Trajectories of Insomnia Symptoms From Childhood Through Young Adulthood

Insomnia symptoms are transdiagnostic to physical and mental health disorders. Given the lack of population-based cohorts with objective sleep measures and long-term follow-ups, little is known about the chronicity of childhood insomnia symptoms. We determined the developmental trajectories of insom...

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Published inPediatrics (Evanston) Vol. 149; no. 3; p. 26
Main Authors Fernandez-Mendoza, Julio, Lenker, Kristina P, Calhoun, Susan L, Qureshi, Myra, Ricci, Anna, Bourchtein, Elizaveta, He, Fan, Vgontzas, Alexandros N, Liao, Jiangang, Liao, Duanping, Bixler, Edward O
Format Journal Article
LanguageEnglish
Published United States American Academy of Pediatrics 01.03.2022
Subjects
Adolescent
Adolescents
Adult
Adults
Child development
Children
Critical period
Development and progression
Diseases
Humans
Insomnia
Pediatric diseases
Pediatrics
Phenotypes
Polysomnography
Remission
Self Report
Sleep
Sleep - physiology
Sleep disorders
Sleep Initiation and Maintenance Disorders - epidemiology
Sleep Wake Disorders
Teenagers
Young Adult
United States
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Summary:Insomnia symptoms are transdiagnostic to physical and mental health disorders. Given the lack of population-based cohorts with objective sleep measures and long-term follow-ups, little is known about the chronicity of childhood insomnia symptoms. We determined the developmental trajectories of insomnia symptoms, their evolution into adult insomnia, and the role of objective sleep duration in the transition to adulthood. A total of 502 children (median 9 years old, 71.7% response rate) were studied 7.4 years later as adolescents (median 16 years old) and 15 years later as adults (median 24 years old). Insomnia symptoms were ascertained as moderate-to-severe difficulties initiating and/or maintaining sleep via parent- or self reports at all 3 time points, adult insomnia via self-report in young adulthood, and objective short-sleep duration via polysomnography in childhood and adolescence. Among children with insomnia symptoms, the most frequent trajectory was persistence (43.3%), followed by remission (26.9% since childhood, 11.2% since adolescence) and a waxing-and-waning pattern (18.6%). Among children with normal sleep, the most frequent trajectory was persistence (48.1%), followed by developing insomnia symptoms (15.2% since adolescence, 20.7% in adulthood) and a waxing-and-waning pattern (16.0%). The odds of insomnia symptoms worsening into adult insomnia (22.0% of children, 20.8% of adolescents) were 2.6-fold and 5.5-fold among short-sleeping children and adolescents, respectively. Early sleep interventions are a health priority because pediatricians should not expect insomnia symptoms to developmentally remit in a high proportion of children. Objective sleep measures may be clinically useful in adolescence, a critical period for the adverse prognosis of the insomnia with short-sleep duration phenotype.
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Dr Fernandez-Mendoza conceptualized and designed the study, drafted the initial manuscript, reviewed and critically revised the manuscript for important intellectual content, collected data and contributed to data interpretation, supervised the statistical analyses, and acquired funding; Ms Ricci and Dr Lenker contributed to data acquisition, drafted the initial manuscript, and critically revised the manuscript for important intellectual content; Drs Bourchtein and Vgontzas interpreted the data and critically revised the manuscript for important intellectual content; Ms Qureshi contributed to data acquisition, drafted the initial manuscript, and critically revised the manuscript for important intellectual content; Drs Jiangang Liao and Duanping Liao and Mr. He conducted the statistical analyses, contributed to data interpretation, and critically revised the manuscript for important intellectual content; Drs Calhoun and Bixler contributed to data acquisition and data interpretation and critically revised the manuscript for important intellectual content; and all authors approved the final manuscript as submitted and agreed to be accountable for all aspects of the work.
ISSN:0031-4005
1098-4275
1098-4275
DOI:10.1542/peds.2021-053616