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International Journal of Adolescent Medicine and Health

Editor-in-Chief: Merrick, Joav

Editorial Board: Birch, Diana ML / Blum, Robert W. / Greydanus, MD, Dr. HC (Athens), Donald E. / Hardoff, Daniel / Kerr, Mike / Levy, Howard B / Morad, Mohammed / Omar, Hatim A. / de Paul, Joaquin / Rydelius, Per-Anders / Shek, Daniel T.L. / Sher, Leo / Silber, Tomas J. / Towns, Susan / Urkin, Jacob / Verhofstadt-Deneve, Leni / Zeltzer, Lonnie / Tenenbaum, Ariel


CiteScore 2018: 0.79

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Sleep disorder prevalence in at-risk adolescents and potential effects of nightmare triad syndrome

Natalia D. McIver
  • Sleep and Human Health Institute, Albuquerque, NM 87109, USA
  • Maimonides Sleep Arts and Sciences Ltd., Albuquerque, NM 87109, USA
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
/ Barry Krakow
  • Corresponding author
  • Sleep and Human Health Institute, Albuquerque, NM 87109, USA
  • Maimonides Sleep Arts and Sciences Ltd., Albuquerque, NM 87109, USA
  • Los Alamos Medical Center, Los Alamos, NM 87544, USA
  • Email
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
/ Jessica Krakow
  • Sleep and Human Health Institute, Albuquerque, NM 87109, USA
  • Maimonides Sleep Arts and Sciences Ltd., Albuquerque, NM 87109, USA
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
/ Michael R. Nadorff
  • Department of Psychology, Mississippi State University, Mississippi State, MS 39762, USA
  • Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX 77030, USA
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
/ Victor A. Ulibarri
  • Sleep and Human Health Institute, Albuquerque, NM 87109, USA
  • Maimonides Sleep Arts and Sciences Ltd., Albuquerque, NM 87109, USA
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
/ Robert Baade
Published Online: 2018-02-17 | DOI: https://doi.org/10.1515/ijamh-2017-0125

Abstract

Objective

At-risk high school students, those considered to have a higher probability for academic failure or dropping out, were assessed for various sleep disorders. Effects were compared between students with and without the nightmare triad syndrome (NTS+), the sleep disorders’ cluster of frequent nightmares, insomnia disorder and suspected sleep-disordered breathing (SDB).

Methods

Data were gathered at a charter school for at-risk youth using: computer based surveys, physical airway exams, and mental health interviews by school social worker. Ninety-two students were enrolled, and 70 completed all study components.

Results

Students were teenaged [17.10 (1.50) years], male (52.2%) slightly overweight [BMI 25.50 (6.41)] Hispanics (87.0%); two-thirds (65 of 92) subjectively reported a sleep problem. Frequent nightmares (39.1%), insomnia (ISI ≥ 12, 41.3%), and SDB risk (79.3%) were common. Several presumptive sleep disorders (insomnia, SDB risk, parasomnia, or nightmares) were associated with worse sleep quality and lower quality of life. Nineteen students met criteria for NTS. Compared to NTS−, NTS+ showed significantly lower quality of life (p < 0.003, g = 0.84). Regression analyses revealed higher levels of depression and anxiety symptoms in NTS+ students. NTS was associated with reduced quality of life independent of anxiety symptoms.

Conclusion

Prevalence of presumptive sleep disorders was high with a tendency for clusters of sleep disorders in the same individual. Students with NTS+ showed worse outcomes and reduced quality of life, mediated partially by depression and anxiety. To examine relationships between sleep disorders and mental health in at-risk adolescents, research investigations must include both subjective and objective measurements of sleep.

This article offers supplementary material which is provided at the end of the article.

Keywords: anxiety; depression; insomnia; nightmares; sleep-disordered breathing; quality of life

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About the article

Received: 2017-07-18

Accepted: 2017-11-26

Published Online: 2018-02-17


Conflict of interest: Authors NDM, JK, MRN, VAU, and RB declare that they have no conflict of interest. Author BK reports: 6 main activities related to my work in sleep medicine:

For websites, I own and operate 6 sites that provide education and offer products and services for sleep disorders patients:www.nightmaretreatment.com: www.ptsdsleepclinic.com: www.sleeptreatment.com: www.sleepdynamictherapy.com: www.soundsleepsoundmind.com: www.nocturiacures.com.

For other professional services, I am the medical director of a national DME company Classic Sleep Care for which my sole functions are consultation and QA; I have neither patient encounters nor do I benefit from the sale of any DME equipment.

For intellectual property, I market and sell 3 books for sleep disorders patients: Insomnia Cures, Turning Nightmares into Dreams, and Sound Sleep, Sound Mind.

For clinical services, I own and operate one commercial sleep center: Maimonides Sleep Arts & Sciences, Ltd.

For educational and consulting services: I conduct CME/CEU educational programs for medical and mental health providers to learn about sleep disorders. Sometimes these programs involve the attendee paying a fee directly to our center. Other times, I conduct the workshops at other locations, which may be paid for by vendors such as Respironics and RESMED or other institutions such as the AMEDDC&S, VAMC, and regional sleep center conferences.

I am also president and principal investigator of a non-profit sleep research center, the Sleep & Human Health Institute (www.shhi.org) that occasionally provides consultation services or receives grants for pilot studies, the most recent: ResMed ∼$400,000 January 2015 (funding for randomized control trial of treatment in insomnia patients).

Funding: This research received funding from the non-profit Simon Foundation, Santa Fe, NM and non-profit Oxnard Foundation, Newport Beach, CA.


Citation Information: International Journal of Adolescent Medicine and Health, 20170125, ISSN (Online) 2191-0278, DOI: https://doi.org/10.1515/ijamh-2017-0125.

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