Delayed sleep phase disorder in an Australian school-based sample of adolescents

STUDY OBJECTIVES

To establish the extent to which the developmental changes in sleep timing experienced by Australian adolescents meet the International Classification of Sleep Disorders (ICSD-2) diagnostic criteria for delayed sleep phase disorder (DSPD), and whether adolescents with DSPD engage in poorer lifestyle choices, and are more impaired compared to good sleeping adolescents.

METHODS

Three-hundred seventy-four Australian adolescents (mean age 15.6 years, SD 1.0) participants completed a 7-day sleep diary, wore wrist actigraphy, and completed a battery of questionnaires to assess DSPD criteria.

RESULTS

The ICSD-2 criteria for DSPD were met by 1.1% (N = 4) of the adolescents sampled. The majority of adolescents (51.9%, N = 194) met one criterion, 14% (N = 52) of the adolescents met 2 criteria, while 33.2% (N = 124) did not fulfill any DSPD criteria. Despite having significantly delayed sleep timing, adolescents who met all criteria for DSPD reported similar lifestyle habits and daytime functioning. However, there were trends for greater alcohol and caffeine consumption, less sport participation, yet more time spent on extracurricular activities (i.e., learning to play a musical instruments for adolescents with DSPD.

CONCLUSIONS

Despite the majority of adolescents reporting DSPD symptoms, only a small minority met full diagnostic criteria. Adolescents with DSPD reported similar lifestyle habits and daytime functioning to those with some or no symptoms. Future investigations of non-school-attending DSPD adolescents are needed to confirm the trends for lifestyle behaviors found in the present study.

The sleep patterns and well-being of Australian adolescents

AIM

Adolescent sleep patterns vary between countries, and these differences influence adolescent functioning and well-being. The present study provides data on the sleep and well-being of Australian adolescents.

METHODS

385 adolescents aged 13-18 years were recruited from 8 South Australian schools spanning the socio-economic spectrum. Adolescents completed survey battery during class time at school, followed by a 7-day sleep diary.

RESULTS

Australian adolescents, on average, obtained inadequate sleep across the school week. Adolescents commonly reported difficulty initiating sleep, unrefreshing sleep, and the subjective feeling of restless legs. Problematic levels of sleepiness, fatigue, depressed mood and anxiety were highly prevalent. Later bedtimes, longer sleep onset latencies, and shorter sleep duration were significantly associated with aspects of poor daytime functioning.

CONCLUSION

These results add to our knowledge of adolescent sleep and well-being worldwide. They also highlight the need for greater attention to sleep during this phase of development, when future behaviors and outcomes are being shaped.

Insomnia and its symptoms in adolescents: comparing DSM-IV and ICSD-II diagnostic criteria

STUDY OBJECTIVES

Many studies of adolescent insomnia use experience of insomnia-like symptoms to categorize "caseness." This is likely to lead to inflated prevalence and may have important ramifications for the research using individual symptoms to operationalize insomnia. The aim of the present study was to contrast the occurrence of insomnia symptoms with cases of insomnia diagnosed using criteria from the fourth edition of the Diagnostic and Statistical Manual for Mental Disorders (DSM-IV) and the second edition of the International Classification of Sleep Disorders (ICSD-II) in a sample of Australian adolescents.

METHODS

Data were collected from 384 representative Australian adolescents aged 13-18 years old (59% male). During school hours, adolescents completed a comprehensive questionnaire battery targeting insomnia criteria and then completed a sleep diary for 7 days.

RESULTS

Insomnia symptoms were frequently reported by adolescents (e.g., 34.6% for frequent sleep-related daytime consequences). The proportion of adolescents meeting the diagnositc criteria for insomnia was much smaller: 10.9% of adolescents were classified as having General Insomnia using ICSD-II criteria, and 7.8% were classified as having Primary Insomnia according to DSM-IV criteria. ICSD-II Psychophysiological Insomnia was observed in 3.4% of adolescents. Insomnia diagnoses did not vary according to age, gender, school grade, or socioeconomic status. Using the ICSD-II criteria for General Insomnia resulted in a significantly higher number of insomnia diagnoses than did DSM-IV criteria for Primary Insomnia (p < 0.001) and ICSD-II Psychophysiological Insomnia (p < 0.001).

CONCLUSIONS

These results reveal that approximately 3 adolescents in the average classroom of 30 are likely to meet the diagnostic criteria for insomnia, while many more will have insomnia symptoms. There were significant differences in prevalence rates, depending on how insomnia was operationalized.

A randomized controlled trial of cognitive-behavior therapy plus bright light therapy for adolescent delayed sleep phase disorder

OBJECTIVE

To evaluate cognitive-behavior therapy plus bright light therapy (CBT plus BLT) for adolescents diagnosed with delayed sleep phase disorder (DSPD).

DESIGN

Randomized controlled trial of CBT plus BLT vs. waitlist (WL) control with comparisons at pre- and post-treatment. There was 6-month follow-up for the CBT plus BLT group only.

SETTING

Flinders University Child & Adolescent Sleep Clinic, Adelaide, South Australia.

PATIENTS

49 adolescents (mean age 14.6 ± 1.0 y, 53% males) diagnosed with DSPD; mean chronicity 4 y 8 months; 16% not attending school. Eighteen percent of adolescents dropped out of the study (CBT plus BLT: N = 23 vs. WL: N = 17).

INTERVENTIONS

CBT plus BLT consisted of 6 individual sessions, including morning bright light therapy to advance adolescents' circadian rhythms, and cognitive restructuring and sleep education to target associated insomnia and sleep hygiene.

MEASUREMENTS AND RESULTS

DSPD diagnosis was performed via a clinical interview and 7-day sleep diary. Measurements at each time-point included online sleep diaries and scales measuring sleepiness, fatigue, and depression symptoms. Compared to WL, moderate-to-large improvements (d = 0.65-1.24) were found at post-treatment for CBT plus BLT adolescents, including reduced sleep latency, earlier sleep onset and rise times, total sleep time (school nights), wake after sleep onset, sleepiness, and fatigue. At 6-month follow-up (N = 15), small-to-large improvements (d = 0.24-1.53) continued for CBT plus BLT adolescents, with effects found for all measures. Significantly fewer adolescents receiving CBT plus BLT met DPSD criteria at post-treatment (WL = 82% vs. CBT plus BLT = 13%, P < 0.0001), yet 13% still met DSPD criteria at the 6-month follow-up.

CONCLUSIONS

CBT plus BLT for adolescent DSPD is effective for improving multiple sleep and daytime impairments in the immediate and long-term. Studies evaluating the treatment effectiveness of each treatment component are needed.

CLINICAL TRIAL INFORMATION

Australia-New Zealand Trials Registry Number: ACTRN12610001041044.

Time for bed: parent-set bedtimes associated with improved sleep and daytime functioning in adolescents

STUDY OBJECTIVES

To determine the proportion of adolescents whose bedtime is set by their parents and to evaluate whether parent-set bedtimes are associated with earlier bedtimes, more sleep, and better daytime functioning.

PARTICIPANTS

385 adolescents aged 13-18 years (mean = 15.6, SD = 0.95; 60% male) from 8 socioeconomically diverse schools in South Australia.

MEASUREMENTS AND METHODS

Adolescents completed the School Sleep Habits Survey during class time and then completed an 8-day Sleep Diary. The Flinders Fatigue Scale was completed on the final day of the study.

RESULTS

17.5% of adolescents reported a parent-set bedtime as the main factor determining their bedtime on school nights. Compared to adolescents without parent-set bedtimes, those with parent-set bedtimes had earlier bedtimes, obtained more sleep, and experienced improved daytime wakefulness and less fatigue. They did not differ significantly in terms of time taken to fall asleep. When parent-set bedtimes were removed on weekends, sleep patterns did not significantly differ between groups.

CONCLUSIONS

Significant personal and public health issues, such as depression and accidental injury and mortality, are associated with insufficient sleep. Converging biological and psychosocial factors mean that adolescence is a period of heightened risk. Parent-set bedtimes offer promise as a simple and easily translatable means for parents to improve the sleep and daytime functioning of their teens.

The effect of presleep video-game playing on adolescent sleep

STUDY OBJECTIVES

Video-game use before bedtime has been linked with poor sleep outcomes for adolescents; however, experimental evidence to support this link is sparse. The present study investigated the capacity of presleep video-game playing to extend sleep latency and reduce subjective feelings of sleepiness in adolescents. The arousing psychophysiologic mechanisms involved and the impact of presleep video-game playing on sleep architecture were also explored.

METHOD

Thirteen male adolescent "evening types" (mean age = 16.6 years, SD = 1.1) participated in a counterbalanced, within-subjects design with experimental (active video gaming) and control (passive DVD watching) conditions. The experiment was conducted in the Flinders University Sleep Research Laboratory.

RESULTS

Relative to the control condition, presleep video-game playing increased sleep-onset latency (Z= 2.45, p= .01) and reduced subjective sleepiness (Z = 2.36, p = .02)-but only slightly. Video gaming was related to changes in cognitive alertness (as measured by a power: p < 0.01) but not physiologic arousal (as measured by heart rate: p > 0.05). Contrary to previous findings, sleep architecture was unaffected (both rapid eye movement and slow wave sleep: p > 0.05).

CONCLUSIONS

Results suggest the direct effect of presleep video-game playing on adolescent sleep may be more modest than previously thought, suggesting that surveys linking stimulating presleep activities to poor sleep need substantiating with empirical evidence.

The contribution of peer and media influences to the development of body satisfaction and self-esteem in young girls: a prospective study

This study aimed to prospectively examine the role of peer and media influences in the development of body satisfaction (incorporating the desire for thinness and satisfaction with appearance) in young girls, as well as the relationship between body satisfaction and self-esteem. A sample of 97 girls 5-8 years of age completed individual interviews at Time 1 and 1 year later at Time 2. Linear panel analyses found that Time 1 perception of peers' desire for thinness was temporally antecedent to girls' desire for thinness, appearance satisfaction, and self-esteem 1 year later. In addition, the watching of appearance-focused television programs was temporally antecedent to appearance satisfaction. Finally, girls' desire for thinness was found to temporally precede low self-esteem. Thus, as early as school entry, girls appear to already live in a culture in which peers and the media transmit the thin ideal in a way that negatively influences the development of body image and self-esteem.