Cleveland Adolescent Sleepiness Questionnaire Research Articles

The Adolescent Insomnia Questionnaire: the Turkish validity and reliability study.

This study aimed to evaluate the Turkish validity and reliability of the Adolescent Insomnia Questionnaire. The study was carried out with 265 adolescents. Data were collected with the Adolescent Insomnia Questionnaire and the Cleveland Adolescent Sleepiness Questionnaire. Exploratory factor analysis and confirmatory factor analysis were used to analyze the construct validity of Adolescent Insomnia Questionnaire. The scale reliability was tested using test-retest, Cronbach's α test, Pearson correlation analysis, and inter-item correlation analysis. The Cronbach's α coefficients were found to be above 0.80 for all sub-dimensions and the total scale. Correlations between Adolescent Insomnia Questionnaire and Cleveland Adolescent Sleepiness Questionnaire scores were positively highly significant. The test-retest correlation analysis of Adolescent Insomnia Questionnaire was 0.675. The results of confirmatory factor analysis were χ2/df=2.861, comparative fit index=0.966, incremental fit index=0.966, Tucker-Lewis index=0.956, normed fit index=0.949, root-mean-square error of approximation=0.084. The suitability of the data for exploratory factor analysis was evaluated with Bartlett's test of sphericity (p<0.05), and the sample adequacy was evaluated with the Kaiser-Meyer-Olkin test (0.77). The Adolescent Insomnia Questionnaire Turkish version is a valid and reliable tool for measuring insomnia in adolescents aged 11-18 years. Adolescent Insomnia Questionnaire is a brief, practical, self-reported, age-appropriate, easily applicable, valid, and reliable tool in Turkish. This is the first Turkish validity and reliability study of Adolescent Insomnia Questionnaire.

0102 Are there associations between intraindividual variability in sleep and mental health among adolescents reporting alcohol use?

Abstract Introduction Considering the increasing number of studies that report on ecological momentary assessment by uses of sleep diary and actigraphy, it may also be valuable to consider the relationship between fluctuations that exists in sleep measures on adolescent health outcomes. Above the impact of mean sleep measures, intraindividual variability (IIV) in sleep provides information on the degree to which daily variations or fluctuations in sleep/wake patterns are occurring and may prompt important cues to adolescents’ health outcome. The present study examined the objective IIV in sleep and its relationship to their sleep and mental health outcomes among adolescents with history of alcohol use. Methods The study analyzed 8 days of wrist actigraphy data from 72 high school students reporting prior alcohol use (58.3% female; mean age 17.0 years). Bayesian variability method using varian (R package) was performed to calculate IIV in total sleep time (TST), time in bed (TIB), midpoint sleep, bedtime, and risetime. Participants also completed Pittsburgh Sleep Quality Index (PSQI), Cleveland Adolescent Sleepiness Questionnaire (CASQ), Inventory of Depressive Symptomatology (IDS-SR-30), Chapman’s Inventories – Social Anhedonia (CHAPSAS), and Rutgers Alcohol Problem Index (RAPI). Multiple linear regression models were adjusted for biological sex, age, and the sum of alcohol drinks in the past 3 months. Results Participants reported average of 18.52 (SD=23.10) total drinks consumed over the past 3 months. IIV in TST, TIB, and risetime were associated with lower sleep quality (B=3.04, 95% CI, 0.02, 7.39, p&amp;lt; 0.05 for IIV in TST; B=2.87, 95% CI, 0.39, 5.88, p&amp;lt; 0.05 for IIV in TIB; and B=2.74, 95% CI, 0.57, 6.19, p&amp;lt; 0.05 for IIV in risetime, respectively). There was no statistically significant association between IIV of sleep measures and excessive daytime sleepiness or mental health outcomes such as social anhedonia, depressive symptoms, and problematic alcohol use. Conclusion Greater fluctuation in TST, TIB, and risetime were negatively associated with overall sleep quality. Our findings add to a growing body of research on IIV in sleep/wake patterns and clinical implications. Future studies should explore the prospective relationship between variability in sleep and other various health outcomes. Support (if any) NIH/NIAAA R01AA025626 (Hasler); Sleep Research Society Foundation Mentor-Mentee Award (Kwon)

Smartphone Addiction and Sleep Status in Adolescents during COVID-19 Pandemic

Aim: This descriptive study investigated smartphone addiction and daytime sleepiness in adolescents during the COVID-19 pandemic. Methods: The sample consisted of 1001 adolescents living in the Central Anatolia Region of Turkey. Data were collected using a sociodemographic characteristics questionnaire, the Cleveland Adolescent Sleepiness Questionnaire (CASQ), and the Smartphone Addiction Scale-Short Version (for Adolescents) (SAS-SV). The data were analyzed using descriptive, comparative, and correlational statistics. Results: Most participants stated that they had spent much more time on their smartphones since the pandemic (87.2%). More than half of the participants noted that they had been on their smartphones for more than 90 minutes daily (63.1%). Less than half of the participants said they spent most of their time on Instagram (44.8%). More than half of the participants reported daytime sleepiness (55.7%). Less than half of the participants had a moderate-level sleep status (44.8%). There was a positive correlation between CASQ “sleep in school” and “sleep in the evening” subscale scores. Conclusion: During the COVID-19 pandemic, adolescents are at high risk of smartphone addiction, affecting daytime sleepiness. Therefore, we need interventions to reduce the risk of psychological problems and daytime sleepiness in adolescents.

Daytime sleepiness, addictive-like eating, and obesity sequelae in Black and African American youth with obesity

ObjectivesThe purpose of the current study was to examine the association between poor sleep health (ie, excessive daytime sleepiness), obesity sequelae (ie, percent overweight and serum leptin levels), and addictive-like eating behaviors, an obesity phenotype, in a sample of Black/African American (B/AA) adolescents. DesignThe current study analyzed archival baseline data from a sample of B/AA adolescents with obesity enrolled in a sequential randomized clinical trial. SettingData were collected in the participants’ homes by trained research assistants unaware of treatment condition. ParticipantsA sample of 181 B/AA adolescents with obesity between the ages of 12 and 16 years (M = 14.26, SD = 1.46) and having a body mass index (BMI) above the 95th percentile for age and gender were sampled. MeasurementsSelf-report measures included the Cleveland Adolescent Sleepiness Questionnaire and the Yale Food Addiction Scale-Children (YFAS-C). Anthropomorphic data and blood samples were used to determine BMI and serum leptin levels, respectively. ResultsExcessive daytime sleepiness was positively correlated with YFAS-C symptom count, r = 0.295, P < .001. Serum leptin levels and percent overweight were both positively correlated with each other, r = 0.445, P < .001 and with YFAS-C symptom count, r = 0.215, P = .006. After controlling for age and gender, results supported an indirect effect from daytime sleepiness to both serum leptin levels (estimate = 2.210, SE = 0.932, P = .018) and percent overweight (estimate = 2.817, SE = 1.415, P = .046) through YFAS-C symptom count. ConclusionsCulturally informed interventions on eating behaviors (ie, addictive-like eating) when excessive daytime sleepiness is reported are needed. Early intervention may help prevent the onset or worsening of obesity among adolescents.

Physical Activity and Executive Functions in Adolescents: The Mediating Role of Sleepiness.

(1) Background: Both physical activity and sleepiness were found to influence the development of executive functioning. The present study aimed to address the effects of different levels of physical activity on adolescents’ executive performance (i.e., working memory and inhibition), and the role of sleepiness in this relationship. It was hypothesized that a higher level of physical activity would be associated with better executive functioning, while this relationship was mediated (at least partially) by reduced sleepiness at school. (2) Methods: 212 adolescents aged from 10 to 17 were recruited, and they were requested to wear accelerometers for seven consecutive days to measure daily levels of physical activity. The Cleveland Adolescent Sleepiness questionnaire (CASQ) was used to assess sleepiness. The working memory and inhibition control were assessed to indicate executive functioning. (3) Results: It was found that sedentary activity was negatively associated with working memory performance, while light and moderate-to-vigorous physical activities were related to better working memory. The relationship between different levels of physical activity and working memory was mediated by reduced sleepiness at school. (4) Conclusions: Our findings provide nuanced evidence that the benefits of light and moderate-to-vigorous physical activity on cognitive development could be explained by reduced sleepiness at school.

Translation and Validation of a Chinese Version of the Cleveland Adolescent Sleepiness Questionnaire.

PurposeThe Cleveland Adolescent Sleepiness Questionnaire was originally developed and published in English and has served as a valid and effective tool for the assessment of adolescents’ experiences with sleepiness in a variety of situations. To allow for comparisons between sleepiness in adolescents from different cultures, and with different linguistic backgrounds, reliable and valid measurement tools are necessary. The purpose of this study was to translate and validate a Chinese version of the Cleveland Adolescent Sleepiness Questionnaire (C-CASQ).Materials and MethodsSensitivity, specificity, internal consistency, and criterion validity data for the C-CASQ were tested using 458 adolescents in Taiwan. Data from 191 participants were used to establish internal consistency reliability and conduct exploratory factor analysis (EFA), while data from 267 participants were used to establish criterion validity and conduct confirmatory factor analysis (CFA). Initial criterion validity was established through a comparison of the C-CASQ with scores from the Chinese version of the Morningness-Eveningness Scale for Children, a measure of chronotype.ResultsEFA resulted in four factors, consistent with the original English version of the CASQ, while CFA established goodness of fit. The scale demonstrated acceptable to good internal consistency (α = 0.77~0.86). Initial criterion validity was evident as the total score and each of the subscale scores on the C-CASQ was significantly higher (greater sleepiness) in evening-types.ConclusionThe C-CASQ appears to be a psychometrically sound measure to evaluate sleepiness in Chinese-speaking adolescents.

The validity and reliability study of the Cleveland Adolescent Sleepiness ​Questionnaire and examination of the sleepiness of university students.

This study aimed to determine the reliability and validity of the Cleveland Adolescent Sleepiness Questionnaire in Turkish university students, and to determine the sleepiness of students. This cross-sectional study was carried out with 852 university students in Turkey, Bolu, between February- May 2019. Results of the analysis indicated that this scale was a valid and reliable measurement tool. As the scores of students' get from Cleveland Adolescent Sleepiness Questionnaire increased, the frequency of students feeling sleepy during the day, sleepiness in and out of school, and getting up in the morning without resting increased. Nurses can use this scale when evaluating university students' sleepiness.

631 Sleep SMART in Adolescents with Neurodevelopmental Disorders

Abstract Introduction: Introduction Sleep disturbances are common in adolescents with neurodevelopmental disorders (NDDs). Inclusion of vulnerable populations such as adolescents with NDDs into sleep intervention efforts is essential as they are at high-risk for poor physical/mental health outcomes. The objective of this study is to pilot a sequential, multiple assignment, randomized trial (SMART) design to compare the impact of a sequence of sleep interventions, based on treatment response, to optimize sleep health in adolescents with NDDs. Methods: Methods Recruitment began June 2019 using convenience sampling. The SMART pilot feasibility study includes 1-week of baseline sleep data, and two 4-week periods of a sleep intervention (9-week total study enrollment). Interventions include exogenous melatonin, The Bedtime Bank, and their combination. Exogenous melatonin (liquid, immediate release, 3mg) is administered 30 minutes before bedtime. The Bedtime Bank, a behavioral sleep intervention, is based upon contingency contracting that relies on a credit- or debt-based system to hold adolescents accountable for maintaining a consistent bedtime. At baseline participants completed demographics, PROMIS pediatric sleep questionnaires, the Cleveland Adolescent Sleepiness Questionnaire (CASQ), salivary &amp; urinary endogenous melatonin measurement, and one week of actigraphy. Upon enrollment, participants were randomly assigned to either melatonin or The Bedtime Bank. Participants who respond (nightly increase in total sleep time (TST) ≥18 minutes) remain on the assigned intervention; if non-responsive participants are re-randomized to a different sleep intervention or combination. Results: Results At baseline, participants (n=29, aged 10–18 years) had an average TST of 7 hours 11 minutes. PROMIS Sleep Disturbance (M=64.3, SE=2.5), PROMIS Sleep-Related Impairment scores (M=58.9, SE=2.2), and CASQ scores (M=40.0, SD= 10.5) were higher than reported normative values. Salivary DLMO &amp; urinary 6-sulfatoyxmelatonin analysis is ongoing. For participants who completed the full 9-week trial, nearly 30% (n=7/24) were responsive (increased baseline TST ≥18 minutes) to one of the 4-week interventions. Conclusion: Conclusion Baseline data of the enrolled participants demonstrates poor indicators of TST, sleep disturbance, and sleep related impairment. Preliminary results of this SMART indicate some adolescents are responsive to sleep interventions aimed to improve their TST. Support (if any) Support: This clinical trial is funded by the National Institute of Nursing Research, National Institutes of Health (1K01NR017465-01A1).

Correlation of overweight nutritional status and sleep quality in 16–18 years old teenagers in South Jakarta

Background and Objectives: Overweight nutritional status in adolescents becomes a health problem that continues to require attention. Not only because of its rapidly increasing prevalence, but also its various adverse effects on adolescent health, especially on the quality of sleep. Sleep quality decrease in adolescents can impact their daily performance, especially in learning. This study aimed to investigate the relationship of overweight nutritional status with sleep quality in adolescents aged 16–18 years old in South Jakarta.Method: This cross-sectional design study was done in two public senior high schools in the South Jakarta. A total of 186 students from classes of 2015, 2016, and 2017 with age between 16-18 years old underwent weight and height measurements, determination of BMI and nutritional status using the CDC BMI-for-age chart, as well as filling the Cleveland Adolescent Sleepiness Questionnaire to assess the quality of sleep.Results: The prevalence of overweight was found by 20.43% (14.52% categorized as overweight, 5.91% categorized as obese) with a median value of the questionnaire 40.00 (23.00 to 58.00). Mann-Whitney test found that the p value for the mean difference of the questionnaire's total score to excess weight is 0.783.Conclusion: There was no correlation between the quality of sleep to excess weight in adolescents aged 16–18 years old in South Jakarta.

Cleveland Adolescent Sleepiness Questionnaire (CASQ): a translation and validation study of the Persian version

The purpose of this study was to assess the validity and reliability of the Persian version of the Cleveland Adolescent Sleepiness Questionnaire (CASQ) in Iranian adolescents. The CASQ consists of 16 items measuring extreme sleepiness during the day in adolescents aged 11–17 years old. The questionnaire includes two dimensions: Sleepiness Statements and Alertness Statements. This study was a descriptive cross-sectional study. The original English text of CASQ was translated into Persian using backward-forward translation. Then, 310 secondary school adolescents aged 11–17 years old completed that in Kashan. The internal validity of the questionnaire was determined two times at an interval of two weeks using Cronbach's alpha coefficient. The concurrent validity was determined using Spearman correlation coefficient. Factor analysis was used by performing principle component analysis for assessing construct validity. 199 (47.1%) of the adolescents participated in this study, were male and 111 (52.9%) were female. Mean and standard deviation of the age of adolescents were 14.31 ± 0.9. The Cronbach's alpha coefficient for the entire CASQ was the satisfactory value of 0.8. The intra-class correlation coefficient (ICC coefficient) of the tool was 0.78, which confirmed the repeatability of this test. Spearman’s correlation coefficient between CASQ and Epworth sleepiness scale (ESS) was equal to 0.21, and the correlation coefficient between CASQ and Pittsburg Sleep Quality Index (PSQI) was 0.25. Both were significant at P < 0.05 level. Based on the present study findings, we concluded that the Persian version of CASQ has an appropriate validity and reliability for assessing the sleepiness of adolescents in the Persian language community.

The association of sleep disturbances with glycemia and obesity in youth at risk for or with recently diagnosed type 2 diabetes.

Poor sleep may increase obesity and type 2 diabetes (T2D) risk in youth. We explored whether subjective sleep duration, sleep quality, or risk for obstructive sleep apnea (OSA) are associated with glycemia, body mass index (BMI), or blood pressure (BP) in overweight/obese youth. Two-hundred and fourteen overweight/obese youth of 10 to 19 years of age at risk for or recently diagnosed with T2D who were screened for the Restoring Insulin Secretion (RISE) Study had a 2-hour oral glucose tolerance test (OGTT) and completed a Cleveland Adolescent Sleepiness questionnaire and a Sleep Disturbances Scale questionnaire. Independent associations between sleep variables and measures of glycemia, BMI, and BP were evaluated with regression models. The multiethnic cohort was 67% female, 14.1 ± 2.1 years, and BMI 35.9 ± 6.5 kg/m2 . Habitual sleep duration <8 hours was reported in 74%. Daytime sleepiness was reported in 51%, poor sleep quality in 26%, and 30% had high obstructive sleep apnea (OSA) risk. Daytime sleepiness was associated with higher HbA1c (0.2%, P = .02) and 2-hour glucose (13.6 mg/dL, P < .05). Sleep duration, sleep quality, and OSA risk were not associated with the evaluated outcomes. Poor sleep quality and OSA risk were associated with higher BMI (2.9 kg/m2 , P = .004 and 2.83 kg/m2 , P < .003, respectively). In overweight/obese youth with or at risk for T2D, daytime sleepiness was associated with higher HbA1c. In addition, poor sleep quality and OSA risk were associated with higher BMI. These findings support intervention studies aimed at improving sleep quality in obese youth.

Delayed Onset of Sleep in Adolescents With PAX6 Haploinsufficiency.

PAX6 haploinsufficiency ( +/-) can occur due to mutations involving only PAX6 in patients with isolated aniridia or as contiguous gene deletions in patients with Wilms tumor, aniridia, genitourinary anomalies, and range of developmental and intellectual disabilities syndrome. Given the role of PAX6 in pineal development and circadian regulation, adolescents with PAX6+/- may experience sleep-wake disturbances. The purpose of this observational study was to explore sleep-related phenotypes in adolescents with PAX6+/-. This study compared sleep phenotypes of nine subjects with PAX6+/- (aged 10-19 years) with previously published data on healthy adolescents ( n = 25, aged 10-18 years). Subjects completed the Cleveland Adolescent Sleepiness Questionnaire (CASQ), Patient Reported Outcomes Measurement Information System (PROMIS) Sleep Disturbance (v. 1.0; 8a), and PROMIS Sleep-Related Impairment (v. 1.0; 8b) Questionnaires and wore actigraphs for seven nights to record sleep patterns. Total CASQ, PROMIS sleep-related impairment, and PROMIS sleep disturbance scores were not statistically different between the groups ( ps > .15). Actigraph data for lights off to sleep-onset time were found to be significantly higher in subjects with PAX6+/- versus the healthy comparison group (adjusted mean [95% confidence interval]: 20.1 min [8.1, 49.8] vs. 6.2 min [3.7, 10.4], respectively, p = .04). Both adolescents with PAX6+/- and the healthy comparison group on average slept less than 8 hr/night, and overall sleep deprivation in adolescents may have masked differences between groups. This study used rare genetic disorders with biological vulnerability to sleep problems as a genotype-phenotype model. Knowledge of sleep-related phenotypes will assist in designing studies to manage sleep-related symptoms in adolescents.

PROMIS Sleep Disturbance and Sleep-Related Impairment in Adolescents: Examining Psychometrics Using Self-Report and Actigraphy.

The National Institutes of Health Patient-Reported Outcomes Measurement Information System (PROMIS) has self-reported health measures available for both pediatric and adult populations, but no pediatric measures are available currently in the sleep domains. The purpose of this observational study was to perform preliminary validation studies on age-appropriate, self-reported sleep measures in healthy adolescents. This study examined 25 healthy adolescents' self-reported daytime sleepiness, sleep disturbance, sleep-related impairment, and sleep patterns. Healthy adolescents completed a physical exam at the National Institutes of Health Clinical Center (Bethesda, MD), had no chronic medical conditions, and were not taking any chronic medications. The Cleveland Adolescent Sleepiness Questionnaire (CASQ), PROMIS Sleep Disturbance (v. 1.0; 8a), and PROMIS Sleep-Related Impairment (v. 1.0; 8b) questionnaires were completed, and sleep patterns were assessed using actigraphy. Total scores on the three sleep questionnaires were correlated (all Spearman's r > .70, p < .001). Total sleep time determined by actigraphy was negatively correlated with the CASQ (p = .01), PROMIS Sleep Disturbance (p = .02), and PROMIS Sleep-Related Impairment (p = .02). The field of pediatric sleep is rapidly expanding, and researchers and clinicians will benefit from well-designed, psychometrically sound sleep questionnaires. Findings suggest the potential research and clinical utility of adult versions of PROMIS sleep measures in adolescents. Future studies should include larger, more diverse samples and explore additional psychometric properties of PROMIS sleep measures to provide age-appropriate, validated, and reliable measures of sleep in adolescents.

Impact of social media usage on daytime sleepiness: A study in a sample of tertiary students in Singapore

ObjectiveMany tertiary students access social networking sites on a daily basis. With the increased usage of smartphones, accessing social networking sites while commuting, in schools, waiting for friends, television commercial breaks has become prevalent among tertiary students. What started as a lifestyle choice has now become a daily necessity. Such behavior among tertiary students raises an important question for educators: how does social media usage affect tertiary students’ sleep patterns and daytime sleepiness, their attention difficulties, especially in school? Thus, the aim of this study was to examine the relationships between tertiary students' self-reports of social media usage and daytime sleepiness.DesignThe design was a cross-sectional, quantitative research study.MethodsWe used a survey that contained questions concerning demographic data, daytime sleepiness, total sleep time and social media usage and a version of the Cleveland Adolescent Sleepiness Questionnaire, modified for use in tertiary students, were used for data collection (n = 969).ResultsThe most preferred tool for accessing social networking sites was smartphones and WhatsApp was the most accessed site. Results indicated that nocturnal technology use has a weak, negative impact on tertiary students’ quantity of sleep that may lead to daytime sleepiness. Local Singapore students spent significantly more time on social networking sites at night compared to foreign students. As a result, local students experienced more daytime sleepiness compared to foreign students.ConclusionsProlonged social media usage, especially in bed, has a negative impact on tertiary students’ daytime sleepiness. Since the technology is such an integral part of most tertiary students’ lives, it is important to understand the impact it has on their sleep and daytime sleepiness.

Subjective sleep measures for adolescents: a systematic review.

Sleep disturbances in adolescents have received significant attention because of their high prevalence and the negative health outcomes. Relative to objective measures, subjective sleep instruments have been the most practical tools used to identify sleep problems and assess responses to interventions in research and clinical settings. This systematic review aims to examine the psychometric properties of subjective measures that are used to assess sleep quality and disturbances among adolescents, identify the strength and limitation of each measurement and inform recommendations for practice. PubMed, Embase and PsycInfo were searched from 2000 through May 2016. The reference lists of important articles were included if they met the inclusion criteria. The available measures were evaluated and classified as positive, intermediate or poor according to the quality criteria for health status questionnaires. Thirteen self-reported or parent-reported sleep measures met the inclusion criteria. Of the measurements reviewed, six were generic instruments assessing overall sleep quality and disturbances; five were dimension-specific instruments measuring daytime sleepiness, sleep insufficiency and sleep hygiene; and two were condition-specific instruments for insomnia. None of the subjective sleep measures for adolescents has a psychometric profile with all essential measurement properties. Specifically, the generic sleep measurements capture multiple dimensions but face issues of participant burden and compatibility. Among the domain-specific tools, the Cleveland Adolescent Sleepiness Questionnaire and the Chronic Sleep Reduction Questionnaire have achieved good psychometric merits but need further evaluation for responsiveness. Likewise, essential measurement properties of condition-specific tools for insomnia have yet to be established. Because of the limited evidence, no definite recommendations can be made at this point. However, each available measurement has its own uniqueness and strength despite the limitations. Future research on measurement development and evaluation for adolescent sleep is needed to ensure the relevance and suitability to different stages of adolescence and social contexts.

Factors influencing excessive daytime sleepiness in adolescents

ObjectiveSleep deprivation in adolescents has lately become a health issue that tends to increase with higher stress prevalence, extenuating routines, and new technological devices that impair adolescents’ bedtime. Therefore, this study aimed to assess the excessive sleepiness frequency and the factors that might be associated to it in this population. MethodsThe cross‐sectional study analyzed 531 adolescents aged 10–18 years old from two private schools and one public school. Five questionnaires were applied: the Cleveland Adolescent Sleepiness Questionnaire; the Sleep Disturbance Scale for Children; the Brazilian Economic Classification Criteria; the General Health and Sexual Maturation Questionnaire; and the Physical Activity Questionnaire. The statistical analyses were based on comparisons between schools and sleepiness and non‐sleepiness groups, using linear correlation and logistic regression. ResultsSleep deprivation was present in 39% of the adolescents; sleep deficit was higher in private school adolescents (p<0.001), and there was a positive correlation between age and sleep deficit (p<0.001; r=0.337). Logistic regression showed that older age (p=0.002; PR: 1.21 [CI: 1.07–1.36]) and higher score level for sleep hyperhidrosis in the sleep disturbance scale (p=0.02; PR: 1.16 [CI: 1.02–1.32]) were risk factors for worse degree of sleepiness. ConclusionsSleep deficit appears to be a reality among adolescents; the results suggest a higher prevalence in students from private schools. Sleep deprivation is associated with older age in adolescents and possible presence of sleep disorders, such as sleep hyperhidrosis.

Sleep Promotion Program for Improving Sleep Behaviors in Adolescents: A Randomized Controlled Pilot Study.

Aims. The purpose of this pilot trial was to determine the efficacy of sleep promotion program to adapt it for the use of adolescents studying in various schools of Mangalore, India, and evaluate the feasibility issues before conducting a randomized controlled trial in a larger sample of adolescents. Methods. A randomized controlled trial design with stratified random sampling method was used. Fifty-eight adolescents were selected (mean age: 14.02 ± 2.15 years; intervention group, n = 34; control group, n = 24). Self-report questionnaires, including sociodemographic questionnaire with some additional questions on sleep and activities, Sleep Hygiene Index, Pittsburgh Sleep Quality Index, The Cleveland Adolescent Sleepiness Questionnaire, and PedsQL™ Present Functioning Visual Analogue Scale, were used. Results. Insufficient weekday-weekend sleep duration with increasing age of adolescents was observed. The program revealed a significant effect in the experimental group over the control group in overall sleep quality, sleep onset latency, sleep duration, daytime sleepiness, and emotional and overall distress. No significant effect was observed in sleep hygiene and other sleep parameters. All target variables showed significant correlations with each other. Conclusion. The intervention holds a promise for improving the sleep behaviors in healthy adolescents. However, the effect of the sleep promotion program treatment has yet to be proven through a future research. This trial is registered with ISRCTN13083118.

Factors influencing excessive daytime sleepiness in adolescents

ObjectiveSleep deprivation in adolescents has lately become a health issue that tends to increase with higher stress prevalence, extenuating routines, and new technological devices that impair adolescents’ bedtime. Therefore, this study aimed to assess the excessive sleepiness frequency and the factors that might be associated to it in this population. MethodsThe cross-sectional study analyzed 531 adolescents aged 10–18 years old from two private schools and one public school. Five questionnaires were applied: the Cleveland Adolescent Sleepiness Questionnaire; the Sleep Disturbance Scale for Children; the Brazilian Economic Classification Criteria; the General Health and Sexual Maturation Questionnaire; and the Physical Activity Questionnaire. The statistical analyses were based on comparisons between schools and sleepiness and non-sleepiness groups, using linear correlation and logistic regression. ResultsSleep deprivation was present in 39% of the adolescents; sleep deficit was higher in private school adolescents (p<0.001), and there was a positive correlation between age and sleep deficit (p<0.001; r=0.337). Logistic regression showed that older age (p=0.002; PR: 1.21 [CI: 1.07–1.36]) and higher score level for sleep hyperhidrosis in the sleep disturbance scale (p=0.02; PR: 1.16 [CI: 1.02–1.32]) were risk factors for worse degree of sleepiness. ConclusionsSleep deficit appears to be a reality among adolescents; the results suggest a higher prevalence in students from private schools. Sleep deprivation is associated with older age in adolescents and possible presence of sleep disorders, such as sleep hyperhidrosis.

Caffeine Awareness in Children: Insights from a Pilot Study.

Caffeine, a commonly consumed psychoactive substance, can have significant effects on sleep. Caffeine intake among children is increasing, mainly in the form of sodas. However, adolescent caffeine consumers may lack knowledge about the caffeine content in common beverages. If true, this very fact may hamper the assessment of the effects of caffeine consumption on sleep in children if such assessments are a priori dependent on responders being able to reliably distinguish between caffeinated and noncaffeinated beverages. This preliminary study investigated adolescents' caffeine knowledge and intake at a Cleveland-area public middle school. Seventh- and eighth-grade students were surveyed using: (1) the Caffeine Literacy and Sleep Study (CLASS), a 15-question pilot instrument designed to assess caffeine knowledge and intake by type, quantity and timing, as well as sleep habits; and (2) the Cleveland Adolescent Sleepiness Questionnaire (CASQ), a validated survey measuring excessive daytime sleepiness in adolescents. These questionnaires were distributed and collected during a specified class period. Of the 635 seventh- and eighth-grade students who attended school on the day of the study, 555 (87%) participated. Lack of knowledge about caffeine content of particular drinks was noted in seventh and eighth graders of both sexes with nearly 29% unaware that their favorite drinks contain caffeine and more than 50% unable to correctly identify the drinks with the most caffeine. A low percentage of students correctly identified light-colored sodas lacking caffeine: 7-Up (24.1%), Sierra Mist (38.9%), ginger ale (39.8%), Sprite (39.8%), and Fresca (53.7%). The percentages of students correctly identifying caffeinated light-colored beverages were: Arizona Green Tea (43.5%), Mello Yellow (50.9%), and A&W cream soda (67.6%). However, Mountain Dew was correctly identified by most (93.5%) as caffeinated. Students were not consistently able to identify caffeine content or lack thereof in some common beverages. The results of this pilot study show that caffeine literacy in adolescents warrants further investigation and educational intervention.

Sleep Duration and Daytime Sleepiness in Indian Adolescents: Is There a Gender Difference?

To the Editor: Studies on adolescent sleep show that adolescents are not obtaining optimum hours of sleep recommended for their age group, which is 9.2 h across all pubertal ages [1, 2]. Many adolescents are reported to have sleep problems, which can cause chronic deprived sleep and excessive daytime sleepiness, leading to negative effects on individual performance and health [2, 3]. Almost 45 to 85 % of sixth to 12th grade students obtain less than recommended hours of sleep for their age group and 44 % of students report to have difficulty staying awake in school times [4]. However, only few studies have been done on excessive daytime sleepiness among adolescents in Asia. The daytime sleepiness and the association of gender with sleep duration and daytime sleepiness was assessed among sixth to 12th grade students between 11 and 17 y and studying in various schools in Mangalore, India. The adolescents were randomly selected using stratified random sampling method. Stratification was based on gender. The data was collected in July and August 2013. Sleep duration was assessed in hours using questions like “how much sleep do you get on an average during a school day?”. Daytime sleepiness was assessed using Cleveland Adolescent Sleepiness Questionnaire developed by Spilsbury et al. [5]. A total of 58 adolescents, 29 males and females each, participated in the study. When classified according to groups (adolescent classification by American Academy of Pediatrics) 31 of them were early adolescents (11–14 y) and 27 of them were middle adolescents (15–17 y). The adolescents were not obtaining the recommended hours of sleep for their age group on week days, as shown by a catch up sleep during weekends (7.68 ± 0.99 h vs. 8.70 ± 1.63 h). Early adolescents obtained better sleep than middle adolescents’. The mean daytime sleepiness scores for adolescents were 36.83 ± 8.38, higher in middle adolescents and among female adolescents. Sleep duration and daytime sleepiness by gender however showed no statistically significant differences between male and female adolescents. Negative correlation between sleep duration and daytime sleepiness (r=–0.295 and p value 0.025) shows that as sleep duration increases, daytime sleepiness decreases. This study highlights the importance of adolescent sleep and provides an evidence for the direction of future research. It also provides an implication that adolescents’ suffer significantly with daytime sleepiness and future results could provide more insight into this existing evidence.