Insomnia Symptoms in the Transition from Childhood to Adolescence

Sleep has garnered attention over the years for its relationship with health outcomes. Research supported by the NHLBI, NIMH, and NCATS sought to study the natural history of insomnia symptoms in children that were followed into adolescence to establish population-based rates to better understand the course of insomnia, as well as risk factors. In youth, falling asleep and/or staying asleep are one of the most common parent-reported insomnia symptoms; with a prevalence in childhood and adolescence of 20-25%. Prior research has yielded varying estimates of persistence rates of insomnia symptoms in youth that range from 0% over a 12-year period to 52% over a 4-year period. Due to this high variability in results, the researchers examined individual risk factors that contribute to the persistence and incidence of insomnia symptoms in youth.

In the present study the researchers followed a large, population-based, cohort sample of children into adolescence to evaluate the natural history of insomnia symptoms and a broad number of relevant clinically and objectively assessed risk factors. The sample was from the Penn State Child Cohort, which is a random, population-based sample of children (n = 700, 5-12 years at baseline), of whom 421 (53.9% male and 21.9% racial/ethnic minorities) were followed up as adolescents (12-23 years at follow-up). Subjects underwent polysomnography, clinical history, physical exam, and parent- and self-reported scales at baseline and follow-up. Insomnia symptoms were defined as a parent- or self-report of difficulty falling and/or staying asleep.

The results showed that the persistence of childhood insomnia symptoms was 56% (95% CI = 46.5-65.4), with only 30.3% (95% CI = 21.5-39.0) fully remitting with the incidence of insomnia symptoms being 31.1% (95% CI = 25.9 – 36.3). Several factors were associated with a higher persistence or incidence of insomnia symptoms including, female sex, racial/ethnic minority, and low socioeconomic status as well as psychiatric, behavioral or neurological disorders, obesity, smoking, and clear preference for activity in the evening.

In summary, childhood insomnia symptoms are highly persistent, with full remission occurring in only a third of children in the transition to adolescence. Disparities in youth with insomnia occur early in childhood and are associated with sex, racial/ethnic background, and socioeconomic status. However, other factors such as mental and/or physical health, lifestyle, and circadian risk factors play a key role in the incidence and persistence of chronic childhood insomnia symptoms into adolescence. This study provides findings that may allow for an informed risk-assessment approach to determine and monitor the likelihood for incidence and persistence of insomnia symptoms in certain youths, such as in girls, racial/ethnic minorities, children of low socioeconomic status, those with psychiatric/behavioral, neurological or metabolic disorders, and evening circadian preference. Additionally, these data indicate that childhood insomnia symptoms should not be expected to resolve or remit over the developmental period and that they should become the focus of integrated behavioral health strategies and/or interventions in this population.

Fernandez-Mendoza J, Bourchtein E, Calhoun S, Puzino K, Snyder CK, He F, Vgontzas AN, Liao D, Bixler E. 2020. Natural History of Insomnia Symptoms in the Transition from Childhood to Adolescence: Population Rates, Health Disparities and Risk Factors. Sleep. doi: 10.1093/sleep/zsaa187

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