| 1.BackgroundAdolescents are in a critical period of physical and psychological development from childhood to adolescence.Globally,the prevalence of depressive symptoms among adolescents increases from 5%in early adolescence to 20%by the end of adolescence.Adolescent depression is associated with a variety of psychosocial,developmental,environmental,and genetic factors.It is also associated with sleep problems,anxiety,behavior disorders,and substance abuse.And which is an important risk factor for self-injury and suicidal behaviors among adolescents.Sleep-related breathing problems(SRB)covers a large spectrum of respiratory abnormalities from habitual snoring,to partial or complete airway obstruction.The prevalence of SRB problems ranged from 2%to 20%in adolescents.However,there is evidence that SRB problems are often overlooked and grossly underdiagnosed.Risk factors for SRB include upper airway stenosis,inflammation,obesity,smoking,and alcohol consumption,etc.The development of SRB may lead to many short-and long-term adverse consequences,such as sleep fragmentation at night,daytime dysfunction,cardiovascular disease,mental and cognitive problems.Previous studies have suggested that SRB was associated with depressive symptoms.However,there were few studies on the relationship between SRB and depressive symptoms in adolescents,and the conclusions of relevant studies were not consistent.To our knowledge,there are few longitudinal studies on the relationship between SRB and depressive symptoms in adolescents,and few studies have explored the relationship between SRB and depressive symptoms by gender2.ObjectivesThis study used the Shandong Adolescent Health Behavior Cohort to study the epidemiological characteristics of SRB and depressive symptoms,the changes of SRB and depressive symptoms in baseline and follow-up data over three years,and explore the relationship between SRB and depressive symptoms in adolescents.3.Methods3.1 SubjectsThe study population was from the Shandong Province Adolescent Health and Behavior Cohort Study.A total of 12,301 students participated in the baseline survey in 2015,and 11,831 valid questionnaires were finally obtained.A total of 6,995 students from grade 7 and grade 10 who participated in the baseline survey were included in this study.5,807 students were successfully followed-up in 2016 and 4,614 students were successfully followed-up in 2017.In this study,subjects with two successful follow-ups were included in the longitudinal analysis(N=4,614).3.2 MeasurementsTrained MPH students brought the Adolescent Health and Behaviour Questionnaire(AHQ)into classes during the regular school hours.The survey was voluntary and anonymous,and the questionnaire were completed in about 30 minutes.3.3 ContentsThe AHQ was used to get information in this study.AHQ consists of seven components,including general health,daily activities and sleep behaviors,mental health problems,family conditions,and life stress events et al.SRB was assessed by adolescents self-reported frequency of loud snoring,breathing pauses,and snorting/gasping.A new variable of "any SRB problems" was created as a proxy to the general SRB status.Any SRB problems“<1 time/week" referred to all three kinds of SRB problems were less than once per week,"≥3 times/week" referred to any of the three kinds of SRB problems≥3 times/week,the others were "1-2 times/week".Depressive symptoms were assessed using the CES-D.3.4 Statistical analysisThe statistical analysis of the whole study was divided into two stages.The first stage was a cross-sectional study(N=6,995).Univariate and multivariate Logistic regression was used to analyze the relationship between SRB problems and depressive symptoms,and then gender stratified analysis was conducted.In the second stage,univariate and multivariate generalized estimation equations(GEE)was used to explore the relationship between SRB problems and depressive symptoms in a longitudinal study(N=4,614),followed by gender stratified analysis.4.Main results4.1 Adolescents baseline survey in 2015In the baseline survey in 2015,a total of 6,995 students in Grades 7 and 10 were surveyed.The prevalence of loud snoring 1-2 times/week was 4.7%in adolescents,>3 times/week was 3.7%,the prevalence of breathing pauses and snorting/gasping was lower than loud snoring.The prevalence of all SRB problems was higher in boys than in girls,and the difference was statistically significant(P<0,05).There were 731(10.5%)adolescents with depressive symptoms in the baseline survey,including 371(10.9%)of girls and 360(10.0%)of boys.The prevalence of depressive symptoms in boys was higher than that in girls,but the difference was not statistically significant(P=0.217).Univariate Logistic regression analysis showed that loud snoring,breathing pauses,snorting/gasping and any SRB problems were associated with depressive symptoms.After adjusting for gender,age,physical health,BMI,smoking,drinking,sleep duration,insomnia,negative life events,family economic status,father’s education level,mother’s education level,parental relationship and school,multiple Logistic regression suggested that elevated frequency of SRB problems were associated with depressive symptoms(loud snoring:≥3 times/week:OR=1.49,95%CI:1.05-2.12;stop breathing:≥3 times/week:OR=3.24,95%CI:1.90-5.52;snorting/gasping:1-2 times/week:OR=1.62,95%CI:1.16-2.27;≥3times/week:OR=2.64,95%CI:1.86-3.73;any SRB problems:≥3 times/week:OR=2.04,95%CI:1.56-2.66).The relationship between SRB problems and depressive symptoms was further analysis by gender.Multiple Logistic regression suggested that elevated frequency of SRB problems were associated with depressive symptoms both in boys and girls.4.2 Follow-up survey of adolescents from 2015 to 2017The prevalence of SRB problems was stable from 2015 to 2017,the prevalence of all SRB problems≥1 time/week were higher in boys than in girls,the difference was statistically significant(P<0.05).Depressive symptoms affected 6.1%and 9.9%of adolescents in 2016 and 2017,respectively.The prevalence of depressive symptoms among adolescents in 2016 was lower than that in 2015 and 2017.Univariate GEE analysis showed that loud snoring,breathing pauses,snorting/gasping and any SRB problems were all associated with depressive symptoms.After adjusting for potential confounding factors,multiple GEE analysis suggested that elevated frequency of SRB problems were associated with depressive symptoms(loud snoring:≥3 times/week:OR=1.48,95%CI:1.10-1.99;stop breathing:1-2 time/week:OR=1.86,95%CI:1.27-2.72;≥3times/week:OR=2.98,95%CI:1.91-4.64;snorting/gasping:1-2 times/week:OR=1.43 95%CI:1.08-1.88;≥3 times/week:OR=2.68,95%CI:2.02-3.54;any SRB problems:1-2 times/week:OR=1.34,95%CI:1.06-1.69;≥3 times/week:OR=1.99,95%CI:1.58-2.49).The relationship between SRB problems and depressive symptoms was further analysis by gender.Multiple GEE analysis suggested that elevated frequency of SRB problems were associated with depressive symptoms both in boys ang girls.5.Conclusions(1)This study finds that self-reported SRB problems among adolescents in Shandong province is relatively high.The prevalence of SRB problems is basically stable in the follow-up survey,and the prevalence among boys is higher than that of girls.(2)In this study,the self-reported depressive symptoms of adolescents are consistent with the results of other domestic and foreign studies.The depressive symptoms in the second year of follow-up are lower than that in the first year and the third year,and there is no difference in the prevalence of depressive symptoms among boys and girls.(3)This study finds a significant correlation between SRB problems and depressive symptoms in adolescents,and this correlation is significant for both boys and girls. |
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