0900 NATURAL HISTORY OF INSOMNIA SYMPTOMS AND INCIDENCE OF PSYCHIATRIC DISORDERS: ROLE OF CHILDHOOD-ONSET, ADOLESCENCE-ONSET AND FULL REMISSION

Abstract

Introduction: Adolescence is a critical developmental period during which many psychiatric disorders have their first onset. We examined the potential relationship between the natural history of insomnia symptoms and the incidence of psychiatric disorders using a longitudinal design during the transition from childhood to adolescence. Methods: Data from the Penn State Child Cohort, a longitudinal study of 421 children (5-12y) followed-up as adolescents (12-23y) was used. Insomnia symptoms were defined by the presence of difficulties falling and/or staying asleep using parent/self-reports on the Pediatric Behavior Scale and Pediatric Sleep Questionnaire. Psychiatric disorders were ascertained by parent/self-report during clinical history and physical examination. Logistic regression analysis predicting incident psychiatric disorders adjusted for sex, race, age, eveningness, body mass, apnea/hypopnea, and periodic limb movement indices. Results: Compared to controls (11.9%), adolescents with incident insomnia symptoms at follow-up had a significantly higher (25%) incidence of psychiatric disorders (OR=2.4, 95%CI=1.17–5.05) and this incidence was even higher (38.6%) in adolescents with persistent insomnia symptoms since childhood (OR=4.5, 95%CI=2.05–9.72). In contrast, adolescents who fully remitted from their childhood insomnia symptoms had an incidence of psychiatric disorders (11.5%) similar to that of controls (OR=0.90, 95%CI=0.24–3.43) and significantly lower than childhood-onset insomnia (OR=0.11, 95%CI=0.02–0.61). Child/Adult Behavior Checklist analyses confirmed that internalizing and externalizing behaviors were increased in those with childhood-onset and adolescent-onset insomnia symptoms, while internalizing behaviors improved with full remission of insomnia symptoms. Conclusion: Insomnia symptoms in the transition from childhood to adolescence are associated with increased incidence of psychiatric disorders, with the greatest incidence found in childhood-onset insomnia. Importantly, full remission of childhood insomnia symptoms confers a reduced incidence of psychiatric disorders comparable to never experiencing insomnia symptoms. This transitional period may be critical for the treatment of insomnia symptoms and associated internalizing behaviors to prevent developing psychiatric disorders, particularly mood and anxiety disorders. Support (If Any): National Institutes of Health R01 HL63772, R01 HL97165, UL1 TR000127, C06 RR16499