To determine the sociodemographic, behavioral, and clinical risk factors associated with the persistence, remission, and incidence of insomnia symptoms in the transition from childhood to adolescence.
The Penn State Child Cohort is a random, population-based sample of 700 children (5-12 years at baseline), of whom 421 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 421 subjects with baseline (Mage=8.8y) and follow-up (Mage=17y) data were 53.9% male and 21.9% racial/ethnic minorities. 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. The incidence of adolescent insomnia symptoms was 31.1% (95%CI=25.9-36.3). Female sex, racial/ethnic minority and low socioeconomic status as well as psychiatric/behavioral or neurological disorders, obesity, smoking, and evening chronotype were associated with a higher persistence or incidence of insomnia symptoms.
Childhood insomnia symptoms are highly persistent, with full remission occurring in only a third of children in the transition to adolescence. Sex-, racial/ethnic- and socioeconomic-related disparities in insomnia occur as early as childhood, while different mental/physical health and lifestyle/circadian risk factors play a key role in the chronicity of childhood insomnia symptoms vs. their incidence in adolescence. Childhood insomnia symptoms should not be expected to developmentally remit and should become a focus of integrated pediatric/behavioral health strategies.
Fernandez-Mendoza J, et al. Natural History of Insomnia Symptoms in the Transition from Childhood to Adolescence: Population Rates, Health Disparities and Risk Factors. Sleep. 2020 Sep 15:zsaa187