Sleep Initiation and Maintenance Disorders: Roberts RE

Roberts RE. · The University of Texas, School of Public Health, USA. · J Psychosom Res. · Pubmed #18374741 No free full text.

This publication has no abstract.

Roberts RE, Roberts CR, Duong HT. · Division of Health Promotion and Behavioral Sciences, School of Public Health, University of Texas Health Science Center at Houston, Houston, Texas 77030, USA. · J Adolesc Health. · Pubmed #18295138 links to  free full text

Abstract: PURPOSE: To estimate prevalence and chronicity of insomnia and the impact of chronic insomnia on health and functioning of adolescents. METHODS: Data were collected from 4175 youths 11-17 at baseline and 3134 a year later sampled from managed care groups in a large metropolitan area. Insomnia was assessed by youth-reported DSM-IV symptom criteria. Outcomes are three measures of somatic health, three measures of mental health, two measures of substance use, three measures of interpersonal problems, and three of daily activities. RESULTS: Over one-fourth reported one or more symptoms of insomnia at baseline and about 5% met diagnostic criteria for insomnia. Almost 46% of those who reported one or more symptoms of insomnia in Wave 1 continued to be cases at Wave 2 and 24% met DSM-IV symptom criteria for chronic insomnia (cases in Wave 1 were also cases in Wave 2). Multivariate analyses found chronic insomnia increased subsequent risk for somatic health problems, interpersonal problems, psychological problems, and daily activities. Significant odds (p < .05) ranged from 1.6 to 5.6 for poor outcomes. These results are the first reported on chronic insomnia among youths, and corroborate, using prospective data, previous findings on correlates of disturbed sleep based on cross-sectional studies. CONCLUSIONS: Insomnia is both common and chronic among adolescents. The data indicate that the burden of insomnia is comparable to that of other psychiatric disorders such as mood, anxiety, disruptive, and substance use disorders. Chronic insomnia severely impacts future health and functioning of youths. Those with chronic insomnia are more likely to seek medical care. These data suggest primary care settings might provide a venue for screening and early intervention for adolescent insomnia.

Roberts RE, Roberts CR, Chan W. · Division of Health Promotion and Behavioral Sciences, School of Public Health, University of Texas Health Science Center at Houston, Houston, TX 77030, USA. · Sleep. · Pubmed #18274264 links to  free full text

Abstract: OBJECTIVE: To estimate the incidence, chronicity, and remission of symptoms of insomnia and to examine factors associated with the incidence and chronicity of insomnia among adolescents. METHODS: Data were collected using diagnostic interviews and questionnaires from 4175 youths aged 11 to 17 years at baseline, and 3134 of these youths followed-up a year later. Subjects were sampled from large managed care populations in a metropolitan area of over 4.7 million. Insomnia was assessed by youth-reported DSM-IV symptom criteria. RESULTS: One year incidence was 13.9% for 1 or more symptoms, 5.5% for 1 or more symptoms plus daytime fatigue or sleepiness, and 5.3% for insomnia caseness. Rates of chronicity were 45.8% for 1 or more symptoms, 34.7% with daytime fatigue or sleepiness, and 22.8% for insomnia caseness. There were no effects of age, sex, or family income in predicting incidence or chronicity of insomnia. There was a weak association of both somatic and psychological dysfunction with risk of future sleep outcomes, with stronger prediction for psychological dysfunction. CONCLUSIONS: These results document further the public health burden of insomnia among adolescents. Prevalence of insomnia is comparable to that of other major psychiatric disorders such as mood, anxiety, disruptive, and substance use disorders. Incidence over one year also is high. Insomnia represents a chronic condition, further enhancing burden.

Roberts RE, Roberts CR, Chan W. · Division of Behavioral Sciences, School of Public Health, University of Texas Health Science Center at Houston, PO Box 20186, 1200 Herman Pressler DR, Houston, TX 77030, USA. · Sleep. · Pubmed #16553022 No free full text.

Abstract: SUBJECT OBJECTIVE: To provide data on the prevalence of symptoms of disturbed sleep, particularly insomnia, and to ascertain whether there are differentials attributable to ethnic culture or ethnic status. DESIGN: Data were collected from youths (aged 11-17 years) and adult caregivers from a community-based sample of households using personal interviews and questionnaires. SETTING: Managed-care subscriber populations in metropolitan area of over 4.5 million. PARTICIPANTS: The sample consisted of 4175 youths and their caregivers (35.4% European American, 35.4% African American, 20.5% Mexican American, and 8.7% Other American). INTERVENTIONS: N/A. MEASUREMENTS AND RESULTS: The overall prevalence of DSM-IV insomnia-like syndrome in the past month was 4.7%. Females were more likely to report this syndrome, as were lower-income youths. Prevalence for European American youths was 5.3%, 5.2% for African American, and 3.5% Mexican American youths (p > .05). There also were some ethnic differences across symptoms of sleep disturbance that constitute insomnia. CONCLUSION: For most comparisons, subsequent multivariate analyses indicate no significant ethnic difference, supporting the hypothesis that observed ethnic differences are due primarily to the effects of status differences (e.g., age, gender, socioeconomic status, etc.). Insomnia clearly is a major public health problem, with prevalences comparable to mood, anxiety and disruptive behavior disorders among adolescents.

Roberts RE, Lee ES, Hemandez M, Solari AC. · University of Texas, School of Public Health, Houston 77037, USA. · Sleep. · Pubmed #15283011 No free full text.

Abstract: STUDY OBJECTIVES: To estimate the prevalence of symptoms of insomnia among adolescents living along the United States-Mexico border and to examine whether ethnicity and birthplace affect risk for such symptoms. DESIGN: Cross-sectional school-based survey using a version of the 2001 Youth Risk Behavior Survey, modified to elicit data on sleep problems. SETTING: A probability sample of 13 high schools selected from more than 40 high schools in the 4 southernmost counties in Texas-the Lower Rio Grande Valley-contiguous with Mexico. PARTICIPANTS: All ninth-grade students who agreed to participate (n = 5,118). MEASUREMENTS: The sleep module consisted of queries about trouble initiating asleep, trouble maintaining sleep, early morning waking, nonrestorative sleep, quality of sleep, and amount of sleep. RESULTS: Symptoms of insomnia were common, with 12.4% of respondents meeting symptom criteria for insomnia almost every day of the past month. Females were more likely to report insomnia, as were youths reporting lower socioeconomic status. Crude odds ratios suggested foreign-born and those who identified themselves as "Mexican" rather than "Mexican American" were at lower risk of insomnia. However, multivariate analyses eliminated these differences. CONCLUSIONS: More comparative research is needed to ascertain whether and how ethnic culture affects risk for disordered sleep.

Roberts RE, Roberts CR, Chen IG. · School of Public Health, University of Texas Health Science Center, 1200 Herman Pressler, Houston, TX 77030, USA. · J Psychosom Res. · Pubmed #12127172 No free full text.

Abstract: OBJECTIVE: To examine the impact of insomnia among adolescents on somatic, interpersonal, and psychological functioning using data from a two-wave, prospective study. METHODS: Subjects were adolescents 11-17 years of age sampled from managed care enrollment rosters in the United States. The baseline sample was 4175 and the follow-up sample a year later was 3136. Data were collected using computer-assisted personal interviews and self-administered questionnaires. Insomnia was measured using DSM-IV symptom criteria, scored as a summated scale and as separate symptoms. Indicators of somatic functioning were perceived health, limitations due to health problems, and impact of illness on family activities. Indicators of interpersonal functioning were social support, relations with parents, relations with peers and relations at school. Indicators of psychological functioning were self-esteem, perceived mental health, life satisfaction, and depression. RESULTS: Symptoms of insomnia were common, with 17% reporting nonrestorative sleep, 6% difficulty initiating sleep, 7% daytime fatigue, and 5% daytime sleepiness almost every day. Without adjustment for insomnia at follow-up, the odds of dysfunction at follow-up for those with insomnia averaged 2.5 across 11 indicators of functioning. For 9 of 11 indicators, there was a clear dose-response relation such that moderate levels of insomnia increased risk and this risk increased with greater insomnia. Adjusting for insomnia at follow-up eliminated the association with somatic functioning and attenuated associations with interpersonal and psychological functioning. DISCUSSION: These prospective data provide additional evidence that insomnia can have adverse consequences for the functioning of adolescents. Given the growing evidence for a relation between disturbed sleep and impaired adolescent functioning, more attention needs to be directed to identifying causal pathways and possible strategies for intervention.

Ohayon MM, Roberts RE, Zulley J, Smirne S, Priest RG. · Sleep Disorders Center, Stanford University School of Medicine, CA 94305, USA. · J Am Acad Child Adolesc Psychiatry. · Pubmed #11128333 No free full text.

Abstract: OBJECTIVE: Despite many constraints on time schedules among teenagers, epidemiological data on sleep complaints in adolescence remain limited and are nonexistent for sleep disorders. This study provides additional data on sleep habits and DSM-IV sleep disorders in late adolescence. METHOD: A representative sample of 1,125 adolescents aged 15 to 18 years was interviewed by telephone using the Sleep-EVAL system. These adolescents came from 4 European countries: France, Great Britain, Germany, and Italy. Information was collected about sociodemographic characteristics, sleep/wake schedule, sleep habits, and sleep disorders and was compared with information from 2,169 young adults (19-24 years of age). RESULTS: Compared with young adults, adolescents presented with a distinct sleep/wake schedule: they went to sleep earlier, they woke up later, and they slept longer than young adults did. On weekends and days off, they also slept more than young adults did. However, the prevalence rates of sleep symptoms and sleep disorders were comparable in both groups. Approximately 25% reported insomnia symptoms and approximately 4% had a DSM-IV insomnia disorder. Fewer than 0.5% had a circadian rhythm disorder. CONCLUSIONS: Prevalence of insomnia disorders is lower in the adolescent population than in middle-aged or elderly adults. However, a rate of 4% in this young population is important given their young age and the consequences for daytime functioning.