Barbara Schwerdtle

Subjective Sleep Quality Exclusively Mediates the Relationship Between Morningness-Eveningness Preference and Self-Perceived Stress Response

Eveningness preference has been associated with lower sleep quality and higher stress response compared with morningness preference. In the current study, female morning (n = 27) and evening (n = 28) types completed the Pittsburgh Sleep Quality Index (PSQI) and were additionally challenged with an arithmetic stress-induction task. Evening types reported lower subjective sleep quality and longer sleep latency than morning types. Furthermore, evening types reported higher self-perceived stress after the task than morning types. Subjective sleep quality fully mediated the relationship between morningness-eveningness preference and stress response. Poor sleep quality may, therefore, contribute to the elevated health risk in evening types. (Author correspondence: karolin.roeser@uni-wuerzburg.de)

Relationship of sleep quality and health-related quality of life in adolescents according to self- and proxy ratings: a questionnaire survey

Introduction: Sleep disturbances are common in adolescents and adversely affect performance, social contact, and susceptibility to stress. We investigated the hypothesis of a relationship between sleep and health-related quality of life (HRQoL), and applied self- and proxy ratings. Materials and Methods: The sample comprised 92 adolescents aged 11–17 years. All participants and their parents completed a HRQoL measure and the Sleep Disturbance Scale for Children (SDSC). Children with SDSC T-scores above the normal range (above 60) were classified as poor sleepers. Results: According to self- and proxy ratings, good sleepers reported significantly higher HRQoL than poor sleepers. Sleep disturbances were significantly higher and HRQoL significantly lower in self- as compared to parental ratings. Parent-child agreement was higher for subscales measuring observable aspects. Girls experienced significantly stronger sleep disturbances and lower self-rated HRQoL than boys. Discussion: Our findings support the positive relationship of sleep and HRQoL. Furthermore, parents significantly underestimate sleep disturbances and overestimate HRQoL in their children.

Health-related quality of life in adolescent chronotypes--a model for the effects of sleep problems, sleep-related cognitions, and self-efficacy.

In adolescence, the circadian preference shifts toward eveningness orientation. Eveningness seems to be negatively correlated with quality of life. The present study investigates influencing factors of this association and proposes a model for the mediating effects of sleep, sleep-related cognitions, and self-efficacy according to chronotype. The sample comprised N = 280 adolescents (172 girls) aged 14–16 yrs (mean = 15.19, SD = .76). Circadian preference, health-related quality of life (HRQoL), sleep disturbances, sleep-related dysfunctional cognitions, and general perceived self-efficacy were assessed online. Morning-orientated adolescents reported significantly higher HRQoL and less insomnia symptoms compared with evening-oriented chronotypes. In the total sample, insomnia symptoms mediated the relationship of chronotype and HRQoL. The strongest predictor of HRQoL in evening types was the degree of sleep-related dysfunctional cognitions. HRQoL in morning types was most strongly predicted by general self-efficacy, i.e., the global confidence in coping abilities. The findings support a negative relationship of eveningness and HRQoL in adolescents. Insomnia symptoms were identified to be mediating factors in this relationship. The influence of the mediating factors on HRQoL differed between morning and evening types. The model provides implications of how to enhance HRQoL in adolescents according to their circadian preference. (Author correspondence: karolin.roeser@uni-wuerzburg.de)

Further Evidence for the JuSt Program as Treatment for Insomnia in Adolescents: Results from a 1-Year Follow-Up Study.

STUDY OBJECTIVES Insomnia in adolescence adversely affects young peoples current and future functioning, as well as their mental and physical health. Thus, effective and economic treatment is invaluable. The present study evaluated a 6-session multimodal group therapy, JuSt, for adolescents suffering from insomnia including cognitive-behavioral elements and clinical hypnosis. METHODS Participants (n = 19, 68.4% female) were aged 11-16 years and suffered from insomnia. Sleep onset latency (SOL), time spent awake time after sleep onset (WASO), and sleep efficiency (SE) were measured with sleep logs before and after treatment, and at 3-, 6-, and 12-month follow-up. RESULTS Compared to baseline, SOL and WASO significantly decreased, while there was a significant increase in SE and the feeling of being rested after the JuSt treatment. At 12-month follow-up, all parameters were still significantly different from their baseline level. The long-term effect sizes were at least as large as the short-term effects, indicating a stable improvement. CONCLUSIONS These results suggest that the JuSt program represents a potent intervention to sustainably reduce insomniac complaints in adolescents. Given the unselected nature of our sample, a broad indication can be assumed. To further evaluate the programs efficacy, randomized controlled trials should be conducted.

Children's Sleep Comic: development of a new diagnostic tool for children with sleep disorders.

Background A solid diagnosis of sleep disorders in children should include both self-ratings and parent ratings. However, there are few standardized self-assessment instruments to meet this need. The Children’s Sleep Comic is an adapted version of the unpublished German questionnaire “Freiburger Kinderschlafcomic” and provides pictures for items and responses. Because the drawings were outdated and allowed only for qualitative analysis, we revised the comic, tested its applicability in a target sample, and suggest a procedure for quantitative analysis. Methods All items were updated and pictures were newly drawn. We used a sample of 201 children aged 5–10 years to test the applicability of the Children’s Sleep Comic in young children and to run a preliminary analysis. Results The Children’s Sleep Comic comprises 37 items covering relevant aspects of sleep disorders in children. Application took on average 30 minutes. The procedure was well accepted by the children, as reflected by the absence of any dropouts. First comparisons with established questionnaires indicated moderate correlations. Conclusion The Children’s Sleep Comic is appropriate for screening sleep behavior and sleep problems in children. The interactive procedure can foster a good relationship between the investigator and the child, and thus establish the basis for successful intervention if necessary.

Nightmares and Associations with Sleep Quality and Self-Efficacy among University Students

Sleep problems are a common complaint among adults. In university students international studies showed prevalence rates between 4.7 and 36.2% for sleep difficulties and 2-3% of students report nightmares. Previous studies show that nightmares are often associated with insomnia and mental strain, but also with gender. The goal of this study was to outline nightmares, associations with sleep disturbances and mental strain as well as self-efficacy among university students. An amount of 2196 students (70.9% women; mean age 24.16 years) participated in the study. Sleep characteristics, nightmares, mental strain and self-efficacy were assessed by self-report questionnaires. Analyses revealed that more than 24.3% of surveyed students suffered from nightmares, 18.5% reported nightmares more often than once a week and 5.8% suffered from nightmares at least 3 times a week. Moreover, nightmares were associated with symptoms of insomnia and low self-efficacy was significantly associated with an increased rate of nightmares. Besides, a total of 52% of students reported fitful sleep.

Applicability and validity of the Amnestic Comparative Self-Assessment in adolescents

The Amnestic Comparative Self-Assessment (ACSA) is a sensitive, efficient, and economic instrument to assess overall quality of life in adult populations. The present study investigates the applicability of the ACSA in an adolescent sample and compares it to a measure of health-related quality of life, the Kiddo-Kindl. The sample comprised 92 adolescents (50 girls, 42 boys) aged 11-17 years (mean age: 13.67, standard deviation: 1.34). Of the investigated sample, n=69 (75%) completed the ACSA. No significant demographic differences were found between ACSA-respondents and non-respondents. The correlation of the Kiddo-Kindl and the ACSA was moderate (r=0.50). The Kiddo-Kindl subscales and the ACSA correlated between r=0.07 and 0.41. The majority of adolescents are able to complete the ASCA, and its acceptance and validity are independent of age. Thus, future investigations could adopt the ACSA in adolescents to assess overall quality of life.