Sleep problems and emotional and behavioral problems among adolescents: examining independent types, cumulative...

Despite the established association between sleep problems and emotional and behavioral problems in adolescents, there is limited evidence on the relationships of independent, cumulative, and distinct patterns of sleep problems with emotional and behavioral problems.

Cross-sectional data were collected from middle school students in Daye City, Hubei Province, China, with 1,381 participants included. Emotional and behavioral problems and sleep problems were assessed using the Strengths and Difficulties Questionnaire and Pittsburgh Sleep Quality Index, respectively. Latent class analysis was used to identify the latent patterns of sleep problems, and linear regression analyses were used to explore the associations between sleep problems (including independent types and cumulative scores) and emotional and behavioral problems. The Bolck-Croon-Hagenaars method was applied to compare emotional and behavioral problems across distinct sleep problem patterns. Additionally, relative importance analysis was conducted to estimate the relative contribution of each sleep problem to the variance in emotional and behavioral problems.

Prolonged sleep latency, short sleep duration, inefficient sleep, sleep disturbances, use of sleep medications, and daytime dysfunction were independently correlated with higher levels of emotional and behavioral problems, except for poor subjective sleep quality. Among these sleep problems, daytime dysfunction contributed the most to the variance in emotional (23.5%) and behavioral problems (30.4%). Additionally, the more sleep problems adolescents experienced, the more severe their emotional and behavioral problems were. Three distinct patterns of sleep problems were identified: "global sleep dysfunction", "disturbed and non-restorative sleep", and "mild sleep problems". Adolescents with the "global sleep dysfunction" pattern exhibited the most severe emotional and behavioral problems, whereas those with the "mild sleep problems" pattern exhibited the least severe.

The findings highlight the need to consider the types, numbers, and patterns of sleep problems when developing tailored interventions to alleviate emotional and behavioral problems in adolescents.