Emergence of Sex Differences in Insomnia Symptoms in Adolescents: A Large-Scale School-Based Study.
This study aimed to explore the moderation of pubertal status on the onset of sex differences in the prevalence of insomnia symptoms and their health correlates.



A total of 7,507 children and adolescents (weighted percentage of female: 48.5%) aged between 6-17 y were recruited from thirty-one primary and secondary schools. Participants with difficulty initiating sleep (DIS), difficulty maintaining sleep (DMS), and/or early morning awakening (EMA) ≥ 3 times/week in the past month were considered as having insomnia symptoms. The severity of insomnia was measured by the Insomnia Severity Index (ISI).



The prevalence of insomnia symptoms increased from 3.4% to 12.2% in girls (3.6-fold) and from 4.3% to 9.1% in boys (2.1-fold) from Tanner stage 1 to 5. There was a significant interaction between sex and Tanner stage in the prevalence of insomnia (P < 0.001) with an emergence of female preponderance at Tanner stage 4 even after controlling for age, family income, and school start time. Similar sex-Tanner stage interactions were found in DIS, DMS, and ISI total score but not EMA. Insomnia symptoms were strongly associated with behavioral problems, poor mental health, and poor general health in both sexes. Boys with insomnia would report more maladaptive lifestyles (smoking, alcohol, and energy drinks) whereas girls with insomnia were more susceptible to emotional and relationship difficulties.



Pubertal maturation was associated with a progressive increase in the prevalence of insomnia symptoms with the emergence of female preponderance in both the prevalence and severity of insomnia symptoms at late puberty.



Chinese Clinical Trial Register, http://www.chictr.org.cn, ID: ChiCTR-TRC-12002798.
Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China.
Jihui
J
Zhang
Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China.
Ngan Yin
NY
Chan
Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China.
Siu Ping
SP
Lam
Department of Psychology, The University of Hong Kong, Pokfulam Road, Hong Kong SAR, China.
Shirley Xin
SX
Li
Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China.
Yaping
Y
Liu
Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China.
Joey W Y
JW
Chan
Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China.
Alice Pik Shan
AP
Kong
Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China.
Ronald C W
RC
Ma
Department of Paediatrics, The Chinese University of Hong Kong, Hong Kong SAR, China.
Kate C C
KC
Chan
Department of Paediatrics, The Chinese University of Hong Kong, Hong Kong SAR, China.
Albert Martin
AM
Li
Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China.
Yun-Kwok
YK
Wing
D000293:Adolescent; D000428:Alcohol Drinking / Q000453:epidemiology; D044466:Asian People; D002648:Child; D002681:China / Q000453:epidemiology; D061215:Energy Drinks / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008019:Life Style; D008297:Male; D015995:Prevalence; D012727:Sex Characteristics; D012741:Sexual Maturation; D007319:Sleep Initiation and Maintenance Disorders / Q000453:epidemiology* / Q000503:physiopathology / Q000523:psychology*; D012907:Smoking / Q000453:epidemiology
adolescents; insomnia symptoms; pubertal status; sex differences