The relation of objective sleep patterns, depressive symptoms, and sleep disturbances in adolescent children and their parents: A sleep-EEG study with 47 families
Introduction
Sufficient and restoring sleep is essential for psychological well-being, cognitive processes, and a range of adaptive behavioural functions (Diekelmann and Born, 2010; Owens, 2000; Stein et al., 2001; Walker, 2009). Since the period of adolescence is accompanied by dramatic changes in physiology and neural networks (Giedd et al., 1999; Paus et al., 2008), sleep and sleep regulation play a crucial role in adolescents' well-being and development (Brand and Kirov, 2011; Colrain and Baker, 2011; Jan et al., 2010; Kirov and Brand, 2011; Ringli and Huber, 2011). However, poor sleep in adolescence has become a significant public mental and physical health problem (Aronen et al., 2000; Laberge et al., 2000; Owens et al., 2000; Paavonen et al., 2000). Cross-sectional (Kaneita et al., 2007; Lund et al., 2010) and longitudinal studies (Fricke-Oerkermann et al., 2007; Roberts et al., 2008; Wong and Brower, 2012) have shown that acute and chronic sleep loss during development persist over time, with negative effects on adolescents' physical and mental health. At the same time poor psychological well-being may itself negatively impact on adolescents' sleep (Baglioni et al., 2010; Riemann et al., 2010). In other words, the association between sleep and psychological functioning is likely to be bi-directional.
Among the many factors that can affect sleep during adolescence, the role for family environment is still poorly understood. In recent years a growing body of research has emphasized the interdependence between children's sleep and family environment (El-Sheikh, 2011, for extensive overview). Martin et al. (2007) investigated families of 5107 infants and 4983 children aged between 4 and 5 years and assessed both children's and parents' sleep and psychological functioning using questionnaires and sleep logs. They concluded that these children's sleep problems were strongly associated with parents' mental health, particularly that of mothers irrespective of whether they reported a history of health problems. Smedje et al. (1998) asked 367 mothers and 273 fathers about the sleep of their 5–6 year old children using questionnaires. Parents who reported sleep problems in their children had increased sleep problems of their own. The authors interpreted this as an effect of children's sleep problems on parental sleep. In another cross-sectional study of 20,778 Chinese families, parents of 5–11 year old children were asked about the latter's sleep; children's shorter sleep duration was associated with parents' shorter sleep duration (Li et al., 2010). Likewise, Zhang et al. (2010) examined parental reports from 4470 families on the sleep of their school-aged children (7–11 years). Their results revealed similarities between parents' and children's sleep and wake patterns, although children's sleep–wake patterns were influenced more strongly by the mother–child relationship than by the father–child relationship. Last, Meltzer and Mindell (2007) recruited 47 mothers of children aged from 3 to 14 years. A key finding from this questionnaire-based study was that children's sleep disruptions were highly associated with mothers' poor sleep and poor mental status.
In summary, although the evidence is largely correlational, research on the sleep of infants, toddlers and children suggests that children's poor sleep has a negative impact on parents' and particularly mothers' sleep.
However, whereas a growing body of evidence indicates that sleep characteristics in young children and their parents are associated, research on the relationship between parents' and adolescents' sleep is limited. Lemola et al. (2012) showed in a sample of 176 eleven years olds that a large difference in sleep duration between weekdays and weekends mediated a relation between inter-parental conflict and early adolescent aggression; irregular sleep seemed to be a vulnerability factor for aggression in early adolescence. Similarly, Tynjälä et al. (1999) showed that self-reported sleep patterns of 4187 adolescents aged between 11 and 15 years were associated with their quality of life including their relationships with parents and peers. The main finding, however, was that a positive home atmosphere was the principal factor favouring high quality sleep. This finding held irrespective of gender or age. Likewise, Vignau et al. (1997) examined the prevalence and correlates of sleep problems in 763 16-year-old students as assessed by self-reported questionnaires. A key finding was that sleep problems were highly related to various personal issues and particularly to poor family climate. These findings suggest that quality of family life is related to adolescents' sleep. Further, Bernert et al. (2007) investigated the association between stress in family life and sleep problems in 115 undergraduates aged 17–22 years, using self-reported questionnaires. They showed that familial stress was highly related to increased insomnia and poor academic achievement in late adolescence. Last, in two previous studies (Brand et al., 2009a, 2009b), we were able to show that mothers' and adolescents' sleep quality, both subjectively assessed, were associated with parenting style being a mediating factor.
To summarize, there is compelling evidence that children's sleep is related to parents' sleep and mental health. This observation holds true not only for infants and children (Bernert et al., 2007; Li et al., 2010; Martin et al., 2007; Smedje et al., 1998) but also for in early2 (Lemola et al., 2012; Li et al., 2010; Zhang et al., 2010), middle (Vignau et al., 1997) and late adolescence (Bernert et al., 2007; Brand et al., 2009a, 2009b). However, one major limitation of the research so far is the source of evidence on sleep quality. In the majority of studies, information about parents' and children's sleep was obtained either from parents or from their children, and exclusively by questionnaire. Moreover, research focussing on adolescents remains limited. To the best of our knowledge, no study has so far examined the relationship between children's and parents' sleep architecture via objective sleep-EEG evaluation of entire families. Nor have parents and their adolescent children been tested for their sleep concomitantly and separately.
To address these limitations, the present study aimed at extending and specifying previous research by (1) evaluating adolescents' and parents' sleep objectively by means of sleep-EEG and (2) assessing adolescents' and parents' sleep separately, with a focus on middle adolescence. Given the relative lack of objectively measured sleep variables, we believe that the results of the present study may be a valuable contribution the current literature. Additionally, given the strong possibility that health professionals will encounter adolescents' issues and concerns surrounding sleep complaints alongside difficulties with parents, results may be of value in family counselling and treatment of adults' and adolescents' sleep complaints. This is crucial as family conditions have been identified as protective factors that foster resilient adaptation among adolescents, particularly if they are exposed to adversity and stressful life circumstances (Cicchetti, 2010; Luthar et al., 2006; Lyssenko et al., 2010; Masten, 2004; Masten et al., 1999; Sameroff and Rosenblum, 2006; Tiet et al., 1998).
The following three hypotheses were formulated. First, following Li et al. (2010) and Zhang et al. (2010), we hypothesized that adolescents' sleep, measured by sleep-EEG (sleep continuity and sleep architecture) would be related to parents' sleep. Second, consistent with other findings (Bernert et al., 2007; Brand et al., 2009a, 2009b; Tynjälä et al., 1999; Vignau et al., 1997; Zhang et al., 2010), we expected that sleep objectively assessed in this way (by sleep-EEG), would be associated with subjective measures of sleep (using the Insomnia Severity Index: ISI), psychological well-being (using the Depression Scale and self-perceived and parents' perceived Family Climate), among adolescents and also their mothers and fathers, Third, in line with previous studies (Brand et al., 2009a, 2009b) and information from the Swiss Federal Statistical Office (2009), we expected that mothers' sleep patterns and psychological functioning would be more closely associated with family functioning than those of fathers or adolescents.
Section snippets
Participants
A total of 52 families were recruited for the study. Five families dropped out during the course of the study, for work-related reasons, and other participant refusal. The final sample consisted of 47 families. One hundred and sixty six complete datasets were obtained from 47 mothers (mean age: 49.45 ± 4.04 years), 39 fathers (mean age: 50.81 ± 5.12 years), and 80 adolescents (overall mean age: 16.28 ± 2.00 years; males (n = 44): 16.32 ± 1.97 years; females (n = 36): 16.22 ± 2.12 years). The
Results
First, adolescent's and parent's objective sleep were compared. Second, associations between subjective sleep disturbances, depressive symptoms, and family climate were compared to each other. Finally, associations between sleep-EEGs, and subjective sleep disturbances, depressive symptoms, and family climate were examined.
Discussion
The key findings of the present family-study are that, first, objective evidence was provided for the existence of a relationship between the sleep patterns of parents and their adolescent offspring. We showed that adolescents' objectively evaluated sleep continuity and architecture were associated with parents' sleep-EEG parameters of sleep continuity and architecture, and especially with those of mothers. Second, objectively assessed poor sleep continuity, elevated light sleep and decreased
Conclusion
The pattern of results suggests first that, there may be a bi-directional association between family climate, family functioning and adolescents' sleep and well-being, and, second, that mothers' and adolescent children's sleep and well-being are particularly closely associated. The present findings therefore add to the existing literature in an important way in that we were able to show that parents' and adolescents' subjective, and especially objective, sleep and psychological well-being are
Role of funding
The present study was conducted without external fundings.
Contributors
NK, MG, RK, TM, UP, EHT and SB designed the study and wrote the protocol, and all of them managed the literature searches and analyses. NK and MG were highly engaged with data collection and data entry. SB undertook the statistical analyses, and NK and MG the statistical check. SB wrote the draft of the manuscript and coordinated the integration of the different comments and corrections of the authors. UP is MG's senior researchers. EHT is the responsible senior researcher of NK, TM and SB. SB
Conflict of interest
All authors declare that they have no conflicts of interest.
Acknowledgements
We thank Marielle Koenig and Vladimir Djurdjevic for sleep-EEG scoring, and Tanja Häfliger and Dominique Keller for data collection and data entry. Moreover, we thank Nick Emler (Surrey, UK) who assisted with the proofreading of the manuscript.
References (65)
- et al.
Sleep and psychiatric symptoms in school-age children
Journal of the American Academy of Child & Adolescent Psychiatry
(2000) - et al.
Sleep and emotions: a focus on insomnia
Sleep Medicine Reviews
(2010) - et al.
Validation of the Insomnia Severity Index as an outcome measure for insomnia research
Sleep Medicine
(2001) - et al.
Evidence for similarities between adolescents and parents in sleep patterns
Sleep Medicine
(2009) - et al.
Perceived parenting styles, personality traits and sleep patterns in adolescents
Journal of Adolescence
(2009) - et al.
Like mother, like daughter: evidence for non-genomic transmission of parental behavior and stress responsivity
Progress in Brain Research
(2001) - et al.
Declarative and procedural memory consolidation during sleep in patients with borderline personality disorder
Journal of Psychiatric Research
(2008) - et al.
Long-term sleep disturbances in children: a cause of neuronal loss
European Journal of Paediatric Neurology
(2010) - et al.
From early to late adulthood. Changes in EEG sleep of depressed patients and healthy volunteers
Biological Psychiatry
(1991) - et al.
Interparental conflict and early adolescents' aggression: is irregular sleep a vulnerability factor?
Journal of Adolescence
(2012)
Risk factors associated with short sleep duration among Chinese school-aged children
Sleep Medicine
Sleep patterns and predictors of disturbed sleep in a large population of college students
Journal of Adolescent Health
The hyperarousal model of insomnia: a review of the concept and its evidence
Sleep Medicine Reviews
Developmental aspects of sleep slow waves: linking sleep, brain maturation and behavior
Progress in Brain Research
Chronic insomnia and its negative consequences for health and functioning of adolescents: a 12-month prospective study
Journal of Adolescent Health
Adverse life events and resilience
Journal of the American Academy of Child & Adolescent Psychiatry
Epidemiologic study of sleep quality and troubles in French secondary school adolescents
Journal of Adolescent Health
The prospective relationship between sleep problems and suicidal behavior in the National Longitudinal Study of Adolescent Health
Journal of Psychiatric Research
The first night effect: an EEG study of sleep
Psychophysiology
Expressed emotion, parenting stress, and adjustment in mothers of young children with behavior problems
The Journal of Child Psychology and Psychiatry and Allied Disciplines
Parenting and children's cardiovascular functioning
Child: Care, Health and Development
Family life stress and insomnia symptoms in a prospective evaluation of young adults
Journal of Family Psychology
Exercising, sleep-EEG patterns, and psychological functioning are related among adolescents
World Journal of Biological Psychiatry
Sleep and its importance in adolescence and in common adolescent somatic and psychiatric conditions
International Journal of General Medicine
Resilience under conditions of extreme stress: a multilevel perspective
World Psychiatry
Changes in sleep as a function of adolescent development
Neuropsychology Review
The regulation of sleep and arousal: development and psychopathology
Development and Psychopathology
Behavioral treatment of chronic insomnia in psychiatrically ill patients
Journal of Clinical Psychiatry
The memory function of sleep
Nature Reviews Neuroscience
Sleep and development. Familial an socio-cultural considerations
Prevalence and course of sleep problems in childhood
Sleep
Pubertal transition, stressful life events, and the emergence of gender differences in adolescent depressive symptoms
Developmental Psychology
Cited by (67)
Sleep stage classification using Light Gradient Boost Machine: Exploring feature impact in depressive and healthy participants
2024, Biomedical Signal Processing and ControlModifiable parental factors in adolescent sleep: A systematic review and meta-analysis
2021, Sleep Medicine ReviewsThe relationship between sleep duration and mood in adolescents: A systematic review and meta-analysis
2020, Sleep Medicine ReviewsThe impact of delayed sleep phase disorder on adolescents and their family
2019, Sleep Medicine
- 1
Both authors contributed equally to this work.