Disturbed Sleep Associated With Functional Ability, Emotional Distress in Adolescents

A study published in Clinical Child Psychology and Psychiatry found that disturbed sleep was related to functional ability and psychiatric symptoms. The results could have clinical implications in treatment for both.

Data for this study were collected from 4 schools of different socioeconomic levels in a town and its surrounding area in the northern part of Sweden. The data were collected during the 2018-2019 school year. Participants filled out a web survey that they received a code to access. The survey was done during school hours with assistance from a teacher and research assistant if needed.

Students were defined as having disturbed sleep if they indicated that they “often” or “always” had trouble sleeping and/or slept poorly. Nondisturbed sleepers answered “never” or “sometimes” to these. All participants also completed the Patient Reported Outcomes Measurement Information System measures of fatigue, anxiety, depressive symptoms, pain interference, anger, physical activity, peer relationships, and family relationships.

A total of 618 participants were included in the study, with 23% of the respondents reporting having disturbed sleep. Most of the participants were female, born in Sweden, and had both of their parents or guardians working.

Participants with disturbed sleep reported higher scores for symptom domains and lower scores for functional domains. Fatigue differed the most of the symptom domains between poor and good sleepers, with a coefficient of 1.21 (95% CI, 0.96-1.46). Anxiety (0.90; 95% CI, 0.66-1.18), depressive symptoms (0.74; 95% CI, 0.52-0.95), pain interference (0.74; 95% CI, 0.48-1.00), and anger (0.67; 95% CI, 0.66-0.88) also had significant coefficients for the difference between poor and good sleepers.

Physical activity, peer relationships, and family relationships also had significant differences between poor and good sleep groups but had less difference when compared with the symptom domains.

All differences in specific symptoms and functions between the disturbed sleep and nondisturbed sleep groups were significant. The disturbed sleep group reported higher scores for the symptom domains and lower scores for the function domain with 2 exceptions.

The 23 items with the largest regression coefficients regardless of domain had a majority (74%) originate from the scale of fatigue (17 items), with pain interference (3 items), anxiety (2 items), and anger (1 item) making up the other 6 items. The regression coefficients ranged from 0.58 to 0.82 and the effect sizes ranged from 0.48 to 0.91. For the 23 items with the smallest regression coefficient, most of the items (39%) came from the scale of physical activity (9 items), with peer relationships (5 items), anxiety (4 items), pain interference (3 items), and family relationships (2 items) making up the other 14 items.

There were some limitations to this study. Causality could not be evaluated due to the cross-sectional and observational nature of the study. The respondents were not geographically stratified and did not completely match the population of Swedish pediatric patients, which makes the generalizability of the results questionable. The authors noted the possibility of type I error, which would increase the risk of false positive findings.

The researchers concluded that the study “supports the observation that disturbed sleep is associated with higher levels of fatigue, depression, anxiety, anger, and pain interference, as well as lower physical activity and peer and family relationships in adolescents.”

Reference

Aslund L, Andreasson A, Lekander M, Henje E, Dennhag I. Disturbed sleep and patterns of psychiatric symptoms and function in a school-based sample of adolescents. Clin Child Psychol Psychiatry. Published online September 27, 2022. doi:10.1177/13591045221125479