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Freier Beitrag

Der Zusammenhang zwischen Schlafproblemen, unzureichender Schlafdauer und psychischen Auffälligkeiten bei Kindern und Jugendlichen

Published Online:March 05, 2019https://doi.org/10.1026/0942-5403/a000276

Abstract

Zusammenfassung. Schlafprobleme und eine unzureichende Schlafdauer können die psychische Gesundheit im Kindes- und Jugendalter nachhaltig beeinträchtigen. Daten von 6.670 Jungen und Mädchen im Alter von 11 – 13 und 14 – 17 Jahren, aus dem Kinder- und Jugendgesundheitssurvey (KIGGS), wurden getrennt nach Geschlechtern analysiert, um zu untersuchen, ob Schlafprobleme und eine unzureichende Schlafdauer mit einer höheren Risikowahrscheinlichkeit für psychische Auffälligkeiten einhergehen. Während Schlafprobleme unabhängig von Geschlecht und Alter mit einem höheren Risiko für alle Symptombereiche (OR = 1.52 – 3.49) verbunden sind, findet sich hinsichtlich einer geringen Schlafdauer nur bei Mädchen eine höheres Risikowahrscheinlichkeit für Auffälligkeiten im externalisierenden und internalisierenden Bereich. Damit scheint sich der Zusammenhang zwischen unzureichender Schlafdauer und psychischen Auffälligkeiten bei Jungen und Mädchen zu unterscheiden. Mögliche Ursachen und Implikationen für die pädiatrische und psychiatrische Praxis werden diskutiert.


The Relationship Between Sleep Problems, Insufficient Sleep Duration, and Psychiatric Abnormalities in Children and Adolescents

Abstract. Sleep problems and insufficient sleep duration can lead to long-term and sustained impairment of psychological health. Disturbed sleep is a frequent phenomenon in childhood and adolescence. It is associated with lower academic achievement, attention difficulties, increased aggressive behavior, and depressive symptoms. Most studies focus on poor sleep quality in terms of sleep problems or insufficient sleep duration, indicating low sleep quantity to be related to psychosocial health. However, there is a scarcity of studies that consider the effects both of sleep quality and of sleep quantity at the same time. Moreover, gender may influence the relationship between disturbed sleep and psychopathology, but gender-specific studies are rare. Therefore, the present paper investigates whether boys and girls who report sleep problems and insufficient sleep duration have a higher risk of internalizing and externalizing problems. The current data represent secondary analyses of a large German epidemiological study (German Health Survey of Children and Adolescents, KIGGS). The data of 3,414 boys and 3,256 girls were separated into two age groups (11 – 13 years and 14 – 17 years) in order to analyze sleep duration, sleep problems, and psychiatric abnormalities, the later determined using the Strengths and Difficulties Questionnaire (SDQ). Boys and girls with sleep problems showed a higher risk probability of internalizing and externalizing symptoms (OR = 1.52 – 3.38) in both age groups. While the presence of sleep problems increased the risk probability of internalizing and externalizing problems in both genders, insufficient sleep duration did so only in girls. Insufficient sleep duration increased the risk of abnormal scores on the emotional problems scale (OR11-13 = 1.70, OR14-17 = 1.56) and for the total score (OR11-13 = 1.48, OR14-17 = 1.66) only in girls of both age groups. Older girls who reported insufficient sleep duration had a higher risk of abnormal scores on the peer problems scale (OR = 1.36) while younger girls showed a higher risk of abnormal scores on the hyperactivity / inattentiveness scale (OR = 1.64) and on the conduct problems scale (OR = 1.78). It can be concluded that there is an association between sleep problems and psychiatric symptoms in different areas in boys and girls and across a wide age range. Insufficient sleep duration, by contrast, only appears to be a risk factor for psychological abnormalities in girls. These gender differences should be taken into account in future studies. A limitation of the presented study was that sleep duration and sleep problems were only assessed using one question each and no sleep-related questionnaire was employed. Nevertheless, the findings suggest that disturbed sleep may be a warning sign for worsened mental health states and should therefore be addressed in pediatric and psychiatric care.

Literatur

  • Alfano, C. A. & Gamble, A. L. (2009). The role of sleep in psychiatric disorders. Child youth care forum, 38, 327 – 340. First citation in articleCrossref, Google Scholar

  • Armstrong, J., Ruttle, P., Klein, M., Essex, M. & Benca, R. (2013). Associations of child insomnia, sleep movement and their persistence with mental health symptoms in childhood and adolescence. Sleep, 37, 901 – 909. First citation in articleCrossref, Google Scholar

  • Basch, C. E., Basch, C. H., Ruggles, K. V. & Rajan, S. (2014). Prevalence of sleep duration on an average school night among 4 nationally representative successive samples of American high school students, 2007 – 2013. Preventing Chronic Disease, 11. Retrieved from http://dx.doi.org/10.5888/pcd11.140383 [26. 04. 2018]. First citation in articleCrossref, Google Scholar

  • Birmaher, B., Ryan, N. D., Williamson, D. E., Brent, D. A., Kaufman, J., Dahl, R. E. et al. (1996). Childhood and adolescent depression: A review of the past ten years. Part I. Journal of the American Academy of Child and Adolescent Psychiatry, 35, 1427 – 1439. First citation in articleCrossref, Google Scholar

  • Bixler, E. (2009). Sleep and society: An epidemiological perspective. Sleep Medicine, 10 Suppl. 1, 3 – 6. First citation in articleCrossref, Google Scholar

  • Brand, S. & Kirov, R. (2011). Sleep and its importance in adolescence and in common adolescent somatic and psychiatric conditions. International Journal of General Medicine, 4, 425 – 442. First citation in articleCrossref, Google Scholar

  • Chaput, J., Gray, C., Poitras, V., Carson, V., Gruber, R., Olds, T. et al. (2016). Systematic review of the relationship between sleep duration and health indicators in school-aged children and youth. Applied Physiology, Nutrition and Metabolism, 41, 266 – 282. First citation in articleCrossref, Google Scholar

  • Cortese, S., Konofal, E., Yateman, N., Mouren, M.-C. & Lecendreux, M. (2006). Sleep and alertness in children with Attention-Deficit/ Hyperactivity Disorder: A systematic review of the literature. Sleep, 29, 504 – 511. First citation in articleGoogle Scholar

  • Dewald, J. F., Meijer, A. M., Oort, F. J., Kerkhof, G. A. & Bögels, S. M. (2010). The influence of sleep quality, sleep duration and sleepiness on school performance in children and adolescents: A meta-analytic review. Sleep Medicine Reviews, 14, 179 – 189. First citation in articleCrossref, Google Scholar

  • Dikeos, D. & Georgantopoulos, G. (2011). Medical comorbidity of sleep disorders. Current Option Psychiatry, 24, 346 – 354. First citation in articleCrossref, Google Scholar

  • Do, Y. K., Shin, E., Bautista, M. A. & Foo, K. (2013). The associations between self-reported sleep duration and adolescent health outcomes: What is the role of time spent on internet use? Sleep Medicine, 14, 195 – 200. First citation in articleCrossref, Google Scholar

  • Eaton, D. K., McKnight-Eily, L. R., Lowry, R., Perry, G. S., Presley-Cantrell, L. & Croft, J. B. (2010). Prevalence of insufficient, borderline, and optimal hours of sleep among high school students – United States. Journal of Adolescent Health, 46, 399 – 401. First citation in articleCrossref, Google Scholar

  • Fabbian, F., Zucchi, B., De Giorgi, A., Tiseo, R., Boari, B., Salmi, R. et al. (2016). Chronotype, gender and general health. Chronobiology International, 33, 863 – 882. First citation in articleCrossref, Google Scholar

  • Garaulet, M., Ortega, F. B., Ruiz, J. R., Rey-López, J. P., Béghin, L., Manios, Y. et al. (2011). Short sleep duration is associated with increased obesity markers in European adolescents: Effect of physical activity and dietary habits. The HELENA study. International Journal of Obesity, 35, 1308 – 1317. First citation in articleCrossref, Google Scholar

  • Goodman, R. (1997). The strengths and difficulties questionnaire: A research note. Journal of Child Psychology and Psychiatry, 38, 581 – 586. First citation in articleCrossref, Google Scholar

  • Goodman, R. & Scott, S. (1999). Comparing the Strengths and Difficulties Questionnaire and the Child Behavior Checklist: Is small beautiful? Journal of Abnorm Child Psychiatry, 27, 17 – 23. First citation in articleCrossref, Google Scholar

  • Görtelmeyer, R. (2011). Schlaffragebogen A und B (SF-A/R und SF-B/R, rev. Fassung). Göttingen: Hogrefe. First citation in articleGoogle Scholar

  • Gregory, A. (2016). Annual research review: Sleep problems in childhood psychiatric disorders – A review of latest science. Journal of Child Psychology and Psychiatry, 57, 296 – 317. First citation in articleCrossref, Google Scholar

  • Gregory, A. & Sadeh, A. (2012). Sleep, emotional and behavioral difficulties in children and adolescents. Sleep Medicine Review, 16, 129 – 136. First citation in articleCrossref, Google Scholar

  • Herpertz-Dahlmann, B., Bühren, K. & Remschmidt, H. (2013). Growing up is hard – mental disorders in adolescence. Deutsches Ärzteblatt International, 110, 432 – 440. First citation in articleGoogle Scholar

  • Hölling, H., Erhart, M., Ravens-Sieberer, U. & Schlack, R. (2011). Verhaltensauffälligkeiten bei Kindern und Jugendlichen – Erste Ergebnisse aus dem Kinder- und Jugendgesundheitssurvey (KIGGS). Bundesgesundheitsblatt – Gesundheitsforschung – Gesundheitsschutz, 54, 784 – 793. First citation in articleGoogle Scholar

  • Hölling, H., Kurth, B.-M., Rothenberger, A., Becker, A. & Schlack, R. (2008). Assessing psychopathological problems of children and adolescents from 3 to 17 years in a nationwide representative sample: Results of the German health interview and examination survey for children and adolescents (KiGGS). European Child and Adolescents Psychiatry, 17, 34 – 41. First citation in articleCrossref, Google Scholar

  • Hölling, H., Schlack, R., Petermann, F., Ravens-Sieberer, U. & Mauz, E. (2014). Psychische Auffälligkeiten und psychosoziale Beeinträchtigungen bei Kindern und Jugendlichen im Alter von 3 bis 17 Jahren in Deutschland – Prävalenzen und zeitliche Trends zu 2 Erhebungszeitpunkten (2033 – 2006 und 2009 – 2012) Ergebnisse der KIGGS-Studie – Erste Folgebefragung (KIGGS Welle 1). Bundesgesundheitsblatt – Gesundheitsforschung – Gesundheitsschutz, 57, 807 – 819. First citation in articleCrossref, Google Scholar

  • Hsu, C.-Y., Gau, S., Shang, C.-Y., Chiu, Y.-N. & Lee, M.-B. (2012). Associations between chronotypes, psychopathology and personality among incoming college students. Chronobiology International, 29, 491 – 501. First citation in articleCrossref, Google Scholar

  • Iglowstein, I., Jenni, O., Molinari, L. & Largo, R. (2003). Sleep duration from infancy to adolescence: Reference values and generational trend. Pediatrics, 111, 302 – 307. First citation in articleCrossref, Google Scholar

  • Ivanenko, A. & Johnson, K. (2008). Sleep disturbances in children with psychiatric disorders. Seminars in Pediatric Neurology, 15, 70 – 78. First citation in articleCrossref, Google Scholar

  • Lehmkuhl, G., Agache, A., Alfer, D., Fricke-Oerckermann, L. & Tielsch, C. (2015). Schlafinventar für Kinder und Jugendliche. Göttingen: Hogrefe. First citation in articleGoogle Scholar

  • Lin, W. H. & Yi, C. C. (2015). Unhealthy sleep practices, conduct problems, and daytime functioning during adolescence. Journal of Youth and Adolescence, 44, 431 – 446. First citation in articleCrossref, Google Scholar

  • Maslowsky, J. & Ozer, E. J. (2014). Developmental trends in sleep duration in adolescence and young adulthood: Evidence from a national United States sample. Journal of Adolescent Health, 54, 691 – 697. First citation in articleCrossref, Google Scholar

  • McKnight-Eily, L. R., Eaton, D. K., Lowry, R., Croft, J. B., Presley-Cantrell, L. & Perry, G.S. (2011). Relationships between hours of sleep and health risk behaviors in US adolescent students. Preventive Medicine, 53, 271 – 273. First citation in articleCrossref, Google Scholar

  • Mindell, J. & Meltzer, L. (2008). Behavioral sleep disorders in children and adolescents. Annals Academy of Medicine Singapore, 37, 722 – 728. First citation in articleGoogle Scholar

  • National Sleep Association (2015, February). Retrieved from https://sleepfoundation.org/media-center/press-release/national-sleep-foundation-recommends-new-sleep-times [26. 04. 2018] First citation in articleGoogle Scholar

  • O’Brien, E. M., Chelminski, I., Young, D., Dalrymple, K., Hrabosky, J. & Zimmerman, M. (2011). Severe insomnia is associated with more severe presentation and greater functional deficites in depression. Journal of Psychiatric Research, 45, 1101 – 1105. First citation in articleCrossref, Google Scholar

  • Ortega, F. B., Ruiz, J. R., Castillo, R., Chillon, P., Labayen, I., Marinez-Gomez, D. et al. (2010). Sleep duration and cognitive performance in adolescence. The AVENA study. Acta Paediatrica, 99, 454 – 461. First citation in articleCrossref, Google Scholar

  • Palagini, L. & Rosenlicht, N. (2011). Sleep, dreaming, and mental health: A review of historical and neurobiological perspectives. Sleep Medicine Review, 15, 179 – 186. First citation in articleCrossref, Google Scholar

  • Palmer, C. A., Oosterhoff, B., Bower, J. L., Kaplow, J. B. & Alfano, C. A. (2017). Association among adolescent sleep problems, emotion regulation and affective disorders: Findings from a nationally representative sample. Journal of Psychiatric Research, 18, 1 – 8. First citation in articleGoogle Scholar

  • Pasch, K. E., Laska, M. N., Lytle, L. A. & Moe, S. G. (2010). Adolescent sleep, risk behaviors, and depresssive symptoms: Are they linked? American Journal of Health Behavior, 34, 237 – 248. First citation in articleCrossref, Google Scholar

  • Peiro-Velert, C., Valencia-Peris, A., Gonzalez, L. M., Garcia-Masso, X., Sierra-Ano, P. & Devis-Devis, J. (2014). Screen media usage, sleep time and academic performance in adolescents: Clustering a self-organizing maps analysis. PLoS ONE, 9 https://doi.org/10.1371/journal.pone.0099478 First citation in articleCrossref, Google Scholar

  • Pieters, S., Burk, W., Van der Horst, H., Dahl, R., Wiers, R. & Engels, R. (2014). Prospective relationships between sleep problems and substance use, internalizing and externalizing problems. Journal of Youth and Adolescence, 44, 379 – 388. First citation in articleCrossref, Google Scholar

  • Randler, C. & Bilger, S. (2009). Associations among sleep, chronotype, parental monitoring and pupertal development among German adolescents. The Journal of Psychology, 143, 509 – 520. First citation in articleCrossref, Google Scholar

  • Roberts, R. E., Lewinsohn, P. M. & Seeley, J. R. (1995). Symptoms of DSM-III-R major depression in adolescence: Evidence from an epidemiological survey. Journal of the American Academy of Child and Adolescent Psychiatry, 34, 1608 – 1617. First citation in articleCrossref, Google Scholar

  • Sarchiapone, M., Mandelli, L., Carli, V., Iosue, M., Wasserman, C., Hadlaczky, G. et al. (2014). Hours of sleep in adolescents and its association with anxiety, emotional concerns and suicidal ideation. Sleep Medicine, 15, 248 – 254. First citation in articleCrossref, Google Scholar

  • Schlarb, A., Gulewitsch, M., Weltzer, V., Ellert, U. & Enck, P. (2015). Sleep duration and sleep problems in a representative sample of German children and adolescents. Health, 7, 1397 – 1408. First citation in articleCrossref, Google Scholar

  • Settineri, S., Gitto, F., Conte, F., Mallamace, D., Mento, C., Silvestri, R. et al. (2012). Mood and sleep problems in adolescents and young adults: An econometric analysis. The Journal of Mental Health Policy and Economics, 15, 33 – 41. First citation in articleGoogle Scholar

  • Shanahan, L., Copeland, W., Angold, A., Bondy, C. & Costello, E. (2014). Sleep problems predict and are predicted by Generalized Anxiety / Depression and Oppositional Deviant Disorder. Journal of the American Academy of Child and Adolescent Psychiatry, 53, 550 – 558. First citation in articleCrossref, Google Scholar

  • Sunderajan, P., Gaynes, B. N., Wisniewski, S. R., Miyahara, S., Fava, M., Akingbala, F. et al. (2010). Insomnia in patients with depression: A STAR*D Report. CNS Spectrum, 15, 394 – 404. First citation in articleCrossref, Google Scholar

  • Van Litsenburg, R., Waumans, R., Van den Berg, G. & Gemke, R. (2010). Sleep habits and sleep disturbances in Dutch children: A population-based study. European Journal of Pediatrics, 169, 1009 – 1015. First citation in articleCrossref, Google Scholar

  • Wang, B., Isensee, C., Becker, A., Wong, J., Eastwood, P. R., Huang, R.-C. et al. (2016). Developmental trajectories of sleep problems from childhood to adolescence both predict and are predicted by emotional and behavioral problems. Frontiers in Psychology, 7, 1874. https://doi.org/10.3389/fpsyg.2016.01874 First citation in articleGoogle Scholar

  • Wiater, A. (2013). Praktisches Vorgehen bei Schlafstörungen im Kindes- und Jugendalter. Schlaf, 3, 171 – 174. First citation in articleCrossref, Google Scholar

  • Wiater, A., Lehmkuhl, G., Mischke, A. & Fricke-Oerkermann, L. (2007). Schlaf, Verhaltung und Leistungen bei Schulkindern. Pädiatrische Praxis, 71, 397 – 408. First citation in articleGoogle Scholar

  • Winsler, A., Vorona, R. & Szklo-Coxe, M. (2015). Sleepless in Fairfax: The difference one more hour of sleep can make for teens hopelessness, suicidal ideation and substance use. Journal of Youth and Adolescence, 44, 362 – 378. First citation in articleCrossref, Google Scholar