Depressive Symptoms and Cigarette Smoking Predict Development and Persistence of Sleep Problems in US Adolescents

OBJECTIVE: To evaluate factors related to the development and persistence of adolescent sleep problems. METHODS: In this longitudinal, population-based study, the Teenage Attitudes and Practices Survey was administered by telephone to 7960 adolescents (3921 girls and 4039 boys) 12 to 18 years old in 1989 and at follow-up in 1993. Sleep problems at both time points were assessed using a single item on the Teenage Attitudes and Practices Survey. Those who responded that they "often or sometimes" had trouble going to sleep or staying asleep during the past 12 months were categorized as reporting sleep problems, whereas those who responded "often" were categorized as having frequent sleep problems. Multiple logistic regression analyses were used to identify baseline characteristics predictive of the development and persistence of sleep problems or frequent sleep problems, respectively, from baseline to follow-up. RESULTS: Of the 4866 adolescents without sleep problems at baseline, 28% developed sleep problems by 1993, and 9% developed frequent sleep problems. Of the 3094 adolescents who reported sleep problems at baseline, 52% reported sleep problems in 1993, and 21% reported frequent sleep problems. Female sex and notable depressive symptoms were associated with the development and persistence of sleep problems and frequent sleep problems at follow-up. Cigarette smoking status showed a dose-response relationship with development of sleep problems and frequent sleep problems, and with persistence of frequent sleep problems at follow-up. CONCLUSION: The reduction of depressive symptoms and cigarette smoking among adolescents are important factors to consider in prevention and treatment efforts focused on adolescent sleep problems.