A community-based study of insomnia in Hong Kong Chinese children: Prevalence, risk factors and familial aggregation

Department of Psychiatry, The Chinese University of Hong Kong, Shatin, Hong Kong.
Sleep Medicine (Impact Factor: 3.15). 05/2009; 10(9):1040-6. DOI: 10.1016/j.sleep.2009.01.008
Source: PubMed


There has been limited data on familial aggregation of insomnia. We aimed to explore the prevalence, risk factors and familial aggregation of childhood insomnia with a large community-based sample.
A community-based epidemiologic study of sleep disorders was conducted among primary school children. Those children with at least one reported biological parent were recruited. A total of 5695 children (mean age 9.2; SD 1.8), 4939 of their reported biological mothers (mean age 38.9; SD 4.6) and 4289 of their reported biological fathers (mean age 43.3; SD 5.5) were studied.
The rates of insomnia 3 times/week in the past 12 months were 4.0%, 12.8% and 9.7% for children, mothers and fathers, respectively. A robust familial aggregation of insomnia was found even after adjustment of the shared environmental and socio-demographic factors. There was a significant dose-response relationship among the children across their parental status from neither, fathers, mothers to both parents with insomnia [3.0%, 7.1%, 9.5% and 11.9%; with ORs (95% CIs)=2.48 (1.82-4.37) for fathers, 3.42 (2.55-4.59) for mothers and 4.42 (2.42-8.10) for both parents, respectively]. In addition, the frequency of insomniac symptoms of the parents also had a dose-response effect on the rate of insomnia of their children.
Insomnia is a common problem in both children and their parents. A significant familial aggregation of childhood onset insomnia was seen in this study even after adjustment of the co-risk factors. There was a dose-response effect of parental insomnia on the rate of insomnia of their children with a slight predilection of maternal influences.

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    • "relatives, particularly the mother (Bastien and Morin, 2000; Beaulieu-Bonneau et al., 2007; Dauvilliers et al., 2005; Hauri and Olmstead, 1980; Wing et al., 201; Zhang et al., 2009). However, the vast majority of these studies were limited by the reliance on self-report of the probands with regard to the family history, with only two studies directly assessing first-degree relatives (Wing et al., 2012; Zhang et al., 2009). Moreover, twin studies have shown substantial heritability of insomnia and related constructs of poor sleep quality (see Barclay and Gregory, 2013 for an extensive review). "
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    ABSTRACT: Cognitive-emotional hyperarousal is believed to be a predisposing factor for insomnia; however, there is limited information on the association of familial vulnerability to insomnia and cognitive-emotional hyperarousal. The aim of this study was to estimate the heritability of stress-related insomnia and examine whether parental vulnerability to stress-related insomnia is associated with cognitive-emotional hyperarousal in their offspring. We studied a volunteer sample of 135 nuclear families comprised of 270 middle-aged (51.5 ± 5.4 years) fathers and mothers and one of their biological offspring (n = 135, 20.2 ± 1.1 years). We measured vulnerability to stress-related insomnia (i.e. Ford Insomnia Response to Stress Test: FIRST), perceived stress, depression and anxiety in all participants, and arousability, presleep cognitive and somatic arousal, coping and personality in the offspring. We found a heritability estimate of 29% for FIRST scores. High FIRST parents had three to seven times the odds of having offspring highly vulnerable to stress-related insomnia. Offspring of high FIRST parents showed higher arousability, presleep cognitive arousal and emotion-oriented coping. Furthermore, high FIRST mothers contributed to offspring's higher anxiety and lower task-oriented coping, while high FIRST fathers contributed to offspring's higher presleep somatic arousal and conscientiousness. Vulnerability to stress-related insomnia is significantly heritable. Parents vulnerable to stress-related insomnia have offspring with cognitive-emotional hyperarousal who rely upon emotion-oriented coping. These data give support to the notion that arousability and maladaptive coping are key factors in the aetiology of insomnia.
    Full-text · Article · May 2014 · Journal of Sleep Research
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    • "It has been demonstrated to have satisfactory validity and internal consistency (Cronbach's α coefficient=0.846) (16). Teachers distributed the questionnaires to the children for completion by their parents. "
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    ABSTRACT: Epidemiological studies of short and long sleepers have not been conducted previously. We collected socioeconomic, psychological, and polysomnographic characteristics of 6501 parents (3252 men and 3249 women) of 4036 primary school children in Guangzhou city. The study data were collected in three phases. The overall prevalence of short (5 h or less) and long (10 h or more) sleep duration was 0.52 and 0.64%, respectively. Long sleepers had higher Eysenck Personality Questionnaire neuroticism scores [odds ratio (OR)=1.224, 95% confidence interval (CI)=1.047-1.409] and lower education levels (OR=0.740, 95%CI=0.631-0.849) than short sleepers. In the polysomnographic assessment, short, long, and normal sleepers (7-8 h) shared similar durations of Stage 3 sleep (short=25.7±10.7, long=20.3±7.9, and normal=28.0±12.8 min, F=1.402, P=0.181). In daytime multiple sleep latency tests, short sleepers (10/19, 52.6%) were more prone to have a short sleep latency (≤8 min) than long sleepers (2/23, 8.7%). In addition to different sleep durations, neuroticism might also contribute to differences between short and long sleepers in social achievements. Stage 3 sleep might be essential for humans. The short sleep latency (≤8 min) of short sleepers in multiple sleep latency tests should be interpreted cautiously, since it was of the same severity as required for a diagnosis of narcolepsy or idiopathic hypersomnia.
    Full-text · Article · Feb 2014 · Brazilian journal of medical and biological research = Revista brasileira de pesquisas medicas e biologicas / Sociedade Brasileira de Biofisica ... [et al.]
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    • "Consequently , prevalence estimates of insomnia symptoms in childhood have varied from 4% to 41% [1] [2] [3] [4] [5] [6] [7] [8] [9]. Insomnia symptoms of difficulty falling (DFA) and/or staying asleep (DSA) are the most common parent-reported sleep complaints in children, but little is known about the risk factors associated with insomnia symptoms in prepubescent children, with the exception of two population-based studies in China of children ages 6–13 years [3] [10]. These studies did not find age or gender effects on the prevalence of insomnia symptoms. "
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    ABSTRACT: Our population-based study examined the prevalence of insomnia symptoms and its sociodemographic, subjective, and polysomnographic (PSG) sleep risk factors in young and preadolescent children. We performed a cross-sectional study of 700 children, ages 5-12 years who underwent a 9-h PSG and parent-completed sleep and development questionnaires (Penn State Child Cohort). Insomnia symptoms were defined as parent report of difficulty falling or staying asleep and sleep-disordered breathing (SDB) as an apnea hypopnea index of ⩾1. The prevalence of insomnia symptoms was 19.3% and did not significantly change (20.2%) when children with SDB were excluded. A significant interaction between gender and age revealed that the prevalence of insomnia symptoms was highest in girls ages 11 to 12 years (30.6%). This gender difference was not associated with significant differences between girls and boys ages 11-12years in anxiety and depressive symptoms. In contrast girls ages 11-12years with insomnia symptoms, but not boys of the same group, demonstrated clinically significant PSG sleep disturbances compared to those without insomnia symptoms. These data suggest that one out of five young children and preadolescents of the general population have insomnia symptoms. Importantly, the prevalence of insomnia symptoms peaks in girls ages 11 to 12 years and is associated with objective sleep disturbances which may be related to hormonal changes associated with the onset of puberty rather than anxiety and depression.
    Full-text · Article · Jan 2014 · Sleep Medicine
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