Sleep Disorders in Early Childhood and the Development of Mental Health Problems in Adolescents: A Systematic Review of Longitudinal and Prospective Studies

Toddler Screen Use Before Bed and Its Effect on Sleep and Attention: A Randomized Clinical Trial

Importance

Toddler screen time has been associated with poorer sleep and differences in attention. Understanding the causal impact of screen time on early development is of the highest importance.

Objective

To test (1) the feasibility of the 7-week parent-administered screen time intervention (PASTI) in toddlers (aged 16-30 months) who have screen time in the hour before bed and (2) the impact of PASTI on toddlers' sleep and attention.

Design, Setting, and Participants

This assessor-blinded, UK-based randomized clinical trial was conducted between July 2022 and July 2023. This was a single-site study that enrolled families with a toddler aged between 16 and 30 months, living within 75 miles of the Babylab, and with 10 minutes or more of screen time in the hour before bed on 3 or more days a week. Exclusion criteria were (1) a genetic or neurological condition, (2) premature birth (<37 weeks), and (3) current participation in another study.

Interventions

Families were randomized (1:1:1) to (1) PASTI: caregivers removed toddler screen time in the hour before bed and used activities from a bedtime box instead (eg, reading, puzzles); (2) bedtime box (BB only): used matched before-bed activities, with no mention of screen time; or (3) no intervention (NI): continued as usual.

Main Outcomes and Measures

Feasibility outcomes: participation rate, intervention adherence, retention, family experiences, and assessment acceptability. Efficacy outcomes: screen use, actigraphy-measured sleep, and eye-tracking attention measures.

Results

A total of 427 families were screened, 164 were eligible (38.4%), and 105 families were randomized (mean [SD] age, 23.7 [4.6] months; 60 male [57%]). The trial was feasible, with 99% participant (104 of 105) retention and 94% of families (33 of 35) adhering to PASTI. PASTI showed reductions in parent-reported screen time (vs NI: Cohen d = -0.96; 95% CI, -1.32 to -0.60; vs BB only: Cohen d = -0.65; 95% CI, -1.03 to -0.27). PASTI showed small to medium improvements in objectively measured sleep efficiency (vs NI: Cohen d = 0.27; 95% CI, -0.11 to 0.66; vs BB only: Cohen d = 0.56; 95% CI, 0.17-0.96), night awakenings (vs NI: Cohen d = -0.28; 95% CI, -0.67 to 0.12; vs BB only: Cohen d = -0.31; 95% CI, -0.71 to 0.10), and reduced daytime sleep (vs NI: Cohen d = -0.30; 95% CI, -0.74 to 0.13) but no difference compared with BB only. There was no observable effect of PASTI on objective measures of attention. Compared with BB only, PASTI showed a difference on parent-reported effortful control (Cohen d = -0.40; 95% CI, -0.75 to -0.05) and inhibitory control (Cohen d = -0.48; 95% CI, -0.77 to -0.19), due to an increase in BB-only scores.

Conclusions and Relevance

Results of this randomized clinical trial show that, supporting pediatric recommendations, removing screen time before toddler bedtime was feasible and showed modest preliminary beneficial effects on sleep. A future full confirmatory trial is needed before PASTI's adoption by parents and pediatricians.

Trial Registration

ISRCTN.org Identifier: ISRCTN58249751.

Trajectories of sleep problems and the longitudinal associations with mental health difficulties among Chinese adolescents

OBJECTIVE

Growing research highlights the negative impact of sleep problems on adolescent mental health. However, the developmental trajectory of sleep problems during adolescence and their relationship with mental health difficulties, including both internalizing and externalizing symptoms, remain unclear. Additionally, the direction of the effects between sleep problems and mental health difficulties is not well established. This study aims to identify the developmental trajectories of sleep problems and examine their association with mental health difficulties in both internalizing and externalizing domains.

METHOD

The study involved 1,281 Chinese middle school students (645 males, mean age at initial assessment = 12.73, SD = 0.68). Data were collected at four time points (T1, T2, T3, T4) over approximately 6-month intervals, spanning from the first semester of seventh grade to the second semester of 8th grade.

RESULTS

Latent growth modeling revealed an overall increasing trend in sleep problems. Parallel latent growth modeling indicated that trajectories of sleep problems were positively related to the developmental trends of mental health difficulties, as shown by intercept-intercept and slope-slope associations. The cross-lagged panel model demonstrated significant bidirectional associations between sleep problems and internalizing symptoms. In contrast, we observed unidirectional associations between sleep problems and externalizing symptoms. Hence, sleep problems were a significant predictor of subsequent externalizing symptoms, with no significant reverse effect observed.

CONCLUSION

These findings suggest that future research should explore whether interventions targeting sleep problems can reduce the incidence of both internalizing and externalizing symptoms. Additionally, interventions aimed at internalizing symptoms may potentially improve adolescent sleep, while those targeting externalizing symptoms may not have the same effect.

Medical practitioners' experiences and considerations when managing sleep medication for adolescents and young adults

INTRODUCTION

The prevalence of sleep disorders and use of sleep medication, particularly melatonin, are rising among adolescents and young adults (13-24 years). In Denmark, melatonin is approved for use in children with autism and ADHD up to 18 years of age, with other prescriptions being off-label in these age groups. The perspectives of medical practitioners on prescribing sleep medications to this age group remain largely unexplored.

AIM

This study aims to investigate the considerations of general practitioners (GPs) and child and adolescent psychiatrists (psychiatrists) when prescribing and deprescribing sleep medications for 13-24-year-olds.

METHODS

We conducted qualitative semi-structured interviews with 10 GPs and six psychiatrists. Data were analyzed using an inductive approach.

RESULTS

Psychiatrists typically prescribed melatonin with the expectation that deprescription would occur in general practice. Despite the universal goal of deprescription, it was hindered by various challenges. GPs identified patient motivation and a clear focus on deprescription as facilitative factors and expressed a need for enhanced emphasis on these aspects in general practice.

DISCUSSION AND IMPLICATIONS

The findings align with existing prescription trends and literature on factors that promote and inhibit deprescription. The study underscores the complexities of deprescribing sleep medications for adolescents and young adults, suggesting the need for expanded guidelines and enhanced continuing education for GPs.

CONCLUSIONS

The research highlights significant discrepancies among medical practitioners regarding the deprescription process of sleep medications for young individuals, complicated by multiple factors. This underscores the need for better guidelines and further studies.

Obstructive Sleep Apnea and Mental Health Disorders in the Pediatric Population: A Retrospective, Population-based Cohort Study

Rationale: Information is limited about the association between obstructive sleep apnea (OSA) and mental health disorders in children. Objectives: In children, 1) to evaluate the association between OSA and new mental healthcare encounters; and 2) to compare mental healthcare encounters 2 years after to 2 years before OSA treatment initiation. Methods: We conducted a retrospective longitudinal cohort study using Ontario health administrative data (Canada). Children (0-18 yr) who underwent diagnostic polysomnography (PSG) 2009-2016 and met criteria for definition of moderate-severe OSA (PSG-OSA) were propensity score weighted by baseline characteristics and compared with children who underwent PSG in the same period but did not meet the OSA definition (PSG-No-OSA). Children were followed until March 2021. Weighted cause-specific Cox proportional hazards and modified Poisson regression models were used to compare time from PSG to first mental healthcare encounter and frequency of new mental healthcare encounters per person time, respectively. Among those who underwent adenotonsillectomy (AT) or were prescribed and claimed positive airway pressure therapy (PAP), we used age-adjusted conditional logistic regression models to compare 2 years post-treatment to pretreatment odds of mental healthcare encounters. Results: Of 32,791 children analyzed, 7,724 (23.6%) children met criteria for moderate-severe OSA. In the PSG-OSA group, 7,080 (91.7%) were treated (AT or PAP). Compared with PSG-No-OSA, the PSG-OSA group had a shorter time from PSG to first mental healthcare encounter (hazard ratio, 1.08; 95% confidence interval [CI], 1.05-1.12) but less frequent mental healthcare encounters in follow-up (rate ratio, 0.92; 95% CI, 0.87-0.97). OSA treatment (AT or PAP) was associated with lower odds of mental healthcare encounters 2 years after treatment initiation compared with 2 years before (odds ratio, 0.69; 95% CI, 0.65-0.74). Conclusions: In this large, population-based study of children who underwent PSG for sleep disorder assessment, OSA diagnosis/treatment was associated with an improvement in some mental health indicators, such as fewer new mental healthcare encounters compared with no OSA and lower odds of mental healthcare encounters compared with before OSA treatment.

Prevalence and Characteristics of Sleep Disorders in Children Aged 7-17: Insights from Parental Observations at the Dental Office

Sleep disorders (SD) in children is a topic of great relevance due to their impact on a child's general health. This has led us to study their prevalence and the factors that disturb them in the developing population. Using a validated Likert-type questionnaire, different behaviors observed by the parents during the different phases of their children's sleep were evaluated during the last 6 months. A total of 206 children between the ages of 7 and 17 who attended a dental office participated in the study. The prevalence of SD was 47.6%. There were no significant differences regarding the SD in relation to sex (p = 0.796). The mean total score for children aged 7 to 11 years old was 42.3 (±14.25) compared to 45.44 (±15.51) for the group consisting of children aged 12 to 17 years old, reporting a statistically significant difference among both age groups (p = 0.01). The most frequent disorder was related to initiating and maintaining sleep (64.9%) while the least prevalent were the respiratory sleep disorders (27.2%). Given the high prevalence of these disorders, it is necessary to intercept them during childhood and establish educational guidelines in this regard throughout primary care.

Early childhood sleep quantity, but not caregiver-reported sleep problems, predicts impulse control in children at age 8 years

Short duration of sleep and poor sleep quality have been linked to poor attention and impulse control in children. We aimed to determine the longitudinal predictive value of sleep quantity and quality during early childhood on objective and caregiver-report measures of attention, impulse control, and executive function in children at age 8 years. We used data from the Health Outcomes and Measures of the Environment (HOME) Study, a pregnancy and birth cohort. Caregivers reported on their child's sleep at ages 2, 2.5, 3, 4, and 5 years. Analysis included 410 participants. We used longitudinal growth curve models of early childhood sleep patterns to predict neurobehavioral functioning at age 8 years. Sleep problems did not predict any of our outcome measures at age 8 years. Sleep duration trended shorter as children matured, so predictive models examined both intercept and slope. Children with the least decline in sleep duration across early childhood had fewer impulsive errors at age 8 years on a continuous performance test (unadjusted p = .013; adjusted p = .013). Children with shorter duration of sleep across early childhood had worse caregiver-reported behavioral regulation at age 8 years (unadjusted p = .002; adjusted p = .043). Neither sleep duration slope nor intercept predicted inattention or metacognitive skills at age 8 years (p > .05). Total sleep time across early childhood predicts behavior regulation difficulties in school-aged children. Inadequate sleep during early childhood may be a marker for, or contribute to, poor development of a child's self-regulatory skills.

[Relationship between diet, nutritional aspects and sleep quality in a pediatric population]

Introduction

The relationship between diet and sleep has been studied in adults. However, there is little evidence in the pediatric population. The objective of this review was to analyze in a narrative way the relationship between diet, some nutritional aspects and sleep quality in population under 14 years. A quick review was performed in MEDLINE (PubMed) and Cochrane with a search strategy combining MeSH terms and keywords. Studies were selected to estimate diet and evaluate nutritional status and sleep in children using different tools. The risk of bias from the 14 selected studies was determined with validated tools (AMSTAR 2, Newcastle Ottawa scale [NOS] and Risk of Bias [Rob2]). Adherence to some dietary patterns such as the Mediterranean, high consumption of fruits and vegetables, tryptophan intake or substitution of saturated fatty acids by unsaturated fats were associated with better sleep quality. The consumption of ultra-processed products, the "unhealthy fast food" or the high intake of simple sugars hinder an adequate rest. On the other hand, an association between a high body mass index and lack of sleep was observed in young people under 14. In conclusion, the collected studies showed a significant association between some dietary patterns, food groups and nutrients with sleep quality. "Unhealthy" dietary factors were associated with poorer sleep quality. However, healthier and recommended habits and diets were associated with improved sleep hygiene. On the other hand, the lack of hours of rest in the youth population increases height, weight and BMI. Further research is needed in this direction.

Prevalence and correlates of sleep disturbance among adolescents in the eastern seaboard of China

BACKGROUND

Sleep disturbances are serious public health issues that warrant increased attention, especially in adolescents. The aim of this study was to investigate the prevalence and factors associated with sleep disorders among urban adolescents in China.

METHODS

This study utilized an online survey to assess the demographic characteristics and mental health status of secondary school students in Lianyungang City. The Patient Health Questionnaire-9 (PHQ-9) was used to evaluate sleep disturbances in adolescents. The seven-item Generalized Anxiety Disorder (GAD-7) assessed anxiety symptoms, and the Perceived Social Support Scale (PSSS) was used to measure perceived social support.

RESULTS

Among 3443 adolescents, the prevalence of sleep disorders were 10.8%, with significantly higher proportions of sleep disorders (13.7% VS 8.3%, P < 0.001) among female adolescents when compared to males. Binary regression analysis revealed that anxiety symptoms (OR = 1.305, 95% CI: 1.269-1.342, P < 0.001) was risk factor for sleep disturbances, and significant other support (OR = 0.944, 95% CI: 0.896-0.994, P = 0.028) and good annual household income (OR = 0.616, 95% CI: 0.394-0.963, P = 0.034) were protective factors. Furthermore, multinomial logistic regression analysis showed that age, sex, and anxiety symptoms were associated with an elevated risk of experiencing more frequent sleep disturbances (all P < 0.05).

CONCLUSIONS

We have found that 10.8% of adolescents experience sleep disorders, and it is evident that various factors can influence healthy sleeping. These results underscore the significance of addressing these factors to enhance sleep health among this population.

Longitudinal study of childhood sleep trajectories and adolescent mental health problems

Study Objective

To investigate whether childhood sleep trajectories are associated with mental health symptoms such as social phobia, generalized anxiety, depression, attention deficit hyperactivity disorder (ADHD), conduct problems, and opposition at age 15.

Methods

A total of 2120 children took part in the Quebec Longitudinal Study of Child Development. Childhood sleep trajectories were computed from maternal reports at 2.5, 3.5, 4, 6, 8, 10, and/or 12 years. At age 15, 1446 adolescents filled out mental health and sleep questions. A path analysis model was assessed in the full sample.

Results

Four childhood nocturnal sleep duration trajectories were identified: (1) a short pattern (7.5%), (2) a short-increasing pattern (5.8%), (3) a 10 hours pattern (50.7%), and (4) an 11 hours pattern (36.0%). Three childhood sleep latency trajectories were found: (1) a short pattern (31.7%), (2) an intermediate pattern (59.9%), and (3) a long pattern (8.4%). Finally, two childhood wakefulness after sleep-onset trajectories were found: (1) a normative pattern (73.0%) and (2) a long pattern (27.0%). The path analysis model indicated that children following a long childhood sleep latency trajectory were more likely to experience symptoms of depression (β = 0.06, 95% CI: 0.01 to 0.12), ADHD (β = 0.07, 95% CI: 0.02 to 0.13), conduct problems (β = 0.05, 95% CI: 0.00 to 0.10) and opposition (β = 0.08, 95% CI: 0.02 to 0.13) at age 15.

Conclusions

This longitudinal study revealed that children presenting a long sleep latency throughout childhood are at greater risk of symptoms of depression, ADHD, conduct problems, and opposition in adolescence.

The association of obstructive sleep apnea and behavioral insomnia in children ages 10 and under

STUDY OBJECTIVES

Behavioral insomnia of childhood (BIC) and obstructive sleep apnea (OSA) are highly prevalent conditions affecting 10%-20% and 1%-5% of children, respectively. Studies in adults and adolescents have suggested that comorbid insomnia and OSA may have distinct clinical characteristics. The association between the two conditions in the pediatric population has not been thoroughly investigated. This study aimed to examine the association between BIC and OSA in young children.

METHODS

Children, 6 months to 10 years old, referred to a sleep specialist and polysomnography at the Hadassah Medical Center between 2018 and 2021 were included in this retrospective analysis. We excluded children with chromosomal and craniofacial abnormalities, posttonsillectomy, or neurological impairment. BIC diagnosis was extracted from the electronic health records in accordance with the International Classification of Sleep Disorders, third edition criteria. OSA was diagnosed by polysomnography (apnea-hypopnea index > 2 events/h).

RESULTS

Of 312 children (age 4.42 ± 2.42 years), 126 (40.4%) were non-OSA non-BIC, 125 (40.1%) OSA non-BIC, 34 (10.9%) BIC non-OSA, and 27 (8.7%) comorbid insomnia and OSA. OSA and non-OSA children had a similar prevalence of BIC. Children in the comorbid insomnia and OSA group were significantly younger (2.22 ± 1.21 years). Younger age at polysomnography, premature birth, and increased periodic leg movements on polysomnography were independently associated with OSA in a multivariable analysis. Lower body mass index, regardless of OSA, was associated with BIC.

CONCLUSIONS

Current findings do not support an association between behavioral insomnia of childhood and obstructive sleep apnea in children. Healthcare providers should consider each of these sleep disorders in children presenting with sleep difficulties since each has distinct diagnostic and therapeutic options.

CITATION

Yelov L, Reiter J, Meira E Cruz M, Gileles-Hillel A. The association of obstructive sleep apnea and behavioral insomnia in children ages 10 and under. J Clin Sleep Med. 2024;20(2):245-251.

Mapping insomnia symptoms and circadian preferences to mental health problems in men and women across the lifespan

This study identified subgroups in the general population based on combinations in three night-time insomnia symptoms and four dimensions of circadian preferences ("sleep profiles") and investigated the associations between sleep profiles and nine common mental health problems. The data came from the Lifelines cohort add-on study "Comorbid Conditions of ADHD" and included 37,716 individuals (aged 4-91 years) from the Dutch general population who completed a digital survey. Latent profile analysis was used to identify sleep profiles in twelve age-sex subgroups. Linear regression was used to investigate whether sleep profiles differ in mental health problems. Participants were classified into three sleep profiles: "Healthy Larks", who had early circadian preferences and no insomnia symptoms; "Sleepy Owls" with late circadian preferences and nonrestorative sleep; and "Sleepless Doves" with intermediate circadian preferences and severe insomnia symptoms. Compared to "Healthy Larks", all mental health problems were significantly more severe in "Sleepy Owls" and even worse in "Sleepless Doves". These associations were similar in men and women but weakened with age. However, "Sleepy Owls" and "Sleepless Doves" did not differ in heavy alcohol drinking, drug use, and smoking. Our findings strengthened the evidence for the universal role of healthy sleep in mental wellbeing.

Association between early childhood sleep difficulties and subsequent psychiatric illness

STUDY OBJECTIVES

Chronic disruptions to sleep in childhood are associated with increased prevalence of psychiatric disease later in development. When sleep disruptions remit before adolescence, the increased prevalence of psychiatric disease is no longer observed, highlighting the importance of early detection and intervention. Clinicians typically rely on caregivers' reports for diagnosis and management of childhood sleep challenges. We examined whether findings on polysomnogram (PSG) can offer similar insight into childhood sleep difficulties and the risk of subsequent psychiatric illness.

METHODS

A cohort was identified of 348 children ages 5 years 11 months and younger with sleep difficulties rising to the level of formal clinical workup. A retrospective review of caregiver-reported sleep concerns, PSG results, and subsequent psychiatric illness was completed. PSG findings were compared to presence of psychiatric illness later in life as well as caregivers' reported concerns. Chi-squared and Fisher's exact tests were completed to evaluate correlations and Cohen's kappa was used to evaluate agreement.

RESULTS

With only a few exceptions, comparisons between clinician findings on PSG and subsequent psychiatric diagnoses were statistically nonsignificant. Similarly, the relationship between caregivers' subjective reports about sleep and clinicians' findings on PSG demonstrated only slight to fair agreement, suggesting reported concerns were not predictive of PSG results.

CONCLUSIONS

Parental reports of subjective sleep concerns are indicative of different sleep pathologies compared to sleep pathologies detected on PSG. The addition of PSG to caregiver-reported data appears to have limited clinical utility in understanding sleep concerns associated with the risk of subsequent psychiatric illness in young children.

CITATION

Pease E, Shekunov J, Savitz ST, et al. Association between early childhood sleep difficulties and subsequent psychiatric illness. J Clin Sleep Med. 2023;19(12):2059-2063.

A bibliometric analysis of insomnia in adolescent

Background

The negative effects of insomnia on adolescents' development, academic performance, and quality of life place a burden on families, schools, and society. As one of the most important research directions for insomnia, adolescent insomnia has significant research value, social value, and practical significance. Unfortunately, there is no bibliometric analysis in this field of study. This study aims to analyze published articles using bibliometrics, summarize the current research progress and hot topics in this field systematically and exhaustively, and predict the future direction and trend of research.

Methods

For this study, the Web of Science Core Collection (WoSCC) database was searched between 2002 and 2022 for publications related to adolescent insomnia. The R-bibliometrix, VOSViewer, and CiteSpace software were utilized for bibliometric analysis.

Results

This investigation included 2468 publications from 3102 institutions in 87 countries, led by China and the United States. This field of research has entered a period of rapid development since 2017. The journal with the most publications on adolescent insomnia is Sleep, which is also the most co-cited journal. American Journal of Psychology has the highest impact factor among the top 10 journals. These papers were written by 10605 authors; notably, Liu Xianchen emerged as the author with the highest frequency of publications, while Mary A. Carskadon was the most frequently co-cited author. Mental health and comorbid diseases were the main research directions in this field. "Depression," "anxiety," "mental health," "COVID-19," "stress," "quality of life," "heart rate variability," and "attention-deficit hyperactivity disorder" were hot spots and trends in this field at the current moment.

Conclusion

The research on adolescent insomnia has social value, research value, and research potential; its development is accelerating, and an increasing number of researchers are focusing on it. This study summarized and analyzed the development process, hot spots, and trends of adolescent insomnia research using bibliometric analysis, which identified the current hot topics in this field and predicted the development trend for the future.

Prevalence of Mental Health Problems, Associated Factors, and Health-Related Quality of Life in Children with Long-Gap Esophageal Atresia in Sweden

BACKGROUND

Children with long-gap esophageal atresia (LGEA) face a high risk of digestive and respiratory morbidity, but their mental health outcomes have not been investigated. We aimed to identify the prevalence of mental health problems in children with LGEA, associated factors and health-related quality of life (HRQOL).

METHODS

Twenty-six children with LGEA aged 3-17 were recruited nationwide in Sweden. One of their parents and adolescents aged 11-17 completed information on the child's mental health (Strength and Difficulties Questionnaire), generic (PedsQL 4.0) and condition-specific HRQOL (EA-QOL). Parents gave information on current child symptomatology. Mental health level was determined using validated norms; abnormal≥90 percentile/borderline≥80 percentile/normal. Elevated levels were considered borderline/abnormal. Data were analyzed using descriptives, correlation and Mann-Whitney-U test. Significance level was p < 0.05.

RESULTS

Twelve children with LGEA aged 3-17 (46%) had elevated scores of ≥1 mental health domain in parent-reports, whereas 2 adolescents (15%) in self-reports. In parent-reports, 31% of the children had elevated levels of peer relationship problems, with associated factors being child sex male (p = 0.037), airway infections (p = 0.002) and disturbed night sleep (p = 0.025). Similarly, 31% showed elevated levels of hyperactivity/inattention, and associated factors were male sex (p = 0.005), asthma (p = 0.028) and disturbed night sleep (p = 0.036). Elevated levels of emotional symptoms, seen in 20%, were related to swallowing difficulties (p = 0.038) and vomiting problems (p = 0.045). Mental health problems correlated negatively with many HRQOL domains (p < 0.05).

CONCLUSIONS

Children with LGEA risk mental health difficulties according to parent-reports, especially peer relationship problems and hyperactivity/inattention, with main risk factors being male sex, airway problems and sleep disturbances. This should be considered in follow-up care and research, particularly since their mental health problems may impair HRQOL.

LEVELS OF EVIDENCE

Prognosis study, LEVEL II.

The Relationship between Sleep, Chronotype, and Dental Caries-A Narrative Review

This article provides an overview of how sleep and circadian rhythm disturbances mutually influence the occurrence of dental caries and how it is possible to reduce the risk of circadian rhythm disturbances, sleep, and associated adverse effects. Dental caries is a global problem worldwide that contributes to sociological limitations. Numerous factors influence the occurrence of dental caries, from socioeconomic factors to cariogenic bacteria, dietary habits, and oral hygiene. However, sleep disorders and circadian rhythm disturbances represent a new approach in the fight against the increasing prevalence of dental caries worldwide. Bacteria in the oral cavity and the oral microbiome are mainly responsible for the development of caries, and saliva plays an important role in their regulation. The circadian rhythm regulates numerous physiological functions, including sleep and saliva production. Disturbances in sleep and circadian rhythms affect saliva production, which impacts the development of dental caries, as saliva is necessary for regulating and maintaining oral health, especially for controlling oral infections. A person's preference for a particular time of day depends on the circadian rhythm called chronotype. Individuals with an evening chronotype have a less healthy lifestyle that can lead to a higher caries risk than individuals with a morning chronotype. Because circadian rhythms are critical to maintaining sleep homeostasis and oral health, sleep disturbances can disrupt circadian rhythms and lead to a vicious cycle.

Relating parental stress with sleep disorders in parents and children

OBJECTIVE

To assess whether child sleep disorders positively correlate with parental insomnia, hypersomnia, and sleep apnea, and whether parental and child sleep disorders simultaneously positively associate with parental stress. Potential modifying influences of these associations by age, sex, and marital status will be considered.

METHODS

Analyses are based on 14,009 employees aged 18-64 with dependent children (n = 44,157) insured by Deseret Mutual Benefit Administrator (DMBA) in 2020. Rate ratios are adjusted for age, sex, and marital status.

RESULTS

The rate of parental stress is 3.00 (95% CI 2.33-4.85) times greater for those with insomnia and 1.88 (95% CI 1.59-2.22) times greater for those with sleep apnea. There is no increased risk of stress for those with hypersomnia. The number of dependent children filing one or more medical claims for a sleep disorder is 2.0%. Mean age is significantly older among those with a sleep disorder (17.1 vs. 14.4, t p < .0001). Child sex is not associated with the risk of having a sleep disorder. The rate of employee insomnia is 111% greater if their child has a sleep disorder, and employee sleep apnea is 115% greater if their child has a sleep disorder. The association between child sleep disorders and sleep apnea decreases with employee age (Wald chi-square p = 0.0410). The rate of employee stress is 90% greater if their child has a sleep disorder, 189% greater if they have insomnia, and 81% greater if they have sleep apnea. The strength of the association between insomnia and stress is greater for women (Wald Chi-square p = 0.0114), between sleep apnea and stress is greater for women (Wald chi-square p = 0.0010), and between sleep apnea and stress is greater for singles (Wald chi-square p = 0.0010).

CONCLUSIONS

Better understanding the connection between parent and child sleep problems and parent stress, and modifying influences, may improve treatment of these disorders.

The Effect of Learning Burnout on Sleep Quality in Primary School Students: The Mediating Role of Mental Health

Due to the growth of research on sleep, mental health, and learning burnout on healthy growth and its related public health significance of adolescents, this study aimed to provide a deeper understanding of the effect of mental health and learning burnout on sleep among primary school students. The sleep quality (subjective sleep quality, sleep time, sleep latency, sleep duration, sleep efficiency, sleep disturbance, and daytime dysfunction), mental health, and learning burnout (exhaustion, learning cynicism, and reduced efficacy) of 900 students of grades 3–6 in primary schools were assessed in 2020. The PSQI scores of participants were 4.19 ± 2.545, of which a number of 322 (39.03%) students had sleep disturbance (PSQI scores ≧ 5). Binary logistic regression analysis showed that screen time (OR = 1.518, 95% CI: 1.164–1.980), ranking status (OR = 0.659, 95% CI: 0.480–0.907), learning burnout (OR = 1.088, 95% CI: 1.067–1.108), and mental health (OR = 4.672, 95% CI: 1.954–11.173) were the influencing factors for sleep quality of grade 3–6 students. According to the mediation effect analyses, mental health played a mediating effect (58.73% of the total effect) on the relationship between learning burnout and sleep quality. In conclusion, primary school students in Hunan of China have prominent sleep problems, and the daytime dysfunction caused by sleep problems is the most serious. Learning burnout positively predicted poorer sleep quality, and mental health played a mediating effect on the relationship between learning burnout and sleep quality.

Bidirectional associations between sleep problems and behavioural difficulties and health-related quality of life in adolescents: Evidence from the SCAMP longitudinal cohort study

Background

Sleep problems show associations with negative outcomes in both physical and mental health in adolescents, but the associations may be reciprocal. We aimed to assess bidirectional associations between sleep problems and mental health symptoms including behavioural difficulties (internalising and externalising difficulties) and low health-related quality of life (HRQoL).

Methods

A total of 6616 adolescents (52.4% females) across Greater London completed baseline assessments when they were aged 11-12 years, and 3803 of them (57.2% females) completed follow-up assessments at aged 13-15 years. Weekday and weekend sleep duration were derived from self-reported bedtime, sleep onset latency and wake time. Sleep disturbance was assessed using a standardized sleep disturbance scale. Internalising and externalising difficulties were assessed using subscales of the Strength and Difficulties Questionnaire. HRQoL was assessed using the KIDSCREEN-10 questionnaire. Cross-lagged structural equation modelling was used with multiple imputation to examine bidirectional associations between sleep problems and mental health symptoms.

Results

Females had greater internalising difficulties, worse HRQoL and more sleep disturbance than males. Persistent insufficient weekday and weekend sleep, and sleep disturbance (i.e., at both baseline and follow-up) were associated with internalising and externalising difficulties and low HRQoL at follow-up (ORs ranged from 1.53 to 3.63). Persistent externalising difficulties and low HRQoL were also associated with insufficient weekend sleep and sleep disturbance at follow-up (ORs ranged from 1.68 to 4.25). Using continuous variables, we found bidirectional associations between weekday sleep duration and HRQoL, weekend sleep duration and externalising score, sleep quality and internalising score, and sleep quality and HRQoL. The association magnitudes were mostly similar in the two directions.

Conclusions

Our study showed bidirectional associations between sleep problems and mental health symptoms during adolescence, indicating that early intervention and treatment on the first-occurring symptom may prevent the development of subsequent problems.