Predictors of diagnostically defined insomnia in child and adolescent community samples: a literature review

Trauma and sleep disruption in Gaza: a qualitative content analysis of war-related effects

BACKGROUND

The escalation of violence and oppression in Gaza, particularly following Hamas' military attack on Israeli settlements in the Gaza envelope on October 7, 2023, has intensified trauma and related disorders, especially sleep disturbances, exacerbating the already dire conditions of dispossession and exploitation faced by Palestinians.

AIMS

The present exploratory research sought to explore the impact of war-related trauma following the recent Israeli war on the Gaza Strip on sleep disturbance among Gazans.

METHODS

Thirty participants 14 females and 16 males, aged between 18 and 58 years (mean age for males = 31.43 years, SD = 11.12; mean age for females = 31.23 years, SD = 10.13) were recruited via snowball sampling. Interviews were analyzed through thematic content analysis.

RESULTS

Thematic content analysis of the interview transcripts led to the identification of five main themes. (1), sleepless nights amid constant fear (2), children's sleep shattered by trauma. (3), the impact of overcrowded shelters on sleep. (4), mothers as guardians of sleepless nights. (5), health consequences of chronic sleep deprivation. The findings highlight the negative impact of war-related trauma on the sleep of Gazans, leading to various disturbances such as nightmares, particularly among children.

CONCLUSIONS

Our findings illuminate the pervasive impact of war-related trauma on the sleep patterns of Gazan refugees. This study highlights the critical importance of integrating psychological support and targeted interventions into community health initiatives, particularly for vulnerable groups such as children. Future research should focus on developing culturally sensitive interventions to mitigate the adverse effects of trauma on sleep and overall well-being in conflict-affected population.

Multifactorial influences on childhood insomnia: Genetic, socioeconomic, brain development and psychopathology insights

Insomnia is the most prevalent sleep disturbance during childhood and can result in extensively detrimental effects. Children's insomnia involves a complex interplay of biological, neurodevelopmental, social-environmental, and behavioral variables, yet remains insufficiently addressed. This study aimed to investigate the multifactorial etiology of childhood insomnia from its genetic architecture and social-environmental variables to its neural instantiation and the relationship to mental health. This cohort study uses 4340 participants at baseline and 2717 participants at 2-year follow-up from the Adolescent Brain Cognitive Development (ABCD) Study. We assessed the joint effects of polygenic risk score (PRS) and socioeconomic status (SES) on insomnia symptoms and then investigated the underlying neurodevelopmental mechanisms. Structural equation model (SEM) was applied to investigate the directional relationships among these variables. SES and PRS affected children's insomnia symptoms independently and additively (SES: β = -0.089, P = 1.91 × 10-8; PRS: β = 0.041, P = 0.008), which was further indirectly mediated by the deviation of inferior precentral sulcus (β = 0.0027, P = 0.0071). SEM revealed that insomnia (β = 0.457, P < 0.001) and precentral development (β = -0.039, P = 0.009) significantly mediated the effect of SES_PRS (accumulated risks of PRS and SES) on psychopathology symptoms. Furthermore, baseline insomnia symptoms, SES_PRS, and precentral deviation significantly predicted individual total psychopathology syndromes (r = 0.346, P < 0.001). These findings suggest the additive effects of genetic and socioenvironmental factors on childhood insomnia via precentral development and highlight potential targets in early detection and intervention for childhood insomnia.

Insomnia and stress: the mediating roles of frontoparietal network

Insomnia is a widespread health problem among adults, and it impairs cognitive control and emotional regulation functions. Stress and insomnia are positively correlated, and their vicious cycle has been widely reported. In this study, we explore the neural biomarkers of insomnia from the perspective of whole-brain functional connectivity and investigate the neural mechanisms underlying the association between stress and insomnia. The current study was conducted on a cross-sectional sample (N = 430). First, we investigated the correlation between perceived stress and insomnia. Second, we applied connectome-based predictive modeling (CPM) to determine the neuromarkers of insomnia. Finally, we explored the neural basis underlying the association between perceived stress and insomnia. A significant positive correlation was found between perceived stress and insomnia in the present research. Results of CPM revealed the following as the neural substrates supporting insomnia: the emotion regulation circuit involving repetitive negative thinking and the cognitive control circuit involving attention control. According to further results from mediation analysis, the frontoparietal network supporting cognitive emotion regulation is an important neural mechanism that maintains the correlation between stress and insomnia. The present study offers a profound insight into the alterations of brain activity related to insomnia, and it further investigates the neural underpinnings of the robust association between stress and insomnia. This study also opens new avenues for neural interventions to alleviate stress-related insomnia.

Predictors of early adulthood insomnia following exposure to a single mass violence attack during adolescence: 7-13 year follow-up from the Utøya and HUNT studies

Background: The long-term impact of mass violence attacks is practically unknown, especially in children and adolescents. In a previous study, we found that 8.5 years after a terror attack targeting mainly adolescents, nearly half of the survivors met diagnostic criteria for insomnia.Objectives: The aims of this study were to investigate: (1) whether exposure to a single mass violence event during adolescence increases the risk of insomnia almost a decade later above that expected for a non-exposed population; and (2) whether prior interpersonal violence exposure and early post-traumatic reactions predict later insomnia.Method: Participants were survivors of the 2011 Utøya Island terrorist attack (n = 279) and controls from the HUNT Norwegian general population study (n = 35,664). Early adulthood insomnia was assessed using four items from the Karolinska Sleep Questionnaire 8.5 years after the attack. Participants who had also completed earlier data collection waves for both studies (n = 116 and 2382, respectively) were included in logistic regression models testing the associations between predictors during adolescence and later insomnia.Results: Nearly a decade after the Utøya attack, 38.4% (n = 56) of the survivors reported symptoms of insomnia indicative of probable insomnia compared to 20.5% (n = 5771) of controls. Terror exposure during adolescence was a significant predictor of later insomnia [odds ratio (OR) = 3.18, 95% confidence interval (CI) = 2.05-4.87, p < .001]. Early post-trauma symptoms of anxiety and depression (OR = 1.34, 95% CI = 1.02-1.76, p = .033) and weekly headaches (OR = 1.64, 95% CI = 1.08-2.47, p = .018) were also significant predictors while controlling for background factors and other predictors.Conclusion: Long-term assessment and treatment are needed for survivors of mass violence to improve resilience and recovery.

The association between sleep quality and obstructive sleep apnea with health-related quality of life in children with obesity

STUDY OBJECTIVES

Obstructive sleep apnea (OSA) and poor sleep quality are highly prevalent in children with obesity, but their individual associations with health-related quality of life (HRQOL) are unknown in this population. The primary objective was to describe the independent association of OSA and sleep quality with HRQOL in children with obesity.

METHODS

This was a cross-sectional study of children with obesity at 2 tertiary care centers. Sleep quality and HRQOL were measured with the Pittsburgh Sleep Quality Index and Pediatric Quality of Life Inventory questionnaires, respectively. Multivariable regression models were created to evaluate associations between OSA and sleep quality with HRQOL.

RESULTS

There were 98 children (median age 15.0 years, median body mass index z-score 3.8, 44% females). Among the study population, 49/98 (50%) children reported poor sleep quality, 41/98 (42%) children had OSA, and 52/98 (53%) children reported impaired HRQOL. Self-reported poor sleep quality was independently associated with reduced HRQOL, whereas the presence of OSA was not. Children with poor sleep quality had a reduced Pediatric Quality of Life Inventory score by 8.8 compared to children with good sleep quality (95% confidence interval, 2.6-14.9; P = .006), when adjusting for age, sex, body mass index z-score, attention-deficit/hyperactivity disorder, mood/anxiety disorder, and study site.

CONCLUSIONS

In the current study of children with obesity, we found that HRQOL was more strongly associated with the self-reported experience of sleep than the presence of OSA. Clinicians should assess and optimize sleep quality as part of the evaluation for OSA in children with obesity.

CITATION

Xiao L, Voutsas G, Ryan CM, Katz SL, Narang I. The association between sleep quality and obstructive sleep apnea with health-related quality of life in children with obesity. J Clin Sleep Med. 2023;19(11):1877-1883.

A bibliometric analysis of insomnia in adolescent

Background

The negative effects of insomnia on adolescents' development, academic performance, and quality of life place a burden on families, schools, and society. As one of the most important research directions for insomnia, adolescent insomnia has significant research value, social value, and practical significance. Unfortunately, there is no bibliometric analysis in this field of study. This study aims to analyze published articles using bibliometrics, summarize the current research progress and hot topics in this field systematically and exhaustively, and predict the future direction and trend of research.

Methods

For this study, the Web of Science Core Collection (WoSCC) database was searched between 2002 and 2022 for publications related to adolescent insomnia. The R-bibliometrix, VOSViewer, and CiteSpace software were utilized for bibliometric analysis.

Results

This investigation included 2468 publications from 3102 institutions in 87 countries, led by China and the United States. This field of research has entered a period of rapid development since 2017. The journal with the most publications on adolescent insomnia is Sleep, which is also the most co-cited journal. American Journal of Psychology has the highest impact factor among the top 10 journals. These papers were written by 10605 authors; notably, Liu Xianchen emerged as the author with the highest frequency of publications, while Mary A. Carskadon was the most frequently co-cited author. Mental health and comorbid diseases were the main research directions in this field. "Depression," "anxiety," "mental health," "COVID-19," "stress," "quality of life," "heart rate variability," and "attention-deficit hyperactivity disorder" were hot spots and trends in this field at the current moment.

Conclusion

The research on adolescent insomnia has social value, research value, and research potential; its development is accelerating, and an increasing number of researchers are focusing on it. This study summarized and analyzed the development process, hot spots, and trends of adolescent insomnia research using bibliometric analysis, which identified the current hot topics in this field and predicted the development trend for the future.

Care Their Diet and Mind: Association between Eating Habits and Mental Health in Chinese Left-behind Children

Studies have shown that the prevalence of mental health problems is high among left-behind children (LBC). Modifiable eating habits may play an important role in promoting mental health among these adolescents. This study aimed to investigate the situation of dietary habits and their association with mental health problems in a sample of Chinese LBC. We conducted this cross-sectional study in an economically disadvantaged area of China in May 2020. Information on socio-demographic factors, eating habits (the frequency of eating carbohydrates, fruits, vegetables, protein, and breakfast), and mental health problems (insomnia, depression, and anxiety) were collected among local adolescents. Among 8939 adolescents were recruited, a total of 3314 LBC (1455 males and 1859 females, aged 12–17 years) were identified and included in the current study. Associations between dietary habits and mental health were analyzed by generalized linear models. Results indicated that the dietary pattern was unhealthy among LBC and even worse in females. Compared to routinely eating breakfast and fruits, lower frequencies of eating breakfast and fruits were identified as two significant factors with higher risks of mental health problems. Moreover, the association was more pronounced in females. Therefore, improving diet quality, particularly the frequency of eating breakfast and fruit intake may be an effective approach in the mental health promotion for LBC, especially for females.