Sleep problems linked to unfavorable outcomes in American Indian, Alaska Native youth
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Key takeaways:
- Adverse changes in behavioral and cardiometabolic health outcomes were related to sleep problems.
- Urban American Indian and Alaska Native adolescents slept an average of 6.9 hours a night on weekdays.
Among urban American Indian and Alaska Native youth, there was a significant link between sleeping less on weekdays and more depression and anxiety symptoms 2 years later, according to results published in JAMA Network Open.
“These findings underscore the importance of promoting sleep health, particularly during adolescence, as this is a critical developmental period characterized by high prevalence of sleep problems and the emergence of health behaviors and risk factors that can set the stage for long-term health,” Wendy M. Troxel, PhD, senior behavioral scientist at RAND Corporation, told Healio.
“In addition, findings highlight the importance of developing culturally-informed treatment strategies to support sleep health among urban, American Indian and Alaska Native youth — a population that has been underrepresented in clinical research,” she added.
In an observational cohort study, Troxel and colleagues evaluated 114 urban American Indian and Alaska Native adolescents (mean age, 14.1 years; 62% female) in California to find out the impact of sleep problems at baseline on behavioral and cardiometabolic health outcomes at a 2-year follow-up.
Researchers collected data on several mental/behavioral health outcomes (depression, anxiety, alcohol and cannabis use in past year), as well as cardiometabolic health outcomes (BMI, systolic blood pressure, diastolic blood pressure, waist circumference and glycosylated hemoglobin) at baseline and follow-up.
Sleep was evaluated through four measures: sleep duration via actigraphy, sleep efficiency via actigraphy, self-reported sleep disturbances and self-reported social jet lag, which Troxel said is “an indicator of irregular sleep schedules during the week and weekend.”
On weekdays, adolescents in this population slept for an average of 6.9 hours a night. Additionally, baseline sleep efficiency averaged at 81.2%, which researchers deemed poor.
Sleep disturbance was reported as a score ranging from 15 to 75, in which a higher score meant more frequent disturbances. At baseline, the average score was 30.6. Researchers also observed “a delay in sleep phase during the weekends relative to weekdays” when measuring social jet lag (mean, 84 minutes).
“We know from prior work that adolescents in general are at high-risk of having insufficient sleep and sleep disturbances; however, it was striking to see in this sample of urban American Indian and Alaska Native youth that the average, objectively measured sleep duration during the school week was less than 7 hours per night — far short of the recommended 8 to 10 hours of sleep for this age group,” Troxel told Healio.
Following adjustment for age, sex and baseline outcome measures, researchers observed a significant relationship between sleeping less on weekdays and more depression symptoms, as well as more anxiety symptoms.
Further, there was a significant link between fewer hours of sleep at baseline and heightened odds for alcohol use (weekday duration: OR = 0.57; 95% CI, 0.36-0.91) and cannabis use (full week duration: OR = 0.59; 95% CI, 0.35-0.99) after 2 years.
In terms of cardiometabolic health outcomes, having a shorter sleep duration was also linked to elevated diastolic blood pressure and glycosylated hemoglobin.
Switching to other measures of sleep, researchers noted a significant relationship between greater baseline social jet lag and increased systolic blood pressure during the 2-year follow-up visit.
Researchers also found a significant link between more sleep disturbances and reduced BMI and waist circumference after 2 years.
“Our findings are consistent with prior work demonstrating that sleep disturbances in adolescents are critical for both mental and physical health,” Troxel said. “However, this is the first study to our knowledge to examine how sleep is associated with changes in mental and physical health problems among urban American Indian and Alaska Native youth.
“Our success in conducting this work is a testament to our team’s established relationships with American Indian and Alaska Native community partners,” she added. “This is critical especially when working with populations that have historically faced abuses in the name of research and medicine.”
Moving forward, Troxel told Healio a sleep intervention would benefit this population.
“We hope to build on these findings by developing and testing a culturally informed intervention that integrates traditional practices with an evidence-based behavioral sleep intervention to promote sleep health in urban, American Indian and Alaska Native adolescents,” she said.