Chan Ngan Yin, Zhang Jihui, Tsang Chi Ching, Li Albert Martin, Chan Joey Wing Yan, Wing Yun Kwok, Li Shirley Xin
Department of Psychology, The University of Hong Kong, Pokfulam, Hong Kong SAR, China; Sleep Assessment unit, Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China.
Sleep Assessment unit, Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China.
Sleep Med. 2020 Oct;74:124-131. doi: 10.1016/j.sleep.2020.05.035. Epub 2020 Jun 3.
To investigate the association of insomnia and chronotype preference with daytime impairment and psychopathology in a community sample of adolescents in Hong Kong.
This was a cross-sectional study that included seven local secondary schools in Hong Kong. A total of 1667 adolescents (mean age: 14.8 ± 1.6 years old; boys: 56.5%) returned a battery of self-report questionnaires including Insomnia Severity Index (ISI) and reduced Horne and Östberg Morningness and Eveningness Questionnaire (rMEQ) for assessing insomnia symptoms and chronotype preference, respectively. A subset of adolescent samples (n = 768) were additionally assessed for suicidal ideation. Potential confounders including age, gender and sleep duration were controlled for in the analyses.
The prevalence of insomnia symptoms and eveningness chronotype was 37% and 25.6%, respectively. Regression models indicated that insomnia and eveningness were independently associated with excessive daytime sleepiness (insomnia: adjusted OR [AdjOR] = 3.8; 95% confidence interval [C.I.] = 2.9-5.0; eveningness: AdjOR = 2.6; 95% C.I. = 1.9-3.7), and an increased risk of depression (insomnia: AdjOR = 3.5, 95% C.I. = 2.5-5.0; eveningness: AdjOR = 2.0, 95% C.I. = 1.3-3.2). The odds ratio increased to 8.7 (95% C.I. = 6.1-12.3, p < 0.001) for excessive daytime sleepiness and 4.8 (95% C.I. = 3.2-7.2, p < 0.001) for depression among adolescents with both insomnia and eveningness. Insomnia symptoms, but not eveningness, were associated with anxiety symptoms (AdjOR = 5.8; 95% C.I. = 3.6-9.4) and suicidal ideation (AdjOR = 2.1, 95% C.I. = 1.4-3.2).
The present study provided further evidence that insomnia and eveningness uniquely contributed to poor daytime functioning and mood related outcomes, while the co-existence of these two conditions could confer a greater risk in adolescents. However, insomnia, but not eveningness, was significantly linked to suicidality after controlling for mood symptoms. Our findings highlighted the necessity of timely management of sleep and circadian issues in adolescents.
在香港青少年社区样本中，研究失眠和昼夜节律类型偏好与日间功能损害及精神病理学之间的关联。
这是一项横断面研究，纳入了香港的七所本地中学。共有1667名青少年（平均年龄：14.8±1.6岁；男孩：56.5%）返回了一系列自我报告问卷，包括失眠严重程度指数（ISI）和简化的霍恩与奥斯特伯格晨型和夜型问卷（rMEQ），分别用于评估失眠症状和昼夜节律类型偏好。另外对一部分青少年样本（n = 768）进行了自杀意念评估。分析中控制了包括年龄、性别和睡眠时间等潜在混杂因素。
失眠症状和夜型昼夜节律类型的患病率分别为37%和25.6%。回归模型表明，失眠和夜型昼夜节律类型与日间过度嗜睡独立相关（失眠：调整后的比值比[AdjOR]=3.8；95%置信区间[C.I.]=2.9 - 5.0；夜型昼夜节律类型：AdjOR = 2.6；95% C.I.=1.9 - 3.7），以及抑郁风险增加（失眠：AdjOR = 3.5，95% C.I.=2.5 - 5.0；夜型昼夜节律类型：AdjOR = 2.0，95% C.I.=1.3 - 3.2）。对于同时患有失眠和夜型昼夜节律类型的青少年，日间过度嗜睡的比值比增加到8.7（95% C.I.=6.1 - 12.3，p < 0.001），抑郁的比值比增加到4.8（95% C.I.=3.2 - 7.2，p < 0.001）。失眠症状而非夜型昼夜节律类型与焦虑症状（AdjOR = 5.8；95% C.I.=3.6 - 9.4）和自杀意念（AdjOR = 2.1，95% C.I.=1.4 - 3.2）相关。
本研究提供了进一步的证据，表明失眠和夜型昼夜节律类型分别对日间功能不良和情绪相关结果有独特影响，而这两种情况同时存在可能使青少年面临更大风险。然而，在控制情绪症状后，失眠而非夜型昼夜节律类型与自杀倾向显著相关。我们的研究结果强调了及时管理青少年睡眠和昼夜节律问题的必要性。
