Beyond Sleep Duration: Bidirectional Associations Among Chronotype, Social Jetlag, and Drinking Behaviors in a Longitudinal Sample of US High School Students

Network characteristics of comorbid symptoms in alcohol use disorder

BACKGROUND

Individuals with alcohol use disorder (AUD) often experience symptoms such as anxiety, depression, and decreased sleep quality. Although these are not diagnostic criteria, they may increase dependence risk and complicate treatment. This study aims to analyze comorbidities and their complex relationships in AUD patients through epidemiological surveys and network analysis.

MATERIALS AND METHODS

Using multi-stage stratified cluster random sampling, we selected 27,913 individuals and identified those with AUD for the study. All screened subjects were assessed with the General Health Questionnaire, Pittsburgh Sleep Quality Index, and Simple Coping Style Questionnaire, and diagnosed according to DSM-IV criteria. Network analysis and visualization were performed in R 4.4.0. The qgraph and bootnet packages in R were used to obtain partial correlation network analysis and node centrality of mental health, sleep quality, and coping styles in individuals with AUD through the estimateNetwork function. The bootnet package was used to assess the accuracy and stability of the network. The bnlearn package in R was used to construct directed acyclic graph (DAG) for individuals with AUD using the Bayesian hill-climbing algorithm.

RESULTS

In the partial correlation network, among the three major comorbidity categories, 'anxiety/depression' was most strongly associated with 'sleep quality'. 'Anxiety/depression' and 'sleep quality' had the highest node centrality, with 'sleep latency' also showing notable centrality. The DAG results indicated that 'sleep latency' had the highest probability priority, directly affecting 'anxiety/depression' and key sleep quality symptoms such as 'subjective sleep quality', 'sleep disturbances', 'sleep duration', and 'sleep efficiency', while also indirectly influencing other symptoms.

CONCLUSIONS

Among the comorbid symptoms of AUD, sleep latency appears to be a key factor in triggering other comorbid symptoms. This study provides a basis for interventions aimed at reducing the comorbid symptoms of AUD and promoting recovery.

Circadian phase in high-school students: weekday-weekend shifts and relationships to other sleep/circadian characteristics

STUDY OBJECTIVES

In a sample of high-school students, (1) to characterize within-person changes in sleep and circadian characteristics from school nights to weekend nights, (2) to examine whether later circadian phase relates to weekday-weekend changes in sleep/circadian characteristics, and (3) to examine correlations between biological and proxy measures of circadian phase.

METHODS

Sample included 95 high-school students reporting at least one drink of alcohol in their lifetime. Participants completed baseline self-report measures, wrist actigraphy for 8 days, and two overnight laboratory visits (Thursday and Sunday) for salivary melatonin sample collection. Circadian phase was calculated as the dim light melatonin onset (DLMO; 4 pg/mL threshold). Proxy circadian phase measures included the Composite Scale of Morningness (CSM), Munich Chronotype Questionnaire (MCTQ), and actigraphy-based midsleep.

RESULTS

Other than nap duration, all examined actigraphy-based sleep characteristics, DLMO, and DLMO-sleep phase angles showed weekday-weekend differences (adjusted p-value < .05). Later mean DLMO was associated with larger weekday-weekend changes in total sleep time (b = 0.39, padjusted = .010). CSM and actigraphy-based midsleep showed small-to-moderate (rho = ~0.3) and moderate (rho = ~0.5) correlations with DLMO, respectively, but chronotype based on the MCTQ was not correlated with DLMO.

CONCLUSIONS

In the largest published sample to date, circadian phase substantially shifted from the school week to weekend, underscoring the "social jetlag" imposed by early school start times. Similarly, teens with the latest circadian phase exhibited the greatest weekend catch-up sleep. Finally, perhaps due to the instability of circadian phase in this context, self-reported proxies for circadian timing were poor approximations of biological circadian phase.

Sleep as a Protective Factor: Multiple Forms of Discrimination and Substance Use Intention Among Racially and Ethnically Minoritized United States Youth

PURPOSE

Research has rarely examined biobehavioral factors in mitigating substance use (SU) risks associated with discrimination among racially and ethnically minoritized youth. This study investigated sleep duration as a potential moderator of the association between multiple forms of discrimination based on race and ethnicity, sexual orientation, and weight (i.e., multiple discrimination) and subsequent SU intention in this population.

METHODS

Data were drawn from a national, longitudinal sample of racially and ethnically minoritized early adolescents (N = 3,495, Mage = 11.52 years) participating in the Adolescent Brain Cognitive Development Study. Multiple discrimination was assessed through aggregated youth reports at 1-year follow-up (Y1) and 2-year follow-up (Y2). Sleep duration was assessed at Y2 via self-reports in the full sample and actigraphy over 3 weeks in a subsample (N = 1,404). Youth reported SU intention at Y2 and 3-year follow-up (Y3). Relevant sociodemographic and psychosocial covariates were included.

RESULTS

Path analyses showed that more exposure to multiple discrimination was associated with greater subsequent SU intention, controlling for prior SU intention levels. However, this association was only significant among adolescents with shorter sleep duration on weekdays, not among those who slept longer (above 9.6 hours based on self-reports or 7.5 hours based on actigraphy) on weekdays. Actigraphy sleep duration mean and variability also exhibited nuanced linkages with subsequent SU intention.

DISCUSSION

Findings highlighted sleep duration as a promising lever of change for preventative interventions aiming to curb SU among racially and ethnically minoritized youth in early development.

Associations between sleep habits and different impulsivity facets in adolescence

BACKGROUND

Sleep patterns change during adolescence due to physiological maturation and psychosocial factors, leading to progressively higher eveningness, sleep deprivation and social jetlag (SJL). These sleep changes are associated with impulsivity, a common behavioral trait in adolescence which can make those with developmental disabilities more vulnerable to behavioral, cognitive and clinical difficulties. However, it is unclear which aspects of sleep and what types of impulsivity are involved.

AIMS

To investigate the relationships between sleep/circadian variables and self-reported impulsivity.

METHODS AND PROCEDURES

Three sleep/circadian variables (time in bed on weekdays, eveningness and SJL) and five dissociable facets of self-reported impulsivity (UPPS-P scale) were answered by 389 healthy 9-17-year-olds (225 girls).

OUTCOMES AND RESULTS

A significant (but small) association between eveningness and a multivariate composed of the five facets of impulsivity (5 % of variance explained) was found and negative urgency was the main driver (4 %) of this relationship.

CONCLUSION AND IMPLICATIONS

Typically developing adolescents with high eveningness traits display slight difficulty controlling their behavior when in a state of negative affect. This finding deserves an in-depth investigation in youth with neurodevelopmental disabilities, who are more prone to presenting sleep/circadian changes, externalizing problems like impulsiveness and internalizing one such as mood alterations.

Sleep Loss and Substance Use Disorders: An Issue from Adolescents to Adults

Unsatisfactory sleep is a worldwide concern, as evidenced by the high prevalence of insomnia symptoms and diagnosis in the general population, and an issue that has also risen among adolescents. These circumstances are a cause of worry due to, among other factors, the observed bidirectional association of sleep disturbances and the risk of substance use disorder development. In this regard, across the globe, several reports indicate that substance consumption is at an all-time high, with alcohol, nicotine, and cannabis leading the charts. Additionally, the age of onset has dropped, with reports suggesting that first contact is usually during adolescence. Although the nature of the link between poor sleep and substance use disorder development is still not fully understood, it is possible that an overactive orexinergic system could play a role, as it has been observed that treatment with orexinergic antagonists improves insomnia symptoms and that postmortem studies show an increase in orexin immunoreactive neurons in sections obtained from habitual opioid consumers. We further argue that it is during adolescence that this maladaptive loop can be established, priming for the development of substance use disorders.

The association of chronotype, sleep duration and trajectories of health-risk behaviors among college students: a cohort study

PURPOSE

To describe the trajectories of health-risk behaviors (HRBs) among college students through four consecutive surveys and explore the relationship between chronotype, sleep duration and different trajectories of HRBs.

METHODS

We used a data sample of 1,042 college students from the College Student Behavior and Health Cohort Study. Students reported sleep parameters, including chronotype (Morningness-Eveningness Questionnaire-5, MEQ-5) and sleep duration. The behavior scale was used to evaluate four HRBs (smoking, alcohol use, low physical activity, smartphone addiction). The latent class growth analysis (LCGA) was used to estimate the trajectory of self-reported HRBs. Multivariate logistic regression models were used to study whether sleep parameters (chronotype and sleep duration) correlated with HRBs' trajectories.

RESULTS

Four unique trajectories of behaviors were identified: unhealthy group (7.4%), increasing group (21.3%), decreasing group (10.3%) and healthy group (61.0%). Compared with the normal sleep, results from logistic regression analyses indicated that long sleep (> 9 h) was associated with the decreasing group and the unhealthy group (P < 0.05), while short sleep (< 7 h) was associated with the increasing group and the unhealthy group (P < 0.05). Compared with the M-type, the E-type were positively correlated with the unhealthy group, the increasing group, and the decreasing group (P < 0.05).

CONCLUSION

E-type, short sleep duration and long sleep duration were significantly associated with the trajectory of HRBs. Findings underscore the need for targeted screening and prevention of modifiable sleep behaviors with the aim of improving HRBs in college students.

Social jetlag and sleep habits in children and adolescents: Associations with autonomy (bedtime setting and electronics curfew) and electronic media use before sleep

For young people attending school, social jetlag (SJL) refers to discrepancy in sleep/wake timing between school days and weekends. This study investigated SJL in school-aged children and adolescents in England and whether this is associated with age, gender, and sleep habits including bedtimes and electronic media use. Students (school y 5-13; typical age 9-18 y) completed the 2021 OxWell Student Survey. In total 19,760 participants (55% female) reported on sleep/wake timing, rules concerning bedtime setting on school night/weekend, electronic media curfew, and frequency of social media use and video gaming before sleep intention. The mean SJL was 1 h 53 min (SD = 1 h 7 min) and peaked at 2 h 7 min at age 15. Multiple regression analysis revealed SJL was positively associated with age and being male was associated with slightly lower SJL than being female. After controlling for age and gender, weekend bedtime setting (β = 0.21), frequency of social media use before sleep (β = 0.16) and video gaming before sleep (β = 0.12) were the strongest predictors of SJL. Findings suggest that household rules regarding weekend bedtimes and less electronic media use before sleep may be connected with lower SJL as well as more regular sleep timing across the whole week.

The Relationship Between Intraindividual Sleep-Wake Variability and Mental Health in Adolescents

OBJECTIVE

We investigated the relationship between irregular sleep-wake patterns and other aspects of sleep and mental health among adolescents.

METHODS

Community-based sample of adolescents (n = 200, mean age 16.8; 61.7% female) completed baseline assessment (i.e. sleep quality, daytime sleepiness, depressive symptoms, social anhedonia, problematic alcohol use), and 7-8 consecutive days of wearing wrist actigraphy. Irregular sleep-wake patterns were assessed via two methods, both based on actigraphy, to capture day-to-day irregularity (intraindividual variability, IIV) and weekly irregularity (social jet lag, SJL). The Bayesian variability method was performed to calculate IIV in total sleep time (TST), sleep onset, and offset time. SJL was quantified as the actual difference in the sleep midpoint on school days versus non-school days.

RESULTS

Greater IIV in TST was associated with poorer sleep quality (B = 1.66, 95% CI, 0.14, 3.31, p < .05), and greater depressive symptoms (B = 0.72, 95% CI, 0.17, 1.35, p < .05), while greater IIV in sleep offset time was associated greater depressive symptoms (B = 0.63, 95% CI, 0.03, 1.28, p < .05), and greater problematic alcohol use (B = 0.70, 95% CI, 0.12, 1.35, p < .05), all after adjusting for age, sex, family SES, alcohol drinks, and SJL. No significant association was found with sleep onset time. Greater SJL was associated with poorer sleep quality (B = 0.40, 95% CI, 0.27, 0.54, p < .001) and fewer problematic alcohol uses (B = -0.05, 95% CI, -0.09, -0.00, p < .05), when adjusting for age, sex, family SES, and alcohol drinks.

CONCLUSION

Our findings add to a growing body of research on irregularity in sleep-wake patterns and clinical implications.

Association between social jetlag and leisure-time physical activity and muscle strengthening exercise in young adults: findings from a nationally representative sample in South Korea

OBJECTIVES

Social jetlag (SJL), which is characterised by a misalignment between biological and social time, is associated with cardiometabolic risk factors. This study investigated the relationship between SJL, leisure-time physical activity (LTPA) and muscle strengthening exercise (MSE) in young adults.

STUDY DESIGN

This was a cross-sectional study.

METHODS

This cross-sectional study included a nationally representative sample of young adults aged 19-29 years (n = 2113). SJL was calculated as the difference in the midpoint of sleep onset and offset time between weekdays and weekends. The dependent variables were engagement in ≥150 min/week of moderate-to-vigorous LTPA and engagement in MSE ≥2 days/week based on guidelines provided by the World Health Organisation. Logistic regression analysis was performed to estimate odds ratios (ORs) and 95% confidence intervals (CIs). Non-linear relationships were estimated using restricted cubic spline regression.

RESULTS

The study population comprised 975 men and 1138 women. Among participants, 4.6% had <0 min, 41.9% had 0-59 min, 25.7% had 60-119 min and 27.7% had ≥120 min SJL. Those with ≥120 min SJL had a reduced likelihood of achieving the recommended level of LTPA (OR: 0.71, 95% CI: 0.52-0.95) and MSE (OR: 0.73, 95% CI: 0.55-0.97). In the non-linear model, an inverse U-shaped association was observed, wherein the highest probability of meeting the recommended level of LTPA and MSE was observed in those with 45 min SJL, decreasing after this threshold.

CONCLUSIONS

Individuals with ≥120 min SJL were less likely to engage in the recommended level of both aerobic and anaerobic exercise. Although future studies using a longitudinal design are required to elucidate the causal relationship between SJL and physical activity, the current findings suggest that physical inactivity during leisure time may play an important role in the increased risk of cardiometabolic abnormalities in young adults with SJL.

Changes in Rest-Activity Rhythms in Adolescents as They Age: Associations With Brain and Behavioral Changes in the ABCD Study

OBJECTIVE

Adolescents with disrupted rest-activity rhythms (RARs), including shorter sleep duration, later sleep timing, and low physical activity levels, are at greater risk for mental health and behavioral problems. It remains unclear whether the same associations can be observed for within-subject changes in RARs.

METHOD

This longitudinal investigation on RARs used Fitbit data from the Adolescent Brain Cognitive Development (ABCD) Study at the 2-year follow-up (FL2) (ages 10-13 years) and 4-year follow-up (FL4) (ages 13-16 years). Good-quality Fitbit data were available for 963 youths at both time points. Changes in RARs from FL2 to FL4, their environmental and demographic contributors, and brain and behavioral correlates were examined.

RESULTS

From FL2 to FL4, adolescents showed decreases in sleep duration and physical activity as well as delayed sleep timing (Cohen d = 0.44-0.75). Contributions of environmental and demographic factors to RAR changes were greatest for sleep timing (explained 10% variance) and least for sleep duration (explained 1% variance). Delays in sleep timing had stronger correlations with behavioral problems including impulsivity and poor academic performance than reductions in sleep duration or physical activity. Additionally, the various brain measures differed in their sensitivity to RAR changes. Reductions in sleep duration were associated with decreased functional connectivity between subcortical regions and sensorimotor and cingulo-opercular networks and with enhanced functional connectivity between sensorimotor, visual, and auditory networks. Delays in sleep timing were mainly associated with gray matter changes in subcortical regions.

CONCLUSION

The current findings corroborate the importance of sleep and physical activity in brain neurodevelopment and behavioral problems in adolescents. RARs might serve as biomarkers for monitoring behavioral problems and be potential therapeutic targets for mental disorders in adolescents.

Racial/ethnic disparities in sleep health among adolescents in South Korea: The role of substance use behaviours

AIM

To examine the relationship between racial/ethnic disparities and substance use behaviours (alcohol and tobacco use) and their impact on the sleep health of South Korean adolescents.

DESIGN

Secondary analysis of cross-sectional study data from the 2021 Korea Youth Risk Behaviour Web-based Survey dataset.

METHODS

Given that Korean society has historically linked its racial/ethnic identity to a shared bloodline, we categorized 2644 adolescents from the Korea Youth Risk Behaviour Web-based Survey based on their racial/ethnic status, determined by their parents' birthplaces. Using multiple linear regression, we investigated whether the impact of racial/ethnic disparities on sleep health (sleep duration, debt, and timing) varies depending on substance use behaviours (alcohol and tobacco use) after controlling for age, sex, household economic status, depressed mood, suicidal ideation, perceived excessive stress, and anxiety level.

RESULTS

Despite no statistical differences in sleep health and the prevalence of substance use between racial/ethnic groups, racial/ethnic minority adolescents experienced greater sleep debt than racial/ethnic majority adolescents when consuming alcohol. Moreover, racial/ethnic minority adolescents were more likely to report psychosocial distress and had lower parental education level.

CONCLUSION

Racial/ethnic minority adolescents were more vulnerable to the detrimental effects of alcohol use on sleep health compared to racial/ethnic majority adolescents. This heightened vulnerability may be attributed to the more pronounced psychosocial challenges and the lower socioeconomic status of parents in the racial/ethnic minority group.

IMPACT

Racial/ethnic disparities are concerning in South Korea, particularly since the negative effects of substance use on sleep health are intensified among racial/ethnic minority adolescents. Nurses and other healthcare providers should recognize the importance of addressing the social disadvantages linked to racial/ethnic disparities. Beyond just advocating for the cessation of substance use, it is crucial to address these underlying issues to reduce sleep disparities among South Korean adolescents.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

Sex differences in the association between social jetlag and hazardous alcohol consumption in Korean workers: A nationwide cross-sectional study

BACKGROUND

Social jetlag, the misalignment between biological and social rhythms, can lead to adverse health outcomes. This study explored the association between social jetlag and hazardous alcohol consumption, as well as the sex differences in this association.

METHODS

This study included a nationally representative sample of Korean workers consisting of 11,462 individuals (5479 women). Social jetlag was calculated as the difference in the mid-point between sleep onset and offset on free days and workdays. Hazardous alcohol consumption was determined using the Alcohol Use Disorder Identification Test-Consumption (range 0-12), with a cutoff of ≥6 for men, ≥5 for women, and ≥3 for those aged ≥65. Logistic regression analysis was used to estimate the odds ratios (ORs) and 95 % confidence intervals (CIs).

RESULTS

Among men, 599 out of 5983 individuals (10.0 %) had ≥120 min of social jetlag. Among women, 550 out of 5479 individuals (10.0 %) had ≥120 min of social jetlag. The prevalence of hazardous alcohol use was 56.2 % for men and 27.3 % for women. In the regression analysis, there was a significant sex interaction, where social jetlag ≥120 min was associated with hazardous alcohol consumption in female workers (OR: 1.52, 95 % CI: 1.18-1.96), but not in male workers (OR: 1.04, 95 % CI: 0.84-1.29).

CONCLUSION

High social jetlag was associated with an increased likelihood of hazardous alcohol consumption among women. Our findings underscore the importance of considering sex differences in future research and policy interventions regarding social jetlag and its associated behavior outcomes.

Sex Differences in Temporal Sleep Patterns, Social Jetlag, and Attention in High School Adolescents

Insufficient sleep and irregular sleep hours are common in adolescents, who experience a delayed sleep phase due to biopsychosocial changes associated with puberty, resulting in later sleep times. However, early morning class hours shorten sleep duration on weekdays. This condition is harmful to cognitive performance, which may be accentuated in girls due to a greater sleep need and less resistance to sleep deprivation. In this study, we evaluated sex differences concerning temporal sleep patterns, social jetlag, and attention in high school adolescents attending morning classes. Students ( n  = 146 - F: 73-16.1 ± 0.8 years; M: 73-16.2 ± 0.9 years) completed a Health and Sleep questionnaire, kept a sleep diary for 10 days, which incorporated a Maldonado Sleepiness Scale, and performed a Continuous Performance Task. Girls went to bed earlier and woke up on weekends, and spent more time in bed at night and in 24 h on weekdays and weekends, while they also had a greater irregularity in wake-up times ( p  < 0.05). There were no differences between sexes in terms of social jetlag, sleep debt, and sleepiness upon awakening ( p  > 0.05). Regarding attention, the girls had a longer reaction time in phasic alertness ( p  < 0.01) and a tendency to have fewer errors in selective attention ( p  = 0.06). These results persisted when controlled for sleep parameters. Therefore, we suggest that girls have a greater sleep need and less resistance to sleep deprivation, while the differences in attention performance could be due to different strategies, the girls could be making a trade, increasing reaction time in favor of better accuracy, while the boys could be prioritizing a faster response time.

Adolescent Sleep Quality and Alcohol Use: An Initial Examination of the Serial Indirect Effects of Anxiety Symptoms and Coping Motives for Alcohol Use

Background: Insufficient sleep and insomnia are associated with alcohol use as well as anxiety during adolescence and young adulthood. A negative reinforcement path to explain the association between sleep difficulties and alcohol misuse has been proposed. Within this pathway, it is speculated that while sober, insomnia and insufficient sleep lead to increased anxiety as well as anxiolytic responses to alcohol, thereby increasing the risk for both alcohol use and alcohol use problems. No work to date has examined the negative reinforcement path to alcohol use among adolescents who have consumed alcohol. Objectives: The current study aims to address this gap in the literature by examining if sleep quality is related to adolescent alcohol use problems and frequency through serial indirect effects of adolescent anxiety symptoms and coping motives for alcohol use. A total of 147 adolescents between the ages of 13 and 18 years (Mage = 16.31; SD = 0.96) from all geographic regions in the US were recruited using social media platforms (i.e., Facebook and Instagram). Participants who reported having tried alcohol at least once completed self-report measures to examine sleep quality, anxiety symptoms, alcohol use problems, alcohol use frequency, and coping motives for alcohol use. Results: Adolescent sleep quality was found to be associated with higher levels of both alcohol use problems and alcohol use frequency through the serial indirect effect of anxiety symptoms and coping motives for alcohol use. Conclusions: Overall, these findings represent a step towards understanding the complex relationship between sleep quality, alcohol, anxiety, and coping motives among adolescents.

Do sleep and circadian characteristics predict alcohol use in adult drinkers?

BACKGROUND

While sleep and circadian rhythms are recognized contributors to the risk for alcohol use and related problems, few studies have examined whether objective sleep and circadian measures can predict future alcohol use in humans, and no such studies have been conducted in adults. This study examined whether any baseline sleep and/or circadian characteristics of otherwise healthy adults predicted their alcohol use over the subsequent 12 months.

METHODS

Participants (21-42 years) included 28 light and 50 heavy drinkers. At baseline, a comprehensive range of self-reported and objective sleep/circadian measures was assessed via questionnaires, wrist actigraphy, and measurement of dim light melatonin onset and circadian photoreceptor responsivity. Following this, the number of alcoholic drinks per week and binge drinking episodes per month were assessed quarterly over the subsequent 12 months. Anticipated effects of alcohol (stimulation, sedation, and rewarding aspects) were also assessed quarterly over the 12 months. Analyses included generalized linear mixed-effects models and causal mediation analysis.

RESULTS

Across the range of measures, only self-reported insomnia symptoms and a longer total sleep time at baseline predicted more drinks per week and binges per month (ps <0.02). There was a trend for the anticipated alcohol effect of wanting more alcohol at the 6-month timepoint to mediate the relationship between insomnia symptoms at baseline and drinks per week at 12 months (p = 0.069).

CONCLUSIONS

These results suggest that in otherwise healthy adults, insomnia symptoms, even if subclinical, are a significant predictor of future drinking, and appear to outweigh the influence of circadian factors on future drinking, at least in otherwise healthy adults. Insomnia symptoms may be a modifiable target for reducing the risk of alcohol misuse.

Is the association between social jetlag and BMI mediated by lifestyle? A cross-sectional survey study in the Dutch general population

OBJECTIVE

Social jetlag is a discordance between the social and biological rhythm and is associated with higher HbA1c, higher BMI, and higher odds of obesity. The pathways that could explain these associations are still debated. This study aims to assess the mediating role of several lifestyle factors in the cross-sectional association between social jetlag and BMI.

METHODS

We used cross-sectional data from 1784 adults from urban areas in the Netherlands, collected in 2019. Social jetlag (difference in midpoint of sleep between week and weekend nights) was categorized as low(<1 h), moderate(1-2h), and high(>2 h). BMI(kg/m2) was calculated from self-reported height and weight. The association between social jetlag and BMI was assessed using linear regression, adjusted for sex, age, education, and sleep duration and stratified for the effect modifier stress (high vs. low). Mediation analysis was performed for self-reported smoking, physical activity, alcohol consumption, and adherence to a healthy diet.

RESULTS

High social jetlag was associated with higher BMI (0.69 kg/m2,95%CI 0.05;1.33). This association was stronger in people with high stress (0.93 kg/m2,95%CI 0.09;1.76). Social jetlag was also associated with higher odds of smoking, lower physical activity, higher alcohol consumption, and lower healthy diet adherence. In people with high stress, these factors mediated 10-15% of the association between social jetlag and BMI.

CONCLUSIONS

Social jetlag is associated with higher BMI and this association is stronger in people with high stress. In people with high stress, healthy diet adherence mediated 12% of this association. Other pathways involved in this association should be further investigated.

Sleep-Related Predictors of Risk for Alcohol Use and Related Problems in Adolescents and Young Adults

PURPOSE

Growing evidence supports sleep and circadian rhythms as influencing alcohol use and the course of alcohol use disorder (AUD). Studying sleep/circadian-alcohol associations during adolescence and young adulthood may be valuable for identifying sleep/circadian-related approaches to preventing and/or treating AUD. This paper reviews current evidence for prospective associations between sleep/circadian factors and alcohol involvement during adolescence and young adulthood with an emphasis on the effects of sleep/circadian factors on alcohol use.

SEARCH METHODS

The authors conducted a literature search in PsycInfo, PubMed, and Web of Science using the search terms "sleep" and "alcohol" paired with "adolescent" or "adolescence" or "young adult" or "emerging adult," focusing on the title/abstract fields, and restricting to English-language articles. Next, the search was narrowed to articles with a prospective/longitudinal or experimental design, a sleep-related measure as a predictor, an alcohol-related measure as an outcome, and confirming a primarily adolescent and/or young adult sample. This step was completed by a joint review of candidate article abstracts by two of the authors.

SEARCH RESULTS

The initial search resulted in 720 articles. After review of the abstracts, the list was narrowed to 27 articles reporting on observational longitudinal studies and three articles reporting on intervention trials. Noted for potential inclusion were 35 additional articles that reported on studies with alcohol-related predictors and sleep-related outcomes, and/or reported on candidate moderators or mediators of sleep-alcohol associations. Additional articles were identified via review of relevant article reference lists and prior exposure based on the authors' previous work in this area.

DISCUSSION AND CONCLUSIONS

Overall, the review supports a range of sleep/circadian characteristics during adolescence and young adulthood predicting the development of alcohol use and/or alcohol-related problems. Although sleep treatment studies in adolescents and young adults engaging in regular and/or heavy drinking show that sleep can be improved in those individuals, as well as potentially reducing alcohol craving and alcohol-related consequences, no studies in any age group have yet demonstrated that improving sleep reduces drinking behavior. Notable limitations include relatively few longitudinal studies and only two experimental studies, insufficient consideration of different assessment timescales (e.g., day-to-day vs. years), insufficient consideration of the multidimensional nature of sleep, a paucity of objective measures of sleep and circadian rhythms, and insufficient consideration of how demographic variables may influence sleep/circadian-alcohol associations. Examining such moderators, particularly those related to minoritized identities, as well as further investigation of putative mechanistic pathways linking sleep/circadian characteristics to alcohol outcomes, are important next steps.

Modifiable dietary factors in adolescent sleep: A systematic review and meta-analysis

OBJECTIVE

Sleep problems are prevalent during adolescence, and modifying dietary factors may contribute to better sleep outcomes in adolescents. This systematic review and meta-analysis aimed to evaluate the impact of modifiable dietary factors on sleep health among adolescents.

METHODS

A systematic search of records from six databases including MEDLINE, PubMed, Embase, Scopus, CINAHL, and the CENTRAL from inception up to November 2023, identified 33 peer-reviewed publications that assessed the relationship between modifiable dietary factors and sleep outcomes in adolescents aged 12-18 years. The NIH Quality Assessment Tools were used to assess the quality of the included studies. Meta-analysis was performed on a sub-group of studies (n = 6) to ascertain the effect of dietary factors on sleep health.

RESULTS

Although the included studies were predominantly cross-sectional and exhibited heterogeneity, relying mainly on self-reported measures, it was observed that consumption of healthy foods was consistently linked with improved sleep outcomes among adolescents, whereas higher intake of fat-rich or sugar-rich foods and red meats or processed food was associated with poorer sleep features. The meta-analysis further substantiated that adolescents with higher caffeine intake faced increased odds of sleep problems (OR = 1.67, 95% CI: 1.28-2.17), while alcohol consumption was significantly associated with insomnia (OR = 1.17, 95% CI: 1.07-1.27).

CONCLUSION

Overall, despite high heterogeneity among studies, this systematic review underscores the promising role of healthy dietary factors in enhancing both the quality and quantity of sleep in adolescents. The meta-analysis results also highlight that reducing caffeine and alcohol intake holds potential for supporting better sleep in this population. However, further validation through intervention studies is warranted.

Associations of social jetlag with physical activity and sedentary behaviour in children and adolescents: A systematic review and meta-analysis

Sleep and daytime movement behaviours occur co-dependently with each other within a finite 24 h day. Sleep parameters other than sleep duration, such as social jetlag and chronotype, have been linked to health problems and unhealthy behaviours among children and adolescents. Given the increasing number of studies examining sleep timing/chronotype and weight-related behaviours, including physical activity and sedentary behaviour, in the past decade, this systematic review and meta-analysis collated and evaluated the evidence on the relationships of social jetlag and chronotype with physical activity and sedentary behaviour among children and adolescents aged 3-17 years. Seven databases were searched on 16 March 2022, and 52 studies were identified as eligible for inclusion, 47 of which were suitable for the meta-analysis. A positive association was found between social jetlag and screen media use (r = 0.14, 95% CI: 0.04-0.24; I2  = 96%; p = 0.008). The morning chronotype was associated with a higher level of physical activity and a lower level of sedentary behaviour than the evening chronotype. No relationship was found between social jetlag and physical activity. The magnitude of heterogeneity among the included studies was high. Further experimental studies are urgently required to understand how circadian preference or misalignment affects activity behaviours. Interventions to promote an active lifestyle in young populations should consider their circadian preference, especially among individuals with the evening chronotype.

Lifestyle factors, dietary patterns, and social determinants of social and eating jetlag: A cross-sectional survey

Social jetlag (SJL) and, more recently, eating jetlag have been linked with an increased risk of non-communicable diseases. Here we aim to investigate lifestyle factors (diet, eating behavior, smoking, perceived stress, time spent sedentary/day) and social determinants (education level, employment status, and place of residence) associated with SJL corrected for sleep duration (SJLsc) and eating jetlag. Self-declared data on age, gender, lifestyle, and eating behavior were collected online from March 2021 to February 2022 of 432 adults. Principal component analysis was used to extract three dietary patterns (Prudent, Western, and Risky). Prevalence of SJLsc was 35.2%, with no significant difference between men and women (p = 0.558). Adults with SJLsc had significantly larger eating jetlag (56.0 min vs 41.2 min, p = 0.001). Increasing SJLsc duration was associated with an increased adherence to a Risky dietary pattern (standardized β coefficient = .165, p = 0.012); increasing eating jetlag duration was associated with an increased adherence to a Western dietary pattern (standardized β coefficient = .127, p = 0.039) and a shorter sleep duration (standardized βcoefficient = -0.147, p = 0.011). Among social determinants analyzed, only being a student or employed was associated with eating jetlag (standardized β coefficient = 0.125, p = 0.044), while none displayed any relationship with SJLsc. Our survey provides evidence on a risky behavior among young persons with SJLsc and eating jetlag, characterized by a higher alcohol consumption, and a diet rich in processed meat and high-fat food, eating during nights, and shorter sleep duration with potential long-term negative health outcomes.

Circadian preference and mental health outcomes in youth: A systematic review and meta-analysis

Youth is a vulnerable developmental period associated with an increased preference for eveningness and risk for developing psychopathology. Growing evidence suggests a link between eveningness and poorer mental health outcomes, but the findings in the current literature are inconsistent, and a comprehensive synthesis of evidence in this area remains lacking. This meta-analysis aimed to 1) synthesise the existing evidence on the association between circadian preference and mental health outcomes in youths and 2) explore potential sleep-related factors that may moderate the relationship between circadian preference and mental health outcomes. A systematic search of five electronic databases resulted in 81 observational studies included in the review. Eveningness was found to be significantly associated with general mental health (r = 0.20), mood-related disturbances (r = 0.17), and anxiety problems (r = 0.13). The qualitative review also identified that eveningness was associated with greater risks for psychotic symptoms and maladaptive eating behaviours. These findings highlighted the need to consider circadian preference in the clinical management of youth mental health problems. Further research is needed to examine the efficacy of a circadian-focused intervention in the context of youth mental health.

Construction of a model for adolescent physical and mental health promotion based on the multiple mediating effects of general self-efficacy and sleep duration

We developed a model for promoting adolescent physical and mental health (MH) to investigate the integrated pathways of physical activity (PA), MH, general self-efficacy (GSE), and sleep duration (SD) promotion among adolescents in China. The research hypotheses were tested using questionnaires, descriptive statistics, and validated factor analysis. The mean age of the respondents was 14.94 ± 1.76 years, the PA level was 2.49 [95% confidence interval (CI): 2.46-2.53], the GSE score was 2.60 (95% CI: 2.57-2.64), the SD was 436.52 min/day (95% CI: 432.89-440.15), and the total mean MH score was 1.72 (95% CI: 1.69-1.76) (model fitness index: χ2/df = 1.295, comparative fit index = 0.999, Tucker-Lewis index = 0.997, root mean square error of approximation = 0.014, standardized root mean square residual = 0.007). The SD accounted for 46.85% of the mediating effect. The adolescents exhibited moderately low PA levels, severe SD deficits, and high rates of overall MH abnormalities. Consequently, the constructed model for promoting adolescent physical health and MH was confirmed to be reliable; GSE and SD are significant factors mediating MH promotion.

Is evening chronotype associated with higher alcohol consumption? A systematic review and meta-analysis

A broader understanding of whether and to what extent chronotype should be considered a risk factor for alcohol consumption is needed. The aim of this systematic review was to summarize the evidence on the association between evening chronotype and alcohol consumption. A systematic search of observational studies on this association was conducted in the PubMed, Scopus, Web of Science, Cochrane Library and PsycINFO databases up to April 30th, 2023. Random-effect models estimated the pooled odds ratio (OR) of alcohol consumption according to chronotype. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and Quality Assessment tool for Observational Cohorts and Cross-sectional Studies from the National Heart, Lung and Blood Institute were followed. A total of 33 studies involving 28 207 individuals (age range: 18-93 years) were included in this review. Overall, most studies indicated a higher volume and frequency of alcohol consumption in evening-type individuals than in individuals with different chronotypes. Additionally, a meta-analysis including 13 studies showed that evening-type individuals were 41% more likely to consume alcohol than those with other chronotypes (OR = 1.41, 95% confidence interval: 1.16-1.66; I2 = 38.0%). Limitations of the present findings are the predominance of cross-sectional studies and varied definitions of alcohol consumption. The available evidence supports an association between the evening chronotype and alcohol consumption. The evening-type population, especially young adults, is a specific target for educational interventions for preventing or reducing alcohol consumption.PROSPERO number: CRD42022343778.

Sensation seeking, drinking motives, and going out mediate the link between eveningness and alcohol use and problems in adolescence

The present study was aimed at obtaining a more comprehensive understanding of the possible mediating factors in the morningness-eveningness → alcohol consumption relation. We explored the role of mediators such as sensation seeking, the frequency of going out in the evenings, and drinking motives. We tested the proposed mediation model via structural equation modeling based on cross-sectional research conducted among Hungarian adolescents and young adults (N = 1695, 42.5% male, Mage = 18.98, SDage = 1.89). The outcomes included the frequency of alcohol consumption and problematic drinking. Both alcohol consumption and problematic drinking were predicted in similar directions and magnitudes by sensation seeking, "going out," and coping drinking motives. However, eveningness still had a significant direct effect on alcohol consumption and problematic drinking after we controlled for sensation seeking, going out, and drinking motives. For problematic drinking, the possible role of drinking motives seems to be higher and more complex than it is for alcohol consumption. The mediators, such as sensation seeking, the amount of time spent out in the evenings, and drinking motives, can explain the eveningness → alcohol consumption relationship and should be targeted for alcohol prevention programs among evening-type adolescents.

Leveraging Ecological Momentary Assessment to Examine Bi-directional Associations Between Sleep Quality, Adolescent/Young Adult Alcohol Craving and Use

BACKGROUND

Alcohol use is common among adolescents and young adults (AYA) and linked to poor sleep quality. Poor sleep quality may also increase alcohol use and alcohol craving, yet bi-directional relations between sleep quality and AYA alcohol use are poorly understood.

PURPOSE

This study examined bi-directional associations between sleep quality, alcohol craving, and alcohol use in AYA using ecological momentary assessment (EMA) and explored if biological sex, age, or race moderated these associations.

METHODS

This pre-registered secondary analysis pooled EMA data from the baseline, pre-randomization period (M = 8.18 days, range = 1-17) in two double-blind randomized placebo-controlled clinical trials examining medication effects on alcohol use in AYA (N = 115). Each morning, participants reported sleep quality and alcohol consumption (i.e., number of standard drinks) from the previous day, and craving was rated at several random points each day.

RESULTS

Multilevel modeling showed that poorer average sleep quality was associated with higher levels of alcohol craving for females but not for males, and better overall levels of sleep quality were associated with decreased likelihood of engaging in alcohol use. No other person- or day-level associations between sleep and alcohol use emerged.

CONCLUSIONS

Better sleep quality may be protective against alcohol use in AYA, and female AYA who report poorer sleep quality may experience higher levels of alcohol craving. Research and clinical assessment of AYA sleep quality can contribute to understanding of factors promoting alcohol craving and use.

A comparison of sleep-wake patterns among school-age children and adolescents in Hong Kong before and during the COVID-19 pandemic

STUDY OBJECTIVES

The lifestyles change of children and adolescents during the COVID-19 pandemic due to antipandemic measures can affect their sleep health. Existing studies have used convenient samples and focused on the initial months of the pandemic, leaving a knowledge gap on changes in young people's sleep patterns under the "new normal" under COVID-19.

METHODS

As part of a territory-wide epidemiological study in Hong Kong, this cross-sectional study recruited primary and secondary school students by stratified random sampling. Sleep parameters were collected using the structured diagnostic interview for sleep patterns and disorders. We investigated the pandemic's effects on sleep parameters by comparing data of participants recruited pre-COVID and those recruited during COVID using multivariate regression, adjusting for age, sex, household income, seasonality, and presence of mental disorders, and the moderators and mediators of the effects.

RESULTS

Between September 1, 2019 and June 2, 2021, 791 primary and 442 secondary school students were recruited and analyzed. Primary school and secondary school participants assessed before COVID had a longer sleep latency on school days (95% confidence interval [CI] = 1.0-5.2 minutes, adjusted P-value = .010; and 95% CI= 3.9-13.0 minutes, adjusted P-value = .004, respectively) and nonschool days (95% CI = 1.7-7.2 minutes, adjusted P-value = .005; 95% CI = 3.4-13.7 minutes, adjusted P-value = .014, respectively). Low household income was a moderator for later bedtime (adjusted P-value = .032) and later sleep onset (adjusted P-value = .043) during nonschool days among secondary school students.

CONCLUSIONS

Changes associated with COVID have a widespread and enduring effect on the sleep health of school-aged students in Hong Kong. Household income plays a role in adolescent sleep health resilience, and the impact of antiepidemic measures on the health gaps of the youth should be considered.

CITATION

Chau SWH, Hussain S, Chan SSM, et al. A comparison of sleep-wake patterns among school-age children and adolescents in Hong Kong before and during the COVID-19 pandemic. J Clin Sleep Med. 2023;19(4):749-757.

Association of emotional and behavioral problems with sleep disturbance among Chinese adolescents: The moderation effect of academic performance

BACKGROUND

This study aimed to explore the association of emotional and behavioral problems with sleep disturbance among Chinese adolescents, and to test whether these associations vary with adolescents' academic performance.

METHODS

Data were from the 2021 School-based Chinese Adolescents Health Survey using a multistage, stratified-cluster, and random-sampling method to collect information from 22,684 middle school students in Guangdong Province, China.

RESULTS

Emotional problems (aOR = 1.34, 95 % CI = 1.32-1.36), conduct problems (aOR = 1.19, 95 % CI = 1.16-1.21), hyperactivity (aOR = 1.35, 95 % CI = 1.33-1.37), and peer problems (aOR = 1.06, 95 % CI = 1.04-1.09) were significantly associated with the increased risk of sleep disturbance among middle school students in Guangdong Province. The prevalence of sleep disturbance among adolescents was 29.4 %. There were significant interactions of emotional problems/conduct problems/peer problems/prosocial behavior with academic performance on sleep disturbance. Further stratification analyses by academic performance showed that adolescents with self-reported good academic performance had a higher risk of sleep disturbance than those students with self-reported average or poor academic performance.

LIMITATIONS

This study only included school students and used the cross-sectional design to preclude causality determination.

CONCLUSIONS

Our findings suggest that emotional and behavioral problems elevate the risk of sleep disturbance in adolescents. Adolescent academic performance plays a modulating role in these above-mentioned significant associations for sleep disturbance.

Development of morning-eveningness in adolescence: implications for brain development and psychopathology

BACKGROUND

Morning-evening preference is defined as an individual's preference for a morning- or evening-oriented rhythm. Across adolescence, a preference for eveningness becomes more predominant. Although eveningness is cross-sectionally associated with internalizing and externalizing psychopathology, few studies have examined developmental changes in eveningness and its potential biological substrates. Here, we investigated the longitudinal relationships among the trajectory of eveningness preference, internalizing and externalizing psychopathology and white matter development, across adolescence.

METHODS

Two-hundred and nine adolescents (49% male) were assessed longitudinally at four separate time points between 12 and 19 years of age. Morning-evening preference and internalizing and externalizing symptoms were assessed at each time point. Diffusion-weighted images were acquired on a subset of participants at the final two time points to estimate changes in global mean fractional anisotropy (FA). Linear mixed models were performed to estimate the change in eveningness over time. A series of linear regression models assessed the influence of change in eveningness on psychopathology and white matter development at age 19.

RESULTS

Across the sample, a preference for eveningness became more predominant by 19 years of age. Greater individual-level change towards eveningness significantly predicted greater severity in externalizing, but not internalizing, symptoms at 19 years of age. In contrast, change in psychopathology from 12 to 19 years of age was not associated with morning-eveningness at age 19. A change towards eveningness predicted an attenuated increase in FA between 17 and 19 years of age.

CONCLUSIONS

This study suggests that developmental changes in morning-evening preference may predict both neurodevelopmental and psychological outcomes in adolescents.

Cluster Analysis of Sleep Time and Adolescent Health Risk Behaviors

Adolescents are prone to multiple health risk behaviors. These might lead to insufficient sleep, which is inconducive to adolescent growth. Therefore, this study explored the impact of a cluster of adolescent health risk behaviors on sleep time, providing a reference for designing relevant intervention measures. From November to December 2019, a stratified cluster sampling method was used to sample middle and high schools in 4 functional districts of Chongqing, China. A total of 8546 participants were selected for a questionnaire survey. Two-step clustering helped identify the health risk behavior clusters. Multivariate logistic regression models helped examine the association between the different clusters and sleep time. The rate of insufficient sleep was 65.8%. Three types of clusters were identified, namely (1) high-risk (poor) cluster (17.3%), (2) low physical activity (medium) cluster (55.1%), and (3) low-risk (good) cluster (27.6%). The high-risk and low physical activity clusters showed that the adjusted OR values of 1.471 (1.266-1.710) and 1.174 (1.052-1.310) were significantly associated with insufficient sleep (P < .001). Adolescent health risk behaviors were clustered, and different clusters had different sleep time. Schools authorities and healthcare practitioners should formulate effective intervention measures according to the characteristics of different clusters to promote healthy growth among adolescents.

The trajectories and associations of insomnia symptoms with addictive behaviours in adolescents: A two-year longitudinal study

Insomnia displays heterogeneous trajectories across adolescence, which may induce addictive behaviours, including internet gaming disorder and substance use. This study aimed to investigate the latent trajectory classes of insomnia symptoms over 2 years and to examine the associations between insomnia trajectories and these addictive behaviours. Participants were 910 adolescents from six middle schools in Shanghai, China (52.7% males; mean age = 13.17 years). The three-wave survey measured insomnia symptoms, internet gaming disorder, substance use, depressive symptoms, and sociodemographic characteristics from 7th to 9th grade. Latent class growth modelling was performed to identify the latent trajectory classes of insomnia symptoms. Then multivariable logistic regressions were conducted within the best-fitting latent class growth model to examine the associations of insomnia trajectories with internet gaming disorder and substance use. Two latent trajectory classes of insomnia symptoms were recognised: the non-insomnia group (71.8%) and the insomnia group (28.2%). In the multivariable analysis controlling for baseline demographic variables and depressive symptoms, the insomnia group had a higher risk of developing internet gaming disorder (OR = 2.203 [95% CI: 1.258-3.858]) and substance use (OR = 2.215 [95% CI: 1.324-3.705]) compared with the non-insomnia group. These findings add to a growing body of research on heterogeneous trajectories of insomnia symptoms during adolescence, suggesting that intervention strategies are needed to target the characteristics or developmental patterns of different insomnia subgroups. The ultimate goal is to mitigate the impact of insomnia symptoms on adolescent addictive behaviours.

A developmental perspective on sleep consistency: Preschool age through emerging adulthood

OBJECTIVE/BACKGROUND

Beyond sleep duration, the regularity of sleep patterns (e.g., sleep consistency), including variability in sleep timing (e.g., bedtime, wake time) and duration, is a critical marker of sleep health. Sleep consistency is captured using a variety of methods within the literature (e.g., sleep intraindividual variability, social jetlag), but most of the research focuses on adolescents.

METHODS

Drawing on a developmental perspective, this narrative review highlights how normative changes at the individual (e.g., biological, cognitive, and social) and contextual (e.g., home, school, sociocultural) levels may contribute to inconsistent sleep patterns across development.

RESULTS AND CONCLUSIONS

This review emphasizes how inconsistent sleep may increase across pivotal transitions throughout development (e.g., elimination of naps, puberty, summertime, entering college). Finally, recommendations for measuring sleep consistency and areas to address in future research are discussed.

Food addiction and emotional eating are associated with intradaily rest-activity rhythm variability

PURPOSE

The aim of the present investigation was to study the associations among parameters characterizing eating behavior and actimetry-derived indices of circadian rhythm of motor activity.

METHODS

The study involved 81 healthy participants (average age: 21.5 ± 9.6 y, women: 77.8%). Each study participant provided personal data, filled out the Yale Food Addiction Scale and the Dutch Eating Behavior Questionnaire, and wore a wrist actimeter for 7 consecutive days to record motor activity. Using time series treatments, we obtained: (a) three cosinor-derived parametric indices [Medline Estimating Statistics of Rhythm (MESOR), amplitude, and acrophase], and (b) four non-parametric indices [interdaily stability, intradaily variability (I.V.), most active 10-h period (M10), and least active 5-h period] characterizing the 24-h rhythm of motor activity. A multiple regression analysis adjusted for age, sex, and BMI was performed to assess the associations among the studied indicators.

RESULTS

It was shown that I.V. is a predictor of symptoms of food addiction (β = 0.242, P = 0.037) and emotional eating (β = 0.390, P = 0.004), MESOR is a predictor of symptoms of food addiction (β = 0.342, P = 0.003), and M10 predicts restraint (β = 0.257, P = 0.015) and emotional eating (β = 0.464, P = 0.001).

CONCLUSION

It was shown for the first time that an increase in symptom counts of food addiction is associated with an increase in the average level and fragmentation of 24-h rhythm of motor activity.

LEVEL OF EVIDENCE

Level V, cross-sectional descriptive study.

Adolescent sleep myths: Identifying false beliefs that impact adolescent sleep and well-being

OBJECTIVE

Commonly held beliefs about sleep unsupported by scientific evidence (ie, myths) among adolescents and their parents/caregivers may adversely influence sleep-related attitudes and behaviors among adolescents. Thus, identifying such myths with the goal of developing effective evidence-based counter-messages has the potential to improve sleep health in adolescents.

METHOD

We identified myths with a panel of adolescent sleep health experts (n = 12) using the Delphi method in three sequential steps: (1) focus groups; (2) online discussion; and (3) closed-ended questionnaires with which the experts rated myths on: (1) falseness and (2) public health significance using 5-point Likert scales ranging from 1 (not at all false/important for public health) to 5 (extremely false/important for public health). Next, we explored the prevalence of the myths among a demographically diverse sample of parents/caregivers of adolescents in the United States. Finally, we report the counterevidence to refute each myth.

RESULTS

Ten myths about adolescent sleep were identified by the experts using the Delphi method. The most prevalent myths were the beliefs that (1) "Going to bed and waking up late on the weekends is no big deal for adolescents, as long as they get enough sleep during that time," reported by 74% of parents/caregivers; (2) "If school starts later, adolescents will stay up that much later," reported by 69% of parents/caregivers; and (3) "Melatonin supplements are safe for adolescents because they are natural," reported by 66% of parents/caregivers.

CONCLUSION

Parents/caregivers have the potential to serve as sleep health advocates for their adolescent and support their adolescent's sleep health behaviors. Our study found that many parents/caregivers endorse myths about adolescent sleep that may hinder their ability to support their adolescent's sleep health. Future research may explore methods for promoting evidence-based beliefs about adolescent sleep among parents/caregivers.

Longitudinal associations between high school sleep characteristics and young adult health outcomes

STUDY OBJECTIVES

Short sleep duration and evening chronotype are independently associated with negative health outcomes. However, it is unclear how adolescent sleep duration and chronotype are longitudinally associated with health outcomes during early adulthood.

METHODS

Participants from the NEXT Generation Health Study (n = 2,783; 54.5% female) completed measures of sleep duration (scheduled day and unscheduled day) and chronotype in high school. Sleep duration, chronotype, general health, depressive symptoms, and psychosomatic symptoms were also assessed 4 years after high school. Latent variables estimated high school scheduled-day sleep duration, unscheduled-day sleep duration, and chronotype using the during high school measures. Two path analyses tested the prospective associations between high school sleep duration (separate models for scheduled and unscheduled days) and chronotype with 4 years after high school health outcomes as mediated by concurrent sleep duration and chronotype.

RESULTS

In the scheduled-day model, longer high school sleep duration and later chronotype were associated with longer duration and later chronotype in early adulthood. Longer high school sleep duration was directly associated with fewer psychosomatic symptoms and indirectly associated with fewer depressive and psychosomatic symptoms through longer sleep duration in early adulthood. Later chronotype in high school was indirectly associated with poorer general health, greater depressive symptoms, and greater psychosomatic symptoms in early adulthood through later chronotype.

CONCLUSIONS

Findings highlight the roles of scheduled-day sleep duration and evening chronotype in shaping health outcomes and suggest the importance of chronotype and optimal sleep habits among adolescents.

CITATION

Maultsby KD, Temmen CD, Lewin D, et al. Longitudinal associations between high school sleep characteristics and young adult health outcomes. J Clin Sleep Med. 2022;18(11):2527-2536.

Sleep Modulates Alcohol Toxicity in Drosophila

Alcohol abuse is a significant public health problem. While considerable research has shown that alcohol use affects sleep, little is known about the role of sleep deprivation in alcohol toxicity. We investigated sleep as a factor modulating alcohol toxicity using Drosophila melanogaster, a model for studies of sleep, alcohol, and aging. Following 24 h of sleep deprivation using a paradigm that similarly affects males and females and induces rebound sleep, flies were given binge-like alcohol exposures. Sleep deprivation increased mortality, with no sex-dependent differences. Sleep deprivation also abolished functional tolerance measured at 24 h after the initial alcohol exposure, although there was no effect on alcohol absorbance or clearance. We investigated the effect of chronic sleep deprivation using mutants with decreased sleep, insomniac and insulin-like peptide 2, finding increased alcohol mortality. Furthermore, we investigated whether pharmacologically inducing sleep prior to alcohol exposure using the GABA_A-receptor agonist 4,5,6,7-tetrahydroisoxazolo(5,4-c)pyridin-3-ol (THIP) mitigated the effects of alcohol toxicity on middle-aged flies, flies with environmentally disrupted circadian clocks, and flies with short sleep. Pharmacologically increasing sleep prior to alcohol exposure decreased alcohol-induced mortality. Thus, sleep prior to binge-like alcohol exposure affects alcohol-induced mortality, even in vulnerable groups such as aging flies and those with circadian dysfunction.

Later school start time is associated with better academic performance, sleep-wake rhythm characteristics, and eating behavior

There are numerous studies which show that an early school start time has a negative impact on the sleep, well-being, and academic performance of students. There is not enough information on the association between school start time and eating disorders, however: the disruption of the circadian rhythm is known to be a risk factor for eating disorders. The aim of this study is to analyze the relationship between school start time (SST) and the sleep, well-being, academic performance, and eating behavior of children and adolescents. The study was conducted in April and May 2021 in two regions of Russia: the Komi Republic and Yekaterinburg. The online study involved the anonymous and voluntary participation of 6571 students in grades 6-11 (mean age: 14.5 ± 1.6 years, 60.1% female), who have morning classes. All participants were divided into three groups according to SST: 08:00 (n = 3661), 08:30 (n = 2020), and 09:00 (n = 890). Each participant of the study indicated their place of residence, SST, age, sex, height, weight, academic performance, and filled out the Munich Chronotype Questionnaire, the Zung Self-Rating Depression Scale, and the Yale Food Addiction Scale for Children. As a result of multiple regression analysis, it was shown that schoolchildren with SST of 09:00 wake up at a later time on school days (B = 0.432; ΔR² = 0.039), sleep more (B = 0.293; ΔR² = 0.004), have less pronounced social jetlag (B = -0.223; ΔR² = 0.005) and sleep loss (B = -0.292; ΔR² = 0.005), and higher academic performance (B = 0.113; ΔR² = 0.003) than schoolchildren with SST of 08:00. As a result of logistic regression analysis, it was found that the frequency of the detection of food addiction is ~30% lower in schoolchildren with SST of 09:00 (OR = 0.690; 95% CI = 0.485-0.981) than in their peers with SST of 08:00. Thus, an overly early SST in Russia has a negative impact on the sleep function, academic performance, and eating behavior of children and adolescents.

Relationships between Sleep Duration, Timing, Consistency, and Chronotype with Myopia among School-Aged Children

Background

The role of sleep in childhood myopia has been a research focus; however, the existing evidence is conflicting on sleep duration and timing, and as yet, no studies involve sleep consistency and chronotype. This study is done to make multiple-perspective analyses on the associations between sleep variables and myopia.

Methods

A population-based cross-sectional study was conducted in Shanghai, China, which included 10,142 school-aged children (7–12 years old, 53.2% boys). The Chinese version of the Children's Sleep Habits Questionnaire (CSHQ) was used to assess sleep variables. Propensity score matching was adopted to balance the difference of covariates between nonmyopic and myopic groups. Logistic regression models were implemented to examine the associations between sleep variables and myopia.

Results

Sleep duration and timing, mainly during weekdays, were correlated with myopia in a dose-dependent pattern, in which longer sleep duration was associated with decreased risk of myopia (9-10 hours/day: odds ratio (OR) = 0.87; ≥10 hours/day: OR = 0.77; by comparison with <9 hours/day); later bedtime (9 pm to 9:30 pm: OR = 1.46; 9:30 pm to 10 pm: OR = 1.51; 10 pm and after: OR = 2.08; by comparison with before 9 pm) and later wake-up time (7 am and after: OR = 1.36; by comparison with before 6:30 am) increased the risk (all P < 0.05). Moreover, longer weekend catch-up sleep duration and intermediate and evening chronotype were positively correlated with myopia, while social jetlag was associated with a lower odds of myopia. All these findings were also similarly observed in the matching sample.

Conclusions

Multiple dimensions of sleep were involved in childhood myopia. In addition to sleep duration and timing, sleep consistency and chronotype were also strictly related to myopia. More studies are needed to enrich the current evidence, thus further clarifying the association between sleep and childhood myopia.

Characterisation of the genetic relationship between the domains of sleep and circadian-related behaviours with substance use phenotypes

Sleep problems and substance use frequently co-occur. While substance use can result in specific sleep deficits, genetic pleiotropy could explain part of the relationship between sleep and substance use and use disorders. Here we use the largest publicly available genome-wide summary statistics of substance use behaviours (N = 79,729-632,802) and sleep/activity phenotypes to date (N = 85,502-449,734) to (1) assess the genetic overlap between substance use behaviours and both sleep and circadian-related activity measures, (2) estimate clusters from genetic correlations and (3) test processes of causality versus genetic pleiotropy. We found 31 genetic correlations between substance use and sleep/activity after Bonferroni correction. These patterns of overlap were represented by two genetic clusters: (1) tobacco use severity (age of first regular tobacco use and smoking cessation) and sleep health (sleep duration, sleep efficiency and chronotype) and (2) substance consumption/problematic use (drinks per day and cigarettes per day, cannabis use disorder, opioid use disorder and problematic alcohol use) and sleep problems (insomnia, self-reported short sleep duration, increased number of sleep episodes, increased sleep duration variability and diurnal inactivity) and measures of circadian-related activity (L5, M10 and sleep midpoint). Latent causal variable analyses determined that horizontal pleiotropy (rather than genetic causality) underlies a majority of the associations between substance use and sleep/circadian related measures, except one plausible genetically causal relationship for opioid use disorder on self-reported long sleep duration. Results show that shared genetics are likely a mechanism that is at least partly responsible for the overlap between sleep and substance use traits.

Sleep Duration Buffers The Effects of Adversity on Mental Health Among Recently Immigrated Latinx Adolescents

The rate of Latinx migration to the U.S. has risen rapidly over the last several decades. Recognizing that Latinx migrant youth are exposed to a high rate of adverse events and that sleep has potential buffering effects on mental health, the current study aimed to examine sleep duration as a moderator of the link between childhood adversity and emotional and behavioral symptoms among Latinx migrant youth. One hundred and twelve first-generation migrants of Latinx ethnicity (and 46 caregivers) participated in this study; the average age was 19 (SD = 2). Participants self-reported demographics: 59.8% of participants were male, with the racial breakdown as follows: 38.8% white, 6.1% black, 4.1% mixed race, and 51% marked "other." Data were collected from a public high school for immigrant youth in the Southwestern U.S. and included average sleep duration, Adverse Childhood Experiences; the Child PTSD Symptoms Scale and the Child Behavior Checklist. Findings indicated experiences of neglect in childhood were associated with youth-reported mental health symptoms, but this relation was significantly moderated by sleep duration such that the relation was weakened in the presence of high sleep duration. Both effects were statistically significant and of medium size. Caregiver reports supported the buffering effects of sleep; medium or large interactions between sleep and all three adversity variables (abuse, neglect, and household dysfunction) were noted in multivariate analyses. The current study takes an important first step in identifying that short sleep duration is prevalent among Central American immigrant youth. Findings suggest that sleep duration has important public health potential as a means of buffering the effects of childhood adversity on mental health in a vulnerable group.

Chronotype at the beginning of secondary school and school timing are both associated with chronotype development during adolescence

The misalignment between late chronotypes and early school start times affect health, performance and psychological well-being of adolescents. Here we test whether, and how, the baseline chronotype (i.e. chronotype at the beginning of secondary school) and the school timing affect the magnitude and the direction of the developmental change in chronotype during adolescence. We evaluated a sample of Argentinian students (n = 259) who were randomly assigned to attend school in the morning (07:45 a.m.–12:05 p.m.), afternoon (12:40 p.m.–05:00 p.m.) or evening (05:20 p.m.–09:40 p.m.) school timings. Importantly, chronotype and sleep habits were assessed longitudinally in the same group of students along secondary school (at 13–14 y.o. and 17–18 y.o.). Our results show that: (1) although chronotypes partially align with class time, this effect is insufficient to fully account for the differences observed in sleep-related variables between school timings; (2) both school timing and baseline chronotype are independently associated with the direction and the magnitude of change in chronotype, with greater delays related to earlier baseline chronotypes and later school timings. The practical implications of these results are challenging and should be considered in the design of future educational timing policies to improve adolescents’ well-being.

Chronotype and trait self-control as unique predictors of sleep quality in Chinese adults: The mediating effects of sleep hygiene habits and bedtime media use

This study examined the distinctive roles of chronotype and trait self-control in predicting sleep quality and the mediation of sleep hygiene habits and bedtime media use of the relations between chronotype, trait self-control and sleep quality. Self-report questionnaire measuring chronotype, trait self-control, sleep hygiene behaviors, bedtime media use and sleep quality was administered to 224 Chinese adult participants (83.5% female). A multiple mediation model was estimated with sleep hygiene habits and bedtime media use as parallel mediators of the relations between chronotype, trait self-control, and sleep quality. Chronotype and trait self-control positively predicted sleep quality. Results of mediation analyses indicated that trait self-control predicted sleep quality both directly and indirectly through pre-sleep stress management and keeping a restful sleep environment, whereas chronotype predicted sleep quality indirectly through pre-sleep stress management and bedtime media use. This study provides evidence for the possible mechanism through which eveningness and low trait self-control undermine sleep quality: Whereas bedtime media use and sleep timing irregularity are linked to poor sleep quality in evening types, environmental interference (e.g., noise or disorganization) appears to be more relevant to poor sleep quality in individuals low in self-control. These findings can inform the design of personalized sleep hygiene recommendations appropriate for the target population. Practical implications regarding sleep hygiene education and interventions are discussed.

Preliminary Evidence That Circadian Alignment Predicts Neural Response to Monetary Reward in Late Adolescent Drinkers

BACKGROUND

Robust evidence links sleep and circadian rhythm disturbances to alcohol use and alcohol-related problems, with a growing literature implicating reward-related mechanisms. However, the extant literature has been limited by cross-sectional designs, self-report or behavioral proxies for circadian timing, and samples without substantive alcohol use. Here, we employed objective measures of sleep and circadian rhythms, and an intensive prospective design, to assess whether circadian alignment predicts the neural response to reward in a sample of late adolescents reporting regular alcohol use.

METHODS

Participants included 31 late adolescents (18-22 y/o; 19 female participants) reporting weekly alcohol use. Participants completed a 14-day protocol including pre- and post-weekend (Thursday and Sunday) circadian phase assessments via the dim light melatonin onset (DLMO), in counterbalanced order. Sleep-wake timing was assessed via actigraphy. Circadian alignment was operationalized as the DLMO-midsleep interval; secondary analyses considered social jet lag based on weekday-weekend differences in midsleep or DLMO. Neural response to reward (anticipation and outcome) was assessed via a monetary reward fMRI task (Friday and Monday scans). Alcohol use was assessed at baseline and via ecological momentary assessment. Mean BOLD signal was extracted from two regions-of-interest (striatum and medial prefrontal cortex, mPFC) for analyses in regression models, accounting for age, sex, racial identity, and scan order.

RESULTS

In primary analyses, shorter DLMO-midsleep intervals (i.e., greater misalignment) on Thursday predicted lower striatal and mPFC responses to anticipated reward, but not reward outcome, on Friday. Lower neural (striatum and mPFC) responses to anticipated reward on Friday correlated with more binge-drinking episodes at baseline, but were not associated with alcohol use in the post-scan weekend. In secondary analyses, greater social jet lag (particularly larger weekend delays in midsleep or DLMO) was associated with lower neural responses to reward anticipation on Monday.

CONCLUSION

Findings provide preliminary evidence of proximal associations between objectively determined circadian alignment and the neural response to anticipated monetary reward, which is linked in turn to patterns of problematic drinking. Replication in a larger sample and experimental designs will be important next steps to determining the extent to which circadian misalignment influences risk for alcohol involvement via alterations in reward function.

Associations of circadian factors with insomnia symptoms and emotional and behavioral problems among school-age children

STUDY OBJECTIVES

To examine the associations of circadian characteristics (ie, chronotype and social jetlag) with insomnia symptoms and emotional and behavioral problems among school-age children.

METHODS

A total of 620 primary school children (median_age = 10.06, standard deviation = 1.16, 58.7% boys) were recruited and assessed by a set of parent-report questionnaires, including Children's Sleep Habit Questionnaire for measuring sleep-wake patterns and insomnia symptoms (bedtime resistance, sleep onset delay, and night waking), Children's Chronotype Questionnaire for assessing the child's chronotype preference, and Strength and Difficulties Questionnaire for assessing emotional and behavioral problems. Linear regression models were applied to examine the associations of chronotype and social jetlag with insomnia symptoms and mental health outcomes, in which age, sex, family income, and average sleep duration were entered as covariates.

RESULTS

Evening chronotype was significantly associated with bedtime resistance and sleep onset delay, while social jetlag was not related to insomnia symptoms. Evening chronotype was also significantly associated with externalizing symptoms after controlling for potential confounders.

CONCLUSIONS

Evening chronotype, but not social jetlag, was the risk factor for insomnia symptoms, and evening chronotype was further associated with increased behavioral problems in school-age children. Our findings underscored the roles of circadian factors in relation to sleep and mental health problems in this young population.

CITATION

Sun W, Kwok NTT, Chan NY, et al. Associations of circadian factors with insomnia symptoms and emotional and behavioral problems among school-age children. J Clin Sleep Med. 2021;17(10):2107-2114.

Three Dimensions of Sleep, Somatic Symptoms, and Marijuana Use in U.S. High School Students

PURPOSE

This study aimed to investigate potential bidirectional relations between key sleep characteristics and somatic symptoms with past 30-day marijuana use in high school students.

METHODS

Participants from the NEXT Generation Health Study (n = 2,770) reported on 10th and 11th grade (W1 and W2) sleep characteristics and somatic symptoms and 12th grade (W3) past 30-day marijuana. Multivariate logistic regressions and path analyses were conducted.

RESULTS

Sleep duration was not associated with marijuana use. However, later W1 chronotype, greater W1 social jetlag, W1 trouble falling asleep, W1 trouble staying asleep, and W1 somatic symptoms were associated with increased odds of W3 past 30-day marijuana use. Path models indicated direct associations between W1 chronotype and W3 past 30-day marijuana use, and W1 social jetlag and W3 past 30-day marijuana use.

CONCLUSIONS

Later sleep timing was longitudinally associated with past 30-day marijuana use. Improved understanding of sleep health, specifically chronotype and social jetlag as risk factors for marijuana use is warranted, which may inform additional screening targets and interventions that address these associated domains.

Circadian preference and academic achievement in school-aged students: a systematic review and a longitudinal investigation of reciprocal relations

We provide a systematic review of findings on the relation between circadian preference and school achievement published after the last comprehensive review in 2015. We further test this relation in a longitudinal study. Our review of 26 studies revealed a positive relation between morningness and students' school achievement, and a negative relation between eveningness and school achievement. In most studies, these relations were not affected by students' age, sex, or intelligence, but were significantly mediated by students' conscientiousness, motivation, and sleep behavior. Furthermore, circadian preference and school achievement showed no significant relation when school started in the afternoon. All studies were cross-sectional. Therefore, the direction of the relations between circadian preference, school achievement, and potential mediating variables like conscientiousness and motivation could not be investigated. In our longitudinal study, we tested the direction of the relations between circadian preference, academic achievement, conscientiousness, self-efficacy, and attitude toward school over time in a sample of 764 German high school students who were tested in the first (T1) and third (T2) year of high school. Findings from confirmatory cross-lagged models indicated reciprocal relations between circadian preference and school achievement: T1 morningness positively predicted change in grade point average over time while T1 grade point average positively predicted change in morningness and negatively predicted change in eveningness. Furthermore, T1 conscientiousness and T1 attitude toward school both positively predicted change in morningness, whereas T1 morningness and T1 eveningness did not significantly predict change in these variables.

Longitudinal associations of sleep problems with alcohol and cannabis use from adolescence to emerging adulthood

STUDY OBJECTIVES

This study examined longitudinal associations of sleep problems with alcohol and cannabis use across six annual waves of data from adolescence to emerging adulthood.

METHODS

Participants were 3,265 youth from California (ages 16 to 22 across waves). At each wave, past-month alcohol use and cannabis use, mental health, and several dimensions of sleep health (i.e., social jetlag, bedtimes, time in bed, trouble sleeping) were assessed via questionnaire. Parallel process latent growth models examined the association between sleep and alcohol or cannabis use trajectories and the role of mental health in contributing to such trajectories.

RESULTS

Smaller declines in social jetlag (r = .11, p = .04), increases in trouble sleeping (r = .18, p < .01), and later weekday (r = .16, p < .01) and weekend bedtimes (r = .25, p < .01) were associated with increases in likelihood of alcohol use over time. Declines in weekend TIB (r = -.13, p = .03), as well as increases in weekday TIB (r = 0.11, p = 0.04) and later weekday (r = .18, p < .01) and weekend bedtime (r = .24, p < .01), were associated with increases in likelihood of cannabis use over time. Most associations remained significant after controlling for time-varying mental health symptoms.

CONCLUSIONS

Trajectories of sleep health were associated with trajectories of alcohol and cannabis use during late adolescence to emerging adulthood. Improving sleep is an important target for intervention efforts to reduce the risk of substance use during this critical developmental transition.

Sleep-Wake Timings in Adolescence: Chronotype Development and Associations with Adjustment

Adolescent sleep research has focused heavily on duration and quality with less work examining chronotype, defined as individual differences in sleep-wake timings driven by the circadian rhythm. This study filled a gap in the literature by utilizing actigraphy-based sleep estimates in an accelerated longitudinal design in order to better understand the developmental trajectory and individual stability of chronotype during adolescence, as well as the associations between chronotype with risky behaviors, substance use, and depressive symptoms. A total of 329 adolescents (57% female; 21% Asian American, 31% European American, 41% Latino, 7% other ethnicity) provided actigraphy-based estimates of sleep and completed questionnaires at up to three time points, two years apart, beginning at 14-17 years of age. Multilevel modeling revealed a non-linear developmental trend in chronotype whereby eveningness increased from 14 to 19 years of age followed by a trend toward morningness. Individual differences in chronotype exhibited modest stability during adolescent development. Furthermore, greater evening chronotype was associated with more risky behaviors and substance use among males, and more substance use among older adolescents, whereas depressive symptoms were not associated with chronotype. The findings from this study may have practical implications for adolescent behavioral health interventions targeted at reducing risky behaviors and substance use among youth.

The search for causality of personality-chronotype associations: insights from a one-year longitudinal study of adolescents

Associations between certain personality traits and individual differences in diurnal preferences, referred to as morningness-eveningness, are well established from cross-sectional studies. However, it is unclear whether personality affects diurnal preference, diurnal preference affects personality, or some third factor influences both. The current study assessed the Big Five personality traits and morningness-eveningness in a one-year, two-wave longitudinal design, in a sample of 169 Polish high school students (59% females), aged 16-17 years (M = 16.80, SD = 0.39) during the first wave of measurement. During the second wave the participants were respectively 1 year older. Cross lagged panel analyses were run to determine wave 1 predictors of wave 2 variables. Cross-sectional analyses replicated the association between morningness and conscientiousness that has been reliably found in previous studies, but the cross-lagged paths between these variables were nonsignificant. These two traits appear to be intrinsically linked to one another by adolescence, possibly as a consequence of genetic influences that shape temperament earlier in childhood. In contrast, emotional stability and morningness were not significantly correlated in wave 1 cross-sectional data, but a significant relationship was found in the cross-lagged panel analysis. Wave 1 emotional stability predicted wave 2 morningness, although wave 1 morningness did not predict personality. We tentatively suggest that there may be a causal effect of personality on diurnal preference, associated with avoidance strategies for coping with academic stress as the high school years approach their end. More neurotic individuals may cope with their aversion to classes by distracting themselves with evening pursuits, such as use of the internet. Further work might examine in more depth how contextual stressors interact with personality to affect daily activities at different times of the day.

Circadian Misalignment Is Negatively Associated with the Anthropometric, Metabolic and Food Intake Outcomes of Bariatric Patients 6 Months After Surgery

PURPOSE

Circadian misalignment has been associated with an increased risk of overweight and obesity, as well as changes in metabolic parameters. This study evaluated the association between social jet lag (SJL), a measure of circadian misalignment, and anthropometric, metabolic and food intake outcomes 6 months after bariatric surgery.

MATERIALS AND METHODS

A total of 122 bariatric patients were included (77% female, aged 33 years (range 28-41); 79.5% underwent Roux-en-Y gastric bypass). Anthropometric, food consumption and SJL were evaluated in the preoperative evaluation and in the third and sixth months after surgery. SJL was calculated based on the absolute difference between the mid-sleep time on weekends and weekdays. Generalised estimating equations and linear regression were performed to evaluate the associations between mean SJL exposure and the outcomes.

RESULTS

The interaction between SJL and follow-up time negatively influenced the evolution of weight (p = 0.01), BMI (p = 0.04) and insulin levels (p = 0.01). SJL had an effect on intake of calories (p = 0.001), carbohydrate (p = 0.005) and total (p = 0.007), monounsaturated (p = 0.03) and polyunsaturated fat (p < 0.001). Linear regression showed a negative association between mean SJL exposure over the 6 months and the percentage of weight loss (coefficient = - 0.30, p = 0.006), body weight loss (kg) (coefficient = - 0.17, p = 0.03) and the reduction of BMI (coefficient = - 0.24, p = 0.007).

CONCLUSIONS

SJL was negatively associated with anthropometric, metabolic and food consumption outcomes 6 months after bariatric surgery. Future studies with longer follow-up are needed to confirm these findings.

TRIAL REGISTRATION

Clinical Trials.gov : NCT03485352.

Sleep and Women's Health: Sex- and Age-Specific Contributors to Alcohol Use Disorders

Prior research on alcohol use disorder (AUD) has focused primarily on men, but psycho-social-cultural changes have led to more women drinking or binge drinking, thus highlighting sex differences observed in alcohol use. In parallel, recent evidence indicates bidirectional links between alcohol use and sleep disruption, offering a burgeoning field of research for the study of sex differences in sleep-alcohol interactions. As part of the 2018 Research Conference on Sleep and the Health of Women at the National Institutes of Health, three presentations focused on the intersection between alcohol and sleep in women, including links between disrupted sleep and the risk of AUD. The literature to date hints at sex differences in the relationships between sleep and alcohol use that may be relevant to prevention and/or intervention. For example, insomnia is more prevalent among women, yet men may be more likely to self-medicate insomnia with alcohol and may benefit more from alcohol's sedating effects. Sex differences in sleep timing and duration that begin during adolescence may also be relevant, as later and/or shorter sleep appear to be risk factors for binge drinking. Preliminary data also implicate circadian timing as a sex difference potentially relevant to alcohol use. Limited extant data suggest complex relationships between sex, sleep, and alcohol problems, but defy easy summary. Relevant studies sufficiently powered to test sex differences are needed.