Insomnia Symptoms And Eveningness Chronotype: Independent Associations With Emotional And Behavioural Problems In Adolescents

Abstract

Background: Insomnia symptoms are common and often under-reported in adolescents. While evidence suggests that adolescents experience an intrinsic developmental change in their circadian phase, there have been limited studies to investigate whether insomnia symptoms and eveningness chronotype are associated with the risk of developing emotional and behavioural problems in adolescents. Methods: A total of 5,168 adolescents (mean age: 14.9 + 1.6 years, 56% female) completed the self-report measures to assess their sleep pattern, insomnia severity (Insomnia Severity Index, ISI), daytime sleepiness (Pediatric Daytime Sleepiness Scale, PDSS), and chronotype preference (Morningness-Eveningness Questionnaire, MEQ). Emotional and behavioural problems were assessed by the Strengths and Difficulties Questionnaire (SDQ). Analysis: Multiple logistic regression analysis was conducted to examine the independent associations of insomnia (ISI score) and evening type with the emotional and behavioural problems (SDQ score), controlling for the potential confounding factors (e.g. age, gender, chronic use of medication, sleep duration). Results and Conclusion: Prevalence of any insomnia symptoms (as defined by having one of the following sleep problems at least three times per week: difficulty initiating sleep, difficulty maintaining sleep, or early morning awakening) was 8.9%. Adolescents with evening type reported a higher degree of daytime sleepiness (p<.001) and had shorter sleep duration during weekdays (<.001) but longer sleep duration during weekends and holidays (<.001) as compared to their counterparts. Insomnia symptoms (adj ORs = 1.19, 95% CI 1.17-1.21) and evening type (adj ORs = 1.32, 95% CI 1.12-1.56) were found to be independently associated with emotional and behavioural problems in adolescents. The findings underscore the need to consider both sleep and circadian factors in the clinical management of emotional and behavioural problems in the adolescent population.