NEWS & PERSPECTIVE

Adolescent-onset insomnia is preventable: The world’s first trial revealed

09 Apr 2021

Adolescence is an important transitional period from childhood to adulthood that is susceptible to the development of insomnia.1-2 Where the epidemiological association between insomnia and symptoms of mood disorders was previously reported, no effective management strategies were available until recent findings reported in Pediatrics.1 In the study, a brief cognitive behavioral therapy (CBT) program was proven effective in reducing the incidence of insomnia by more than 70% at one-year follow-up among adolescents with a family history of insomnia or subthreshold insomnia.1 In addition to reducing daytime sleepiness, improving sleep hygiene practices and increasing total sleep time, the CBT program was associated with less depressive symptoms and may potentially reduce the burden of affective disorders among adolescents in Hong Kong.1

Adolescence is susceptible to insomnia.1-2 In Hong Kong, between 4% and 39% of youths have reported sleeplessness at night.2 Youths with parental history of insomnia are at higher risk of developing subthreshold insomnia, as defined by the Insomnia Severity Index (ISI) of 8 to 14.1,3 A cross-sectional survey involving 1,669 adolescents conducted in Hong Kong showed that insomnia was independently associated with daytime sleepiness [Adjusted Odds Ratio (aOR)=3.80; 95% CI: 2.90-5.00; p<0.001], anxiety symptoms (aOR=5.80; 95% CI: 3.60-9.40; p<0.001) and depressive symptoms (aOR=3.50; 95% CI: 2.50-5.00; p<0.001).2 Notably, the presence of insomnia symptoms in the youth population was as high as 37%.2 In this connection, proper management of adolescent-onset insomnia would potentially alleviate psychiatric disease burden amongst this population in Hong Kong.

Prof. Yun Kwok Wing and Dr. Rachel Ngan Yin Chan from the Department of Psychiatry of The Chinese University of Hong Kong, Dr. Shirley Xin Li from the Department of Psychology, The University of Hong Kong and Prof. Charles M Morins from the Universite Laval, Quebec, Canada jointly initiated the world’s first randomized controlled trial on teenagers who were at risk of developing insomnia.1 Between 2015 and 2017, a total of 121 boys and 121 girls with mean age of 15 years old participated in the study. All participants had family history of insomnia and subthreshold insomnia. The participants were randomized into either intervention group or control group. The intervention group received four weekly CBT sessions, each of which lasted for one hour and was delivered by professional CBT therapists. The control group received no active intervention. All participants were followed up at 5-week, 6-month and 12-month.

Over the 12-month follow-up period, CBT significantly reduced the occurrence of acute or chronic insomnia in the intervention group (5.8% vs. 20.7%, intervention group vs. placebo; p=0.002).1 In the intervention group, the number needed to treat was 6.7 (HR=0.29; 95%CI: 0.12-0.66; p=0.003).1 The intervention group also experienced milder insomnia symptoms, reduced daytime sleepiness and longer total sleep time (p<0.050). Importantly, the intervention group reported fewer depressive symptoms (p=0.020). 1

In practice, insomnia is known to be associated with depression and substance use disorder amongst other mental health issues.4,5 In this connection, this study presented a promising CBT intervention for preventing insomnia in at-risk teenagers as well as reducing vulnerability factors and functioning outcomes. The program was well tolerated by the participants with a completion rate of 94%.1 To conclude, implementing this CBT program could potentially reduce the burden of affective disorders in teenagers in the territory. 1,2

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