The effects of insomnia on mood and cognitive functioning in adolescents: The role of pubertal development

Wanqi Sun, Jiefan Ling, Ngan Yin Chan, Forrest Tin Wai Cheung, Jihui Zhang, Joey Wing Yan Chan, Albert Martin Li, Tatia Mei Chun Lee, Yun Kwok Wing, Shirley Xin Li

Abstract

Introduction Adolescence is a critical and sensitive period during which there is a substantial increase of the prevalence of sleep problems, such as insomnia, as a result of various psychosocial and physiological changes. Whilst previous research has found that insomnia is associated with poor daytime functioning in adults, there has been limited evidence on the effects of insomnia in relation to pubertal development in adolescents. The current study aimed to examine the role of pubertal status on the association between insomnia and daytime functioning in adolescents.

Materials and Methods A total of 121 adolescents (males: 31.4%, mean age: 16.2y) completed a set of questionnaires and neurobehavioural tasks. Sleep was measured by Insomnia Severity Index (ISI), Pittsburgh Sleep Quality Index (PSQI) and 7-day prospective actigraphic monitoring. Insomnia cases were defined as ISI score ≥ 9. Pubertal status was assessed by the Tanner pubertal self-assessment questionnaire (early adolescence: Tanner 2 & 3; late adolescence: Tanner 4 & 5). Mood symptoms were measured by the Depressive Anxiety and Stress Scale (DASS-21). Sustained attention, selective attention, working memory and set shifting were measured by Psychomotor Vigilance Task, Color-Word Stroop Task, Digit Span Task and Wisconsin Card Sorting Task, respectively. General linear models were applied to examine the interaction between insomnia and pubertal status on mood and cognitive functioning, in which gender was entered as covariate.

Results The prevalence of insomnia symptoms was 41.7% in the overall sample, and 82.6% of the sample were at late pubertal stage. Insomnia was associated with more depressive and anxiety symptoms only in the adolescents at late pubertal stage (interaction for depression: F=3.92, p=0.050; interaction for anxiety: F=4.66, p=0.033). Meanwhile, insomnia was particularly associated with poorer working memory in the adolescents at late pubertal stage (interaction: Fforward=1.35, p=0.248; Fbackward =5.76, p=0.018). No interaction effect was found on other cognitive domains.

Conclusion The association between insomnia and impaired daytime functioning emerges during late puberty. Our findings suggested the role of pubertal maturation in relation to the adverse impacts of insomnia in adolescents and highlighted the need for early assessment and timely intervention of insomnia in early adolescence.

Recommended citation: Sun, W., Ling, J., Chan, N. Y., Cheung, T. W. F., Zhang, J., Chan, J. W. Y., ... & Li, S. X. (2019). The effects of insomnia on mood and cognitive functioning in adolescents: the role of pubertal development. Sleep Medicine, 64, S367.