Childhood sleep problems have been linked to a range of adverse health outcomes, but there is lim... more Childhood sleep problems have been linked to a range of adverse health outcomes, but there is limited knowledge as to the temporal association between sleep problems and subsequent emotional and behavioral problems in young children. To examine whether sleep problems in toddlers aged 18 months are related to both concurrent and subsequent emotional and behavioral problems in preschool children aged 5 years. A large population-based longitudinal study was conducted in September 2014 using data from the Norwegian Mother and Child Cohort Study conducted at the Norwegian Institute of Public Health from June 1, 1999, to December 31, 2008. A total of 32 662 children or pregnancies were included. Sleep was assessed by mother-reported child sleep duration and nocturnal awakenings. Emotional and behavioral problems were measured with items from the Child Behavior Checklist and operationalized according to recommended clinical cutoffs, corresponding to T scores of greater than 65 (93rd percen...
Changes in sleep patterns and increased substance involvement are common in adolescence, but our ... more Changes in sleep patterns and increased substance involvement are common in adolescence, but our knowledge of the nature of their association remains limited. The aim of this study was to examine the association between several sleep problems and sleep behaviours, and use and misuse of alcohol and illicit drugs using data from a large population-based sample. A large population-based study from Norway conducted in 2012, the youth@hordaland study, surveyed 9328 adolescents aged 16-19 years (54% girls). Self-reported sleep measures provided information on sleep duration, sleep deficit, weekday bedtime and bedtime difference and insomnia. The main dependent variables were frequency and amount of alcohol consumption and illicit drug use, in addition to the presence of alcohol and drug problems as measured by CRAFFT. The results showed that all sleep parameters were associated with substance involvement in a dose-response manner. Short sleep duration, sleep deficit, large bedtime differe...
Adolescents spend increasingly more time on electronic devices, and sleep deficiency rising in ad... more Adolescents spend increasingly more time on electronic devices, and sleep deficiency rising in adolescents constitutes a major public health concern. The aim of the present study was to investigate daytime screen use and use of electronic devices before bedtime in relation to sleep. A large cross-sectional population-based survey study from 2012, the youth@hordaland study, in Hordaland County in Norway. Cross-sectional general community-based study. 9846 adolescents from three age cohorts aged 16-19. The main independent variables were type and frequency of electronic devices at bedtime and hours of screen-time during leisure time. Sleep variables calculated based on self-report including bedtime, rise time, time in bed, sleep duration, sleep onset latency and wake after sleep onset. Adolescents spent a large amount of time during the day and at bedtime using electronic devices. Daytime and bedtime use of electronic devices were both related to sleep measures, with an increased risk...
The aim of this study was to examine the link between adolescent sleep and non-attendance in scho... more The aim of this study was to examine the link between adolescent sleep and non-attendance in school. A large population-based study from Norway conducted in 2012, the youth@hordaland study, surveyed 8,347 adolescents aged 16-19 years (54% girls). Self-reported sleep measures included bedtime, rise time, sleep duration, sleep efficiency, sleep onset latency (SOL), wake after sleep onset (WASO), insomnia symptoms, tiredness, and sleepiness. School attendance was obtained from national administrative registries. Most sleep parameters were associated with increased risk of school non-attendance. After adjusting for gender and socioeconomic status, short sleep duration and sleep deficiency were the sleep measures with the highest odds of non-attendance (OR=4.61, CI 95% 3.29-6.46) and (OR=3.26, CI 95% 2.67-3.99), respectively). Also, large bedtime discrepancies in weekend versus weekdays were associated with non-attendance (OR=2.43, CI 95% 1.93-2.02), as well as insomnia (OR=2.25, CI % 1....
The use of alcohol and drugs is prevalent among adolescents, but too little is known about the as... more The use of alcohol and drugs is prevalent among adolescents, but too little is known about the association between debut of alcohol and drug use, problematic use and concurrent mental health. The aim of the study was to investigate the cross-sectional association between debut of any alcohol or drug use and alcohol-related and drug-related problems and mental health. We also wanted to examine potential interactions between gender and age, and alcohol-related and drug-related variables. Cross-sectional study. Population-based sample of Norwegian adolescents. Data stem from the large population-based ung@hordaland study (N=9203), where all adolescents aged 17-19 years living in Hordaland county (Norway) were invited to participate. The main independent variables were debut of alcohol and drug use, alcohol consumption and the presence of alcohol and drug problems as measured by CRAFFT. The dependent variables were self-reported symptoms of anxiety, depression, inattention and hyperacti...
The aim of this study was to examine the association between body mass index (BMI) and sleep dura... more The aim of this study was to examine the association between body mass index (BMI) and sleep duration, insomnia and symptoms of obstructive sleep apnea (OSA) in adolescents. Data were taken from a large population based study of 9,875 Norwegian adolescents aged 16-19. BMI was calculated from the self-reported body weight and categorized according to recommended age and gender specific cut offs for underweight, overweight and obesity. Detailed sleep parameters (sleep duration, insomnia, and OSA symptoms) were reported separately for weekdays and weekends. Data were analyzed using Pearson's chi-squared test and ANOVAs for simple categorical and continuous comparisons, and multinomial logistic regressions for analyses adjusting for known confounders. There was evidence for a curvilinear relationship between BMI and both sleep duration and insomnia for girls, whereas the relationship was linear for boys. Compared to the average weekday sleep duration among adolescents in the normal ...
Maternal risk drinking may be a risk factor for child behavior problems even if the mother has di... more Maternal risk drinking may be a risk factor for child behavior problems even if the mother has discontinued this behavior. Whether pre-pregnancy risk drinking is an independent predictor of child behavior problems, or whether a potential effect may be explained by maternal alcohol use during and after pregnancy or other adverse maternal characteristics, is not known. Employing data from the Norwegian Mother and Child Cohort Study (MoBa), longitudinal associations between maternal pre-pregnancy risk drinking and behavior problems in toddlers aged 18 and 36 months were examined. Included in the study was mothers answering MoBa questionnaires when the child was 18 (N = 56,682) and 36 months (N = 46,756), and who had responded to questions regarding pre-pregnancy risk drinking at gestation week 17/18, using the screening instrument T-ACE. Toddler behavior problems were measured with items from Child Behavior Checklist. Associations were analyzed with multivariate logistic regression, co...
Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine, Jan 15, 2009
To examine polysomnographic parameters and sleep diary data, as well as the prevalence of sleep a... more To examine polysomnographic parameters and sleep diary data, as well as the prevalence of sleep apnea and periodic limb movement disorder (PLMD) in older chronic users of zopiclone compared with aged-matched drug-free patients with insomnia and good sleepers. Polysomnographic data were collected at a university-based outpatient clinic for adults and elderly. Seventeen patients using zopiclone on a daily basis for at least 1 year were compared with 64 drug-free patients with insomnia and 26 good sleepers. Mean (SD) age was 63.8 (7.0) years. Outcome measures were polysomnographic sleep parameters, sleep diary data, and psychological symptoms, as well as prevalence estimates of sleep apnea and PLMD. The zopiclone users spent more time awake, had longer sleep latencies, and reduced sleep efficiency compared with the good sleepers. The amount of slow-wave sleep was also significantly lower in the zopiclone group compared with the good sleepers. There were no differences between the zopic...
Tidsskrift for den Norske lægeforening : tidsskrift for praktisk medicin, ny række, Jan 13, 2007
The purpose of this study was to assess quality of life (QoL, self-reported health) and psycholog... more The purpose of this study was to assess quality of life (QoL, self-reported health) and psychological adjustment in a sample of heart transplanted patients. The sample comprised 147 (117 men) Norwegian heart transplanted patients (operated 1983 - 1999). Data on QoL and psychological adjustment were collected during annual routine follow-up controls between 1998 and 2000. The Short Form 36 (SF-36), the Symptom Checklist 90-Revised (SCL-90-R), and Beck Depression Inventory (BDI) were used. On average, heart transplant recipients reported significantly reduced QoL and increased levels of psychological symptoms compared to a normative population. Recently operated patients reported a generally good QoL compared to the norms, while there was a worsening after 3 years of both the patients' psychological symptoms and QoL, compared to patients who were transplanted less than 3 years ago. The clinical significance was underscored by the BDI; 30 % of the patients were classified as suffer...
The present study explores the accuracy and clinical utility of actigraphy compared with polysomn... more The present study explores the accuracy and clinical utility of actigraphy compared with polysomnography in older adults treated for chronic primary insomnia. Polysomnographic and actigraphic data were collected before and after treatment. A university-based outpatient clinic for adults and elderly. Thirty-four participants with chronic primary insomnia. Mean age was 60.5 years. Participants received either a manualized treatment package based on cognitive-behavior therapy and sleep management or hypnotic-drug treatment (7.5 mg zopiclone) for 6 weeks (these findings are reported elsewhere). Although the sensitivity of actigraphy to detect sleep was very high (95.2%), actigraphy performed poorly in detecting wakefulness (specificity: 36.3%), yielding on an overall level of accuracy of 83.1%. However, the level of actigraphy accuracy was dependent upon polysomnography-registered sleep efficiency. Actigraphy underestimated total wake time and sleep-onset latency and consequently overes...
Chronic insomnia is common in the general population. Its effect on functioning and disability is... more Chronic insomnia is common in the general population. Its effect on functioning and disability is usually attributed to an underlying condition, so the diagnosis of insomnia does not qualify for award of a disability pension in the United States or Europe. The aim of this study was to investigate whether insomnia, defined according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, contributed to long-term work disability. Using a historical cohort design, the authors gathered baseline data from a population-based Norwegian health study of 37,308 working-age people not claiming a disability pension through 1995-1997. The outcome was subsequent award of a disability pension (18-48 months after the health screening) as registered by the National Insurance Administration. Insomnia was a strong predictor of subsequent permanent work disability (adjusted odds ratio=3.90, 95% confidence interval: 3.20, 4.76). Sociodemographic and shift-work characteristics had l...
Tidsskrift for den Norske lægeforening : tidsskrift for praktisk medicin, ny række, Jan 21, 2004
Several studies have shown that the prevalence of sleep disorders such as sleep apnoea and period... more Several studies have shown that the prevalence of sleep disorders such as sleep apnoea and periodic limb movements in sleep increases significantly with age. The assessment capacity is limited and there is a paucity of knowledge in this field among health professional, hence we hypothesise that these disorders are to a considerable extent under-diagnosed in the elderly, as the symptoms are often conceived of as insomnia. Using ambulant clinical polysomnography, we investigated 19 patients aged 55 years or above who had been taking hypnotics on a daily basis (5 to 7 days a week) for at least one year. Among these 19 patients, the prevalence of sleep apnoea (AHI > 10) as well as periodic limb movements in sleep (PLM index > 10) was 42%; 74% had either sleep apnoea, periodic limb movements in sleep, or both. Seen in relation to the fact that these elderly patients were given hypnotics for insomnia, the prevalence rates of sleep apnoea and periodic limb movements in sleep were hig...
Childhood sleep problems have been linked to a range of adverse health outcomes, but there is lim... more Childhood sleep problems have been linked to a range of adverse health outcomes, but there is limited knowledge as to the temporal association between sleep problems and subsequent emotional and behavioral problems in young children. To examine whether sleep problems in toddlers aged 18 months are related to both concurrent and subsequent emotional and behavioral problems in preschool children aged 5 years. A large population-based longitudinal study was conducted in September 2014 using data from the Norwegian Mother and Child Cohort Study conducted at the Norwegian Institute of Public Health from June 1, 1999, to December 31, 2008. A total of 32 662 children or pregnancies were included. Sleep was assessed by mother-reported child sleep duration and nocturnal awakenings. Emotional and behavioral problems were measured with items from the Child Behavior Checklist and operationalized according to recommended clinical cutoffs, corresponding to T scores of greater than 65 (93rd percen...
Changes in sleep patterns and increased substance involvement are common in adolescence, but our ... more Changes in sleep patterns and increased substance involvement are common in adolescence, but our knowledge of the nature of their association remains limited. The aim of this study was to examine the association between several sleep problems and sleep behaviours, and use and misuse of alcohol and illicit drugs using data from a large population-based sample. A large population-based study from Norway conducted in 2012, the youth@hordaland study, surveyed 9328 adolescents aged 16-19 years (54% girls). Self-reported sleep measures provided information on sleep duration, sleep deficit, weekday bedtime and bedtime difference and insomnia. The main dependent variables were frequency and amount of alcohol consumption and illicit drug use, in addition to the presence of alcohol and drug problems as measured by CRAFFT. The results showed that all sleep parameters were associated with substance involvement in a dose-response manner. Short sleep duration, sleep deficit, large bedtime differe...
Adolescents spend increasingly more time on electronic devices, and sleep deficiency rising in ad... more Adolescents spend increasingly more time on electronic devices, and sleep deficiency rising in adolescents constitutes a major public health concern. The aim of the present study was to investigate daytime screen use and use of electronic devices before bedtime in relation to sleep. A large cross-sectional population-based survey study from 2012, the youth@hordaland study, in Hordaland County in Norway. Cross-sectional general community-based study. 9846 adolescents from three age cohorts aged 16-19. The main independent variables were type and frequency of electronic devices at bedtime and hours of screen-time during leisure time. Sleep variables calculated based on self-report including bedtime, rise time, time in bed, sleep duration, sleep onset latency and wake after sleep onset. Adolescents spent a large amount of time during the day and at bedtime using electronic devices. Daytime and bedtime use of electronic devices were both related to sleep measures, with an increased risk...
The aim of this study was to examine the link between adolescent sleep and non-attendance in scho... more The aim of this study was to examine the link between adolescent sleep and non-attendance in school. A large population-based study from Norway conducted in 2012, the youth@hordaland study, surveyed 8,347 adolescents aged 16-19 years (54% girls). Self-reported sleep measures included bedtime, rise time, sleep duration, sleep efficiency, sleep onset latency (SOL), wake after sleep onset (WASO), insomnia symptoms, tiredness, and sleepiness. School attendance was obtained from national administrative registries. Most sleep parameters were associated with increased risk of school non-attendance. After adjusting for gender and socioeconomic status, short sleep duration and sleep deficiency were the sleep measures with the highest odds of non-attendance (OR=4.61, CI 95% 3.29-6.46) and (OR=3.26, CI 95% 2.67-3.99), respectively). Also, large bedtime discrepancies in weekend versus weekdays were associated with non-attendance (OR=2.43, CI 95% 1.93-2.02), as well as insomnia (OR=2.25, CI % 1....
The use of alcohol and drugs is prevalent among adolescents, but too little is known about the as... more The use of alcohol and drugs is prevalent among adolescents, but too little is known about the association between debut of alcohol and drug use, problematic use and concurrent mental health. The aim of the study was to investigate the cross-sectional association between debut of any alcohol or drug use and alcohol-related and drug-related problems and mental health. We also wanted to examine potential interactions between gender and age, and alcohol-related and drug-related variables. Cross-sectional study. Population-based sample of Norwegian adolescents. Data stem from the large population-based ung@hordaland study (N=9203), where all adolescents aged 17-19 years living in Hordaland county (Norway) were invited to participate. The main independent variables were debut of alcohol and drug use, alcohol consumption and the presence of alcohol and drug problems as measured by CRAFFT. The dependent variables were self-reported symptoms of anxiety, depression, inattention and hyperacti...
The aim of this study was to examine the association between body mass index (BMI) and sleep dura... more The aim of this study was to examine the association between body mass index (BMI) and sleep duration, insomnia and symptoms of obstructive sleep apnea (OSA) in adolescents. Data were taken from a large population based study of 9,875 Norwegian adolescents aged 16-19. BMI was calculated from the self-reported body weight and categorized according to recommended age and gender specific cut offs for underweight, overweight and obesity. Detailed sleep parameters (sleep duration, insomnia, and OSA symptoms) were reported separately for weekdays and weekends. Data were analyzed using Pearson's chi-squared test and ANOVAs for simple categorical and continuous comparisons, and multinomial logistic regressions for analyses adjusting for known confounders. There was evidence for a curvilinear relationship between BMI and both sleep duration and insomnia for girls, whereas the relationship was linear for boys. Compared to the average weekday sleep duration among adolescents in the normal ...
Maternal risk drinking may be a risk factor for child behavior problems even if the mother has di... more Maternal risk drinking may be a risk factor for child behavior problems even if the mother has discontinued this behavior. Whether pre-pregnancy risk drinking is an independent predictor of child behavior problems, or whether a potential effect may be explained by maternal alcohol use during and after pregnancy or other adverse maternal characteristics, is not known. Employing data from the Norwegian Mother and Child Cohort Study (MoBa), longitudinal associations between maternal pre-pregnancy risk drinking and behavior problems in toddlers aged 18 and 36 months were examined. Included in the study was mothers answering MoBa questionnaires when the child was 18 (N = 56,682) and 36 months (N = 46,756), and who had responded to questions regarding pre-pregnancy risk drinking at gestation week 17/18, using the screening instrument T-ACE. Toddler behavior problems were measured with items from Child Behavior Checklist. Associations were analyzed with multivariate logistic regression, co...
Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine, Jan 15, 2009
To examine polysomnographic parameters and sleep diary data, as well as the prevalence of sleep a... more To examine polysomnographic parameters and sleep diary data, as well as the prevalence of sleep apnea and periodic limb movement disorder (PLMD) in older chronic users of zopiclone compared with aged-matched drug-free patients with insomnia and good sleepers. Polysomnographic data were collected at a university-based outpatient clinic for adults and elderly. Seventeen patients using zopiclone on a daily basis for at least 1 year were compared with 64 drug-free patients with insomnia and 26 good sleepers. Mean (SD) age was 63.8 (7.0) years. Outcome measures were polysomnographic sleep parameters, sleep diary data, and psychological symptoms, as well as prevalence estimates of sleep apnea and PLMD. The zopiclone users spent more time awake, had longer sleep latencies, and reduced sleep efficiency compared with the good sleepers. The amount of slow-wave sleep was also significantly lower in the zopiclone group compared with the good sleepers. There were no differences between the zopic...
Tidsskrift for den Norske lægeforening : tidsskrift for praktisk medicin, ny række, Jan 13, 2007
The purpose of this study was to assess quality of life (QoL, self-reported health) and psycholog... more The purpose of this study was to assess quality of life (QoL, self-reported health) and psychological adjustment in a sample of heart transplanted patients. The sample comprised 147 (117 men) Norwegian heart transplanted patients (operated 1983 - 1999). Data on QoL and psychological adjustment were collected during annual routine follow-up controls between 1998 and 2000. The Short Form 36 (SF-36), the Symptom Checklist 90-Revised (SCL-90-R), and Beck Depression Inventory (BDI) were used. On average, heart transplant recipients reported significantly reduced QoL and increased levels of psychological symptoms compared to a normative population. Recently operated patients reported a generally good QoL compared to the norms, while there was a worsening after 3 years of both the patients' psychological symptoms and QoL, compared to patients who were transplanted less than 3 years ago. The clinical significance was underscored by the BDI; 30 % of the patients were classified as suffer...
The present study explores the accuracy and clinical utility of actigraphy compared with polysomn... more The present study explores the accuracy and clinical utility of actigraphy compared with polysomnography in older adults treated for chronic primary insomnia. Polysomnographic and actigraphic data were collected before and after treatment. A university-based outpatient clinic for adults and elderly. Thirty-four participants with chronic primary insomnia. Mean age was 60.5 years. Participants received either a manualized treatment package based on cognitive-behavior therapy and sleep management or hypnotic-drug treatment (7.5 mg zopiclone) for 6 weeks (these findings are reported elsewhere). Although the sensitivity of actigraphy to detect sleep was very high (95.2%), actigraphy performed poorly in detecting wakefulness (specificity: 36.3%), yielding on an overall level of accuracy of 83.1%. However, the level of actigraphy accuracy was dependent upon polysomnography-registered sleep efficiency. Actigraphy underestimated total wake time and sleep-onset latency and consequently overes...
Chronic insomnia is common in the general population. Its effect on functioning and disability is... more Chronic insomnia is common in the general population. Its effect on functioning and disability is usually attributed to an underlying condition, so the diagnosis of insomnia does not qualify for award of a disability pension in the United States or Europe. The aim of this study was to investigate whether insomnia, defined according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, contributed to long-term work disability. Using a historical cohort design, the authors gathered baseline data from a population-based Norwegian health study of 37,308 working-age people not claiming a disability pension through 1995-1997. The outcome was subsequent award of a disability pension (18-48 months after the health screening) as registered by the National Insurance Administration. Insomnia was a strong predictor of subsequent permanent work disability (adjusted odds ratio=3.90, 95% confidence interval: 3.20, 4.76). Sociodemographic and shift-work characteristics had l...
Tidsskrift for den Norske lægeforening : tidsskrift for praktisk medicin, ny række, Jan 21, 2004
Several studies have shown that the prevalence of sleep disorders such as sleep apnoea and period... more Several studies have shown that the prevalence of sleep disorders such as sleep apnoea and periodic limb movements in sleep increases significantly with age. The assessment capacity is limited and there is a paucity of knowledge in this field among health professional, hence we hypothesise that these disorders are to a considerable extent under-diagnosed in the elderly, as the symptoms are often conceived of as insomnia. Using ambulant clinical polysomnography, we investigated 19 patients aged 55 years or above who had been taking hypnotics on a daily basis (5 to 7 days a week) for at least one year. Among these 19 patients, the prevalence of sleep apnoea (AHI > 10) as well as periodic limb movements in sleep (PLM index > 10) was 42%; 74% had either sleep apnoea, periodic limb movements in sleep, or both. Seen in relation to the fact that these elderly patients were given hypnotics for insomnia, the prevalence rates of sleep apnoea and periodic limb movements in sleep were hig...
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