Patterns of sleep problems and internalizing and externalizing problems among Chinese adolescents: A latent class analysis

Different aspects of sleep problems tend to occur simultaneously, which could lead to adolescent health problems. We aimed to identify the distinct patterns of sleep problems and to explore their association with internalizing and externalizing problems.Secondary data from 11,831 adolescents from the Shandong Adolescent Behavior and Health Cohort were obtained and after data cleaning, 9,871 (50.1% females, mean age was 15.02 ± 1.45 years) were used in this study. Sleep problems (short weeknight sleep duration, insomnia, daytime sleepiness, no post-lunch napping, and snoring), and covariates were measured at the baseline, and the internalizing and externalizing problems were measured at both the baseline and one-year follow-up. The latent class analysis was used to identify the patterns of sleep problems at the baseline. Linear mixed effect models were used to examine the relationship between classes of sleep problems and internalizing and externalizing problems.Three classes of sleep problems were identified, named as "short and disturbed sleep" (34.1%), "no post-lunch napping" (16.7%), and "no/mild sleep disturbance" (49.2%), respectively. The "short and disturbed sleep" class exhibited higher levels of internalizing and externalizing problems than the other two classes. Also, it showed a steeper decreasing trend in internalizing and externalizing problems over time.The findings shed light on the importance and significance of identifying the patterns of multiple sleep problems to effectively identify adolescents at higher risk of developing internalizing and externalizing problems, and to designate tailored intervention to eliminate co-occurring sleep problems to promote adolescent emotional and behavioral health.