The Association Between Menstrual Related Problems And Daytime Sleepiness In Chinese Adolescent Girls

1.BackgroundThe adolescence is an important transition stage in the process of human growth and development,and also an important transition period in the lifecycle.At this stage,a series of developmental conditions in adolescents can have important effects on their physical,psychological,behavioral and health aspects.For adolescent girls,menstrual related problems have the greatest impact on their lives,and early age at menarche,menstruation irregularity and dysmenorrhea are the most common.In most studies of menstrual related problems among adolescent girls,in recent years it was reported that the studies in developing and developed countries have shown an earlier trend of age at menarche,and menstruation irregularity were reported from 9.0%to 65.0%,the reported rate of dysmenorrhea ranges from 16.0%to 93.0%in various countries,of which severe dysmenorrhea accounts for about 2.0%to 19.0%.Meanwhile menstrual related problems were concerned with school absenteeism,inattention,academic performance,mental health problems,self-injury and even suicidal behavior,which should draw wide attention from the society.Adolescent sleep health problems are becoming one of the major issues of international concern in the present society.An epidemiological study on adolescent sleep problems found that 5.0%to 57.0%of adolescents have different degrees of sleep problems,of which 10.0%to 50.0%of adolescents have reported daytime sleepiness.And mounting numbers of epidemiological surveys have shown that the effects of daytime sleepiness on adolescent daily life have a rising trend,which in turn has a significant impact on academic performance,school performance,cognitive behavior and quality of life.At present,there are many studies abroad on independent research in menstrual related problems and daytime sleepiness of adolescent girls,or studying other factors between the two.However,in China,there are few studies on menstrual related problems and daytime sleepiness in adolescent girls,and no research to explore the relationship between them.Therefore,this study will initially explore the relationship between menstrual related problems and daytime sleepiness in adolescent girls,and provide an effective way to prevent and screen for daytime sleepiness to improve mental health and life quality of adolescent girls.2.ObjectivesTo study the basic epidemiological characteristics of daytime sleepiness in adolescent girls,the changes at baseline and three years of follow-up,and the trend of daytime sleepiness with increasing age,and to explore the influence factors of daytime sleepiness in adolescent girls;investigating the basic characteristics,the reported rate and composition ratio of menstrual related problems including age at menarche,menstruation irregularity,dysmenorrhea,menstrual cycle interval,menstrual flow length;preliminary exploration of the relationship between menstrual related problems and daytime sleepiness in adolescent girls.3.Methods3.1 SubjectsThe data were derived from a follow-up study based on adolescent behavior and health surveys.The baseline survey was conducted in November to December 2015 in Lijin County,Yanggu County and Zoucheng City of Shandong Province,and two follow-up studies were performed in 2016 and 2017,respectively.In each county(city),two or three schools were selected to conduct the investigation.Finally,eight schools were selected:five junior high schools and three senior high schools.All 7th graders and all 10th graders participated in the survey,while 8th graders,9th graders,and 11th graders were selected randomly by using the classes as sampling units.Prior to the investigation,the consent was obtained from the principals,teachers and students of the target schools.3.2 MeasurementsThis study used adolescent behavior and health questionnaires to collect information,and used a self-filled method to investigate.Before students begin to answer questions,workers with public health background who had been instructed in the guidance of the questionnaire used the guideline to inform the participants.Before filling out the questionnaire,the guideline of the questionnaire needed to be read carefully,and this study was an anonymous survey to ensure the accuracy of the answers.This survey was conducted during normal school hours,it took an average of 45 minutes to complete the entire questionnaire.The research had obtained the consent of the research ethics committee of Shandong University and the principal of the target schools.Two weeks after the survey in Yanggu County was completed in November-December 2015,two classes of 7th,8th,9th,and 10th were selected randomly for retest,and finally 8 classes were retested.A total of 490 participants were included for analysis.3.3 ContentsA self-administered paper and pencil questionnaire named Adolescent Health Questionnaire(AHQ),which consisted of seven parts:general health status,adolescent development status,daily activities and healthy behaviors,personality and emotions,social support and family status,life stress events,and community environment.This analysis included basic demographic information(date of birth,height,weight,school,physical health condition,family economic condition,parental relationship),psychological status(anxiety/depression symptoms),physical exercise,menstrual related problems(age at menarche,menstrual irregularity,dysmenorrhea,menstrual cycle interval,menstrual flow length)and sleep problems(insomnia symptoms,nighttime sleep duration,sleep quality,daytime sleepiness).3.4 Statistical analysisSPSS 24.0 and Stata 15.0 were used to analyze data.?2 test,t test,H test,U test,and variance analysis were used to compare the characteristics.Univariate and multivariate Logistic regression analysis was used to analyze the menstrual related problems and daytime sleepiness of adolescent girls in the 2015 baseline data.And the generalized estimation equation model was used to analyze the correlation between menstrual problems and daytime sleepiness using baseline data from 2015 to 2017 in the follow-up data of adolescent girls in 7th graders and 10th graders.4.Main results4.1 Adolescent girls baseline survey in 2015Among eight schools in Lijin County,Yanggu County and Zoucheng City,the target participants in the 2015 were 12,301,and a total of 11,836 students participated in the survey,with a response rate was 96.2%.Of the 11,836 questionnaires,5 of them were blank,and 11,831 questionnaires were included for the analysis.Among them,there were 5,813 adolescent girls(49.1%),with an average age of 15.02(SD:1.44)years old.In 2015,the overall reported rate of daytime sleepiness in 5,813 adolescent girls at baseline was 42.7%,of which the reported rates of mild,moderate,and severe daytime sleepiness were 20.5%,16.7%,and 5.5%,respectively.The average age at menarche at the baseline survey in 5,813 adolescent girls was 12.73(SD:1.54)years old.About 8.9%of adolescent girls had early age at menarche(?11 years old).Adolescent girls with menarche at 12-13 years old accounted for a large proportion for about 72.2%,and 18.9%of adolescent girls who had later age at menarche(?14 years old);the reported rates of mild,moderate,and severe dysmenorrhea were 53.1%,17.0%,and 5.2%;the reported rates of menstruation sometimes irregularity and very irregularity were 68.9%and 8.6%respectively.The composition ratios of menstrual cycle interval?24 days,25-34 days,?35 days were 10.8%,81.9%,and 7.3%respectively;the menstrual flow length ?3,4-6 days,and?7 days were 5.1%,76.2%,and 18.7%,separately.In univariate Logistic regression analysis,age at menarche ?14 years(OR=1.31,95%CI:1.15-1.50),menstruation sometimes irregularity(OR=1.89,95%CI:1.65-2.16),and very irregularity(OR=3.53,95%CI:2.85-4.37),moderate(OR=1.74,95%CI:1.48-2.06),severe dysmenorrhea(OR=2.86,95%CI:2.21-3.70),menstrual cycle intervals?24 days(OR=1.37,95%CI:1.16-1.62)and?35 days(OR=1.39,95%CI:1.14-1.69)were both associated with an increased risk of daytime sleepiness.In multivariate Logistic regression analysis,menstruation sometimes irregularity(OR=1.32,95%CI:1.12-1.54),menstruation very irregularity(OR=1.88,95%CI:1.45-2.44),moderate(OR=1.27,95%CI:1.05-1.54)and severe(OR=1.40,95%CI:1.04-1.90)dysmenorrhea,menstrual cycle interval?24 days(OR=1.29,95%CI:1.05-1.57)were associated with daytime sleepiness.4.2 Follow-up survey of grade one adolescent girls in junior and senior high schools from 2015 to 2017In the follow-up survey of 7th graders and 10th graders,the target participants of the baseline survey in 2015 were 7,086,and a total of 6,995 students participated in the questionnaire.The response rate was 98.7%,of which 3,399(48.6%)were girls.The average age was 14.92(SD:1.46)years old.A total of 5,807 participants were interviewed for the first follow-up in 2016,there were 2,878 girls(49.6%),with an average age of 15.67(SD:1.52)years old.The second follow-up in 2017 had 4,853 participants,of which there were 2,432 girls(50.1%)with an average age of 16.67(SD:1.53)years old.During the follow-up of adolescent girls,the overall reported rates of daytime sleepiness did not change much.The overall reported rates of daytime sleepiness of adolescent girls were 47.2%,44.9%and 46.0%in three years.In three years,the reported rates of mild daytime sleepiness were 21.9%,20.4%,and 21.8%;the reported rates of moderate daytime sleepiness were 18.8%,18.3%,and 17.2%;the reported rates of severe daytime sleepiness were 6.5%,6.2%,and 7.0%.In the three-year survey,the reported rates of daytime sleepiness change with age:the basic change before the age of 13 was slightly,in the age of 13-15 years increased significantly with age,and after 15 was relatively stable rise.The rates of daytime sleepiness reported among adolescent girls increased with age.The average age of menarche in 7th and 10th adolescent girls was 12.58(SD:1.23)years old,about 9.7%of adolescent girls with early age at menarche(?11 years old),and age at menarche at 12-13 years old accounts for a large proportion,about 73.6%.The overall reported rates of dysmenorrhea were highest among adolescent girls:in follow-up surveys among three years,the reported rates of mild dysmenorrhea were 53.5%,42.7%,and 59.2%;the reported rates of moderate dysmenorrhea were 16.3%,18.7%and 15.5%,and severe dysmenorrhea were 5.1%,9.7%and 4.4%,respectively.Adolescent girls with irregular menstrual periods reported higher rates:in three years,menstruation sometimes irregularity reported at 66.8%,71.1%,and 68.6%;menstruation very irregularity was reported with a rate of 8.7%,9.0%and 8.4%.Short menstrual cycle interval(?24 days)and long menstrual cycle interval(?35 days)showed a gradual decrease trend in the three years.Menstrual cycle interval in 25-34 days gradually increased,and gradually became normal with increasing age.Those with short menstrual flow length(?3 days)and menstrual flow length in 4-6 days showed a gradual decrease in the three-year survey,decreased from 5.4%and 5.0%to 4.5%,and decreased from 76.4%,74.1%to 74.0%;adolescent girls with long menstrual flow length(?7 days)showed a gradually rising trend that were 18.2%,20.9%and 21.5%in three years,respectively.The generalized estimation equation was used to analyze the relationship between menstrual related problems and daytime sleepiness in adolescent girls.Model 1 including age,school,body mass index,physical exercise,physical health condition,family economic condition,and parental relationship.The results showed that menstruation sometimes irregularity(OR=1.45,95%CI:1.28-1.63)and very irregularity(OR=2.47,95%CI:2.00-3.03),moderate(OR=1.61,95%CI:1.38-1.88)and severe(OR=2.34,95%CI:1.85-2.95)dysmenorrhea,short menstrual cycle interval ?24 days(OR=1.17,95%CI:1.01-1.37)could increase the risk of daytime sleepiness among adolescent girls;Model 2 added anxiety/depression symptoms as covariates on the basis of Model 1,and the results showed that menstruation sometimes irregularity(OR=1.37,95%CI:1.20-1.55)and very irregularity(OR=2.01,95%CI:1.62-2.50),moderate(OR=1.38,95%CI:1.18-1.62)and severe(OR=1.78,95%CI:1.39-2.26)dysmenorrhea were related to an increased risk of daytime sleepiness;Model 3 with further adjustment of insomnia symptoms,night sleep duration and sleep quality based on Model 2 for analysis,the results showed that menstruation sometimes irregularity(OR=1.28,95%CI:1.12-1.45),very irregularity(OR=1.77,95%CI:1.41-2.22),moderate(OR=1.29,95%CI:1.10-1.52)and severe(OR=1.62,95%CI:1.26-2.08)dysmenorrhea was associated with an increased risk of daytime sleepiness.5.Conclusions(1)This study found that the overall reported rates of daytime sleepiness in adolescent girls of Shandong Province were relatively high,showing an increasing trend with age,and among adolescent girls with and without daytime sleepiness had discrepancies in the characteristics of demographic information,sleep problems,and psychological problems.(2)In this study,age at menarche of adolescent girls was basically consistent with other studies.The reported rates of menstruation irregularity and dysmenorrhea were relatively high compared with other studies.(3)In this study,menstruation irregularity,moderate and severe dysmenorrhea were significantly associated with an increased risk of daytime sleepiness in adolescent girls.