Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway.
Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway; Department of Child and Adolescent Psychiatry, St Olavs Hospital, Trondheim, Norway.
Sleep Med. 2021 Nov;87:220-226. doi: 10.1016/j.sleep.2021.08.023. Epub 2021 Aug 27.
Insomnia is prevalent among children and adolescents and is associated with a wide range of negative outcomes. Knowledge about its determinants is therefore important, but due to the lack of longitudinal studies, such knowledge is limited. The aim of the present inquiry is to identify child and family predictors of future pediatric insomnia within a psycho-bio-behavioral framework.
A representative community sample (n = 1,037) was followed biennially from 4 to 14 years of age (2007-2017). Insomnia was defined based on the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) criteria and was diagnosed by a semistructured clinical interview of children (from age eight years of age) and parents (all ages). Predictors included parent ratings of child emotional reactivity, family functioning, and marital conflict; self-reports of personality; and teacher-rated emotion regulation skills.
Random intercept cross-lagged analyses revealed that within-person increases (ie, relative to the child's typical levels across childhood) in emotional reactivity and decreases in emotion regulation skills predicted insomnia diagnosis two years later from ages 4 to 14 after adjusting for previous insomnia and all unmeasured time-invariant factors. Previous insomnia was the strongest predictor of later insomnia, whereas family functioning and marital conflict did not predict insomnia.
Increases in emotional reactivity and decreases in emotion regulation skills predicted insomnia above and beyond all unmeasured time-invariant factors and could be targets for interventions. Previous insomnia predicted later insomnia, thereby underscoring the importance of detecting, preventing, and treating insomnia at an early age.
失眠在儿童和青少年中普遍存在，并与广泛的负面后果相关。因此，了解其决定因素很重要，但由于缺乏纵向研究，这种知识有限。本研究旨在根据心理-生物-行为框架，确定儿童和家庭对未来儿科失眠的预测因素。
一个具有代表性的社区样本（n=1037）在 4 至 14 岁期间（2007-2017 年）每两年进行一次随访。失眠是根据《精神障碍诊断与统计手册》（DSM-IV）标准定义的，并通过对儿童（8 岁及以上）和父母（所有年龄）的半结构化临床访谈进行诊断。预测因素包括父母对孩子情绪反应性、家庭功能和婚姻冲突的评定；自我报告的人格；以及教师评定的情绪调节技能。
随机截距交叉滞后分析显示，在个体内情绪反应性增加（即相对于儿童在整个童年期的典型水平）和情绪调节技能下降，在调整以前的失眠和所有未测量的时不变因素后，会在 4 至 14 岁期间预测两年后出现失眠诊断。以前的失眠是失眠的最强预测因素，而家庭功能和婚姻冲突并不能预测失眠。
情绪反应性增加和情绪调节技能下降，在所有未测量的时不变因素之上预测了失眠，可以作为干预的目标。以前的失眠预测了后来的失眠，从而强调了在早期发现、预防和治疗失眠的重要性。
