Adolescent Insomnia and Daytime Sleepiness Linked to Depression Risk
Key Clinical Summary:
- A 3-year longitudinal study of 458 adolescents found that insomnia, excessive daytime sleepiness (EDS), and their co-occurrence were associated with increased odds of depression.
- Combined insomnia and EDS was also associated with a higher risk of suicidal ideation after adjustment for potential confounders.
- EDS prevalence increased while insomnia prevalence declined over the 3-year follow-up, highlighting changing sleep patterns during adolescence.
Adolescents with both insomnia and EDS face a greater risk of adverse mental health outcomes than their peers, according to a 3-year longitudinal study published in the Journal of Affective Disorders. The findings identify the co-occurrence of insomnia and EDS as a high-risk clinical profile associated with depression and suicidality, supporting the need for early identification and intervention.
Study Findings
Researchers conducted a 3-year longitudinal investigation involving 458 adolescents, with an average age of 13.8 years at baseline. Participants completed questionnaires assessing insomnia symptoms, daytime sleepiness, and mental health outcomes throughout the study period.
Adolescents were categorized into 4 groups: insomnia only, EDS only, both insomnia and EDS, and healthy controls. Logistic regression analyses were performed to evaluate associations between sleep disturbances and mental health outcomes while adjusting for potential confounding factors.
The investigators observed that the prevalence of excessive daytime sleepiness increased from 29.0% at baseline to 42.4% at follow-up (p < 0.001), whereas the prevalence of insomnia symptoms declined from 27.7% at baseline to 24.5% (p < 0.001) over the 3-year follow-up.
The study also found that participants with both insomnia and EDS showed the highest adjusted odds of developing subsequent depression compared to healthy controls (adjusted odds ratio [AdjOR] = 5.09; 95% CI: 2.23–11.64, p < 0.001).
Participants with either condition alone also showed significant associations with depression compared to healthy controls (EDS, AdjOR = 2.75, 95% CI: 1.31–5.79, p = 0.008; insomnia, AdjOR = 2.47, 95% CI: 1.16–5.25, p = 0.02).
For suicidal ideation, significant associations were identified in adolescents with co-occurring insomnia and EDS (fully adjusted AdjOR = 3.24, 95% CI: 1.29–8.15, p = 0.01) and in those with only insomnia (AdjOR = 2.80, 95% CI: 1.23–6.24, p = 0.01). In contrast, the EDS-only group did not demonstrate a significant association.
Clinical Implications
The findings highlight the importance of evaluating multiple dimensions of sleep health during psychiatric evaluation. The observed increase in EDS prevalence and decrease in insomnia symptoms further reinforce that adolescent sleep patterns may shift over time. Routine clinical assessment of both nighttime sleep difficulties and daytime sleepiness may therefore improve recognition of adolescents who warrant closer mental health evaluation.
The study also indicates that insomnia, particularly when accompanied by EDS, may be associated with increased suicidal ideation. These findings may help clinicians prioritize comprehensive sleep assessments when evaluating adolescents with depressive symptoms or concerns about suicide risk.
Expert Commentary
“The finding underscores the importance of addressing both nocturnal sleep disturbances and daytime functioning in adolescent mental health interventions,” wrote senior author Rachel Ngan Yin Chan, PhD, MPhil, CPsychol, Li Chiu Kong Family Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China, and coauthors.
“Early sleep and chronotherapeutic interventions may help mitigate these mental health risks in adolescents,” they concluded.
