Late bedtimes weaken school performance and predispose adolescents to health hazards

Association of sleep and generalized anxiety disorder in Korean adolescents

BACKGROUND

Generalized anxiety disorder (GAD) is a common anxiety disorder among adolescents, significantly impacting their concentration and learning capabilities. The connection between emotional well-being and sleep is well-established, and Korean adolescents are particularly prone to inadequate sleep. This study aimed to determine the association between sleep duration and GAD in Korean adolescents.

METHODS

This study was conducted using data from 106,513 adolescents aged 12-18 years. Data from the 2020-2022 Korea Youth Risk Behavior Survey were used. Sleep duration was classified into five groups, based on an average sleep duration of 7-7.9 h in adolescents. Social jet lag was defined as a misalignment between an individual's biological and social clocks. Differences in sleep duration between weekdays and weekends, social jet lag, and bedtime were each classified into three categories. Multiple logistic regression analysis was performed to evaluate the association between sleep duration and GAD.

RESULTS

Comparing the five groups classified based on sleep duration, adolescents in the groups that slept less experienced a significant increase in the odds of developing GAD (adjusted odds ratio [aOR]: boys: 1.10 in the 6.0-6.9-h group, 1.14 in the 5.0-5.9-h group, and 1.23 in the ≤ 4.9-h group; girls: 1.05 in the 6.0-6.9-h group, 1.19 in the 5.0-5.9-h group, 1.22 in the ≤ 4.9-h group). Adolescents with poor sleep quality experienced more frequent instances of inadequate sleep (aOR: boys: 2.51; girls: 2.43).

CONCLUSIONS

GAD is strongly associated with insufficient sleep. Consequently, it is imperative to assess and address GAD in adolescents with irregular sleep patterns.

Impacts of temperature and solar radiation changes in northern Europe on key population health behaviors: a scoping review of reviews

AIM

Climate change threatens health directly as well as indirectly through impacts on health-related behaviors. Physical activity, nutrition and sleep are key health-related behaviors for population health. We aimed at elucidating the impacts of climate change which emerge gradually on these three key health-related behaviors, particularly focusing on scenarios and projections relevant to people living in the northern Europe.

METHODS

We conducted a systematic literature search in three different databases in January 2023 to identify English language review articles summarizing the effects of climate change on either physical activity, nutrition, sleep, or their combination.

RESULTS

We identified 15 review articles on the topic. Data on climate change impacts on nutrition and sleep were sparse, and those on physical activity were heterogeneous. The climate in northern Europe will become warmer and sunnier in summer as well as warmer and darker in winter, which will probably increase the level of physical activity, but decrease the consumption of fruits and vegetables, as well as increase the occurrence of sleep disturbances in a population.

CONCLUSIONS

The anticipated changes in physical activity, nutrition and sleep driven by climate change influence population health and call for grass-roots action plans for adaptation.

Chronotype is associated with eating behaviors, physical activity and overweight in school-aged children

BACKGROUND

A later chronotype has been found to be associated with unhealthy habits and diseases, such as an unhealthy diet and metabolic syndrome in adults. Little is known about the association between chronotype, eating habits, physical activity and obesity. Thus, this study aimed to explore the relationships between chronotype, eating behaviors, physical activity, and overweight in Chinese school-aged children.

METHODS

Data from this study was based on 952 schoolchildren (10-12 y) from six primary schools that participated in China. Anthropometric measurements of height and body weight were performed. Information about sleeping habits, dietary behaviors, and other lifestyle behaviors was gathered using a self-administered questionnaire. Multiple linear regression analysis or multivariable logistic regression model was performed to assess the associations between chronotype, eating behaviors, physical activity, and overweight.

RESULTS

Nearly 70% (69.9%) of the participants had a self-reported morning chronotype. Multiple linear regression analysis revealed chronotype score was positively associated with physical activities (all P values < 0.001) and sleep duration (all P values < 0.001) and negatively associated with BMI, meal time, eating jet lag and social jet lag (all P values < 0.001). Multivariable logistic regression analysis showed that compared to morning types, non-morning types individuals were more likely to be overweight (OR = 1.593, P value < 0.05), and had more frequent consumption of fast food (OR = 1.616, P value < 0.05), but less frequent consumption of milk (OR = 0.716, P value < 0.05), less time taking part in moderate (OR = 1.356, P value < 0.05) or muscle strengthening (OR = 1.393, 1.877, P value < 0.05) physical activity.

CONCLUSIONS

This study indicates that early chronotype children are more active, have healthier dietary habits, get more sleep, have shorter social jet lag, and are less likely to be overweight than non-early chronotype children. Our findings suggest that later chronotype may be a potential indicator in the early detection of overweight, unhealthy eating, and physical inactivity behaviors. Chronotype has been found to have an important impact on individual's health. In the present study, we conducted a cross-sectional study to investigate the association between chronotype, eating behaviors, physical activity, and overweight in school-aged children. The findings showed that children with early chronotype is associated with more active, healthier dietary behaviors, longer sleep duration, short social jet lag, and a lower risk of overweight.

Associations between sleep, reading, and mathematics in Taiwanese children

BACKGROUND

Some research shows a link between sleep behaviours and school achievement in English-speaking children and adolescents.

AIMS

The current study aimed to examine the relationship between children's sleep behaviours and aspects of their school achievement in Mandarin-speaking children who are living in Taiwan.

SAMPLE

The present study reports on 69 second-grade children (age range = 6.84-8.4 years) recruited in Taipei City, Taiwan.

METHODS

Children's sleep behaviours were assessed through two standardized parent self-report questionnaires: the Children's Sleep Habits Questionnaire (CSHQ) and the Sleep Disturbance Scale for Children (SDSC). Children undertook three standardized tests of word reading, reading comprehension and math.

RESULTS

Key findings include: (i) sleep disturbances are more prevalent when using the CSHQ scale than the SDSC scale, (ii) around half of second graders struggle with general sleep disturbances as observed by the CSHQ scale, (iii) children who go to bed before 22:00 and have at least 9-h sleep tend to exhibit fewer sleep disturbances, (iv) parasomnias as measured by the CSHQ are negatively correlated with reading comprehension after controlling age and nonverbal IQ, and (v) the amount of sleep (naps) during daytime is negatively correlated with Chinese character recognition, reading comprehension and math after controlling age and nonverbal IQ.

CONCLUSIONS

There is growing awareness of the value of research that spans culturally and linguistically diverse populations. Our study contributes to ongoing discussions about the relationship between sleep, and skills in reading and math in school-aged children in Taiwan.

Association between Chronotype and Physical Behaviours in Adolescent Girls

The aim of this study was to (1) describe accelerometer-assessed physical behaviours by chronotype, and (2) examine the association between chronotype and accelerometer-assessed physical behaviours in a cohort of adolescent girls. Chronotype (single question) and physical behaviours (GENEActiv accelerometer on the non-dominant wrist) were assessed in 965 adolescent girls (13.9 ± 0.8 years). Linear mixed-effects models examined the relationships among chronotype and physical behaviours (time in bed, total sleep time, sleep efficiency, sedentary time, overall, light and moderate-to-vigorous physical activity) on weekdays and weekend days. Over the 24 h day, participants spent 46% sedentary, 20% in light activity, 3% in moderate-to-vigorous physical activity, and 31% in 'time in bed'. Seventy percent of participants identified as 'evening' chronotypes. Compared to evening chronotypes, morning chronotypes engaged in less sedentary time (10 min/day) and had higher overall physical activity (1.3 mg/day, ~30 min of slow walking) on weekdays. Most girls identified as evening chronotypes with a large proportion of their day spent sedentary and a small amount in physical activities which may be exacerbated in evening chronotypes on weekdays. The results maybe be important for programmes aiming to promote physical activity in adolescent girls.

Circadian Misalignment Impacts the Association of Visceral Adiposity With Elevated Blood Pressure in Adolescents

BACKGROUND

Although insufficient sleep has been shown to contribute to obesity-related elevated blood pressure, the circadian timing of sleep has emerged as a novel risk factor. We hypothesized that deviations in sleep midpoint, a measure of circadian timing of sleep, modify the association between visceral adiposity and elevated blood pressure in adolescents.

METHODS

We studied 303 subjects from the Penn State Child Cohort (16.2±2.2 years; 47.5% female; 21.5% racial/ethnic minority). Actigraphy-measured sleep duration, midpoint, variability, and regularity were calculated across a 7-night period. Visceral adipose tissue (VAT) was measured with dual-energy X-ray absorptiometry. Systolic blood pressure (SBP) and diastolic blood pressure levels were measured in the seated position. Multivariable linear regression models tested sleep midpoint and its regularity as effect modifiers of VAT on SBP/diastolic blood pressure levels, while adjusting for demographic and sleep covariables. These associations were also examined as a function of being in-school or on-break.

RESULTS

Significant interactions were found between VAT and sleep irregularity, but not sleep midpoint, on SBP (P interaction=0.007) and diastolic blood pressure (P interaction=0.022). Additionally, significant interactions were found between VAT and schooldays sleep midpoint on SBP (P interaction=0.026) and diastolic blood pressure (P interaction=0.043), whereas significant interactions were found between VAT and on-break weekdays sleep irregularity on SBP (P interaction=0.034).

CONCLUSIONS

A delayed and an irregular sleep midpoint during school and during free-days, respectively, increase the impact of VAT on elevated blood pressure in adolescents. These data suggest that deviations in the circadian timing of sleep contribute to the increased cardiovascular sequelae associated with obesity and that its distinct metrics require measurement under different entrainment conditions in adolescents.

Association of chronotype, social jetlag, sleep duration and depressive symptoms in Chinese college students

OBJECTIVES

To describe the prevalence of depressive symptoms among Chinese college students and examine the relationship between sleep and circadian rhythm disruption (SCRD) indicators (chronotype, social jetlag, sleep duration) and depressive symptoms.

METHODS

From April to May 2019, the College Student Behavior and Health Cohort Study was conducted among Chinese college students from 2 universities in Anhui and Jiangxi provinces. The current study used data from the third follow-up study. Questionnaire content includes socio-demographic and lifestyle information. Social jetlag and sleep duration were calculated by answering the question about sleep time. Chronotype was assessed by the Morning and Evening Questionnaire (MEQ-5). Depressive symptoms were evaluated by the Patient Health Questionnaire 9 (PHQ-9). A Chi-square test was used to examine the proportion depressive symptoms. Multinomial logistic regression model were used to explore the associations of circadian rhythm indicators with depressive symptoms.

RESULTS

The prevalence of mild depression, moderate and above depression was 18.8 % and 6.9 %. Evening types (E-types) and short sleep duration were significantly associated with depression. Stratified analysis indicated that E-types and social jetlag≥2 h were associated with mild depression (OR = 5.67, 95 % CI: 1.83-17.51), as well as stratified analysis indicated that E-types and sleep duration<8 h were associated with mild depression (OR = 5.10, 95 % CI: 1.88-13.87).

CONCLUSIONS

The findings suggest that depressive symptoms are more severe when multiple SCRD indicators are out of whack. The intervention programs of depressive symptoms should consider the context of the multidimensional aspects of Chinese college student sleep.

Circadian preference in young adults: Associations with sleep and mental health outcomes from a national survey of Norwegian university students

Individual preferred timing of sleep and activity patterns, known as circadian preference, ranges from definitely morning types to definitely evening types. Being an evening type has been linked to adverse sleep and mental health outcomes. This study aimed to explore the associations between circadian preference and self-reported sleep, depression, anxiety, quality of life, loneliness, and self-harm/suicidal thoughts. Data stem from a national survey of students in higher education in Norway (the SHoT-study). All 169,572 students in Norway were invited to participate, and 59,554 students (66.5% women) accepted (response rate = 35.1%). Circadian preference was associated with sleep and mental health outcomes in a dose-response manner. For both genders, being an evening type (either definitely evening or more evening than morning) was associated with an increase in age-adjusted relative risk (RR-adjusted; range = 1.44 to 2.52 vs. 1.15 to 1.90, respectively) across all outcomes compared with definitely morning types. Overall, the present study provides further evidence that evening circadian preference is associated with adverse sleep and mental health outcomes in young adults. As such, future efforts to improve sleep and mental health in young adults should consider their circadian preferences.

Factors influencing health-related quality of life in adolescent girls: a path analysis using a multi-mediation model

BACKGROUND

Recent studies have reported gender differences in adolescents' health-related quality of life (HRQOL), with females scoring significantly lower than males. Researchers have identified the female puberty process as one of the causes of the differences in HRQOL between male and female adolescents. This study examines mechanisms of how social support, dietary habits, sleep quality, and depression contribute to predicting HRQOL in relation to menstrual health among adolescent girls.

METHODS

A cross-sectional study was conducted with 295 students recruited from middle and high schools in Korea using a self-report questionnaire. A multi-mediation model was constructed based on previous literature and tested using path analysis with AMOS, version 21.0.

RESULTS

The study results showed that menstrual health, social support, sleep quality, dietary habits, and depression had significant effects on HRQOL. Both sleep quality and depression had significant direct effects on menstrual health. Dietary habits, social support, sleep quality, and depression had significant indirect effects on HRQOL, mediated through menstrual health. According to serial mediation analysis, the path from social support to HRQOL via dietary habits → sleep quality → depression → menstrual health → HRQOL was significant. However, mediation models including the path of dietary habits → depression were not supported. The study variables explained 57% of the total variance for HRQOL.

CONCLUSIONS

The findings suggest menstrual health is an important factor that mediates the effects of eating, sleeping, psychological health, and social support on HRQOL. Early complaints about sleep disorders and depressive symptoms with poor dietary habits could be an ominous sign for adolescent girls at high risk of menstrual problems and lower HRQOL. Empirical evidence from this study suggests the need to develop and test interventions addressing multiple modifiable behavioral and psychosocial factors to improve HRQOL in adolescent girls. Interventions or supportive systems that aim to improve eating habits and sleep quality thereby achieving a healthier lifestyle need to be developed and incorporated into school health services.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Perceived Barriers and Facilitating Factors in Implementing Delayed School Start Times to Improve Adolescent Sleep Patterns

BACKGROUND

Most adolescents in the United States do not obtain sufficient sleep. Early school start times play a significant role in adolescent sleep deprivation. Most primary and secondary schools begin classes earlier than the 8:30 am. Perceived barriers to implementing a delayed school start time have been suggested in the literature but have not been quantified. This study explored perceived barriers and facilitating factors for implementing delayed high-school start times.

METHODS

A cross-sectional study. School administrators who had delayed their school start times were invited to complete an online questionnaire ranking the perceived barriers and facilitating factors for implementing the delayed start times.

RESULTS

Most commonly cited perceived barriers were lack of a tiered bus system, school athletes missing more afternoon classes, and less time after school for athletics. Most commonly cited facilitating factors were school-administrator involvement in the decision-making process and sleep education for family members and school administrators.

CONCLUSIONS

Participants found that providing sleep education to fellow administrators, teachers, school staff members, families, and students and including them in the decision-making process positively facilitated the implementation of delayed school start times. Perceived barriers to implementation may be overcome with support from stakeholders and planning committees.

Confidence interval-based sample size determination formulas and some mathematical properties for hierarchical data

The use of hierarchical data (also called multilevel data or clustered data) is common in behavioural and psychological research when data of lower-level units (e.g., students, clients, repeated measures) are nested within clusters or higher-level units (e.g., classes, hospitals, individuals). Over the past 25 years we have seen great advances in methods for computing the sample sizes needed to obtain the desired statistical properties for such data in experimental evaluations. The present research provides closed-form and iterative formulas for sample size determination that can be used to ensure the desired width of confidence intervals for hierarchical data. Formulas are provided for a four-level hierarchical linear model that assumes slope variances and inclusion of covariates under both balanced and unbalanced designs. In addition, we address several mathematical properties relating to sample size determination for hierarchical data via the standard errors of experimental effect estimates. These include the relative impact of several indices (e.g., random intercept or slope variance at each level) on standard errors, asymptotic standard errors, minimum required values at the highest level, and generalized expressions of standard errors for designs with any-level randomization under any number of levels. In particular, information on the minimum required values will help researchers to minimize the risk of conducting experiments that are statistically unlikely to show the presence of an experimental effect.

Discrepancies between self-reported current and ideal sleep behaviors of adolescent athletes

It is well documented that many adolescents are not meeting current sleep duration recommendations, with a growing body of literature suggesting adolescent athletes also fall into this category. What is less known is the relationship between current and ideal sleep behaviors. We sought to quantify sleep behaviors in a group of athletes and to understand how their current behaviors compare to their self-reported ideal behaviors. One hundred ninety six competitive, male and female athletes (15.7 ± 1.3 y) completed the Pittsburgh Sleep Quality Index (PSQI) and a questionnaire that captured usual sleep habits. The PSQI was analyzed for habitual bedtime, wake time, sleep duration, and sleep quality. The usual sleep habits questionnaire was analyzed for ideal bedtime, wake time, and calculated sleep duration. Reported mean sleep duration was 7:45 ± 1:06 h:min. Actual bedtime was later (+0:44 ± 0:05 h:min, p<0.001) than ideal bedtime, actual wake time was earlier (-0:50 ± 0:08 h:min, p<0.001) than ideal wake time, and actual sleep duration was less (-2:11 ± 1:27 h:min, p<0.001) than ideal sleep duration. Adolescent athletes are not meeting current sleep duration recommendations and there are significant discrepancies between self-reported current and ideal sleep behaviors in this group.

Structural Alterations in Large-scale Brain Networks and Their Relationship with Sleep Disturbances in the Adolescent Population

Although sleep disturbances are highly prevalent in adolescents, neuroimaging evidence on the effects of sleep disturbances on their developing brains remains limited. Therefore, we explored gray matter volumes (GMVs) at the whole-brain level and investigated their relationship to sleep disturbances in a sample of Korean adolescents in the general population. We recruited participants from one middle school and high school. All participants and their legal guardians gave informed consent before participating in our study. We used component 5 of the Pittsburgh Sleep Quality Index to measure sleep disturbances and conducted a voxel-based morphometry-DARTEL procedure to measure GMVs. We performed partial correlation analyses to examine whether the GMVs were associated with sleep disturbances. A total of 56 adolescents participated in this study. Our results revealed that GMVs in multiple global regions were negatively correlated with sleep disturbances. Moreover, most of these identified regions belong to large-scale brain networks categorized by functional neuroimaging studies. We found an association between regional GMVs in multiple global regions involved in large-scale networks and the severity of sleep disturbances in the adolescent population. Based on this evidence and previous neuroimaging evidence, we suggest that structural alterations in the networks may be linked to sleep disturbances.

The Role of Recreational Online Activities in School-Based Screen Time Sedentary Behaviour Interventions for Adolescents: A Systematic and Critical Literature Review

Sedentary behaviours are highly associated with obesity and other important health outcomes in adolescence. This paper reviews screen time and its role within school-based behavioural interventions targeting adolescents between the years 2007 and 2019. A systematic literature review following PRISMA guidelines was conducted across five major databases to identify interventions targeting screen time—in addition to TV/DVD viewing. The review identified a total of 30 papers analysing 15 studies across 16 countries aiming at addressing reduction of recreational screen time (internet use and gaming) in addition to television/DVD viewing. All of the interventions focused exclusively on behaviour change, targeting in the majority both reduction of sedentary behaviours along with strategies to increase physical activity levels. A mix of intervention effects were found in the reviewed studies. Findings suggest aiming only for reduction in time spent on screen-based behaviour within interventions could be a limited strategy in ameliorating excessive screen use, if not targeted, in parallel, with strategies to address other developmental, contextual and motivational factors that are key components in driving the occurrence and maintenance of adolescent online behaviours. Additionally, it raises the need for a differential treatment and assessment of each online activity within the interventions due to the heterogeneity of the construct of screen time. Recommendations for enhancing the effectiveness of school-based sedentary behaviour interventions and implications for public policy are discussed.

Community, household, and individual correlates of sleep behaviors in Guyanese female youth

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.

The relationship between insomnia symptoms and school performance among 4966 adolescents in Shanghai, China

PURPOSE

Insomnia symptoms are common in adolescents. This study examined the associations of insomnia symptoms with school performance among adolescents in Shanghai, China.

METHODS

A total of 4966 adolescents aged 11-20 years participated in a cross-sectional survey during November of 2009. The Adolescent Sleep Disturbance Questionnaire was used to examine insomnia symptoms, and the Teacher School Achievement Form was applied to evaluate adolescents' school performance.

RESULTS

The results demonstrated that, after adjusting for possible confounders, all 3 dimensions of insomnia symptoms were associated with adolescents' school performance. Difficulty falling asleep problem was associated with poor attention and concentration (odds ratio [OR] = 1.30, 95% confidence interval [CI] 1.11-1.52, P = .001), academic frustration (OR = 1.24, 95% CI: 1.06-1.45, P = .007), and poor school relationships (OR = 1.26, 95% CI: 1.08-1.48, P = .003); maintaining sleep problem was associated with poor attention and concentration (OR = 1.25, 95% CI: 1.06-1.46, P = .007) and poor interest and motivation (OR = 1.22, 95% CI: 1.04-1.44, P = .017); and reinitiating sleep problem was related to poor interest and motivation (OR = 1.20, 95% CI: 1.00-1.45, P = .048). Coexisting insomnia symptoms were associated with poorer school performance, especially in maintaining attention and concentration.

CONCLUSIONS

The findings of this study highlight the importance of sleep in the social and cognitive development of adolescents.

Sleep quality, duration, and consistency are associated with better academic performance in college students

Although numerous survey studies have reported connections between sleep and cognitive function, there remains a lack of quantitative data using objective measures to directly assess the association between sleep and academic performance. In this study, wearable activity trackers were distributed to 100 students in an introductory college chemistry class (88 of whom completed the study), allowing for multiple sleep measures to be correlated with in-class performance on quizzes and midterm examinations. Overall, better quality, longer duration, and greater consistency of sleep correlated with better grades. However, there was no relation between sleep measures on the single night before a test and test performance; instead, sleep duration and quality for the month and the week before a test correlated with better grades. Sleep measures accounted for nearly 25% of the variance in academic performance. These findings provide quantitative, objective evidence that better quality, longer duration, and greater consistency of sleep are strongly associated with better academic performance in college. Gender differences are discussed.

Who benefits from adolescent sleep interventions? Moderators of treatment efficacy in a randomized controlled trial of a cognitive-behavioral and mindfulness-based group sleep intervention for at-risk adolescents

BACKGROUND

The aim of this study was to test moderators of therapeutic improvement in an adolescent cognitive-behavioral and mindfulness-based group sleep intervention. Specifically, we examined whether the effects of the program on postintervention sleep outcomes were dependent on participant gender and/or measures of sleep duration, anxiety, depression, and self-efficacy prior to the interventions.

METHOD

Secondary analysis of a randomized controlled trial conducted with 123 adolescent participants (female = 59.34%; mean age = 14.48 years, range 12.04-16.31 years) who had elevated levels of sleep problems and anxiety symptoms. Participants were randomized into either a group sleep improvement intervention (n = 63) or group active control 'study skills' intervention (n = 60). The sleep intervention ('Sleep SENSE') was cognitive behavioral in approach, incorporating sleep education, sleep hygiene, stimulus control, and cognitive restructuring, but also had added anxiety-reducing, mindfulness, and motivational interviewing elements. Components of the active control intervention ('Study SENSE') included personal organization, persuasive writing, critical reading, referencing, memorization, and note taking. Participants completed the Pittsburgh Sleep Quality Index (PSQI), Spence Children's Anxiety Scale (SCAS), Center for Epidemiologic Studies Depression Scale (CES-D), and General Self-Efficacy Scale (GSE) and wore an actigraph and completed a sleep diary for five school nights prior to the interventions. Sleep assessments were repeated at postintervention. The trial is registered with the Australian New Zealand Clinical Trials Registry (ACTRN12612001177842; http://www.anzctr.org.au/TrialSearch.aspx?searchTxt=ACTRN12612001177842&isBasic=True).

RESULTS

The results showed that compared with the active control intervention, the effect of the sleep intervention on self-reported sleep quality (PSQI global score) at postintervention was statistically significant among adolescents with relatively moderate to high SCAS, CES-D, and GSE prior to the intervention, but not among adolescents with relatively low SCAS, CES-D, and GSE prior to the intervention. The results were consistent across genders. However, the effects of the sleep intervention on actigraphy-measured sleep onset latency and sleep diary-measured sleep efficiency at postintervention were not dependent on actigraphy-measured total sleep time, SCAS, CES-D, or GSE prior to the intervention.

CONCLUSIONS

This study provides evidence that some sleep benefits of adolescent cognitive-behavioral sleep interventions are greatest among those with higher levels of anxiety and depressive symptoms, suggesting that this may be an especially propitious group to whom intervention efforts could be targeted. Furthermore, adolescents with lower levels of self-efficacy may need further targeted support (e.g. additional motivational interviewing) to help them reach treatment goals.

Child Sleep and Socioeconomic Context in the Development of Cognitive Abilities in Early Childhood

Despite a robust literature examining the association between sleep problems and cognitive abilities in childhood, little is known about this association in toddlerhood, a period of rapid cognitive development. The present study examined the association between various sleep problems, using actigraphy, and performance on a standardized test of cognitive abilities, longitudinally across three ages (30, 36, and 42 months) in a large sample of toddlers (N = 493). Results revealed a between-subject effect in which the children who had more delayed sleep schedules on average also showed poorer cognitive abilities on average but did not support a within-subjects effect. Results also showed that delayed sleep explains part of the association between family socioeconomic context and child cognitive abilities.

Verification of effect of sleep health education program in workplace: a quasi-randomized controlled trial

Short sleep duration is a serious problem that not only enhances the risk of various mental and physical disorders, but also affects the productivity in the workplace. However, in terms of studies focused on workers, there are few reports that evaluated sleeping conditions in an objective way. The purpose of this study is to implement sleep health education in the workplace in terms of primary prevention of mental health disorder and then to investigate the subjective and objective effectiveness of the education using self-administered questionnaires (sleep duration, ESS, AIS, PHQ-9, SF-8) and an activity monitor (MTN-210). Study design is a quasi-randomized controlled trial. Sleep health education was provided through three 50-min lectures (total 150 min) as a single cycle for five months in the Intervention group. We obtained baseline data and then six months later. The study analyzed 70 subjects (36 Intervention group, 34 Control group). The weekday sleep duration for the Control group decreased by 12.9 min, whereas that of the Intervention group increased by 14.3 min (difference of 27.2 min), resulting in a significantly increase in score for the Intervention group. The present study suggests that sleep health education may be beneficial for good sleep habits in workers.

What predicts inattention in adolescents? An experience-sampling study comparing chronotype, subjective, and objective sleep parameters

OBJECTIVE

Many adolescents sleep insufficiently, which may negatively affect their functioning during the day. To improve sleep interventions, we need a better understanding of the specific sleep-related parameters that predict poor functioning. We investigated to which extent subjective and objective parameters of sleep in the preceding night (state parameters) and the trait variable chronotype predict daytime inattention as an indicator of poor functioning.

METHODS

We conducted an experience-sampling study over one week with 61 adolescents (30 girls, 31 boys; mean age = 15.5 years, standard deviation = 1.1 years). Participants rated their inattention two times each day (morning, afternoon) on a smartphone. Subjective sleep parameters (feeling rested, positive affect upon awakening) were assessed each morning on the smartphone. Objective sleep parameters (total sleep time, sleep efficiency, wake after sleep onset) were assessed with a permanently worn actigraph. Chronotype was assessed with a self-rated questionnaire at baseline. We tested the effect of subjective and objective state parameters of sleep on daytime inattention, using multilevel multiple regressions. Then, we tested whether the putative effect of the trait parameter chronotype on inattention is mediated through state sleep parameters, again using multilevel regressions.

RESULTS

We found that short sleep time, but no other state sleep parameter, predicted inattention to a small effect. As expected, the trait parameter chronotype also predicted inattention: morningness was associated with less inattention. However, this association was not mediated by state sleep parameters.

CONCLUSIONS

Our results indicate that short sleep time causes inattention in adolescents. Extended sleep time might thus alleviate inattention to some extent. However, it cannot alleviate the effect of being an 'owl'.

Characteristics of sleep in socially vulnerable adolescents

IMPORTANCE

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

OBJECTIVE

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

DESIGN

Cross-sectional and interventional study.

SETTING

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

PARTICIPANTS

125 male and female high school students.

INTERVENTIONS

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

MAIN OUTCOME AND MEASURES

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

RESULTS

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

CONCLUSIONS

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

Sleep duration, quality of life and depression in adolescents: a school-based survey

BACKGROUND

The main objective of this study was to assess the link between sleep duration, quality of life and depression in adolescents. The secondary objective was to study the sleeping behavior of a large sample of adolescents from different socioeconomic backgrounds.

METHODS

Study subjects were high school students studying in or around Paris with a general, vocational or technological training background. A survey was conducted to evaluate the subject's perception of their own sleep, quality of life and depression.

RESULTS

The survey analyzed 855 students between 14 and 19 years of age, with equal numbers of males and females. The average sleep duration was 7 h 14 min ±1 h 20 min and was inversely correlated with age (r=-0.142, P<0.01). Students studying vocational subjects reported significantly more sleep than students studying technological subjects (P=0.02). Univariate analyses revealed a positive relationship between sleep duration and quality of life (r=0.17, P<0.001) and an inverse relationship between sleep duration and depression (r=-0.5, P<0.001). Multivariate analyses identified depression, delayed sleep phase disorder, and medical condition as determinants of sleep duration.

CONCLUSIONS

This investigation of a large student cohort has confirmed that the average sleep duration in adolescents is far below what is recommended. Depression significantly influenced sleep duration. We recommend that a quantitative and qualitative evaluation of sleep should be made during the medical examination of any adolescent.

Sleep habits, academic performance, and the adolescent brain structure

Here we report the first and most robust evidence about how sleep habits are associated with regional brain grey matter volumes and school grade average in early adolescence. Shorter time in bed during weekdays, and later weekend sleeping hours correlate with smaller brain grey matter volumes in frontal, anterior cingulate, and precuneus cortex regions. Poor school grade average associates with later weekend bedtime and smaller grey matter volumes in medial brain regions. The medial prefrontal - anterior cingulate cortex appears most tightly related to the adolescents’ variations in sleep habits, as its volume correlates inversely with both weekend bedtime and wake up time, and also with poor school performance. These findings suggest that sleep habits, notably during the weekends, have an alarming link with both the structure of the adolescent brain and school performance, and thus highlight the need for informed interventions.

Short Blue Light Pulses (30 Min) in the Morning Support a Sleep-Advancing Protocol in a Home Setting

Many people in our modern civilized society sleep later on free days compared to work days. This discrepancy in sleep timing will lead to so-called 'social jetlag' on work days with negative consequences for performance and health. Light therapy in the morning is often proposed as the most effective method to advance the circadian rhythm and sleep phase. However, most studies focus on direct effects on the circadian system and not on posttreatment effects on sleep phase and sleep integrity. In this placebo-controlled home study we investigated if blue light, rather than amber light therapy, can phase shift the sleep phase along with the circadian rhythm with preservation of sleep integrity and performance. We selected 42 participants who suffered from 'social jetlag' on workdays. Participants were randomly assigned to either high-intensity blue light exposure or amber light exposure (placebo) with similar photopic illuminance. The protocol consisted of 14 baseline days without sleep restrictions, 9 treatment days with either 30-min blue light pulses or 30-min amber light pulses in the morning along with a sleep advancing scheme and 7 posttreatment days without sleep restrictions. Melatonin samples were taken at days 1, 7, 14 (baseline), day 23 (effect treatment), and day 30 (posttreatment). Light exposure was recorded continuously. Sleep was monitored through actigraphy. Performance was measured with a reaction time task. As expected, the phase advance of the melatonin rhythm from day 14 to day 23 was significantly larger in the blue light exposure group, compared to the amber light group (84 min ± 51 (SD) and 48 min ± 47 (SD) respectively; t36 = 2.23, p < 0.05). Wake-up time during the posttreatment days was slightly earlier compared to baseline in the blue light group compared to slightly later in the amber light group (-21 min ± 33 (SD) and +12 min ± 33 (SD) respectively; F1,35 = 9.20, p < 0.01). The number of sleep bouts was significantly higher in the amber light group compared to the blue light group during sleep in the treatment period (F1,32 = 4.40, p < 0.05). Performance was significantly worse compared to baseline at all times during (F1,13 = 10.1, p < 0.01) and after amber light treatment (F1,13 = 17.1, p < 0.01), while only in the morning during posttreatment in the blue light condition (F1,10 = 9.8, p < 0.05). The data support the conclusion that blue light was able to compensate for the sleep integrity reduction and to a large extent for the performance decrement that was observed in the amber light condition, both probably as a consequence of the advancing sleep schedule. This study shows that blue light therapy in the morning, applied in a home setting, supports a sleep advancing protocol by phase advancing the circadian rhythm as well as sleep timing.

Sleep health, messaging, headaches, and academic performance in high school students

AIM

We tested for associations of bedtime, sleep duration, instant messaging, and chronic headaches with hypersomnolence and academic performance in a sample of high school students in New Jersey, USA.

METHODS

Students were surveyed anonymously and asked to report their sleep and messaging habits, headache status, and overall grades.

RESULTS

We found that greater hypersomnolence was associated with later bedtimes, shorter sleep durations, and the presence of chronic headaches, but not with messaging after lights out. Also, we found that academic performance was lower in students who messaged after lights out, but it was not affected by headache status, bedtime, or sleep duration.

CONCLUSIONS

These results are consistent with other studies that have demonstrated associations between headaches and hypersomnolence and between instant messaging habits and academic performance. They also add to a growing literature on the relationships among use of electronic devices, sleep health, and academic performance by adolescents.

Circadian Sleep Patterns in Toddlers Born Preterm: Longitudinal Associations with Developmental and Health Concerns

OBJECTIVE

Children born preterm are at elevated risk for several developmental and health concerns. Early sleep patterns may be associated with these concerns. The current study assesses the associations between toddler circadian sleep/activity patterns and later developmental, behavioral, attentional, and health concerns in this at-risk population.

METHOD

We examined circadian sleep/activity patterns at 2 years of age in 99 children born preterm. Child cognitive skills were tested at 3 years of age, and behavior, attention, and health concerns were reported at 3 and 6 years of age. First, sleep/activity data collected via actigraphy were assessed using time series analysis (TSA). For this, we assessed how each child's sleep/activity pattern compared to a specified 24-hour circadian cycle (SCC) with an adjustment for daytime napping. Second, in a series of regression models child sleep/activity parameters from the TSA were assessed with child gender, prematurity, and family sociodemographic assets as covariates.

RESULTS

Toddlers with patterns that closely aligned with the SCC had higher abbreviated intelligence quotient scores at 3 years of age. Additionally, at 6 years these children had a lower risk for illness-related medical visits. Higher toddler average activity level was associated with fewer teacher-reported attention-deficit hyperactivity disorder symptoms and a lower risk for illness-related medical visits.

CONCLUSION

The novel approach used in this study to index child circadian patterns provides a pattern-based analysis of sleep/activity, which may prove to be developmentally consequential. With replication, these findings may help practitioners promote optimal cognitive and health development via circadian sleep supports in infants born preterm.

'Let's Move It' - a school-based multilevel intervention to increase physical activity and reduce sedentary behaviour among older adolescents in vocational secondary schools: a study protocol for a cluster-randomised trial

Background

Physical activity (PA) has been shown to decline during adolescence, and those with lower education have lower levels of activity already at this age, calling for targeted efforts for them. No previous study has demonstrated lasting effects of school-based PA interventions among older adolescents. Furthermore, these interventions have rarely targeted sedentary behaviour (SB) despite its relevance to health. The Let’s Move It trial aims to evaluate the effectiveness and the cost-effectiveness of a school-based, multi-level intervention, on PA and SB, among vocational school students. We hypothesise that the intervention is effective in increasing moderate-to-vigorous-intensity physical activity (MVPA), particularly among those with low or moderate baseline levels, and decreasing SB among all students.

Methods

The design is a cluster-randomised parallel group trial with an internal pilot study. The trial is conducted in six vocational schools in the Helsinki Metropolitan area, Finland. The intervention is carried out in 30 intervention classes, and 27 control classes retain the standard curriculum. The randomisation occurs at school-level to avoid contamination and to aid delivery.

Three of the six schools, randomly allocated, receive the ‘Let’s Move It’ intervention which consists of 1) group sessions and poster campaign targeting students’ autonomous PA motivation and self-regulation skills, 2) sitting reduction in classrooms via alterations in choice architecture and teacher behaviour, and 3) enhancement of PA opportunities in school, home and community environments. At baseline, student participants are blind to group allocation. The trial is carried out in six batches in 2015–2017, with main measurements at pre-intervention baseline, and 2-month and 14-month follow-ups. Primary outcomes are for PA, MVPA measured by accelerometry and self-report, and for SB, sedentary time and breaks in sedentary time (accelerometry).

Key secondary outcomes include measured body composition, self-reported well-being, and psychological variables. Process variables include measures of psychosocial determinants of PA (e.g. autonomous motivation) and use of behaviour change techniques. Process evaluation also includes qualitative interviews. Intervention fidelity is monitored.

Discussion

The study will establish whether the Let’s Move It intervention is effective in increasing PA and reducing SB in vocational school students, and identify key processes explaining the results.

Trial registration

ISRCTN10979479. Registered: 31.12.2015

Electronic supplementary material

The online version of this article (doi:10.1186/s12889-016-3094-x) contains supplementary material, which is available to authorized users.

Gender, Headaches, and Sleep Health in High School Students

BACKGROUND

The effects of gender, headaches, and their interaction on sleep health (sleep duration, sleep onset and continuity, and indications of hypersomnolence) have not been well studied.

MATERIALS AND METHODS

For American adolescents, we contrasted sleep health variables between males (n = 378) and females (n = 372) and between individuals with chronic headaches (n = 102 females and 60 males) and without chronic headaches (n = 270 females and 318 males) using data from surveys.

RESULTS

Not all measures of sleep health differed between groups, but the following patterns were observed for the measures that did differ. Females reported shorter sleep durations on school nights (p = 0.001), increased likelihood of sleepiness on school days (p < 0.05), and higher hypersomnolence scores compared with males (p = 0.005). Individuals with headaches reported shorter sleep durations on weekends (p = 0.009) and higher hypersomnolence scores (p = 0.009) than individuals without headaches. Interestingly, females with headaches reported worse sleep health than females without headaches for multiple measures. Males with headaches did not differ from males without headaches, except for greater waking at night (p = 0.04).

CONCLUSIONS

These results are consistent with other studies of gender-based differences in sleep health and emphasize the importance of recognizing the risk of headache in female adolescents and treating that condition to prevent additional sleep health issues.

Chronotype, gender and general health

BACKGROUND

Light-dark alternation has always been the strongest external circadian "zeitgeber" for humans. Due to its growing technological preference, our society is quickly transforming toward a progressive "eveningness" (E), with consequences on personal circadian preference (chronotype), depending on gender as well. The aim of this study was to review the available evidence of possible relationships between chronotype and gender, with relevance on disturbances that could negatively impact general health, including daily life aspects.

METHODS

Electronic searches of the published literature were performed in the databases MEDLINE and Web of Science, by using the Medical Subject Heading (MeSH), when available, or other specific keywords.

RESULTS

Results were grouped into four general areas, i.e. (a) "General and Cardiovascular Issues", (b) "Psychological and Psychopathological Issues", (c) "Sleep and Sleep-Related Issues" and (d) "School and School-Related Issues". (a) E is associated with unhealthy and dietary habits, smoking and alcohol drinking (in younger subjects) and, in adults, with diabetes and metabolic syndrome; (b) E is associated with impulsivity and anger, depression, anxiety disorders and nightmares (especially in women), risk taking behavior, use of alcohol, coffee and stimulants, psychopathology and personality traits; (c) E has been associated, especially in young subjects, with later bedtime and wake-up time, irregular sleep-wake schedule, subjective poor sleep, school performance and motivation, health-related quality of life; (d) E was associated with lowest mood and lower overall grade point average (especially for women).

CONCLUSIONS

Eveningness may impact general health, either physical or mental, sleep, school results and achievements, especially in younger age and in women. The role of family support is crucial, and parents should be deeply informed that abuse of technological devices during night hours may lead to the immature adjustment function of children's endogenous circadian pacemakers.

Sleep Patterns and Academic Performance During Preparation for College Entrance Exam in Chinese Adolescents

BACKGROUND

Deficient sleep is linked to detrimental outcomes in health and school performance for adolescents. This study characterized sleep patterns in Chinese adolescents preparing for the College Entrance Exam (CEE) and evaluated the association between sleep patterns, self-rated academic performance, and the CEE scores.

METHODS

A sample of 481 Chinese adolescents in 12th grade (ages 16-19 years) completed questionnaires about sleep patterns, academic performance, academic stress, and sociodemographic factors 4-6 weeks before the CEE in June 2013. The CEE scores for each student also were obtained.

RESULTS

A total of 21% of the students had bedtimes after 12:00 am, 78.3% had sleep latency longer than 30 minutes, 14.6% had wake time earlier than 6:00 am, and the vast majority (94.4%) had sleep duration less than 8 hours. After adjusting for selected confounders such as academic stress, prolonged sleep latency was associated with poorer self-reported academic performance, and late bedtime was associated with higher CEE score.

CONCLUSIONS

Our findings highlight the complex association between sleep and academic performance. Assessing and monitoring sleep patterns in adolescents during periods of high academic demand and stress may yield important recommendations for their health and safety as well as establishing optimal sleep and study habits.

Chronotyp und Depression bei Jugendlichen – ein Review

Zusammenfassung. Depressive Erkrankungen gehen mit vielen Symptomen einher, die in Bezug zu einer tageszeitlichen Rhythmik und dem Schlafverhalten stehen. Die vielfältigen Zusammenhänge zwischen Schlaf, Depression und Tagesrhythmik sind nicht eindeutig geklärt. In den Forschungsarbeiten der letzten Jahre kommt dem Chronotyp eine besondere Bedeutung zu. Als biologisches Maß der inneren Uhr kann der Chronotyp – basierend auf Schlafzeiten – mit dem Munich ChronoType Questionnaire (MCTQ) bestimmt werden, als subjektive Präferenz für bestimmte Tageszeiten wird er mit dem Morningness-Eveningness-Questionnaire (MEQ) erfasst. Durch eine systematische Literaturrecherche konnten Studien identifiziert werden, die überwiegend einen Zusammenhang zwischen einem späten Chronotyp und depressiven Symptomen und depressiven Störungen zeigen. Dies ist besonders für Jugendliche relevant, da sich der Chronotyp zur Adoleszenz hin stark verändert. Bisher ist nicht geklärt, was am Zusammenhang zwischen Chronotyp und depressiver Störung Ursache und Wirkung ist und welche Faktoren als Moderator oder Mediator fungieren. Möglicherweise ist der Zusammenhang bidirektional: Einerseits ziehen sich Patienten mit depressiven Störungen häufig zurück und sind weniger Tageslicht ausgesetzt, was ihren Chronotyp später werden lässt. Andererseits führt eine Diskrepanz von Innenzeit (festgelegt durch die innere Uhr) und Außenzeit (z. B. durch Schul- und Arbeitszeiten) zu Problemen wie einer verringerten Schlafqualität und schlechteren Schulnoten, die wiederum im Zusammenhang mit Depressivität stehen können.

Eveningness relates to burnout and seasonal sleep and mood problems among young adults

AIMS

Diurnal preference towards eveningness among adults has been associated with unhealthy habits and a range of health hazards, such as sleeping problems and higher odds for depression. We wanted to analyse whether diurnal preference towards eveningness is associated with more severe symptoms regarding sleep problems and mental disorders among young adults.

METHODS

Our sample consists of 469 young adults, aged 18-29 years, from the Mental Health in Early Adulthood Study in Finland (MEAF) conducted in 2003-2005. Chronotype was based on the assessment of one question that was asked first in 2000-2001 and the second time in 2003-2005. Those 73 participants who changed their chronotype were excluded from the main analysis, but separate analyses were performed with this group.

RESULTS

Concerning sleep, E-types reported higher dependency on alarm clocks (p < 0.001), and E-types and I-types had more problems in feeling refreshed after waking up (p < 0.0001 and p < 0.05 respectively) than M-types. Regarding mental health, E-types and I-types had lower odds for any lifetime DSM-IV Axis I disorder (p < 0.05 and p < 0.01 respectively) than M-types.

CONCLUSIONS

Our results are in line with previous findings that those with the diurnal preference towards eveningness have more frequently three or more lifetime mental disorders, more sleeping problems, more seasonal variation in mood and behaviour, and more burnout compared with those with the diurnal preference towards morningness.

Insomnia in childhood and adolescence: clinical aspects, diagnosis, and therapeutic approach

OBJECTIVES

To review the clinical characteristics, comorbidities, and management of insomnia in childhood and adolescence.

SOURCES

This was a non-systematic literature review carried out in the PubMed database, from where articles published in the last five years were selected, using the key word "insomnia" and the pediatric age group filter. Additionally, the study also included articles and classic textbooks of the literature on the subject.

DATA SYNTHESIS

During childhood, there is a predominance of behavioral insomnia as a form of sleep-onset association disorder (SOAD) and/or limit-setting sleep disorder. Adolescent insomnia is more associated with sleep hygiene problems and delayed sleep phase. Psychiatric (anxiety, depression) or neurodevelopmental disorders (attention deficit disorder, autism, epilepsy) frequently occur in association with or as a comorbidity of insomnia.

CONCLUSIONS

Insomnia complaints in children and adolescents should be taken into account and appropriately investigated by the pediatrician, considering the association with several comorbidities, which must also be diagnosed. The main causes of insomnia and triggering factors vary according to age and development level. The therapeutic approach must include sleep hygiene and behavioral techniques and, in individual cases, pharmacological treatment.

Girls and boys gambling with health and well-being in Finland

BACKGROUND

The aim of this study was to examine the associations among gambling frequency, health status, health risk behavior, and sexual risk-taking among eighth and ninth grade boys and girls (N = 101,167).

METHODS

Data were obtained from the nationwide School Health Promotion Study conducted in Finland 2010 and 2011. Outcome measures were adolescents' health and sexual behavior. Associations with gambling frequency were studied separately for boys and girls using polychotomous logistic regression models where grade level was adjusted.

RESULTS

Approximately 62% of adolescents had gambled during the previous year. Gambling was more common among boys than girls in both grade levels. Gambling frequency was associated with several health and sexual risk-taking indicators such as signs of school burnout, staying up late, and having more than 1 sexual partner. Those who gambled the most had a higher risk for poorer health and taking health risks. Girls and those who had gambled on a weekly basis were the most vulnerable groups.

CONCLUSIONS

It would be beneficial to raise teacher, parent, and adolescent awareness of the wide range of negative health outcomes and risks associated with gambling.

Trends in self-reported sleep problems, tiredness and related school performance among Finnish adolescents from 1984 to 2011

The aim of this study was to investigate long-term trends in insomnia symptoms, tiredness and school performance among Finnish adolescents. A time-series from 1984 to 2011 was analysed from two large-scale survey studies, the Finnish School Health Promotion Study and the Health Behavior in School-Aged Children study. A total of 1,136,583 adolescents aged 11-18 years answered a standardized questionnaire assessing frequency of insomnia symptoms, tiredness and school performance. A clear approximately twofold increasing trend in insomnia symptoms and tiredness was found from the mid-1990s to the end of the 2000s. The increase was evident in all participating age groups and in both genders. After 2008, the increase seems to have stopped. Insomnia symptoms and tiredness were associated with lower school performance and they were more prevalent among girls (11.9 and 18.4%) compared to boys (6.9 and 9.0%, respectively). Unexpectedly, we also observed an increasingly widening gap in school performance between normally vigilant and chronically tired pupils. The underlying causes of these phenomena are unknown, but may concern changes in the broader society. The observed recent increasing trend in adolescents' sleep problems is worrisome: poor sleep quality has also been suggested to associate with clinical or subclinical mood or anxiety disorders and behavioural problems and predispose to sleep and psychiatric disorders later in life. Our results justify further studies and call for serious attention to be paid to adolescent's sleep in the Finnish educational system and society at large.

Sleep duration in Chinese adolescents: biological, environmental, and behavioral predictors

OBJECTIVE

To examine sleep duration-related risk factors from multidimensional domains among Chinese adolescents.

METHODS

A random sample of 4801 adolescents aged 11-20 years participated in a cross-sectional survey. A self-reported questionnaire was used to collect information about the adolescents' sleep behaviors and possible related factors from eight domains.

RESULTS

In all, 51.0% and 9.8% of adolescents did not achieve optimal sleep duration (defined as <8.0 h per day) on weekdays and on weekends, respectively. According to multivariate logistic regression models, after adjusting for all possible confounders, 17 factors were associated with sleep duration <8 h. Specifically, 13 factors from five domains were linked to physical and psychosocial condition, environment, and behaviors. These factors were overweight/obesity, chronic pain, bedtime anxiety/excitement/depression, bed/room sharing, school starting time earlier than 07:00, cram school learning, more time spent on homework on weekdays, television viewing ≥ 2 h/day, physical activity <1 h/day, irregular bedtime, and shorter sleep duration of father.

CONCLUSION

Biological and psychosocial conditions, sleep environments, school schedules, daily activity and behaviors, and parents' sleep habits significantly may affect adolescents' sleep duration, indicating that the existing chronic sleep loss in adolescents could be, at least partly, intervened by improving adolescents' physical and psychosocial conditions, controlling visual screen exposure, regulating school schedules, improving sleep hygiene and daytime behaviors, and changing parents' sleep habits.