Modifying the Impact of Eveningness Chronotype (“Night-Owls”) in Youth: A Randomized Controlled Trial

Allison G Harvey,Kerrie Hein,Emily A Dolsen,Lu Dong,Sophia Rabe-Hesketh,Nicole B Gumport,Jennifer Kanady,James K Wyatt,Stephen P Hinshaw,Jennifer S Silk,Rita L Smith,Monique A Thompson,Nancee Zannone,Daniel Jin Blum

doi:10.1016/j.jaac.2018.04.020

Abstract

To determine whether an intervention to reduce eveningness chronotype improves sleep, circadian, and health (emotional, cognitive, behavioral, social, physical) outcomes. Youth aged 10 to 18 years with an evening chronotype and who were "at risk" in 1 of 5 health domains were randomized to: (a) Transdiagnostic Sleep and Circadian Intervention for Youth (TranS-C; n= 89) or (b) Psychoeducation (PE; n= 87) at a university-based clinic. Treatments were 6 individual, weekly 50-minute sessions during the school year. TranS-C addresses sleep and circadian problems experienced by youth by integrating evidence-based treatments derived from basic research. PE provides education on the interrelationship between sleep, stress, diet, and health. Relative to PE, TranS-C was not associated with greater pre-post change for total sleep time (TST) or bed time (BT) on weeknights but was associated with greater reduction in evening circadian preference (pre-post increase of 3.89 points, 95% CI= 2.94-4.85, for TranS-C, and 2.01 points, 95% CI= 1.05-2.97 for PE, p= 0.006), earlier endogenous circadian phase, less weeknight-weekend discrepancy in TST and wakeup time, less daytime sleepiness, and better self-reported sleep via youth and parent report. In terms of functioning in the five health domains, relative to PE, TranS-C was not associated with greater pre-post change on the primary outcome. However, there were significant interactions favoring TranS-C on the Parent-Reported Composite Risk Scores for cognitive health. For at-risk youth, the evidence supports the use of TranS-C over PE for improving sleep and circadian functioning, and improving health on selected outcomes. Triple Vulnerability? Circadian Tendency, Sleep Deprivation and Adolescence. https://clinicaltrials.gov; NCT01828320.

Highlights

Relative to PE, Transdiagnostic Sleep and Circadian Intervention for Youth (TranS-C) was not associated with greater pre–post change for total sleep time (TST) or bed time (BT) on weeknights but was associated with greater reduction in evening circadian preference, earlier endogenous circadian phase, less weeknight–weekend discrepancy in TST and wakeup time, less daytime sleepiness, and better self-reported sleep via youth and parent report
In terms of functioning in the five health domains, relative to PE, TranS-C was not associated with greater pre–post change on the primary outcome
For at-risk youth, the evidence supports the use of TranS-C over PE for improving sleep and circadian functioning, and improving health on selected outcomes

Summary

Introduction

Relative to PE, TranS-C was not associated with greater pre–post change for total sleep time (TST) or bed time (BT) on weeknights but was associated with greater reduction in evening circadian preference (pre-post increase of 3.89 points, 95% CI = 2.94–4.85, for TranS-C, and 2.01 points, 95% CI = 1.05–2.97 for PE, p = 0.006), earlier endogenous circadian phase, less weeknight–weekend discrepancy in TST and wakeup time, less daytime sleepiness, and better self-reported sleep via youth and parent report. In terms of functioning in the five health domains, relative to PE, TranS-C was not associated with greater pre–post change on the primary outcome. There were significant interactions favoring TranS-C on the Parent-Reported Composite Risk Scores for cognitive health

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Results

Discussion

Conclusion