Adolescents' sleep trajectories over time : school stress as a potential risk factor for the development of chronic sleep problems

• Introduction: Sleep is a complex behavior affected by biological, psychosocial and contextual factors typically present during adolescent development (Becker, Langberg, & Byars, 2015), including increasing autonomy from parents, increasing school demands, and socializing more with peers. However, these normative changes do not explain temporary vs chronic sleep disturbances. Who are the adolescents at risk for developing chronic sleep problems? Some risk factors have been identified as crucial, such as poor sleep hygiene and family stressors, others are not as clear, such as technology use (Bartel et al., 2015). The impact of another important stressor for youths other than family, the school context, has received less attention (Meldrum, 2018). The aim of this study was twofold; first, we explored sleep trajectories from early to mid-adolescence to be able to identify a risk group showing persistent sleep problems (including insomnia and short sleep duration); then, we investigated the role of school stressors (i.e., conflicts with teachers, performance, school-leisure conflict, attendance), controlling for well-established risk factors, in the development of chronic sleep problems in a large cohort of adolescents.Materials and methods: We used three longitudinal waves of questionnaire data collected annually from a sample of Swedish adolescents (n = 1457; Mage = 13.2 [range: 12- 15 years], SD = .43; 52.7% boys). We collected the data from all schools in three communities in central Sweden, during school hours. Using established measures, the students reported on their sleep duration (calculated from reported bedtime, wake-time, and sleep onset latency; SSHS [Wolfson & Carskadon, 1998]), insomnia symptoms (ISI; Morin, 1993), sleep hygiene (ASHS; LeBourgeois, Giannotti, Cortesi, Wolfson, & Harsh, 2005), technology use, and perceived stress (including school, home and peer related stress) (ASQ; Byrne, Davenport, & Mazanov, 2007).First we used latent class analysis (LCA) to identify adolescents' sleep trajectories, then we used regression analyses to predict the risk-group trajectory of chronic insomnia and short sleep duration, controlling for gender.Results: We found four trajectories for adolescents' insomnia; 1) low-stable (69%), 2) low-increasing (18%), 3) high-decreasing (8%), 4) high-increasing (5%; 'risk-group'). For sleep duration, we found two trajectories; 1) ∼8 h slightly decreasing (79%), 2) ∼7 h decreasing (21%; 'risk-group').School stressors including stress of fitting in with peers, stress of schoolwork leaving too little leisure time, a stressful home environment, poor sleep hygiene, and being female were risk factors for chronic insomnia symptoms. Conflicts with teachers, poor sleep hygiene, and being female were risk-factors for chronic insufficient sleep.Conclusions: Over and above well-known risk-factors for poor sleep, such as poor sleep hygiene, (Bartel et al., 2015), school-related stress was a significant predictor of persistent sleep problems in adolescents. Therefore, helping adolescents to handle school stress might be a promising strategy to improve sleep health in this population.

Ämnesord

MEDICIN OCH HÄLSOVETENSKAP  -- Klinisk medicin -- Neurologi (hsv//swe)

MEDICAL AND HEALTH SCIENCES  -- Clinical Medicine -- Neurology (hsv//eng)

SAMHÄLLSVETENSKAP  -- Psykologi (hsv//swe)

SOCIAL SCIENCES  -- Psychology (hsv//eng)

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