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1.  Sleep and use of electronic devices in adolescence: results from a large population-based study 
BMJ Open  2015;5(1):e006748.
Objectives
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.
Design
A large cross-sectional population-based survey study from 2012, the youth@hordaland study, in Hordaland County in Norway.
Setting
Cross-sectional general community-based study.
Participants
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.
Outcomes
Sleep variables calculated based on self-report including bedtime, rise time, time in bed, sleep duration, sleep onset latency and wake after sleep onset.
Results
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 of short sleep duration, long sleep onset latency and increased sleep deficiency. A dose–response relationship emerged between sleep duration and use of electronic devices, exemplified by the association between PC use and risk of less than 5 h of sleep (OR=2.70, 95% CI 2.14 to 3.39), and comparable lower odds for 7–8 h of sleep (OR=1.64, 95% CI 1.38 to 1.96).
Conclusions
Use of electronic devices is frequent in adolescence, during the day as well as at bedtime. The results demonstrate a negative relation between use of technology and sleep, suggesting that recommendations on healthy media use could include restrictions on electronic devices.
doi:10.1136/bmjopen-2014-006748
PMCID: PMC4316480  PMID: 25643702
sleep; media use; EPIDEMIOLOGY; adolescents
2.  Mental health in adolescents with Type 1 diabetes: results from a large population-based study 
BMC Endocrine Disorders  2014;14(1):83.
Background
Diabetes has previously been linked to mental health problems in adolescents, but more recent studies have yielded mixed findings. The aim of the current study was to compare symptoms of mental health problems, sleep and eating disturbances in adolescents with and without Type 1 diabetes in a population based sample.
Methods
Data were taken from the youth@hordaland study, a large population based study in Hordaland County in Norway conducted in 2012. In all, 9883 adolescents aged 16–19 years (53% girls) provided self-reported data on both diabetes and a range of instruments assessing mental health symptoms, including depression, anxiety, obsessive-compulsive behaviours, hyperactivity, impulsivity, inattention, perfectionism, resilience, sleep problems and eating behaviour.
Results
40 adolescents were classified as having Type 1 diabetes (prevalence 0.4%). We found that adolescents with Type 1 diabetes did not differ from their peers on any of the mental health measures.
Conclusions
This is one of the first population-based studies to examine mental health of adolescents with Type 1 diabetes. There was no evidence of increased psychopathology across a wide range of mental health measures. These findings contradict previous studies, and suggest that Type 1 diabetes is not associated with an increased risk of psychosocial problems.
doi:10.1186/1472-6823-14-83
PMCID: PMC4197324  PMID: 25303963
Type 1 diabetes; Mental health; Eating disturbances; Sleep; Correlates; Epidemiology
3.  Alcohol and drug use among adolescents: and the co-occurrence of mental health problems. Ung@hordaland, a population-based study 
BMJ Open  2014;4(9):e005357.
Objectives
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.
Design
Cross-sectional study.
Setting
Population-based sample of Norwegian adolescents.
Participants
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.
Outcomes
The dependent variables were self-reported symptoms of anxiety, depression, inattention and hyperactivity. Statistical analyses included logistic regression models.
Results
Debut of alcohol and drug use were associated with symptoms of depression, inattention and hyperactivity (crude ORs 1.69–2.38, p<0.001), while only debut of drug use was associated with increased symptoms of anxiety (OR=1.33, CI 95% 1.05 to 1.68, p=0.017). Alcohol-related and drug-related problems as measured by CRAFFT were associated with all mental health problems (crude ORs 1.68–3.24, p<0.001). There was little evidence of any substantial age or gender confounding on the estimated associations between alcohol-related and drug-related measures and mental health problems.
Conclusions
Early debut of alcohol and drug use and drug problems is consistently associated with more symptoms of mental health problems, indicating that these factors are an important general indicator of mental health in adolescence.
doi:10.1136/bmjopen-2014-005357
PMCID: PMC4173106  PMID: 25245403
EPIDEMIOLOGY; MENTAL HEALTH
4.  Sleep and body mass index in adolescence: results from a large population-based study of Norwegian adolescents aged 16 to 19 years 
BMC Pediatrics  2014;14:204.
Background
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.
Methods
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.
Results
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 weight range (6 hrs 29 min), both underweight (5 hrs 48 min), overweight (6 hrs 13 min) and obese (5 hrs 57 min) adolescents had shorter sleep duration. OSA symptoms were linearly associated with BMI. Controlling for demographical factors as well as physical activity did not attenuate the associations. Additional adjustment for depression reduced the association between insomnia and obesity to a non-significant level. The evidence for a link between both underweight and overweight/obesity, and short sleep duration and OSA symptoms remained in the fully adjusted analyses. The associations were generally stronger for girls.
Conclusions
This is one of the first population-based studies to investigate the relationship between sleep and BMI in adolescents while simultaneously controlling for important confounding factors. These findings require further research to investigate the temporal association between weights and sleep problems.
doi:10.1186/1471-2431-14-204
PMCID: PMC4148405  PMID: 25128481
Body mass index; Obesity; Overweight; Underweight; Sleep; Sleep duration; Insomnia; Adolescence; Epidemiology
5.  Maternal pre-pregnancy risk drinking and toddler behavior problems: the Norwegian Mother and Child Cohort Study 
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, controlling for pre and postnatal alcohol use, as well as other relevant covariates. Pre-pregnancy risk drinking was associated with child behavior problems at 18 and 36 months, even after controlling for pre and postnatal alcohol use. Maternal ADHD and anxiety and depression were the only covariates that had any substantial impact on the associations. When all covariates were included in the model, the associations were weak for internalizing behavior problems and non-significant for externalizing behavior problems. Pre-pregnancy risk drinking may predict early development of behavior problems in the offspring. This increased risk may be due to other adverse maternal characteristics associated with risk drinking, in particular co-occurring maternal psychopathology.
doi:10.1007/s00787-014-0588-x
PMCID: PMC4186966  PMID: 25053124
Maternal risk drinking; Externalizing behavior problem; Internalizing behavior problems; T-ACE; Child Behavior Checklist; Cohort
6.  Midlife insomnia and subsequent mortality: the Hordaland health study 
BMC Public Health  2014;14:720.
Background
Previous research suggests a possible link between insomnia and mortality, but findings are mixed and well-controlled studies are lacking. The aim of the current study was to examine the effect of insomnia in middle age on all-cause mortality.
Methods
Using a cohort design with 13-15 years follow-up, mortality registry data were linked to health information obtained during 1997-99, as part of the community-based Hordaland Health Study (HUSK), in Western Norway. 6,236 participants aged 40–45 provided baseline information on self- reported insomnia using the Karolinska Sleep Questionnaire Scale (defined according to the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V), sociodemographic factors, health behaviors, shift/night-work, obstructive sleep apnea symptoms, sleep duration, sleep medication use, anxiety, depression, as well as a range of somatic diagnoses and symptoms. Height, weight and blood pressure were measured. Information on mortality was obtained from the Norwegian Cause of Death Registry.
Results
Insomnia was reported by 5.6% (349/6236) at baseline and a significant predictor of all-cause-mortality (hazard ratio [HR] = 2.74 [95% CI:1.75-4.30]). Adjusting for all confounders did not attenuate the effect (HR = 3.34 [95% CI:1.67-6.69]). Stratifying by gender, the effect was especially strong in men (HR = 4.72 [95% CI:2.48-9.03]); but also significant in women (adjusted HR = 1.96 [95% CI:1.04-3.67]). The mortality risk among participants with both insomnia and short sleep duration (<6.5 hours) was particularly high, whereas insomnia in combination with normal/greater sleep duration was not associated with mortality.
Conclusions
Insomnia was associated with a three-fold risk of mortality over 13-15 years follow-up. The risk appeared even higher in males or when insomnia was combined with short sleep duration, although such unadjusted subgroup analyses should be interpreted with caution. Establishing prevention strategies and low-threshold interventions should consequently be a prioritized task for public health policy.
doi:10.1186/1471-2458-14-720
PMCID: PMC4223526  PMID: 25024049
Insomnia; Risk factor; Mortality; Sleep duration; Sleep medication
7.  Delayed sleep phase syndrome in adolescents: prevalence and correlates in a large population based study 
BMC Public Health  2013;13:1163.
Background
The aims of this study were to estimate the prevalence of Delayed Sleep Phase Syndrome (DSPS) in adolescence, and to examine the association to insomnia and school non-attendance.
Methods
Data stem from a large population based study in Hordaland County in Norway conducted in 2012, the ung@hordaland study. In all, 10,220 adolescents aged 16–18 years (54% girls) provided self-reported data on a range of sleep parameters: DSPS was defined according to the International Classification of Sleep Disorders, Revised (ICSD-R) criteria, while insomnia was defined according to the Quantitative Criteria for Insomnia. Other sleep parameters included time in bed, sleep duration, sleep efficiency, oversleeping, sleep onset latency, wake after sleep onset, subjective sleep need, sleep deficiency, sleepiness and tiredness. Sleep data were calculated separately for weekdays and weekends. Data on school non-attendance were provided by official registers.
Results
The prevalence of DSPS was 3.3%, and significantly higher among girls (3.7%) than boys (2.7%). There was a strong overlap between DSPS and insomnia, with more than half of the adolescents with DSPS also meeting the criteria for insomnia (53.8% for boys and 57.1% for girls). Adolescents with DSPS had significantly higher odds ratios (OR) of non-attendance at school. After adjusting for sociodeographical factors, insomnia and depression, the adjusted ORs for days of non-attendance were OR = 3.22 (95% CI: 1.94-5.34) for boys and OR = 1.87 (95% CI: 1.25-2.80) for girls. A similar effect was found for hours of non-attendance for boys, with an adjusted OR = 3.05 (95% CI: 1.89-4.92). The effect for girls was no longer significant after full adjustment (OR =1.48 [95% CI: 0.94-2.32]).
Conclusions
This is one of the first studies to estimate the prevalence of DSPS in adolescents. The high prevalence of DSPS, and overlap with insomnia, in combination with the odds of school non-attendance, suggest that a broad and thorough clinical approach is warranted when adolescents present with symptoms of DSPS.
doi:10.1186/1471-2458-13-1163
PMCID: PMC3878844  PMID: 24330358
Delayes sleep phase syndrome; Sleep; Prevalence; Correlates; Epidemiology
8.  Sleep problems in Parkinson's disease: a community-based study in Norway 
BMC Neurology  2012;12:71.
Background
The purpose of this study was to examine the prevalence of sleep problems in a community-based sample of patients with Parkinson’s disease (PD) in Norway, and their associated factors.
Methods
176 consecutive PD outpatients (41% females) were included in a study of non-motor symptoms, including sleep problems. All participants responded to the Parkinson’s Disease Sleep Scale (PDSS), where an overall score below 82 or a score below 5 on a sub-item indicate possible sleep problem. Factors associated with sleep were also investigated, with special emphasis on severity of PD, fatigue, mental health and restless legs syndrome (RLS).
Results
The mean age was 68.5 years (range 35–90); the mean Hoehn and Yahr stage was 2.11 (SD 0.86), and the mean UPDRS part III was 22.3 (SD 11.7). Sleep problems were common among PD patients. While only 17% of the sample had an overall score below 82 on the PDSS, 70% of the patients had a score below 5 on one item. There was no significant association between PD severity and any of the sleep items in the PDSS; whereas fatigue, mental health problems, and RLS were associated with PDSS score.
Conclusions
The current findings call for increased awareness of sleep problems in PD patients, especially focusing on the association with mental health problems, fatigue and RLS.
doi:10.1186/1471-2377-12-71
PMCID: PMC3472275  PMID: 22883600
Sleep; Parkinson; Prevalence; Norway; Associated factors
9.  Chronicity of sleep problems in children with chronic illness: a longitudinal population-based study 
Background
The aim of this study was to examine the chronicity of sleep problems in children with chronic illness, and potential predictors of sleep problems.
Methods
Using data from a longitudinal total population study in Norway, The Bergen Child Study, data on sleep problems, chronic illness and potential confounders were assessed at ages 7-9 and 11-13.
Results
295 of 4025 (7.3%) children had a chronic illness, and the prevalence of chronic sleep problems was significantly higher in this group compared to children without chronic illness (6.8% versus 3.6%). Sleep problems at the first wave increased the risk of sleep problems at the second wave, also when adjusting for potential confounders (odds-ratio = 5.41). Hyperactivity and emotional problems were also independent risk factors for later sleep problems.
Conclusion
These findings call for increased awareness and development of treatment strategies of sleep problems in children with chronic illness.
doi:10.1186/1753-2000-3-22
PMCID: PMC2744907  PMID: 19712458

Results 1-9 (9)