and mental health of an individual directly or through his community, no systematic reviews on the influence of SES on children's sleep are available. This systematic review make an update on the different measures of SES and sleep disturbances used for pediatric population across the different regions of the world. Recommendations for a future standardization of SES measures is proposed, for a better understanding of its influence on sleep disturbances.
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Affiliation(s)
- FA Etindele Sosso
- Department on Global Health and Ecoepidemiology,Redavi Institute, Montréal, Canada. ,Corresponding author: FA Etindele Sosso E-mail:
| | - Tommy Khoury
- Université de Montréal, Faculté de Médecine - Montréal - Québec - Canada
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14
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Health-related quality of life is strongly associated with self-efficacy, self-esteem, loneliness, and stress in 14-15-year-old adolescents: a cross-sectional study. Health Qual Life Outcomes 2020; 18:352. [PMID: 33138833 PMCID: PMC7607747 DOI: 10.1186/s12955-020-01585-9] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 09/29/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND To enhance and better understand health-related quality of life (HRQOL) in adolescents, it is important to study factors associated with HRQOL. The present study aimed to assess possible associations between sociodemographic variables, self-efficacy, self-esteem, pain, sleep, loneliness, stress and HRQOL in 14 to 15-year-old adolescents. METHODS A cross-sectional study was performed among 696 adolescents (14-15 years) in a school-based setting. Sociodemographic variables, self-efficacy, self-esteem, pain, sleep, loneliness and stress were analyzed. The variables were all assessed with well-validated instruments. HRQOL was analyzed using KIDSCREEN 27. Analyses included Chi-square, independent t-tests, Mann-Whitney U tests, linear regression analyses and hierarchical regression analyses. The results from linear regression models were expressed as standardized beta. RESULTS The adolescents generally reported high levels of HRQOL. However, girls scored significantly worse on HRQOL, self-efficacy, self-esteem, pain, sleep, loneliness and stress compared to boys. Using hierarchical regression analyses we found that Self-efficacy (beta = 0.11-0.24), Self-esteem: (beta = 0.12-0.21), Loneliness: (beta = - 0.24 to - 0.45) and Stress: (beta = - 0.26 to - 0.34) revealed the strongest associations with the HRQOL dimensions. Sociodemographic-, pain- and sleep related covariates were all significantly associated with some of the KIDSCREEN subscales, however their effect on the outcome was smaller than for the psychosocial variables listed above. Being a girl, not living with both parents, not having both parents working, being absent from school more than 4 days, having pain and having lack of enough sleep were all independently negatively associated with HRQOL. CONCLUSIONS HRQOL is strongly associated with self-efficacy, self-esteem, loneliness and stress in 14 to 15-year-old adolescents. Our findings indicate that positive psychosocial factors such as self-efficacy and self-esteem might play a buffer role for negative psychosocial factors (e.g. stress) in adolescents. Further, our results show that girls score significantly worse on factors that are associated to HRQOL compared to boys. To improve HRQOL in school-based populations of adolescents, we suggest that future interventions should aim to strengthen self-efficacy and self-esteem. We recommend gender specific interventions.
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15
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Baumann-Vogel H, Hoff S, Valko PO, Poryazova R, Werth E, Baumann CR. Extending sleep to confirm insufficient sleep syndrome is challenging. J Sleep Res 2020; 30:e13109. [PMID: 32557957 DOI: 10.1111/jsr.13109] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 05/13/2020] [Accepted: 05/15/2020] [Indexed: 11/26/2022]
Abstract
Insufficient sleep syndrome (ISS) is prevalent, but poorly studied. This descriptive study was performed to determine its diagnostic challenges and clinical characteristics in a large (n = 3,461) retrospective sample from a single sleep laboratory. Based on actigraphy, polysomnography and multiple sleep latency tests, we diagnosed "suspected insufficient sleep syndrome" in patients with chronic sleepiness, short time in bed, longer sleep duration during weekends or vacation, and without evidence of other causes of sleepiness. For the diagnosis of "definite insufficient sleep syndrome", we additionally required objectively confirmed resolution of sleepiness with actigraphy-documented extension of time in bed. We diagnosed "suspected insufficient sleep syndrome" in 300 subjects. In 94 subjects, extension of sleep time with consecutive relief of sleepiness was attempted, but only 37 subjects succeeded, often despite being offered several attempts. "Definite insufficient sleep syndrome" was confirmed in 36 patients. In these subjects, mean time in bed after sleep extension was above 8 hr per night and 84 min longer than at baseline. Narcolepsy-like findings were frequently observed before sleep extension, but no sleep onset rapid eye movement sleep on polysomnography. This study indicates that fulfilling the diagnostic criteria of ISS is challenging in clinical practice. It further corroborates the importance of actigraphy and polysomnography for correct diagnosis.
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Affiliation(s)
- Heide Baumann-Vogel
- Department of Neurology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Sophia Hoff
- Department of Neurology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Philipp O Valko
- Department of Neurology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Rositsa Poryazova
- Department of Neurology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Esther Werth
- Department of Neurology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Christian R Baumann
- Department of Neurology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
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16
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Williams AB, Dzierzewski JM, Griffin SC, Lind MJ, Dick D, Rybarczyk BD. Insomnia Disorder and Behaviorally Induced Insufficient Sleep Syndrome: Prevalence and Relationship to Depression in College Students. Behav Sleep Med 2020; 18:275-286. [PMID: 30789063 PMCID: PMC6814500 DOI: 10.1080/15402002.2019.1578772] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Background: College students are at increased risk for sleep disorders, including insomnia disorder and obtaining less than 6.5 hr of sleep per night by choice, or behaviorally induced insufficient sleep syndrome (BIISS). These disorders can have deleterious daytime consequences, including depression. This study aims to establish the prevalence of insomnia and BIISS disorders and examine associations of insomnia and BIISS with other sleep characteristics and depression. Methods: A subset of data from Spit for Science, a college risk behaviors and health study (n = 989) was used. Insomnia and BIISS were defined as mutually exclusive disorders, based on diagnostic criteria. Results: A majority (68%) of students were categorized as normal sleepers, followed by insomnia (22%), and BIISS (10%). Sleep duration was comparable between BIISS and insomnia, while daytime sleepiness was significantly higher in BIISS, and sleep latency was longer in insomnia (m = 44 vs. m = 13 min). Insomnia was associated with the highest depression symptoms, followed by BIISS, and normal sleep, controlling for demographics. Insomnia was associated with twice the risk of moderate or higher depression compared to normal sleep (CI: 1.60, 2.70, p < .001). Conclusion: These findings highlight the sleep difficulties endemic to college populations. Further, this study provides the first prevalence estimation of BIISS in college students and the first comparison of insomnia and BIISS on sleep characteristics and depressive symptoms. This study underscores the importance of targeted screening and intervention to improve both sleep and depression in this vulnerable population.
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Affiliation(s)
- Allison B. Williams
- Department of Psychology, Virginia Commonwealth University, Richmond, Virginia
| | | | - Sarah C. Griffin
- Department of Psychology, Virginia Commonwealth University, Richmond, Virginia
| | - Mackenzie J. Lind
- Department of Psychiatry, Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond, Virginia
| | - Danielle Dick
- Department of Psychology, Virginia Commonwealth University, Richmond, Virginia,Department of Human and Molecular Genetics, Virginia Commonwealth University, Richmond, Virginia
| | - Bruce D. Rybarczyk
- Department of Psychology, Virginia Commonwealth University, Richmond, Virginia
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17
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Kumar Swain R, Pati AK. Use of social networking sites (SNSs) and its repercussions on sleep quality, psychosocial behavior, academic performance and circadian rhythm of humans – a brief review. BIOL RHYTHM RES 2019. [DOI: 10.1080/09291016.2019.1620487] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Rakesh Kumar Swain
- School of Zoology, Gangadhar Meher University, Amruta Vihar, Sambalpur, India
| | - Atanu Kumar Pati
- School of Zoology, Gangadhar Meher University, Amruta Vihar, Sambalpur, India
- School of Studies in Life Science, Pandit Ravishankar Shukla University, Raipur, India
- Center for Translational Chronobiology, Pandit Ravishankar Shukla University, Raipur, India
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18
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Association between snoring and heart rate variability in adolescents: effects of gender and insufficient sleep. Sleep Breath 2019; 24:561-570. [PMID: 31332620 DOI: 10.1007/s11325-019-01883-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2019] [Revised: 05/30/2019] [Accepted: 06/21/2019] [Indexed: 12/19/2022]
Abstract
PURPOSE We explored the association between subjective snoring frequency and heart rate variability (HRV) in a healthy adolescent population. METHODS A total of 102 healthy adolescents were recruited from high schools in South Korea, and reported their sleep habits and snoring frequency. HRV was assessed to indirectly measure autonomic function. We assessed correlations between snoring frequency and HRV indices. We also investigated the effects of sex and behaviorally induced insufficient sleep syndrome (BISS) on the associations between HRV parameters and snoring frequency. RESULTS Overall, significant correlations were apparent between snoring frequency and HRV indices including the standard deviation of the normal-to-normal intervals (SDNN) and the low-frequency/high-frequency (LF/HF) ratio. Associations were more evident in males and those with BISS compared to females and those without BISS. CONCLUSIONS Our findings suggest that snoring changes autonomic nervous system (ANS) activity in adolescents; the changes are more dramatic in males and those with insufficient sleep.
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19
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Singh EI, Vitzthum VJ. Community, household, and individual correlates of sleep behaviors in Guyanese female youth. Am J Hum Biol 2019; 31:e23291. [PMID: 31287207 DOI: 10.1002/ajhb.23291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Revised: 02/25/2019] [Accepted: 06/15/2019] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVES Chronic sleep loss among youth is a worldwide health problem. Since research on its predictors is often limited to high-income countries, it is unclear if these findings are generalizable to all populations. To address this gap from an ecological perspective, we evaluated the associations between adolescents' sleep behaviors and several factors at the community, household, and individual levels in a middle-income country. METHODS This was a cross-sectional study of 73 girls (mean age = 14.5 y; range = 11-18 y) in rural and urban communities in Guyana. Sleep behaviors (nap-duration, bedtime, rise-time, night-bed-duration, and sleep-duration) were assessed with interviews and monitored up to 7 consecutive days using waist-worn accelerometers. RESULTS Similar to other settings, Guyanese urban youth reported significantly later bedtimes than rural youth, and increasing age was associated with later bedtime and shorter night-bed-duration. In contrast to the association observed in high-income countries, increasing household poverty scores in Guyana were associated with longer night-bed-duration. CONCLUSIONS Although the relationships between locale, age, and sleep in Guyana paralleled patterns seen in high-income countries, the positive relationship between poverty and sleep diverges from previous reports. These findings suggest that predictors of chronic sleep loss seen in high-income countries are likely to differ from those in middle- and low-income countries. More sleep studies in underrepresented populations are needed to gain a comprehensive understanding of adolescent sleep behavior and its correlates.
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Affiliation(s)
- Evanna I Singh
- Department of Anthropology, Indiana University, Bloomington, Indiana.,Evolutionary Anthropology Laboratory, Indiana University, Bloomington, Indiana
| | - Virginia J Vitzthum
- Department of Anthropology, Indiana University, Bloomington, Indiana.,Evolutionary Anthropology Laboratory, Indiana University, Bloomington, Indiana.,Kinsey Institute, Indiana University, Bloomington, Indiana
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20
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Han CH, Chung JH. Association of asthma and sleep insufficiency among South Korean adolescents: analysis of web-based self-reported data from the Korean youth risk behavior web-based survey. J Asthma 2019; 57:253-261. [PMID: 30657005 DOI: 10.1080/02770903.2019.1565827] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Objectives: Weekend oversleep or catch-up sleep is common among adolescents, but relatively few data are available with regard to its effects on asthma. Our aim was to investigate whether weekend oversleep is associated with ever having asthma among Korean adolescents. Methods: We analyzed web-based self-reported data from the Korean Youth Risk Behavior Web-based Survey in 25,927 physician-diagnosed adolescent asthma cases and 266,160 non-asthma cases. Self-report questionnaires were used to assess socioeconomic status, health behaviors, psychological factors and sleep patterns. Multiple logistic regression after adjusting for factors was used to determine the association between sleep and asthma. Results: The asthma group slept less (≤5 hours: 23.9% vs. 22.8%) had a later weekend bedtime (≥1:00 AM: 58.1% vs. 57.8%), and an earlier weekend wake time (≤7:00 AM: 18.1% vs. 17.0%) compared to the non-asthma group. After multiple logistic regression, a sleep duration ≤5 hours (odds ratio (OR), 1.09; 95% confidence interval (CI), 1.04-1.14) and weekend "early bird" (weekend wake time ≤7:00 AM: OR, 1.03; 95% CI, 1.00-1.07) were significantly associated with an increased frequency of asthma. Long weekend catch-up sleep (weekend sleep duration minus weekday sleep duration ≥2 hours) was significantly associated with a decreased frequency of asthma (OR, 0.98; 95% CI, 0.94-0.99). Conclusion: Long weekend catch-up sleep, as an indicator of insufficient weekday sleep, is associated with a decreased frequency of asthma in Korean adolescents.
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Affiliation(s)
- Chang Hoon Han
- Division of Pulmonology, Department of Internal Medicine, National Health Insurance Service Ilsan Hospital, Goyang, Republic of Korea
| | - Jae Ho Chung
- Division of Pulmonology, Department of Internal Medicine, International St. Mary`s Hospital, Catholic Kwandong University College of Medicine, Incheon, Republic of Korea
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21
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Chattu VK, Manzar MD, Kumary S, Burman D, Spence DW, Pandi-Perumal SR. The Global Problem of Insufficient Sleep and Its Serious Public Health Implications. Healthcare (Basel) 2018; 7:healthcare7010001. [PMID: 30577441 PMCID: PMC6473877 DOI: 10.3390/healthcare7010001] [Citation(s) in RCA: 302] [Impact Index Per Article: 50.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Revised: 12/17/2018] [Accepted: 12/18/2018] [Indexed: 12/25/2022] Open
Abstract
Good sleep is necessary for good physical and mental health and a good quality of life. Insufficient sleep is a pervasive and prominent problem in the modern 24-h society. A considerable body of evidence suggests that insufficient sleep causes hosts of adverse medical and mental dysfunctions. An extensive literature search was done in all the major databases for “insufficient sleep” and “public health implications” in this review. Globally, insufficient sleep is prevalent across various age groups, considered to be a public health epidemic that is often unrecognized, under-reported, and that has rather high economic costs. This paper addresses a brief overview on insufficient sleep, causes, and consequences, and how it adds to the existing burden of diseases. Insufficient sleep leads to the derailment of body systems, leading to increased incidences of cardiovascular morbidity, increased chances of diabetes mellitus, obesity, derailment of cognitive functions, vehicular accidents, and increased accidents at workplaces. The increased usage of smart phones and electronic devices is worsening the epidemic. Adolescents with insufficient sleep are likely to be overweight and may suffer from depressive symptoms. The paper concludes by emphasizing sleep quality assessments as an important early risk indicator, thereby reducing the incidence of a wide spectrum of morbidities.
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Affiliation(s)
- Vijay Kumar Chattu
- Faculty of Medical Sciences, The University of the West Indies, St. Augustine, Trinidad and Tobago.
| | - Md Dilshad Manzar
- Department of Nursing, College of Applied Medical Sciences, Majmaah University, Majmaah 11952, Saudi Arabia.
| | - Soosanna Kumary
- Faculty of Medical Sciences, The University of the West Indies, St. Augustine, Trinidad and Tobago.
| | - Deepa Burman
- School of Medicine, University of Pittsburgh, 4200 Fifth Ave, Pittsburgh, PA 15260, USA.
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22
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Pires GN, Bezerra AG, de Vries RBM, Leenaars CHC, Ritskes-Hoitinga M, Tufik S, Andersen ML. Effects of experimental sleep deprivation on aggressive, sexual and maternal behaviour in animals: a systematic review protocol. BMJ OPEN SCIENCE 2018; 2:e000041. [PMID: 35047677 PMCID: PMC8749292 DOI: 10.1136/bmjos-2017-000041] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Accepted: 10/24/2018] [Indexed: 12/11/2022] Open
Abstract
Objective Because of the relevance for the research on sleep deprivation and human behaviour, many preclinical studies have been conducted on aggressive, sexual and maternal behaviours in this field. Considering the available data and the complexity of the factors involved, the most appropriate way to summarise the effects of sleep deprivation on these behaviours is through systematic reviews and meta-analyses. This article describes the protocol for three independent systematic reviews and meta-analyses, evaluating the effects of sleep deprivation on aggressive, sexual and maternal behaviours in animals. Search strategy A bibliographic search will be performed in four databases: Pubmed, Scopus, Web of Science and Psychinfo, searching for three domains: sleep deprivation (as the intervention), animals (as the population) and behaviour (as the outcome). Screening and annotation Titles and abstracts will first be screened, followed by analysis of the full text and data extraction. Data management and reporting SYstematic Review Centre for Laboratory Animal Experimentation ’s risk of bias tool will be used to evaluate risk of bias; visual analysis of funnel plots, Egger’s regression and trim-and-fill will be employed to evaluate publication bias. Effect sizes will be calculated from the articles by either direct or standardised mean difference, depending on the nature of the data. Overall estimates will then be calculated using a random effects model. Heterogeneity will be assessed using both I2 index and Cochran’s Q test. These meta-analyses should be useful to summarise the available data on the relationship between sleep deprivation and behaviour, providing a solid background for future behavioural sleep deprivation experiments, improving their validity.
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Affiliation(s)
- Gabriel Natan Pires
- Departamento de Psicobiologia, Universidade Federal de São Paulo, São Paulo, Brazil
- Department of Physiological Sciences, Santa Casa de São Paulo School of Medical Sciences, São Paulo, Brazil
| | | | - Rob B M de Vries
- SYstematic Review Centre for Laboratory Animal Experimentation (SYRCLE) at Central Animal Facility, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | - Merel Ritskes-Hoitinga
- SYstematic Review Centre for Laboratory Animal Experimentation (SYRCLE) at Central Animal Facility, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Sergio Tufik
- Departamento de Psicobiologia, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Monica Levy Andersen
- Departamento de Psicobiologia, Universidade Federal de São Paulo, São Paulo, Brazil
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Kayaba M, Sasai-Sakuma T, Inoue Y. Clinical significance of social jetlag in patients with excessive daytime sleepiness. Chronobiol Int 2018; 35:1637-1646. [DOI: 10.1080/07420528.2018.1499666] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Momoko Kayaba
- Department of Somnology, Tokyo Medical University, Tokyo, Japan
- Japan Somnology Center, Institute of Nueropsychiatry, Tokyo, Japan
| | - Taeko Sasai-Sakuma
- Department of Somnology, Tokyo Medical University, Tokyo, Japan
- Japan Somnology Center, Institute of Nueropsychiatry, Tokyo, Japan
- Department of Clinical Laboratory Science, Faculty of Medical Technology, Teikyo University, Tokyo, Japan
| | - Yuichi Inoue
- Department of Somnology, Tokyo Medical University, Tokyo, Japan
- Japan Somnology Center, Institute of Nueropsychiatry, Tokyo, Japan
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24
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Patrick ME, Griffin J, Huntley ED, Maggs JL. Energy Drinks and Binge Drinking Predict College Students' Sleep Quantity, Quality, and Tiredness. Behav Sleep Med 2018; 16:92-105. [PMID: 27183506 PMCID: PMC5435568 DOI: 10.1080/15402002.2016.1173554] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
This study examines whether energy drink use and binge drinking predict sleep quantity, sleep quality, and next-day tiredness among college students. Web-based daily data on substance use and sleep were collected across four semesters in 2009 and 2010 from 667 individuals for up to 56 days each, yielding information on 25,616 person-days. Controlling for average levels of energy drink use and binge drinking (i.e., 4+ drinks for women, 5+ drinks for men), on days when students consumed energy drinks, they reported lower sleep quantity and quality that night, and greater next-day tiredness, compared to days they did not use energy drinks. Similarly, on days when students binge drank, they reported lower sleep quantity and quality that night, and greater next-day tiredness, compared to days they did not binge drink. There was no significant interaction effect between binge drinking and energy drink use on the outcomes.
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Affiliation(s)
- Megan E. Patrick
- University of Michigan, Institute for Social Research,Address correspondence to: Megan E. Patrick, Institute for Social Research, University of Michigan, 426 Thompson Street, Ann Arbor, MI 48106-1248. Phone 1-734-763-7107, Fax 1-734-936-0043,
| | - Jamie Griffin
- University of Michigan, Institute for Social Research
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25
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Hafner M, Stepanek M, Troxel WM. The economic implications of later school start times in the United States. Sleep Health 2017; 3:451-457. [DOI: 10.1016/j.sleh.2017.08.007] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Revised: 08/15/2017] [Accepted: 08/18/2017] [Indexed: 11/28/2022]
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26
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Maric A, Montvai E, Werth E, Storz M, Leemann J, Weissengruber S, Ruff CC, Huber R, Poryazova R, Baumann CR. Insufficient sleep: Enhanced risk-seeking relates to low local sleep intensity. Ann Neurol 2017; 82:409-418. [PMID: 28833531 DOI: 10.1002/ana.25023] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2016] [Revised: 08/04/2017] [Accepted: 08/15/2017] [Indexed: 01/30/2023]
Abstract
OBJECTIVES Chronic sleep restriction is highly prevalent in modern society and is, in its clinical form, insufficient sleep syndrome, one of the most prevalent diagnoses in clinical sleep laboratories, with substantial negative impact on health and community burden. It reflects every-day sleep loss better than acute sleep deprivation, but its effects and particularly the underlying mechanisms remain largely unknown for a variety of critical cognitive domains, as, for example, risky decision making. METHODS We assessed financial risk-taking behavior after 7 consecutive nights of sleep restriction and after 1 night of acute sleep deprivation compared to a regular sleep condition in a within-subject design. We further investigated potential underlying mechanisms of sleep-loss-induced changes in behavior by high-density electroencephalography recordings during restricted sleep. RESULTS We show that chronic sleep restriction increases risk-seeking, whereas this was not observed after acute sleep deprivation. This increase was subjectively not noticed and was related to locally lower values of slow-wave energy during preceding sleep, an electrophysiological marker of sleep intensity and restoration, in electrodes over the right prefrontal cortex. INTERPRETATION This study provides, for the first time, evidence that insufficient sleep restoration over circumscribed cortical areas leads to aberrant behavior. In chronically sleep restricted subjects, low slow-wave sleep intensity over the right prefrontal cortex-which has been shown to be linked to risk behavior-may lead to increased and subjectively unnoticed risk-seeking. Ann Neurol 2017;82:409-418.
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Affiliation(s)
- Angelina Maric
- Department of Neurology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Eszter Montvai
- Department of Neurology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Esther Werth
- Department of Neurology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Matthias Storz
- Department of Neurology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Janina Leemann
- Department of Neurology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Sebastian Weissengruber
- Laboratory for Social and Neural Systems Research (SNS-Lab), Department of Economics, University of Zurich, Zurich, Switzerland
| | - Christian C Ruff
- Laboratory for Social and Neural Systems Research (SNS-Lab), Department of Economics, University of Zurich, Zurich, Switzerland
| | - Reto Huber
- Child Development Center and Pediatric Sleep Disorders Center, University Children's Hospital Zurich, University of Zurich, Zurich, Switzerland.,Department of Child and Adolescent Psychiatry and Psychotherapy, Psychiatric Hospital, University of Zurich, Zurich, Switzerland
| | - Rositsa Poryazova
- Department of Neurology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Christian R Baumann
- Department of Neurology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
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Abstract
Insufficient sleep duration and poor sleep quality are common among adolescents. The multidimensional causes of insufficient sleep duration and poor sleep quality include biological, health-related, environmental, and lifestyle factors. The most common direct consequence of insufficient and/or poor sleep quality is excessive daytime sleepiness, which may contribute to poor academic performance, behavioral health problems, substance use, and drowsy driving. Evaluation of sleepiness includes a detailed sleep history and sleep diary, with polysomnography only required for the assessment of specific sleep disorders. Management involves encouraging healthy sleep practices such as having consistent bed and wake times, limiting caffeine and electronics at night before bed, and eliminating napping, in addition to treating any existing sleep or medical disorders. [Pediatr Ann. 2017;46(9):e340-e344.].
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Chaput JP, Gray CE, Poitras VJ, Carson V, Gruber R, Olds T, Weiss SK, Connor Gorber S, Kho ME, Sampson M, Belanger K, Eryuzlu S, Callender L, Tremblay MS. Systematic review of the relationships between sleep duration and health indicators in school-aged children and youth. Appl Physiol Nutr Metab 2017; 41:S266-82. [PMID: 27306433 DOI: 10.1139/apnm-2015-0627] [Citation(s) in RCA: 482] [Impact Index Per Article: 68.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The objective of this systematic review was to examine the relationships between objectively and subjectively measured sleep duration and various health indicators in children and youth aged 5-17 years. Online databases were searched in January 2015 with no date or study design limits. Included studies were peer-reviewed and met the a priori-determined population (apparently healthy children and youth aged 5-17 years), intervention/exposure/comparator (various sleep durations), and outcome (adiposity, emotional regulation, cognition/academic achievement, quality of life/well-being, harms/injuries, and cardiometabolic biomarkers) criteria. Because of high levels of heterogeneity across studies, narrative syntheses were employed. A total of 141 articles (110 unique samples), including 592 215 unique participants from 40 different countries, met inclusion criteria. Overall, longer sleep duration was associated with lower adiposity indicators, better emotional regulation, better academic achievement, and better quality of life/well-being. The evidence was mixed and/or limited for the association between sleep duration and cognition, harms/injuries, and cardiometabolic biomarkers. The quality of evidence ranged from very low to high across study designs and health indicators. In conclusion, we confirmed previous investigations showing that shorter sleep duration is associated with adverse physical and mental health outcomes. However, the available evidence relies heavily on cross-sectional studies using self-reported sleep. To better inform contemporary sleep recommendations, there is a need for sleep restriction/extension interventions that examine the changes in different outcome measures against various amounts of objectively measured sleep to have a better sense of dose-response relationships.
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Affiliation(s)
- Jean-Philippe Chaput
- a Healthy Active Living and Obesity Research Group, Children's Hospital of Eastern Ontario Research Institute, 401 Smyth Road, Ottawa, ON K1H 8L1, Canada
| | - Casey E Gray
- a Healthy Active Living and Obesity Research Group, Children's Hospital of Eastern Ontario Research Institute, 401 Smyth Road, Ottawa, ON K1H 8L1, Canada
| | - Veronica J Poitras
- a Healthy Active Living and Obesity Research Group, Children's Hospital of Eastern Ontario Research Institute, 401 Smyth Road, Ottawa, ON K1H 8L1, Canada
| | - Valerie Carson
- b Faculty of Physical Education and Recreation, University of Alberta, Edmonton, AB, Canada
| | - Reut Gruber
- c Attention, Behavior, and Sleep Laboratory, Douglas Mental Health University Institute, Verdun, QC, Canada
| | - Timothy Olds
- d Alliance for Research in Exercise, Nutrition and Activity (ARENA), Sansom Institute of Health Research, University of South Australia, Adelaide, Australia
| | - Shelly K Weiss
- e Division of Neurology, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Sarah Connor Gorber
- f Office of the Task Force on Preventive Health Care, Public Health Agency of Canada, Ottawa, ON, Canada
| | - Michelle E Kho
- g School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada
| | - Margaret Sampson
- a Healthy Active Living and Obesity Research Group, Children's Hospital of Eastern Ontario Research Institute, 401 Smyth Road, Ottawa, ON K1H 8L1, Canada
| | - Kevin Belanger
- a Healthy Active Living and Obesity Research Group, Children's Hospital of Eastern Ontario Research Institute, 401 Smyth Road, Ottawa, ON K1H 8L1, Canada
| | - Sheniz Eryuzlu
- a Healthy Active Living and Obesity Research Group, Children's Hospital of Eastern Ontario Research Institute, 401 Smyth Road, Ottawa, ON K1H 8L1, Canada
| | - Laura Callender
- a Healthy Active Living and Obesity Research Group, Children's Hospital of Eastern Ontario Research Institute, 401 Smyth Road, Ottawa, ON K1H 8L1, Canada
| | - Mark S Tremblay
- a Healthy Active Living and Obesity Research Group, Children's Hospital of Eastern Ontario Research Institute, 401 Smyth Road, Ottawa, ON K1H 8L1, Canada
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Adolescent Sleep and the Impact of Technology Use Before Sleep on Daytime Function. J Pediatr Nurs 2016; 31:498-504. [PMID: 27184356 PMCID: PMC5026973 DOI: 10.1016/j.pedn.2016.04.004] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Revised: 04/25/2016] [Accepted: 04/25/2016] [Indexed: 01/17/2023]
Abstract
UNLABELLED Technology has become pervasive in our culture, particularly among adolescents. The purpose of this study is to examine associations between use of technology before sleep and daytime function in adolescents. DESIGN AND METHODS This study is a secondary analysis of respondents aged 13 to 21 years (N = 259) from the 2011 National Sleep Foundation's Sleep in America Poll. The survey included questions on demographics, sleep habits, and use of technology in the hour before bedtime. Daytime sleepiness was assessed with the Epworth Sleepiness Scale (ESS). Student's t-tests, Mann-Whitney U, and Fischer's exact tests were performed to detect differences in demographics, sleep duration, and technology use in the total sample, and between respondents with "adequate" compared to "inadequate" sleep. Correlations were calculated between technology frequency and daytime function. RESULTS Adolescents had mean sleep duration of 7.3 ± 1.3 h. Almost all respondents (97%) used some form of technology before sleep. Increased technology use and the frequency of being awoken in the night by a cell phone were significantly associated with waking too early, waking unrefreshed, and daytime sleepiness (p < 0.05). Adolescents who reported "inadequate" sleep had shorter sleep duration, greater frequency of technology use before bedtime, feeling unrefreshed on waking, and greater daytime sleepiness than those reporting "adequate" sleep (all p-values < 0.05). CONCLUSION Technology use before sleep by adolescents had negative consequences on nighttime sleep and on daytime function. PRACTICE IMPLICATIONS Healthcare professionals who interact with adolescents should encourage technology to be curtailed before bedtime and for adolescents to value obtaining adequate sleep.
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Wheaton AG, Chapman DP, Croft JB. School Start Times, Sleep, Behavioral, Health, and Academic Outcomes: A Review of the Literature. THE JOURNAL OF SCHOOL HEALTH 2016; 86:363-81. [PMID: 27040474 PMCID: PMC4824552 DOI: 10.1111/josh.12388] [Citation(s) in RCA: 171] [Impact Index Per Article: 21.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2014] [Revised: 09/29/2015] [Accepted: 12/18/2015] [Indexed: 05/05/2023]
Abstract
BACKGROUND Insufficient sleep in adolescents has been shown to be associated with a wide variety of adverse outcomes, from poor mental and physical health to behavioral problems and lower academic grades. However, most high school students do not get sufficient sleep. Delaying school start times for adolescents has been proposed as a policy change to address insufficient sleep in this population and potentially to improve students' academic performance, reduce engagement in risk behaviors, and improve health. METHODS This article reviews 38 reports examining the association between school start times, sleep, and other outcomes among adolescent students. RESULTS Most studies reviewed provide evidence that delaying school start time increases weeknight sleep duration among adolescents, primarily by delaying rise times. Most of the studies saw a significant increase in sleep duration even with relatively small delays in start times of half an hour or so. Later start times also generally correspond to improved attendance, less tardiness, less falling asleep in class, better grades, and fewer motor vehicle crashes. CONCLUSIONS Although additional research is necessary, research results that are already available should be disseminated to stakeholders to enable the development of evidence-based school policies.
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Affiliation(s)
- Anne G Wheaton
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 4770 Buford Hwy. NE, Mailstop F-78, Atlanta, GA 30341-3717.
| | - Daniel P Chapman
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 4770 Buford Hwy. NE, Mailstop F-78, Atlanta, GA 30341-3717.
| | - Janet B Croft
- Epidemiology and Surveillance Branch, Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 4770 Buford Hwy. NE Mailstop F-78, Atlanta, GA 30341-3717.
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31
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Morita Y, Sasai-Sakuma T, Asaoka S, Inoue Y. Prevalence and Correlates of Insufficient Sleep Syndrome in Japanese Young Adults: A Web-Based Cross-Sectional Study. J Clin Sleep Med 2015; 11:1163-9. [PMID: 26094926 DOI: 10.5664/jcsm.5092] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2014] [Accepted: 04/28/2015] [Indexed: 01/22/2023]
Abstract
STUDY OBJECTIVE This study investigated the prevalence and risk factors of insufficient sleep syndrome (ISS), and factors associated with daytime dysfunction in the disorder in Japanese young adults. METHODS In this cross-sectional study, a web-based questionnaire survey was used to assess demographic variables, sleep habits and quality, depressive symptoms, and health-related quality of life (HRQOL) in 2,276 participants aged 20-25. RESULTS Eleven percent of participants were classified as having ISS. Multiple logistic regression analysis revealed that the presence of ISS was significantly associated with social status (student or full-time employee). The participants with ISS had significantly higher depression scores and lower mental component summary scores than healthy sleepers. In the participants with ISS, a delayed sleep-wake schedule was extracted as a factor associated with worse mental component summary. CONCLUSIONS Results indicate a relatively high proportion of Japanese young adults suffer from ISS, and that the condition is associated with a social status of student or full-time employee. Moreover, a delayed sleep-wake schedule may lead to further deterioration of mental HRQOL in ISS-affected persons.
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Affiliation(s)
- Yuko Morita
- Department of Somnology, Tokyo Medical University, Tokyo, Japan
| | - Taeko Sasai-Sakuma
- Department of Somnology, Tokyo Medical University, Tokyo, Japan.,Department of Life Sciences and Bioinformatics, Division of Biomedical Laboratory Sciences, Graduate School of Health Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Shoichi Asaoka
- Department of Psychology and Humanities, Edogawa University, Chiba, Japan.,Sleep Research Institute, Edogawa University, Chiba, Japan
| | - Yuichi Inoue
- Department of Somnology, Tokyo Medical University, Tokyo, Japan.,Japan Somnology Center, Neuropsychiatric Research Institute, Tokyo, Japan
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32
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Lee YJ, Park J, Kim S, Cho SJ, Kim SJ. Academic performance among adolescents with behaviorally induced insufficient sleep syndrome. J Clin Sleep Med 2015; 11:61-8. [PMID: 25515277 DOI: 10.5664/jcsm.4368] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2014] [Accepted: 10/08/2014] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES The present study investigated academic performance among adolescents with behaviorally induced insufficient sleep syndrome (BISS) and attempted to identify independent predictors of academic performance among BISS-related factors. METHODS A total of 51 students with BISS and 50 without BISS were recruited from high schools in South Korea based on self-reported weekday sleep durations, weekend oversleep, and the Epworth Sleepiness Scale (ESS). Participants reported their academic performance in the form of class quartile ranking. The Korean version of the Composite Scale (KtCS) for morningness/eveningness, the Beck Depression Inventory (BDI) for depression, and the Barratt Impulsiveness Scale-II (BIS-II) for impulsivity were administered. RESULTS Adolescents with BISS reported poorer academic performance than adolescents without BISS (p = 0.02). Adolescents with BISS also exhibited greater levels of eveningness (p < 0.001), depressive symptoms (p < 0.001), and impulsiveness (p < 0.01). Longer weekend oversleep predicted poorer academic performance among adolescents with BISS even after controlling for ESS, KtCS, BDI, and BIS-II (β = 0.42, p < 0.01). CONCLUSIONS BISS among adolescents is associated with poor academic performance and that sleep debt, as represented by weekend oversleep, predicts poorer academic performance independent of depression, impulsiveness, weekday sleep duration, daytime sleepiness, and morningness/eveningness among adolescents with BISS.
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Affiliation(s)
- Yu Jin Lee
- Department of Psychiatry, Seoul National University Hospital, Seoul, Republic of Korea
| | - Juhyun Park
- Department of Psychiatry, Seoul National University Hospital, Seoul, Republic of Korea
| | - Soohyun Kim
- Department of Psychiatry, Seoul National University Hospital, Seoul, Republic of Korea
| | - Seong-Jin Cho
- Department of Psychiatry, Gachon University of Medicine and Science, Incheon, Republic of Korea
| | - Seog Ju Kim
- Department of Psychiatry, Seoul National University Hospital, Seoul, Republic of Korea.,Department of Medical Science, Seoul National University College of Medicine, Seoul, Republic of Korea
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33
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Sivertsen B, Harvey AG, Pallesen S, Hysing M. Mental health problems in adolescents with delayed sleep phase: results from a large population-based study in Norway. J Sleep Res 2014; 24:11-8. [PMID: 25358244 DOI: 10.1111/jsr.12254] [Citation(s) in RCA: 97] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2014] [Accepted: 09/28/2014] [Indexed: 11/27/2022]
Abstract
The aim of the current study was to compare mental health problems, resilience and family characteristics in adolescents with and without delayed sleep phase (DSP) in a population-based sample. Data were taken from the youth@hordaland-survey, a large population-based study in Hordaland County in Norway conducted in 2012. In all, 9338 adolescents aged 16-19 years (53.5% girls) provided self-reported data on a wide range of instruments assessing mental health symptoms, including depression, anxiety, obsessive-compulsive behaviours, attention deficit hyperactive disorder (ADHD) symptoms, perfectionism, resilience and sleep. Measures of socioeconomic status were also included. Three hundred and six adolescents (prevalence 3.3%) were classified as having DSP [according to the International Classification of Sleep Disorders-2 (ICSD-2)] criteria. Adolescents with DSP reported higher levels of depression, anxiety and ADHD symptoms. Adolescents with DSP also exhibited significantly lower levels of resilience. The Cohen's d effect sizes ranged from small [obsessive-compulsive disorder (OCD): d = 0.15] to moderate (inattention: d = 0.71). In the fully adjusted model, the significant predictors of DSP included inattention [odds ratio (OR): 2.11], lack of personal structure (OR: 2.07), low (OR: 1.85) and high (OR: 1.91) paternal education, parents not living together (OR: 1.81), hyperactivity/inattention (OR: 1.71) and poorer family economy (OR: 1.59). In conclusion, the high symptom load across a range of mental health measures suggests that a broad and thorough clinical approach is warranted when adolescents present with DSP.
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Affiliation(s)
- Børge Sivertsen
- Division of Mental Health, Norwegian Institute of Public Health, Bergen, Norway; Uni Research Helse, Bergen, Norway; Department of Psychiatry, Helse Fonna HF, Haugesund, Norway
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34
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Abstract
Chronic sleep loss and associated sleepiness and daytime impairments in adolescence are a serious threat to the academic success, health, and safety of our nation's youth and an important public health issue. Understanding the extent and potential short- and long-term repercussions of sleep restriction, as well as the unhealthy sleep practices and environmental factors that contribute to sleep loss in adolescents, is key in setting public policies to mitigate these effects and in counseling patients and families in the clinical setting. This report reviews the current literature on sleep patterns in adolescents, factors contributing to chronic sleep loss (ie, electronic media use, caffeine consumption), and health-related consequences, such as depression, increased obesity risk, and higher rates of drowsy driving accidents. The report also discusses the potential role of later school start times as a means of reducing adolescent sleepiness.
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35
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Garcia C, Zhang L, Holt K, Hardeman R, Peterson B. Latina Adolescent Sleep and Mood: An Ecological Momentary Assessment Pilot Study. JOURNAL OF CHILD AND ADOLESCENT PSYCHIATRIC NURSING 2014; 27:132-41. [DOI: 10.1111/jcap.12082] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Carolyn Garcia
- School of Nursing; University of Minnesota; Minneapolis Minnesota USA
| | - Lei Zhang
- Biostatistical Design and Analysis Center; University of Minnesota; Minneapolis Minnesota USA
| | - Katie Holt
- School of Nursing; University of Minnesota; Minneapolis Minnesota USA
| | - Rachel Hardeman
- Department of Medicine; University of Minnesota and Center for Chronic Disease Outcomes Research; Minneapolis Veterans Affairs Medical Center; Minneapolis Minnesota USA
| | - Barbara Peterson
- School of Nursing; University of Minnesota; Minneapolis Minnesota USA
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36
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Maslowsky J, Ozer E. Developmental trends in sleep duration in adolescence and young adulthood: evidence from a national United States sample. J Adolesc Health 2014; 54:691-7. [PMID: 24361237 PMCID: PMC4401462 DOI: 10.1016/j.jadohealth.2013.10.201] [Citation(s) in RCA: 147] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2013] [Revised: 10/23/2013] [Accepted: 10/23/2013] [Indexed: 11/17/2022]
Abstract
PURPOSE To present normative values of mean sleep duration from adolescence through young adulthood (ages 13-32 years), prevalence of short (<6 hours) and long (>10 hours) sleep durations, and differences in each by sex and race/ethnicity. METHODS Mean sleep duration and prevalence of extremely short and long sleep were estimated using data from the United States National Longitudinal Study of Adolescent Health, Waves 1-4 (N = 15,701). RESULTS Sleep duration showed age-related trends, with decreases across the adolescent period from 8.5 hours per night at age 13 years to 7.3 hours at age 18 years, an increase through the emerging adulthood period to 8.5 hours at age 22, and a gradual decline across early adulthood to 7.7 hours at age 32 years. Prevalence of extremely long and short sleep followed similar developmental trends. Adolescent girls reported lower mean sleep duration than did boys, but women reported longer average sleep duration than did men from age 19 years onward. Short sleep duration was most common among African-Americans at all ages. Long sleep was most common among African-Americans in adolescence and emerging adulthood and among Hispanics in early adulthood. CONCLUSIONS Sleep duration is developmentally patterned from adolescence through early adulthood. Mean and extreme sleep durations vary systematically by sex and race/ethnicity as well as age. These normative data on sleep duration will inform studies of the role of sleep in the etiology of a wide range of health conditions affecting adolescents and young adults.
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Affiliation(s)
- Julie Maslowsky
- Robert Wood Johnson Foundation Health & Society Scholars Program, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin.
| | - Emily Ozer
- Division of Community Health and Human Development, School of Public Health, University of California-Berkeley
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37
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Stea T, Knutsen T, Torstveit M. Association between short time in bed, health-risk behaviors and poor academic achievement among Norwegian adolescents. Sleep Med 2014; 15:666-71. [DOI: 10.1016/j.sleep.2014.01.019] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2013] [Revised: 01/10/2014] [Accepted: 01/11/2014] [Indexed: 01/06/2023]
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38
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Sivertsen B, Pallesen S, Stormark KM, Bøe T, Lundervold AJ, Hysing M. Delayed sleep phase syndrome in adolescents: prevalence and correlates in a large population based study. BMC Public Health 2013; 13:1163. [PMID: 24330358 PMCID: PMC3878844 DOI: 10.1186/1471-2458-13-1163] [Citation(s) in RCA: 99] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2013] [Accepted: 12/06/2013] [Indexed: 12/02/2022] Open
Abstract
Background The aims of this study were to estimate the prevalence of Delayed Sleep Phase Syndrome (DSPS) in adolescence, and to examine the association to insomnia and school non-attendance. Methods Data stem from a large population based study in Hordaland County in Norway conducted in 2012, the ung@hordaland study. In all, 10,220 adolescents aged 16–18 years (54% girls) provided self-reported data on a range of sleep parameters: DSPS was defined according to the International Classification of Sleep Disorders, Revised (ICSD-R) criteria, while insomnia was defined according to the Quantitative Criteria for Insomnia. Other sleep parameters included time in bed, sleep duration, sleep efficiency, oversleeping, sleep onset latency, wake after sleep onset, subjective sleep need, sleep deficiency, sleepiness and tiredness. Sleep data were calculated separately for weekdays and weekends. Data on school non-attendance were provided by official registers. Results The prevalence of DSPS was 3.3%, and significantly higher among girls (3.7%) than boys (2.7%). There was a strong overlap between DSPS and insomnia, with more than half of the adolescents with DSPS also meeting the criteria for insomnia (53.8% for boys and 57.1% for girls). Adolescents with DSPS had significantly higher odds ratios (OR) of non-attendance at school. After adjusting for sociodeographical factors, insomnia and depression, the adjusted ORs for days of non-attendance were OR = 3.22 (95% CI: 1.94-5.34) for boys and OR = 1.87 (95% CI: 1.25-2.80) for girls. A similar effect was found for hours of non-attendance for boys, with an adjusted OR = 3.05 (95% CI: 1.89-4.92). The effect for girls was no longer significant after full adjustment (OR =1.48 [95% CI: 0.94-2.32]). Conclusions This is one of the first studies to estimate the prevalence of DSPS in adolescents. The high prevalence of DSPS, and overlap with insomnia, in combination with the odds of school non-attendance, suggest that a broad and thorough clinical approach is warranted when adolescents present with symptoms of DSPS.
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Affiliation(s)
- Børge Sivertsen
- Division of Mental Health, Norwegian Institute of Public Health, Kalfarveien 31, 5018, Bergen, Norway.
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39
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Hysing M, Pallesen S, Stormark KM, Lundervold AJ, Sivertsen B. Sleep patterns and insomnia among adolescents: a population-based study. J Sleep Res 2013; 22:549-56. [PMID: 23611716 DOI: 10.1111/jsr.12055] [Citation(s) in RCA: 260] [Impact Index Per Article: 23.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2013] [Accepted: 03/08/2013] [Indexed: 01/17/2023]
Abstract
The aim of the current study was to examine sleep patterns and rates of insomnia in a population-based study of adolescents aged 16-19 years. Gender differences in sleep patterns and insomnia, as well as a comparison of insomnia rates according to DSM-IV, DSM-V and quantitative criteria for insomnia (Behav. Res. Ther., 41, 2003, 427), were explored. We used a large population-based study in Hordaland county in Norway, conducted in 2012. The sample included 10,220 adolescents aged 16-18 years (54% girls). Self-reported sleep measurements included bedtime, rise time, time in bed, sleep duration, sleep efficiency, sleep onset latency, wake after sleep onset, rate and frequency and duration of difficulties initiating and maintaining sleep and rate and frequency of tiredness and sleepiness. The adolescents reported short sleep duration on weekdays (mean 6:25 hours), resulting in a sleep deficiency of about 2 h. A majority of the adolescents (65%) reported sleep onset latency exceeding 30 min. Girls reported longer sleep onset latency and a higher rate of insomnia than boys, while boys reported later bedtimes and a larger weekday-weekend discrepancy on several sleep parameters. Insomnia prevalence rates ranged from a total prevalence of 23.8 (DSM-IV criteria), 18.5 (DSM-V criteria) and 13.6% (quantitative criteria for insomnia). We conclude that short sleep duration, long sleep onset latency and insomnia were prevalent in adolescents. This warrants attention as a public health concern in this age group.
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Affiliation(s)
- Mari Hysing
- The Regional Centre for Child and Youth Mental Health and Child Welfare, Uni Health, Uni Research, Bergen, Norway; Department of Biological and Medical Psychology, University of Bergen, Bergen, Norway
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40
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Dauvilliers Y, Lopez R, Ohayon M, Bayard S. Hypersomnia and depressive symptoms: methodological and clinical aspects. BMC Med 2013; 11:78. [PMID: 23514569 PMCID: PMC3621400 DOI: 10.1186/1741-7015-11-78] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2012] [Accepted: 02/27/2013] [Indexed: 11/28/2022] Open
Abstract
The associations between depressive symptoms and hypersomnia are complex and often bidirectional. Of the many disorders associated with excessive sleepiness in the general population, the most frequent are mental health disorders, particularly depression. However, most mood disorder studies addressing hypersomnia have assessed daytime sleepiness using a single response, neglecting critical and clinically relevant information about symptom severity, duration and nighttime sleep quality. Only a few studies have used objective tools such as polysomnography to directly measure both daytime and nighttime sleep propensity in depression with normal mean sleep latency and sleep duration. Hypersomnia in mood disorders, rather than a medical condition per se, is more a subjective sleep complaint than an objective finding. Mood symptoms have also been frequently reported in hypersomnia disorders of central origin, especially in narcolepsy. Hypocretin deficiency could be a contributing factor in this condition. Further interventional studies are needed to explore whether management of sleep complaints improves mood symptoms in hypersomnia disorders and, conversely, whether management of mood complaints improves sleep symptoms in mood disorders.
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Affiliation(s)
- Yves Dauvilliers
- Centre de référence national sur les maladies rares (narcolepsie, hypersomnie idiopathique, syndrome de Kleine-Levin), Service de Neurologie, Unité des troubles du sommeil, Hôpital Gui-de-Chauliac, 80 avenue Augustin Fliche, Montpellier cedex 5 34295, France.
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41
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Abstract
The classification of sleep disorders is necessary to discriminate between disorders and to facilitate an understanding of symptoms, etiology, and pathophysiology that allows for appropriate treatment. The earliest classification systems, largely organized according to major symptoms (insomnia, excessive sleepiness, and abnormal events that occur during sleep), were unable to be based on pathophysiology because the cause of most sleep disorders was unknown. These 3 symptom-based categories are easily understood by physicians and are therefore useful for developing a differential diagnosis. The International Classification of Sleep Disorders, version 2, published in 2005 and currently undergoing revision, combines a symptomatic presentation (e.g., insomnia) with 1 organized in part on pathophysiology (e.g., circadian rhythms) and in part on body systems (e.g., breathing disorders). This organization of sleep disorders is necessary because of the varied nature and because the pathophysiology for many of the disorders is still unknown. The International Classification of Sleep Disorders, version 2 provides relevant diagnostic and epidemiological information on sleep disorders to more easily differentiate between the disorders.
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Affiliation(s)
- Michael J Thorpy
- Montefiore Medical Center and the Albert Einstein College of Medicine, Bronx, New York, NY, USA.
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42
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Abstract
The Bergen Facebook Addiction Scale (BFAS), initially a pool of 18 items, three reflecting each of the six core elements of addiction (salience, mood modification, tolerance, withdrawal, conflict, and relapse), was constructed and administered to 423 students together with several other standardized self-report scales (Addictive Tendencies Scale, Online Sociability Scale, Facebook Attitude Scale, NEO–FFI, BIS/BAS scales, and Sleep questions). That item within each of the six addiction elements with the highest corrected item-total correlation was retained in the final scale. The factor structure of the scale was good (RMSEA = .046, CFI = .99) and coefficient alpha was .83. The 3-week test-retest reliability coefficient was .82. The scores converged with scores for other scales of Facebook activity. Also, they were positively related to Neuroticism and Extraversion, and negatively related to Conscientiousness. High scores on the new scale were associated with delayed bedtimes and rising times.
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Affiliation(s)
| | | | | | - Ståle Pallesen
- Department of Psychosocial Science, University of Bergen, Norway
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43
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Abstract
STUDY OBJECTIVES To investigate the association between the behaviorally induced insufficient sleep and suicidality among adolescents. DESIGN A population-based, cross-sectional survey. SETTING General community. PARTICIPANTS A sample of 8,530 students (grades 7-11) was recruited in the Republic of Korea. The participants were 8,010 students who completed all questionnaires. INTERVENTION N/A. MEASUREMENTS The survey included the Beck Scale for Suicidal Ideation (SSI), the Beck Depression Inventory (BDI), a modified Epworth Sleepiness Scale (ESS), and questionnaires about sleep (weekday/weekend sleep schedule/duration, insomnia and snoring). RESULTS Adolescents with behaviorally induced insufficient sleep syndrome (BISS) had higher SSI scores than those who slept ≥ 7 hours on weekdays, even after controlling for age, sex, and BDI score (F = 11.71, P < 0.001). After controlling for age and sex, longer weekend oversleep and shorter weekday sleep duration predicted a higher SSI score (β = 0.19, P < 0.001; β = 0.37, P < 0.001). The association between weekend oversleep and SSI score remained significant even after additionally controlling for BDI and ESS scores and presence of insomnia and snoring (β = 0.07, P < 0.01). CONCLUSION BISS was found to be associated with increased suicidality. Weekend oversleep was associated with suicidality independently of depression, daytime sleepiness, snoring, and insomnia. The study findings suggest that chronic sleep restriction among adolescents may increase suicidal risk.
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Affiliation(s)
- Yu Jin Lee
- Department of Psychiatry, Gachon University of Medicine and Science, Incheon, Republic of Korea
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44
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Saxvig IW, Pallesen S, Wilhelmsen-Langeland A, Molde H, Bjorvatn B. Prevalence and correlates of delayed sleep phase in high school students. Sleep Med 2011; 13:193-9. [PMID: 22153780 DOI: 10.1016/j.sleep.2011.10.024] [Citation(s) in RCA: 135] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2011] [Revised: 09/12/2011] [Accepted: 10/02/2011] [Indexed: 11/26/2022]
Abstract
PURPOSE To investigate prevalence and correlates of delayed sleep phase, characterized by problems falling asleep in the evening and rising at adequate times in the morning, in a large sample of Norwegian high school students. METHODS A randomized sample of 1285 high school students (aged 16-19 years) participated in an internet based study answering questions about sleep habits, height, weight, smoking, alcohol use, school grades, and anxiety and depression symptoms. Delayed sleep phase was operationalized as difficulties falling asleep before 2 a.m. at least three nights per week together with much or very much difficulty waking up in the morning. RESULTS The results show a prevalence of delayed sleep phase of 8.4%. In all, 68% of these students (5.7% of the total sample) also reported problems advancing their sleep period as well as one daytime consequence (oversleeping at least two days a week or experiencing much/very much sleepiness at school). Delayed sleep phase was associated with lower average school grades, smoking, alcohol usage, and elevated anxiety and depression scores. CONCLUSIONS Delayed sleep phase appears to be common amongst Norwegian adolescents and is associated with negative outcomes such as lower average school grades, smoking, alcohol usage, and elevated anxiety and depression scores.
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Affiliation(s)
- Ingvild W Saxvig
- Department of Public Health and Primary Health Care, University of Bergen, Postboks 7804, 5020 Bergen, Norway.
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