Natural History of Insomnia Symptoms in the Transition from Childhood to Adolescence: Population Rates, Health Disparities and Risk Factors

Julio Fernandez-Mendoza, Elizaveta Bourchtein, Susan Calhoun, Kristina Puzino, Cynthia K Snyder, Fan He, Alexandros N Vgontzas, Duanping Liao, Edward Bixler
Sleep 2020 September 15

STUDY OBJECTIVES: 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.

METHODS: 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.

RESULTS: 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.

CONCLUSIONS: 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.

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