Melisa Moore

Mortality associated with short sleep duration: The evidence, the possible mechanisms, and the future

This review of the scientific literature examines the widely observed relationship between sleep duration and mortality. As early as 1964, data have shown that 7-h sleepers experience the lowest risks for all-cause mortality, whereas those at the shortest and longest sleep durations have significantly higher mortality risks. Numerous follow-up studies from around the world (e.g., Japan, Israel, Sweden, Finland, the United Kingdom) show similar relationships. We discuss possible mechanisms, including cardiovascular disease, obesity, physiologic stress, immunity, and socioeconomic status. We put forth a social-ecological framework to explore five possible pathways for the relationship between sleep duration and mortality, and we conclude with a four-point agenda for future research.

The sleepy adolescent: causes and consequences of sleepiness in teens

The majority of adolescents do not obtain the recommended amount of sleep, resulting in significant daytime sleepiness. For most adolescents, insufficient sleep results from the interaction between intrinsic factors such as puberty and extrinsic factors such as school start times. Insufficient sleep and sleepiness impact all areas of adolescent functioning, including academic, psychological and behavioural, which underscores the importance of evaluating sleepy adolescents. While polysomnography is required for the diagnosis of certain sleep disorders, causes of sleepiness are generally best identified with a detailed sleep history and daily sleep diary. The management of sleep problems in adolescents involves treating any underlying sleep disorders, increasing total sleep time and improving other environmental factors that impact sleep. Recognition and management of insufficient sleep and sleepiness is important for the health and functioning of adolescents.

Correlates of adolescent sleep time and variability in sleep time: The role of individual and health related characteristics

OBJECTIVES Adolescents are predisposed to short sleep duration and irregular sleep patterns due to certain host characteristics (e.g., age, pubertal status, gender, ethnicity, socioeconomic class, and neighborhood distress) and health-related variables (e.g., ADHD, asthma, birth weight, and BMI). The aim of the current study was to investigate the relationship between such variables and actigraphic measures of sleep duration and variability. METHOD Cross-sectional study of 247 adolescents (48.5% female, 54.3% ethnic minority, mean age of 13.7years) involved in a larger community-based cohort study. RESULTS Significant univariate predictors of sleep duration included gender, minority ethnicity, neighborhood distress, parent income, and BMI. In multivariate models, gender, minority status, and BMI were significantly associated with sleep duration (all p<.05), with girls, non-minority adolescents, and those of a lower BMI obtaining more sleep. Univariate models demonstrated that age, minority ethnicity, neighborhood distress, parent education, parent income, pubertal status, and BMI were significantly related to variability in total sleep time. In the multivariate model, age, minority status, and BMI were significantly related to variability in total sleep time (all p<.05), with younger adolescents, non-minority adolescents, and those of a lower BMI obtaining more regular sleep. CONCLUSIONS These data show differences in sleep patterns in population sub-groups of adolescents which may be important in understanding pediatric health risk profiles. Sub-groups that may particularly benefit from interventions aimed at improving sleep patterns include boys, overweight, and minority adolescents.

Relationships Among Sleepiness, Sleep Time, and Psychological Functioning in Adolescents

OBJECTIVE This study examined associations among adolescent sleepiness, sleep duration, variability in sleep duration, and psychological functioning (symptoms of anxiety, depression, externalizing behaviors, and perceived health). METHODS This was a cross-sectional analysis of data from a community-based cohort study of sleep and health. Participants were 247 adolescents (48.6% female, 54.3% ethnic minority, mean age of 13.7 years). Sleep duration and variability in sleep duration were measured by actigraphy and sleepiness was measured by adolescent questionnaire. Primary outcomes were measured by parent, teacher, and adolescent questionnaires. RESULTS Sleepiness was associated with higher scores on measures of anxiety (Adjusted partial r(2) = .28, p < .001), depression (Adjusted partial r(2) = .23, p < .001), and perceived health (indicating more negative outcomes) (Adjusted partial r(2) = .19, p < .01). Significant associations between sleep duration or variability in sleep duration with psychological variables were not found. CONCLUSIONS Findings highlight the inter-relationships between sleepiness and psychological functioning and the potential importance of addressing sleepiness in health and psychological evaluations of adolescents.

Heritability of Insomnia Symptoms in Youth and Their Relationship to Depression and Anxiety

STUDY OBJECTIVES Insomnia is a highly prevalent sleep disorder yet little is known about the role of genetic factors in its pathophysiology. The aim of this study was to examine the relative contributions of genetic and environmental factors in explaining variability in insomnia symptoms. DESIGN Traditional twin design. SETTING Academic medical center. PARTICIPANTS 1412 twin pairs aged 8-16 years (48.8% MZ, 47.2% DZ, 4.0% indeterminate). INTERVENTIONS None. MEASUREMENTS AND RESULTS Ratings of insomnia symptoms, depression, and overanxious disorder were made by trained interviewers based on DSM-III-R criteria. ACE models were conducted using Mx statistical software. Insomnia symptoms were prevalent in this sample based both on parental (6.6%) and youth (19.5%) reports. The overall heritability of insomnia symptoms was modest (30.7%), with the remaining variance attributed to unique environmental effects. There was no evidence of sex differences in the prevalence of insomnia symptoms or in the contribution of genetic and environmental effects. In multivariate models, there was support for insomnia-specific unique environmental effects over and above overlapping effects with depression and overanxious disorder, but no evidence for insomnia-specific genetic effects. CONCLUSIONS Genetic factors play a modest role in the etiology of insomnia symptoms in 8-16 year-olds. These effects overlap with the genetics of depression and overanxious disorder. Further work is needed to determine which genes confer risk for all three disorders.

Follow-up of a Pretend Play Intervention: Effects on Play, Creativity, and Emotional Processes in Children

This study investigated the effects of a pretend play intervention on 45 first and second grade children 2–8 months post-intervention. It was hypothesized that pretend play would be improved in the intervention groups and that they would score higher than controls on measures of play, creativity, and emotional processes. Subjects were randomly assigned to an affect, imagination, or control group. The imagination group significantly increased on multiple play scores from baseline to follow up and compared with controls, scores on frequency of positive affect expression were significantly higher. Differences on other scores were not found. Results indicate that play skills can be improved and cognitive play skills may have a stronger impact on affective processes than anticipated.

Pretend play as a resource for children : Implications for pediatricians and health professionals

ABSTRACT. Pretend play relates to many areas of adaptive functioning in child development including creativity, coping, and emotion regulation. Though pretend play interventions have been employed in medical settings for decades, there are few empirical studies of such interventions in the literature. A review of literature involving pretend play in medical settings indicates that pretend play interventions are effective in inpatient and outpatient settings for preventing and reducing anxiety and distress. Pretend play also has effects on pain, externalizing behavior, and adaptation to chronic illness. Such effects have been demonstrated in the short term; however they have not been shown to be stable in the long term, indicating that intermittent refresher sessions may be necessary. The sparse empirical literature regarding pretend play in medical settings spans a large number of journals and years, and conclusions are limited by methodological issues including measurement, treatment fidelity, research design, statistical procedures, and potential confounding variables. Despite these limitations, existing evidence suggests that play is a helpful intervention and that future research that addresses these limitations is warranted.

Summary of Issues and Challenges in the Use of New Technologies in Clinical Care and With Children and Adolescents With Chronic Illness

New technologies such as telehealth and Internet-based interventions provide powerful methods of clinical intervention and research with pediatric populations, especially children with chronic health conditions. Barriers to utilization of these technologies include the experiences and attitudes of professionals and families, ethical concerns about privacy and confidentiality resources, and control. The utilization of new technologies will be promoted by addressing resistance toward and discomfort of new technology, enhancing ways of providing information via technology, and facilitating education efforts within the general population. Recommendations to advance research concerning new technologies include the following: (a) develop benchmarks for evaluations, (b) use quantitative and qualitative approaches, (c) conduct theory-guided research, (d) study the cost benefits of different technologies, (e) document the impact of technologies on comprehensive outcomes, and (f) facilitate multisite research collaboration.

Genetic and environmental influences on sleep problems: a study of preadolescent and adolescent twins.

BACKGROUND/AIM The aim of this study was to examine the extent to which additive genetic, shared environmental and non-shared environmental factors contribute to adolescent and preadolescent sleep problems. METHODS The sample consisted of a cohort of 270 monozygotic and 246 dizygotic twins from a university-based twin registry. RESULTS Results demonstrated that genetic and environmental influences each appear to be important to adolescent sleep problems. CONCLUSIONS While the magnitude of genetic influence on sleep problems was consistent with findings from the adult literature, it was smaller than in studies with younger children, suggesting genetic effects may be less influential in adolescence and adulthood.

Sleep Problems and Temperament in Adolescents

The aim of this study was to determine the association between temperament and sleep in adolescents. Participants included 516 adolescents and their mothers drawn from the community. Findings indicated that as with younger children, sleep and dimensions of temperament (sociability, impulsivity and negative affect) are related in adolescents.