Results from a prospective cohort study published in the journal Sleep described the natural history of insomnia in the transition from childhood to adolescence. Childhood insomnia symptoms frequently persisted into adolescence, with less than a third of the cohort remitting during follow-up. Insomnia was particularly prevalent among girls and patients of racial/ethnic minority status. Insomnia persistence was also associated with psychiatric and neurological disorders, obesity, smoking, and evening chronotype.
The Penn State Child Sleep Cohort is a longitudinal, population-based study of young children (5-12 years) followed up as adolescents (12-23 years). Briefly, the Penn State Child Cohort comprises 700 children, among whom 421 were followed-up during adolescence with in-lab polysomnography. Patients also underwent a thorough clinical history and physical examination. Patients or parents completed the Pediatric Behavior Scale (PBS) and the Pediatric Sleep Questionnaire at baseline and follow-up.
Childhood insomnia was defined as a parent report of “often/moderate” or “very often/severe” difficulty falling and/or staying asleep on the PBS. Adolescent insomnia symptoms were determined by self-reported difficulty falling and/or staying asleep. Logistic regression was used to assess the impact of childhood insomnia symptoms on sleep problems in adolescence.
Of 421 patients with baseline and follow-up data, 53.9% were boys and 78.1% were white. Black/African American and Hispanic/Latinx participants comprised 12.6% and 6.4% of the study population, respectively. Mean age at baseline visit was 8.7 ± 1.7 years. Mean age at follow-up was 16.5 ± 2.3 years. Overall, 109 patients had childhood insomnia symptoms, among whom 61 (56.0%) continued to experience insomnia in adolescence. Just 30.3% of patients with childhood insomnia symptoms experienced full remission in adolescence.
In regression models, girls were significantly more likely than boys to experience childhood insomnia that persisted into adolescence (odds ratio [OR], 2.45; 95% CI, 1.02-5.86). Low socioeconomic status (OR, 3.12; 95% CI, 1.22-7.99), racial/ethnic minority status (OR, 3.83; 95% CI, 1.14-12.92), and smoking in adolescence (OR, 6.88; 95% CI, 1.19-39.93) were also associated with persistent childhood insomnia symptoms. Participants who were obese in childhood were less likely to remit from insomnia symptoms in adolescence (OR, 0.14; 95% CI, 0.03-0.76).
Finally, incident insomnia in adolescence was associated with childhood mood/anxiety disorder (OR, 4.74; 95% CI, 1.04-21.56), adolescent mood/anxiety disorder (OR, 2.10; 95% CI, 1.14-3.88) and evening sleep chronotype (OR, 1.94; 95% CI, 1.03-3.67).
These results suggest that insomnia in childhood frequently persists into adulthood. Female sex, racial/ethnic minority status, low socioeconomic status, and psychiatric or neurological disorders were each associated with adolescent insomnia. The primary study limitation was the use of self-report to determine symptoms, rather than clinical diagnosis. Even so, results suggest that appropriate management of adolescent insomnia may include early screening for symptoms and management of comorbid conditions, such as mood disorders.
Fernandez-Mendoza J, Bourchtein E, Calhoun S, et al. Natural history of insomnia symptoms in the transition from childhood to adolescence: Population rates, health disparities and risk factors [published online September 15, 2020]. Sleep. doi: 10.1093/sleep/zsaa187