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.     

The relationship between media use in the bedroom, sleep habits and symptoms of insomnia

This postal questionnaire study investigated the use of media in the bedroom and its relationships with sleep habits and symptoms of insomnia. The sample comprised 2500 individuals aged 16-40 years drawn randomly from the Norwegian national register. A total of 816 (34.0%) completed and returned the questionnaire. Respondents were asked how often they used computers, television sets, DVD players, game consoles and mobile telephones and listened to music/radio in their bedrooms. They also reported sleep habits on weekdays and at weekends/days off and symptoms of insomnia. After controlling for gender, age, anxiety and depression, the respondents who used a computer in the bedroom 'often' compared to 'rarely' rose later on weekdays and at weekends/days off, turned off the lights to go to sleep later at weekends/days off, slept more hours at weekends/days off and had a greater discrepancy between turning off the lights to go to sleep on weekdays and at weekends/days off. Respondents who used a mobile telephone in their bedrooms at night 'often' compared to 'rarely' turned off the lights to go to sleep later on weekdays and at weekends/days off, and rose later at weekends/days off. No such differences were found with the use of the other media. There were also no significant differences in symptoms of insomnia. This study indicates that the use of computers and mobile telephones in the bedroom are related to poor sleep habits, but that media use in the bedroom seems to be unrelated to symptoms of insomnia.     

Normative data on the sleep habits of Australian children and adolescents

Study Objective:

To provide normative sleep data on 9-18 year old Australians.

Design:

Cohort study.

Setting:

Participants'' homes.

Participants:

4032 Australians aged 9-18 years.

Interventions:

N/A.

Measurements and Results:

Participants completed a 48h use of time recall, comprising sleep data for one complete night. Sleep duration, bedtime and wake time were compared across age groups, between genders, and between school and non-school days using ANOVA. Sleep duration declined with age (P < 0.0001) at the rate of 12 min/ night per year of age on school days, and 4 min on non-school days. Girls slept slightly longer than boys (5 min/ night; P = 0.03). Non-school day sleep was 16 min longer than school day sleep (P < 0.0001), with the difference increasing with age. Bedtimes got later with age (P < 0.0001), however there were no differences in bedtimes between boys and girls. Bedtimes occurred 34 min later on non-school days (P < 0.0001). Wake times were very similar across age groups on school days, but increased at the rate of 10 min/ year of age on non-school days. Wake times were similar for boys and girls, and occurred on average 82 min later on non-school days (P < 0.0001). Overall, 17% of school days and 20% of non-school days failed to meet the American Centers for Disease Control and Prevention sleep duration guidelines.

Conclusions:

Normative sleep data will provide a valuable yardstick for health and education professionals when dealing with sleep-related issues.

Citation:

Olds T; Maher C; Blunden S; Matricciani L. Normative data on the sleep habits of Australian children and adolescents. SLEEP 2010;33(10):1381-1388.     

Perceived stigma and school attendance among children and adolescents with epilepsy in South Western Uganda

BackgroundEpilepsy is a neurological disorder that has a high worldwide prevalence with eighty percent of the global burden being in low and middle-income countries. There is a high level of perceived stigma among children and adolescents with epilepsy, which has severe debilitating effects and affects school attendance.ObjectiveTo assess the effect of perceived stigma on school attendance patterns among children and adolescents with epilepsy.MethodsWe conducted a cross sectional study among 191 children and adolescents aged from 6–18 years with epilepsy at one large semi-urban hospital and a small rural health center in SouthWestern Uganda. Epilepsy-related perceived stigma was measured using the adapted Kilifi Stigma Scale of Epilepsy and school attendance patterns were assessed using a piloted investigator-designed questionnaire.ResultsChildren with high-perceived stigma were more likely to have never attended school (13.8%) or started school late (average age 5.7 years) compared to those with low-perceived stigma (average age 4.9 years). Additionally, those with high epilepsy-related perceived stigma repeated classes 2.5 times more compared to those with low-perceived stigma.ConclusionThese preliminary findings suggest correlation between high-perceived stigma and disrupted school attendance patterns among children and adolescents with epilepsy, hence the need to address this social challenge.     

Sleep-wake patterns and sleep disturbance among Hong Kong Chinese adolescents

STUDY OBJECTIVES: To determine sleep-wake patterns and evaluate sleep disturbance in Hong Kong adolescents; to identify factors that are associated with sleep disturbance; and to examine the relationship of sleep-wake variables and academic performance. DESIGN AND SETTING: A school-based cross-sectional survey. PARTICIPANTS: Sample included 1629 adolescents aged 12 to 19 years. MEASUREMENTS AND RESULTS: Self-report questionnaires, including sleep-wake habit questionnaire, Sleep Quality Index, Morningness/ Eveningness scale, Epworth Sleepiness Scale, Perceived Stress Scale, academic performance, and personal data were administered. The average school-night bedtime was 23:24, and total sleep time was 7.3 hr. During weekends, the average bedtime and rise time was delayed by 64 min and 195 min, respectively. The prevalence of sleep disturbances occurring > or = 3 days per week in the preceding 3 months were: difficulty falling asleep (5.6%), waking up during the night (7.2%), and waking up too early in the morning (10.4%). The prevalence of > or = 1 of these three symptoms was 19.1%. Stepwise regression analyses revealed that circadian phase preference was the most significant predictor for school night bedtime, weekend oversleep, and daytime sleepiness. Perceived stress was the most significant risk factor for sleep disturbance. Students with marginal academic performance reported later bedtimes and shorter sleep during school nights, greater weekend delays in bedtime, and more daytime sleepiness than those with better grades. CONCLUSION: The prevalence of sleep deprivation and sleep disturbance among Hong Kong adolescents is comparable to those found in other countries. An intervention program for sleep problems in adolescents should be considered.     

Tobacco-refusal skills and tobacco use among high-risk adolescents

Psychosocial tobacco use prevention programs are based on the assumption that refusal skills training will have a suppressive effect on the onset of use by enabling non-using adolescents to refuse offers of cigarettes and smokeless tobacco. The present study investigated this assumption with 389 high-risk junior high-school students involved in a prevention program during their seventh, eighth, and ninth-grade years. Direct behavioral measures of refusal skills were taken by having subjects respond to audiotaped offers of tobacco and then rating the quality of their responses. These ratings were then linked to tobacco use measures obtained at the end of each of the 3 study years. Results showed that the comprehensive prevention program produced a favorable trend in delaying or preventing the onset of tobacco use. However, the refusal skills training, which was carried out throughout the 3-year intervention period, produced significant differences in overall refusal skill quality only at the seventh grade. Moreover, refusal skill quality was not related to overall tobacco use or cigarette use at any grade.This work was supported by Grant R01-CA44921 from the National Cancer Institute.     

Longitudinal sleep efficiency in the elderly and its association with health

The relationships between older age and sleep efficiency have traditionally been assessed using cross‐sectional studies that ignore changes within individuals as they age. This research examines the determinants of sleep efficiency, the heterogeneity in an individual's sleep efficiency trajectory across a period of up to 27 years in later life and its associations with health. The University of Manchester Longitudinal Study of Cognition in Normal Healthy Old Age cohort (n = 6,375; age 42–94 years) was used in this study. Depression and health data were collected using self‐report validated instruments (Cornell Medical Index, Beck Depression Inventory and Geriatric Depression Scale). Longitudinal sleep and sociodemographic data were collected using a study‐specific self‐report questionnaire. A mixed‐effect model was performed for sleep efficiency with adjustments for time‐invariant and time‐variant predictors. Latent class analysis was used to demonstrate subgroups of sleep efficiency trajectories and associations between sleep efficiency clusters and health history of the participants were investigated. Older adults have decreased sleep efficiency over time, with 18.6% decline between 40 and 100 years of age. Three sleep efficiency trajectory clusters were identified: high (32%), medium (50%) and low sleep efficiency (18%). Belonging to the high sleep efficiency cluster was associated with having lower prevalence of hypertension, circulatory problems, general arthritis, breathing problems and recurrent episodes of depression compared to the low efficiency cluster. Overall, ageing decreases sleep efficiency. However, there are detectable subgroups of sleep efficiency that are related to prevalence of different diseases.     

Cognitive effects of split and continuous sleep schedules in adolescents differ according to total sleep opportunity

Study ObjectivesWe compared the basic cognitive functions of adolescents undergoing split (nocturnal sleep + daytime nap) and continuous nocturnal sleep schedules when total sleep opportunity was either below or within the recommended range (i.e. 6.5 or 8 h).MethodsAdolescent participants (age: 15–19 year) in the 8-h split (n = 24) and continuous (n = 29) sleep groups were compared with 6.5-h split and continuous sleep groups from a previous study (n = 58). These protocols involved two baseline nights (9-h time-in-bed [TIB]), 5 nights of sleep manipulation, 2 recovery nights (9-h TIB), followed by a second cycle of sleep manipulation (3 nights) and recovery (2 nights). Cognitive performance, subjective sleepiness, and mood were evaluated daily; sleep was assessed using polysomnography.ResultsSplitting 6.5 h of sleep with a mid-afternoon nap offered a boost to cognitive function compared to continuous nocturnal sleep. However, when total TIB across 24 h increased to 8 h, the split and continuous sleep groups performed comparably in tests evaluating vigilance, working memory, executive function, processing speed, subjective sleepiness, and mood.ConclusionsIn adolescents, the effects of split sleep on basic cognitive functions vary by the amount of total sleep obtained. As long as the total sleep opportunity across 24 h is within the recommended range, students may fulfill sleep requirements by adopting a split sleep schedule consisting of a shorter period of nocturnal sleep combined with a mid-afternoon nap, without significant impact on basic cognitive functions.Clinical trial registration{"type":"clinical-trial","attrs":{"text":"NCT04044885","term_id":"NCT04044885"}}NCT04044885.     

Longitudinal associations of sleep problems with alcohol and cannabis use from adolescence to emerging adulthood

Study ObjectivesThis study examined longitudinal associations of sleep problems with alcohol and cannabis use across six annual waves of data from adolescence to emerging adulthood.MethodsParticipants were 3,265 youth from California (ages 16–22 across waves). At each wave, past-month alcohol use and cannabis use, mental health, and several dimensions of sleep health (i.e. social jetlag, bedtimes, time in bed, trouble sleeping) were assessed via questionnaire. Parallel process latent growth models examined the association between sleep and alcohol or cannabis use trajectories and the role of mental health in contributing to such trajectories.ResultsSmaller declines in social jetlag (r = 0.11, p = 0.04), increases in trouble sleeping (r = 0.18, p < 0.01), and later weekday (r = 0.16, p < 0.01) and weekend bedtimes (r = 0.25, p < 0.01) were associated with increases in likelihood of alcohol use over time. Declines in weekend TIB (r = −0.13, p = 0.03), as well as increases in weekday TIB (r = 0.11, p = 0.04) and later weekday (r = 0.18, p < 0.01) and weekend bedtime (r = 0.24, p < 0.01), were associated with increases in likelihood of cannabis use over time. Most associations remained significant after controlling for time-varying mental health symptoms.ConclusionsTrajectories of sleep health were associated with trajectories of alcohol and cannabis use during late adolescence to emerging adulthood. Improving sleep is an important target for intervention efforts to reduce the risk of substance use during this critical developmental transition.     

Substance use and its relationship to depression, anxiety, and isolation among youth living with HIV

Reductions from lifetime to recent levels of substance use, the time since HIV diagnosis, physical health symptoms, CD4 counts, emotional distress, and social supports were examined among 227 (20% female; 22% African American, 27% Anglo, 35% Latino) youth living with HIV pH) ages 13 to 24 years. Substance use pervaded the lives of these youth. Male YLH had used more drugs., more often, and for longer periods than women. However, there had been major reductions in use. Being male, having high emotional distress, and having fewer negative social supports were significantly associated with greater reductions in substance use. There was a trend for the length of time that an individual was seropositive being associated with reductions in substance use. The counterintuitive findings suggest that there must be a re-examination of the role of the social support networks of youth living with HIV, as well as the ways in which emotional distress interacts with risk behaviors. This research was supported by Grant R01 DA-07903 from the National Institute on Drug Abuse to Mary Jane Rotheram-Borus. We thank Brad Brusavich, Christina Christie, Timothy R Cline, A1 Cohall, Lori Crawford, Donna Futterman, Marya Gwadz, Darius Jatulis, Michael Kennedy. Michelle Kipke, Kris Langabeer, Linda Levin, Sutherland Miller, Zane O’Keefe, Barbara Otto, Ron Reynolds, Mavis Seehaus, Arlene Schneir, Kevin Wong, and Whitney Wright.     

Daytime variation in performance and tiredness/sleepiness ratings in patients with insomnia, narcolepsy, sleep apnea and normal controls

Daytime tiredness or sleepiness and deficits in cognitive performance are common complaints in sleep disordered patients. Till now there are few studies comparing patients from different diagnostic groups of sleep disorders in the same experimental protocol. We studied the time course of cognitive functions and subjective alertness in a parallel group design with four groups of patients [narcolepsy, untreated or treated obstructive sleep apnea (OSA), or psychophysiological insomnia] and a control group of subjects without sleep complaints. Each group consisted of 10 subjects, matched for age and gender. After a night with polysomnography, subjects were studied for 10 h from 08:00 hours to 18:00 hours at 20 min intervals under standardized environmental conditions. Four psychological tests were applied, (1) a critical flicker fusion (CFF) test to measure optical fusion threshold (alertness); (2) a paper-and-pencil visual line tracking test (selective attention); (3) a visual analog scale (VAS) for tiredness/sleepiness; and (4) the Tiredness Symptoms Scale (TSS), a 14 items check list. Each test session lasted for 8 min, followed by a 12 min pause. The level and time course of cognitive performance and self-rating data were analysed with hierarchical linear mixed effects models. Cognitive tests showed decrements in alertness and selective attention in untreated patients with insomnia, narcolepsy, and sleep apnea. Narcoleptic patients and untreated OSA had a lower CFF threshold than controls, and for narcoleptic patients the time course differed from that of all other groups. In the visual tracking test the performance of all groups of patients was worse compared with normal controls. Self-rated tiredness/sleepiness was significantly more pronounced in the three groups of untreated patients than in control subjects.     

Perceived risk, risk taking, estimation of ability and injury among adolescent sport participants

OBJECTIVE: To determine the predictive validity of perceived risk, risk taking, estimation of ability, overefficacy, and previous injuries on actual injury among adolescents in sport; and to examine sex differences on these factors. METHODS: A cohort of 260 (148 male, 112 female) soccer players aged 11 to 14 years participated in a 3-month prospective injury study. Preseason written measures included self-reported perceived risk, previous injuries, risk taking and estimation of ability. RESULTS: Low levels of perceived risk and estimation of ability were associated with a significant increase in risk of injury, with odds ratios (ORs) ranging from 3.77-7.92. Positive relationships between injury and both estimation of ability and overestimation of ability were supported. Estimation of ability was also positively related to risk taking. In this study, however, risk taking was not directly related to injury, nor were previous injuries. Girls reported higher levels of perceived risk and lower levels of risk taking than boys. However, boys and girls reported similar estimation of ability and overestimation of ability and subsequently incurred similar numbers of injuries. CONCLUSIONS: Perceived risk and estimation of ability represent significant psychological risk factors for injury in adolescent sports. Sex differences in perceived risk, risk taking, and previous injuries should be considered when developing environmental and behavioral injury-prevention programs.     

The prevalence of restless sleep disorder among a clinical sample of children and adolescents referred to a sleep centre

Restless sleep disorder (RSD) is a newly described sleep disorder in children characterized by large body movements and repositioning that lasts all night with at least five body movements per hour and a significant impact on daytime behaviours. The authors have previously identified and described the syndrome and compared the sleep parameters and sleep‐related movements to those in children with restless legs syndrome, normal controls and snorers. The current study is a retrospective review of the sleep diagnosis in 300 consecutive children seen and evaluated in a single sleep disorders centre; 252 children underwent polysomnography, as clinically indicated, to identify the proper diagnosis. The current research estimates the prevalence of RSD in a sleep clinical setting to be 7.7% and compares it to the prevalence of other common sleep disorders in the same setting. Another important addition to the literature is the fact that RSD can coexist with other sleep disorders, such as habitual snoring and parasomnia, without confounding the diagnosis.     

Sleep and dream habits in a sample of French college students who report no sleep disorders

There is a lack of up‐to‐date data on sleep and dream habits of college students. To fill in this gap, we used an online questionnaire sent to the student mailing lists of two major universities of Lyon (Lyon 1 and Lyon 2) for the recruitment of an functional magnetic resonance imaging study with sleep disorders as exclusion criteria. In the sample (1,137 French college students, 411 males, mean age = 22.2 ± 2.4 years, body mass index = 22.0 ± 3.2 kg m^?2), on average, the participants reported spending about 8 hr in bed during weekdays, 9 hr during the weekends, and 90.9% of them reported no difficulty falling asleep. Less than 0.4% of students reported to have sleep‐walking episodes regularly, but nearly 7% reported regular sleep‐talking episodes. The average dream recall frequency was about 3 mornings per week with a dream in mind. Dream recall frequency was positively correlated with the clarity of dream content and the frequency of lucid dreaming, and was negatively correlated with age. Fourteen percent of the students reported frequent lucid dreams, and 6% reported frequent recurrent dreams. We found a gender effect for several sleep and dream parameters, including dream recall frequency and time in bed, both of which were higher in women than in men. We have also observed differences between academic disciplines, namely humanities students (Lyon 2) reported spending more time in bed than sciences students (Lyon 1). These results confirm a gender difference for several sleep and dream parameters, and suggest a link between academic disciplines and sleep duration.     

Illness centrality and well-being among male and female early adolescents with diabetes

OBJECTIVE: We examined the implications of illness centrality for psychological and physical health among male and female early adolescents with type 1 diabetes. METHODS: We interviewed 132 adolescents before or after a routine clinic appointment. We measured the extent to which they defined themselves in terms of their illness, their views of the illness, psychological well-being, self-care behavior, and metabolic control. RESULTS: Females scored higher on illness centrality than males. Illness centrality was related to poor psychological well-being when the illness was perceived in negative terms, but only for females. For males, illness centrality was unrelated to psychological well-being. Illness centrality was related to poor metabolic control. CONCLUSIONS: The extent to which adolescent females define themselves in terms of their illness is most problematic when the illness is perceived in highly negative terms. Future research should examine how illness centrality and views of illness change over the course of adolescence.     

Stressful life events among adolescents in Wuhan, China: Associations with smoking, alcohol use, and depressive symptoms

The associations among stress and adolescent smoking, alcohol use, and depression have been well documented in the United States, but few studies have evaluated the evidence for these associations in Asian cultures. This study developed a scale of stressful life events among 7th-grade adolescents in Wuhan, China. The events reported as most frequent involved bad grades or punishment at school, and the events reported as most severe involved disruptions in family life, such as death, divorce, or disability of parents. Associations were observed between life events (especially negative school-related events) and smoking, alcohol use, and depressive symptoms. Results indicate that school-related stress may lead to substance use and mental health problems among Chinese adolescents.     

Joint associations of body mass index and waist-to-height ratio with sleep duration among Saudi adolescents

Background: Numerous studies have shown significant associations between short sleep duration and overall or abdominal obesity. However, no study has reported on the joint association of body mass index (BMI) and waist-to-height ratio (WHtR) with sleep duration in adolescents.

Aim: To examine the joint associations of BMI and WHtR with sleep duration among Saudi adolescents.

Subjects and methods: A school-based cross-sectional study was conducted involving 2852 secondary-school students (51.7% females) aged 15–19 years, randomly selected using a multistage stratified cluster sampling. Self-reported sleep duration was assessed and BMI was classified into high and low categories according to the IOTF classification, whereas WHtR categories were based on above and below 0.5.

Results: The low BMI–low WHtR category had the longest mean sleep duration (7.27 hours/day), whereas the high BMI-high WHtR group had the shortest sleep duration (7.02 hours/day; p?=?0.003) (aOR?=?0.832, 95% CI?=?0.698–0.992, p?=?0.040). In addition, high BMI–low WHtR or low BMI–high WHtR groups didn’t significantly associate with reduced sleep duration among adolescents.

Conclusion: The joint association of high BMI–high WHtR increases adolescent’s risk of having reduced sleep duration. Future research should seek to confirm such findings and provide an explanation for this association.     

Perceived family and individual social status and its association with depression and suicidality in an adolescent clinical sample

There is a well-documented association between subjective social status (SSS) and depression among adults. Yet, the research on SSS and suicidal thoughts and behaviors among adolescent minority populations is limited. The aim of this study was to examine the relationship between the adolescent's SSS and mental health in an adolescent sample. A total of 197 adolescents ages 12 to 18 years (M age = 14.58; SD = 1.54) and their parents were recruited in urban outpatient clinics. Sociodemographics and measures of depression, suicidal thoughts and behaviors, and SSS were collected in a cross-sectional survey and through chart review. Univariate and multivariate analyses were conducted to calculate statistical associations with depression and suicidal thoughts and behaviors. Significant negative associations were found between SSS and depression, suicidal ideation, and prior suicidal attempts, independent of socioeconomic status. Consideration should be given to assessing measures of social rank to appraise risk in adolescent outpatient clinical settings.