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Published online February 1, 2006
PEDIATRICS Vol. 117 No. 2 February 2006, pp. e247-e256 (doi:10.1542/peds.2004-2629)
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Epidemiology of DSM-IV Insomnia in Adolescence: Lifetime Prevalence, Chronicity, and an Emergent Gender Difference

Eric O. Johnson, PhDa, Thomas Roth, PhDb, Lonni Schultz, PhDc, Naomi Breslau, PhDd

a Substance Abuse Epi, Prevention and Risk Behavior, Research Triangle Institute International, Research Triangle Park, North Carolina
b Sleep Disorders and Research Center
c Department of Biostatistics and Research Epidemiology, Henry Ford Health System, Detroit, Michigan
d Department of Epidemiology, Michigan State University, East Lansing, Michigan

OBJECTIVE. The confluence of sleep/wake cycle and circadian rhythm changes that accompany pubertal development and the social and emotional developmental tasks of adolescence may create a period of substantial risk for development of insomnia. Although poor sleep affects cognitive performance and is associated with poor emotional and physical health, epidemiologic studies among adolescents have been limited. In this first epidemiologic study of insomnia defined by Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria in a US sample of adolescents, we estimated lifetime prevalence of insomnia, examined chronicity and onset, and explored the role of pubertal development.

METHODS. Data come from a random sample of 1014 adolescents who were 13 to 16 years of age, selected from households in a 400000-member health maintenance organization encompassing metropolitan Detroit. Response rate was 71.2%. The main outcome measured was DSM-IV–defined insomnia.

RESULTS. Lifetime prevalence of insomnia was 10.7%. A total of 88% of adolescents with a history of insomnia reported current insomnia. The median age of onset of insomnia was 11. Of those with insomnia, 52.8% had a comorbid psychiatric disorder. In exploratory analyses of insomnia and pubertal development, onset of menses was associated with a 2.75-fold increased risk for insomnia. There was no difference in risk for insomnia among girls before menses onset relative to boys, but a difference emerged after menses onset. In contrast, maturational development was not associated with insomnia in boys.

CONCLUSIONS. Insomnia seems to be common and chronic among adolescents. The often found gender difference in risk for insomnia seems to emerge in association with onset of menses.

Key Words: adolescence • epidemiology • insomnia

Abbreviations: DSM-IV— Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition • HMO—health maintenance organization • CDISC-IV—Computerized Diagnostic Schedule for Children, Version Four • ICSD-R—International Classification of Sleep Disorders–Revised • ADHD—attention-deficit/hyperactivity disorder • IQR—interquartile range • HR—hazard ratio • CI—confidence interval • DSPS—delayed sleep-phase syndrome

Accepted Jul 29, 2005.


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