Daytime Sleepiness In Adolescents Research Articles

Assessment of the Brazilian Version of the Epworth Sleepiness Scale Using Item Response Theory: A Psychometric Study.

There seems to be a consensus that adolescents worldwide are not getting enough sleep. This study aimed to evaluate the psychometric properties of the Epworth Sleepiness Scale (ESS) in adolescents using the item response theory. A psychometric study was conducted with 2206 adolescents aged 18 and 19 years in the city of São Luís, Maranhão, Brazil. The dimensionality of the ESS was assessed by principal component analysis. A Samejima's graded response model (SGRM) was fitted to it. The findings of this study showed a good internal consistency and the unidimensionality of the ESS. Considering the latent trait continuum, we obtained three levels, with anchor items. For the item 'Sitting still in a public place', the adolescents presented a small possibility of dozing in level 1, and a medium and great possibility in level 2. The item 'Sitting around talking to someone' presented small, medium, and great possibilities of dozing in level 3. The ESS with five items showed satisfactory psychometric properties. In addition, the results from the SGRM showed that adolescents with high levels of sleepiness are likely to nod off or sleep sitting up while talking to someone. This study allows us to understand excessive daytime sleepiness in adolescents.

Modifiable behavioral risk factors for NCDs and sleep in Brazilian adolescents.

To analyze the association between modifiable behavioral risk factors for non-communicable diseases and sleep parameters in Brazilian adolescents. This was a cross-sectional study that used data from the RPS Cohort Consortium, São Luís, Brazil for the follow-up of adolescents aged 18-19 years (n = 2,515). The outcomes were excessive daytime sleepiness (Epworth Sleepiness Scale - ESS) and sleep quality (Pittsburgh Sleep Quality Index - PSQI). The exposures of interest were the behavioral risk factors for non-communicable diseases (NCDs): screen time, physical inactivity, alcohol, smoking, illicit drugs, caffeine intake, and consumption of sugar-sweetened beverages. Excess weight was considered a possible mediator of this association between the exposures of interest and the outcomes. The models were analyzed by modeling with structural equations. Physical inactivity (standardized coefficient, SC = 0.112; p = 0.001), higher consumption of alcohol (SC = 0.168; p = 0.019) and of sugar-sweetened beverages (SC = 0.128; p < 0.001) were associated with excessive daytime sleepiness in adolescents; better socioeconomic status was also associated with this outcome (SC = 0.128; p < 0.001). Physical inactivity (SC = 0.147; p < 0.001) and higher consumption of sugar-sweetened beverages (SC = 0.089; p = 0.003) were also associated with poor sleep quality. Overweight was neither a mediator nor associated with sleep quality or excessive daytime sleepiness. The main modifiable behavioral risk factors for NCDs are associated with worse sleep parameters already in adolescence, which serves as a warning toward the accumulation of risks for sleep disorders in the future.

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.

Reliability and validity of the Chinese version of the Nightmare disorder index in adolescents.

The Nightmare Disorder Index Questionnaire (NDI) was developed to measure the impact of nightmares. The purpose of this study was to investigate the psychometric properties of NDI among Chinese adolescents. This study investigated the validity and internal consistency of the Nightmare Disorder Index Chinese (NDI-CV) among 6014 Chinese adolescents who completed the NDI-CV, Nightmare Distress Questionnaire-Chinese Version (NDQ-CV), Pittsburgh Sleep Quality Index (PSQI), Insomnia Severity Index (ISI), Chinese Adolescent Daytime Sleepiness Scale (CADSS), Generalized Anxiety Disorder-7 Questionnaire (GAD-7), and Patient Health Questionnaire-9 (PHQ-9). In addition, we investigated the test-retest reliability of the NDI-CV among 423 adolescents who completed a retest of the NDI-CV after a 2-week interval. Finally, NDI-CV demonstrated good psychometric properties in a sample of Chinese adolescents (Cronbach's α coefficient of 0.876), and the 95% confidence interval for the 2-week retest correlation coefficient was 0.675-0.977 (p<0.001).

The impact of sleep-corrected social jetlag on mental health, behavioral problems, and daytime sleepiness in adolescents

Study objectivesThis study aimed to examine the effect of sleep-corrected social jetlag (SJLsc) on mental health, behavioral problems, and daytime sleepiness in adolescents. MethodsThis was a cross-sectional study which included 4787 adolescents (Mean age: 14.83±1.6y, 56.0% girls) recruited from 15 secondary schools in Hong Kong. SJLsc was defined as the absolute difference between sleep-corrected midsleep on weekdays and weekends, at which the sleep debt has been considered. It was classified into three groups: low-level (“LSJLsc”, <1h), mid-level (“MSJLsc”, ≥1h and <2h), and high-level of SJLsc (“HSJLsc”, ≥2h). Adolescents’ mental health, behavioral problems and daytime sleepiness were measured by the General Health Questionnaire (GHQ-12), the Strengths and Difficulties Questionnaire (SDQ) and the Pediatric Daytime Sleepiness Scale (PDSS). Logistic regression analysis and restricted cubic spline regression (RCS) analysis were applied with consideration of confounders including age, gender, puberty and sleep problems. ResultsNearly half (46.9%) of adolescents had SJLsc for at least 1 h. Greater SJLsc was associated with more behavioral difficulties (MSJLsc: OR: 1.20, p = 0.03; HSJLsc: OR: 1.34, p = 0.02) when controlling for age, sex, puberty, chronotype, insomnia, and time in bed. There was a dose-response relationship in which higher SJLsc had an increased risk of conduct problems and hyperactivity, while only high-level SJLsc was associated with a peer relationship problem. In RCS analysis, SJLsc was associated with a higher likelihood of behavioral difficulties (p = 0.03) but not poor mental health or daytime sleepiness. ConclusionsSleep-corrected social jetlag was a unique risk factor for behavioral problems in adolescents. Our findings highlighted the need for interventions to promote healthy sleep-wake patterns in school adolescents.

Asthma control, social jetlag, and sleep impairment in high school adolescents

IntroductionSocial jetlag is associated with several negative health outcomes, but its impact on asthma control has not been previously investigated. Although impaired sleep is common in asthma, studies on the relationship between sleep quality, social jetlag and asthma control in adolescents are scarce. ObjectiveTo investigate the relationship between asthma control and sleep quality, sleep-wake pattern and excessive daytime sleepiness in adolescents. MethodsThis was a cross-sectional study of 1457 Brazilian high-school adolescents. Asthma was identified using the International Study of Asthma and Allergies in Childhood questionnaire, and disease control was measured by the Asthma Control Test. Sleep-wake pattern and social jetlag were assessed by the Munich Chrono-Type Questionnaire; sleep quality, by the Pittsburgh Sleep Quality Index; and daytime sleepiness, by the Epworth Sleepiness Scale. ResultsAsthma was present in 250 (17.2%) participants and was classified as uncontrolled in 120 (47.9%). Both uncontrolled and controlled asthma groups, compared with non-asthmatics, had worse sleep quality (81.7% vs 77.4% vs 56.5%; p < 0.001) and excessive daytime sleepiness (EDS: 56.2% vs 56.5% vs 39.2%; p < 0.001). On average, adolescents with uncontrolled asthma, compared to non-asthmatics, showed later sleep onset (mean ± SD: 23:54pm ± 1 h:45min vs 23:20pm ± 1 h:27min; p = 0.002) and shorter sleep duration (5.7 h ± 1.8 h vs 6.3 h ± 1.4 h; p = 0.002) on school days. No significant difference in social jetlag was found among the three groups. ConclusionsAsthma is associated with EDS and poor-quality sleep in adolescents. Social jetlag is common in these subjects and is not related to the presence and control of asthma.

A symptom of periodic limb movement during sleep is not associated with excessive daytime sleepiness in adolescents with suggestive symptoms of restless legs syndrome

A symptom of periodic limb movement during sleep is not associated with excessive daytime sleepiness in adolescents with suggestive symptoms of restless legs syndrome

Associations between experienced aggression, poor sleep, and suicide risk among Chinese adolescents.

The physical and mental health of adolescents is an important study area. This study aims to examine the occurrence of aggression, sleep disturbances, and suicide risk among Chinese adolescents, along with the relationships between these factors. This is a cross-sectional study conducted through an online survey. Of the original 7011 Chinese adolescent respondents, the analysis included data from 6122 adolescents, aged between 12 and 18 years, from 23 regions, whose average age was 16.12 (±1.44) years, with 48.8% being male. While the chi-square test and t-test were used for analyzing demographic data and continuous variables, respectively, mediation analysis was used to explore the mechanism of experiencing aggression on suicide risk. The respondents' sleep quality, nightmare distress, daytime sleepiness, fatigue, and suicide risk were assessed using the Pittsburgh Sleep Quality Index (PSQI), Nightmare Distress Questionnaire-Chinese version (NDQ-CV), Chinese Adolescent Daytime Sleepiness Scale (CADSS), Multidimensional Fatigue Inventory (MFI-20), and the suicide risk module of the Mini-International Neuropsychiatric Interview (MINI), respectively. Four items were used to assess adolescents' experiences with aggression. Of the respondents, 42% reported experiencing aggression by others, especially parental physical maltreatment. Furthermore, 26.9% of adolescents in school, and in particular, 31.8% in senior high school experienced insomnia symptoms. Adolescents who reported experiences of aggression had more severe insomnia symptoms, nightmare distress, fatigue, and a higher risk of suicide when compared with those who did not (all ps < 0.001). Insomnia symptoms, nightmare distress, and fatigue all mediated the relationship between aggression and suicide risk, and there was a chain of mediating effects between these factors [for total indirect effect β = 1.1512, 95% CI (0.9671 to 1.3426), direct effect β = 0.4934, 95% CI (0.1978 to 0.7891), and total effect β = 1.6446, 95% CI (1.3479 to 1.9414)]. Our findings indicate that among adolescents, experiencing aggression is associated with an increased suicide risk. In addition to the direct effect of aggression on suicide risk, insomnia, nightmare distress, and fatigue mediate the relationship between aggression and suicide risk. More attention should be paid to adolescents experiencing aggression, and interventions should be implemented and strengthened.

Internet Addiction and Sleep Problems among Russian Adolescents: A Field School-Based Study.

This study aims to establish a link between disturbances in the night sleep habitus, quality of sleep, and daytime sleepiness in adolescents with Internet addiction and different types of content consumed. Methods: This is a cross-sectional observational study of a school sample in three large cities in Central Siberia. 4615 schoolchildren of 12–18 years old were examined. The Russian-language versions of the Chen Internet Addiction Scale, the Game Addiction Scale for Adolescents, and the Social Media Disorder Scale were used to identify Internet addiction. Questions from the Pittsburgh Sleep Quality Index questionnaire were used to assess nighttime sleep. Daytime sleepiness was assessed using the Pediatric Daytime Sleepiness Scale questionnaire. Results: Adolescents with Internet addiction go to bed and wake up late; they are characterized by a decrease in the duration of nighttime sleep, an increase in sleep onset latency, and frequent nighttime awakenings, as well as more pronounced daytime sleepiness. Among the sleep parameters studied, the indicators of daytime sleepiness and night awakening scales have the highest effect size in Internet-addicted adolescents, regardless of the media consumed. Conclusion: Internet-addicted adolescents are characterized by significant disturbances in the quality of nighttime sleep and excessive daytime sleepiness, which requires appropriate psychological correction.

Associations of frequent pain symptoms with excessive daytime sleepiness in adolescents: a longitudinal study.

Pain symptoms, sleep disturbance, and daytime sleepiness are common in adolescents. This study examined the cross-sectional and prospective associations between pain symptoms and excessive daytime sleepiness (EDS) in a large sample of adolescents. Participants were 7,072 adolescents (mean age = 14.58 years) in a follow-up study of behavior and health in Shandong, China. A self-administered structured questionnaire was used to assess pain symptoms (headache, stomachache, and other general pain), body weight and height, sleep, anxiety/depression, substance use, and family environment in November-December in 2015 and 1 year later. The Chinese adolescent daytime sleepiness scale was used to measure daytime sleepiness. Of the sample, 19.8% and 23.2% had moderate or severe EDS at baseline and at 1-year follow-up, respectively. The prevalence and 1-year incidence rates of EDS significantly increased with the frequencies of pain symptoms. Frequent pain was significantly associated with increased risk of EDS at baseline (odds ratio = 2.01, 95% confidence interval = 1.56-2.59), incident EDS (odds ratio = 1.41, 95% confidence interval = 1.03-1.93), and persistent EDS (odds ratio = 2.17, 95% confidence interval = 1.52-3.09) while adjusting for adolescent and family covariates, including anxiety/depression, nocturnal sleep duration, insomnia symptoms, frequent snoring, body mass index, and hypnotic use. Similar associations were observed across headache, stomachache, and other pain. Frequent pain is significantly and independently associated with increased risk of EDS. Our findings suggest that assessing and treating pain symptoms is important to improve healthy sleep and reduce risk of EDS in adolescents. Further research is needed to understand the underlying psychological and neurobiological mechanisms between pain and daytime sleepiness in adolescents. Liu X, Liu Z-Z, Yang Y, Jia C-X. Associations of frequent pain symptoms with excessive daytime sleepiness in adolescents: a longitudinal study. J Clin Sleep Med. 2021;17(12):2415-2423.

A longitudinal investigation of sleep and technology use in early adolescence: does parental control of technology use protect adolescent sleep?

ObjectiveA bi-directional relationship between technology use and adolescent sleep is likely, yet findings are mixed, and it is not known whether parental control of technology use can protect sleep. The current study examined bi-directionality between technology use on school nights and morning/eveningness, sleep duration and daytime sleepiness in early adolescents. We also examined whether time spent using technology mediated the relationship between parental control of technology and adolescent sleep. MethodsAdolescents and their primary caregiver (96% mothers) completed questionnaire measures of sleep, technology use and parental control across three, annual waves: Wave 1 (N = 528, Mage = 11.18, SD = 0.56, range = 10–12, 51% male), Wave 2 (N = 502, Mage = 12.19, SD = 0.53, 52% male) and Wave 3 (N = 478, Mage = 13.19, SD = 0.53, 52% male). ResultsWhen examining the direct relationship between sleep and technology use, cross-lagged panel models showed that time spent using technology predicted shorter sleep duration and greater daytime sleepiness in adolescence, and evening diurnal preference and shorter sleep duration contributed to increased technology use over time. The relationship between technology use and sleep duration was bi-directional. Time spent using technology and adolescent sleep predicted, yet were not predicted by, parental control of technology use. ConclusionsWhile normative changes in sleep (eg, increased eveningness) may promote increased technology use, technology use may further impinge upon sleep. Results suggest it may be pertinent to instead find creative ways in which adolescents themselves can mitigate their risk of inadequate sleep.

The mediating role of daytime sleepiness between problematic smartphone use and post-traumatic symptoms in COVID-19 home-refined adolescents

BackgroundCOVID-19 was first recognized in late 2019 in China, at which time school closures forced most students to isolate at home or maintain social distance, both of which increased smartphone use, daytime sleepiness and post traumatic disorder (PTSD) risks. However, to date, no research has fully explored these behavioral risks or the consequences. MethodsTwo thousand and ninety home-confined students from two Chinese high schools participated in an online-based questionnaire battery that assessed their sociodemographic characteristics, COVID-19 related exposures, daytime sleepiness, problematic smartphone use, and PTSD. The subsequent data were subjected to mediation analysis, and structural equation models (SEM) were employed to explore the variable relationships. ResultsThe problematic smartphone use, daytime sleepiness and PTSD prevalence were respectively 16.4%, 20.2% and 6.9%. The number of COVID-19 related exposure was directly associated with problematic smartphone use and PTSD symptoms. Problematic smartphone use was found to be a mediator between COVID-19 related exposure and PTSD symptoms, and daytime sleepiness was found to partially mediate the associations between problematic smartphone use and PTSD. ConclusionsThe more exposure associated with the pandemic, the more psychological and behavioral problems the adolescents had. The relatively high rate of problematic smartphone use in home isolated adolescents possibly increased the risk of daytime sleepiness and psychological problems. Therefore, targeted improvements are needed to reduce the risk of psychological problems and daytime sleepiness in adolescents.

Internet addiction and excessive daytime sleepiness in adolescents

IntroductionInternet addiction (IA) is associated with personal peculiarities, psychosocial characteristics, and physiological factors. Excessive daytime sleepiness (EDS) is one of the most common sleep disorders in adolescents associated with social behavior patterns.ObjectivesTo evaluate the association of IA with EDS in Siberian adolescents.Methods4637 urban Siberian (Krasnoyarsk, Abakan) school-based adolescents (aged 12-18; boys/girl ratio 2215/2422) were tested with Chen Internet Addiction Scale (CIAS). Internet users were categorized into three groups: adaptive Internet users (AIU) (scoring 27–42); maladaptive Internet users (MIU) (scoring 43–64); and pathological Internet users (PIU) (scoring ≥65). EDS was assessed by Pediatric Daytime Sleepiness Scale (PDSS); cutoffs for EDS were PDSS 95% percentiles for each age group: 12 y.o. – 20 points, 13 y.o. – 21 points, 14-16 y.o. – 22 points, 17-18 y.o. – 23 points. Quantitative data are shown as median (25-75% quartiles). Chi-square and Kruskal-Wallis tests were used.ResultsEDS prevalence increase with IA severity: AIU group (n=2402) – 1.4%, MIU group (n=1905) – 3%, and PIU group (n=330) – 12.4% (pAIU-MIU=0.001; pAIU-PIU&lt;0.001; pMIU-PIU&lt;0.001). Positive association was detected between IA severity and PDSS score: AIU group – 10 (6-13), MIU group – 14 (10-17), and PIU group – 17 (13-21), p(K-W)&lt;0.001).ConclusionsEDS is associated with IA in Siberian adolescents. The possible explanations of this relation may be: (1) the higher rate of night activity, (2) night sleep disturbances and (3) the presence of common pathogenic factors in IA and EDS, such as personality characteristics, depression, anxiety. The study was funded by RFBR project № 18-29-2203219.Conflict of interestThe reported study was funded by RFBR according to the research project № 18-29-22032\19.

Effects of Strength Training on Sleep Parameters of Adolescents: A Randomized Controlled Trial.

Santiago, LCS, Lyra, MJ, Germano-Soares, AH, Lins-Filho, OL, Queiroz, DR, Prazeres, TMP, Mello, MT, Pedrosa, RP, Falcão, APST, and Santos, MAM. Effects of strength training on sleep parameters of adolescents: a randomized controlled trial. J Strength Cond Res 36(5): 1222-1227, 2022-This study aimed to examine the effects of 12 weeks of strength training (ST) on sleep quality and daytime sleepiness in adolescents with sleep complaints. Thirty adolescents were randomly assigned to 2 groups: ST group (ST, n = 18) and control group (CG, n = 12). Anthropometric, body composition, one-repetition maximum test, and sleep parameters (Pittsburgh Sleep Quality Index [PSQI] and Epworth Sleepiness Scale [ESS]) were evaluated. Training consisted of 55 min·d-1 (3 times a week, for 12 weeks), 3 sets of 10-12 repetitions with a 1-minute rest interval between sets and exercises. Baseline and postintervention differences were analyzed using Generalized Estimating Equations and the effect size (ES) with Cohen's d coefficient. Significance was set at (p < 0.05). After 12 weeks of ST, a significant decrease in the PSQI score (7.3 ± 0.7 vs. 5.1 ± 0.6; ES = 4.10) was observed in the ST group, but not in the CG (6.3 ± 0.8 vs. 7.4 ± 0.7; ES = 1.53). A significant decrease in ESS score was found in the ST group (10.1 ± 0.7 vs. 8.2 ± 0.7; ES = 3.08), without differences in the CG (10.7 ± 0.8 vs. 11.0 ± 0.7; ES = 0.56). The ST group presented increased total sleep duration (h·min-1) (6.2 ± 0.2 vs. 6.9 ± 0.2; ES = 3.60), but not the CG (7.0 ± 0.2 vs. 6.8 ± 0.1; ES = 1.32). Individual analyses showed ≈67% of adolescents experienced a reduction in PSQI (8.3; confidence interval [CI] 95% 6.8-10.1) and ESS (8.3; CI 95% 6.7-9.9) scores after ST, whereas only ≈17% of control subjects presented reduced scores (PSQI [11.1; CI 95% 9.5-12.9] and ESS [11.0; CI 95% 9.4-12.6]). Strength training improved sleep quality and increased total sleep duration.

Excessive daytime sleepiness in adolescents: current treatment strategies.

The complaints of excessive daytime sleepiness are very common among adolescents. In addition, in this particular subpopulation, the presence of excessive daytime sleepiness is associated with negative impact on school performances, interpersonal difficulties (school friends or family), extracurricular activities, health and driving. In adolescents with complaints of excessive daytime sleepiness, it is important to perform a complete clinical assessment including systematic clinical interview, physical examination, sleep diaries, use of specific questionnaires and possible confirmatory tests. In adolescents, the main causes of excessive daytime sleepiness are sleep deprivation, inadequate sleep hygiene, insomnia disorders, circadian rhythm disorders, chronic somatic pathologies, psychiatric disorders, movement disorders related to sleep, respiratory disorders related to sleep, parasomnias, hypersomnia disorders and use of drugs or medications. Given the multiple aetiologies of excessive daytime sleepiness in adolescents, the implementation of targeted therapeutic strategies is essential in order to allow optimal management of this symptom and better prevention of its negative consequences. The aim of this review is therefore to provide health care professionals caring for adolescents with excessive daytime sleepiness complaints the currently recommended therapeutic strategies for the main aetiologies of excessive daytime sleepiness in this particular subpopulation.

Evening circadian preference is associated with sleep problems and daytime sleepiness in adolescents with ADHD.

Adolescence is a developmental period characterized by disruptions in sleep and changes in circadian preferences. Although adolescents with attention-deficit/hyperactivity disorder (ADHD) are at even higher risk of sleep disruption than their peers, no study has examined whether circadian preference is associated with sleep problems and daytime sleepiness in adolescents with ADHD. This study provides an initial test of the hypothesis that greater evening preference would be associated with more sleep problems and daytime sleepiness in adolescents diagnosed with ADHD. Participants were 80 adolescents (69% male), aged 13-17 years, with ADHD. Adolescents completed measures assessing circadian preference, pubertal development, anxiety/depressive symptoms and weeknight sleep duration. Both adolescents and parents completed measures of sleep problems and daytime sleepiness. In regression analyses controlling for a number of other variables (i.e., age, sex, pubertal development, ADHD medication use, and ADHD, oppositional defiant disorder and internalizing symptom severity), greater evening preference was associated with both adolescent- and parent-reported sleep problems and daytime sleepiness. Greater evening preference remained significantly associated with each of these sleep problems and daytime sleepiness when also controlling for weeknight sleep duration. This is the first study to demonstrate that evening circadian preference is associated with both sleep problems and daytime sleepiness in adolescents with ADHD. The results indicate that it is important to consider circadian function as research examining sleep in adolescents with ADHD continues to advance.

Feasibility and impact on daytime sleepiness of an experimental protocol inducing variable sleep duration in adolescents.

Although most research on sleep and adolescent health has focused on how long each youth sleeps on average, variability in sleep duration may be just as problematic. Existing findings have been inconsistent and unable to address cause-effect relationships. This study piloted an experimental protocol to induce sleep variability and explore its impact on daytime sleepiness in adolescents. Healthy adolescents aged 14–17 participated in a 3-week, at-home protocol. Sleep was monitored by sleep diaries and actigraphy. Following a run-in period to stabilize wake times (set at 6:30am throughout the protocol), participants were randomly counterbalanced across two 5-night experimental conditions. Bedtimes were consistent at 11:00pm during the stable sleep condition (7.5-hour sleep period each night) but changed on alternating nights during the variable sleep condition (ranging from 9:30pm to 12:30am) so that sleep duration averaged 7.5 hours across the condition with a standard deviation of 1.37 hours. Difficulty waking was assessed each morning and daytime sleepiness was assessed by end-of-condition parent- and adolescent-reports. Of the 20 participants who completed the study, 16 met the predetermined adherence definition. For those who were adherent, there were no differences in overall sleep duration between the stable and variable sleep conditions (p>.05) but adolescents had 58.6 minutes greater night-to-night variation in sleep duration in the variable condition (p < .001). Across all nights, youth reported greater difficulty waking following nights of shorter assigned sleep (p = .004) and greater overall sleepiness during the variable condition (p = .03). It is feasible to experimentally vary how long adolescents sleep on a nightly basis while holding average sleep duration constant. Such a protocol will promote tests of the acute effects of day-to-day changes in sleep duration on health.

Sleep and daytime sleepiness in adolescents with and without ADHD: differences across ratings, daily diary, and actigraphy.

Children with attention-deficit/hyperactivity disorder (ADHD) experience greater sleep problems than their peers. Although adolescence is generally a developmental period characterized by insufficient sleep, few studies have used a multi-informant, multi-method design, to examine whether sleep differs in adolescents with and without ADHD. Targeted recruitment was used to enroll an approximately equal number of eighth-grade adolescents (mean age=13years) with (n=162) and without ADHD (n=140). Adolescents and parents completed global ratings of sleep problems; adolescents, parents, and teachers completed ratings of daytime sleepiness. Adolescents wore actigraphs and completed a daily sleep diary for approximately 2weeks. Adolescents with ADHD were more likely than adolescents without ADHD to obtain insufficient sleep on school days (per diary) and weekends (per diary and actigraphy). Adolescents with ADHD were also more likely to report falling asleep in class and to have stayed up all night at least twice in the previous 2weeks (14% and 5% reported all-nighters for ADHD and comparison, respectively). In regression analyses controlling for a number of variables known to impact sleep (e.g. pubertal development, sex, medication use, having an externalizing, anxiety, or depression diagnosis), ADHD remained associated with shorter diary and actigraphy school night sleep duration, adolescent- and parent-reported daytime sleepiness, and parent-reported difficulties initiating and maintaining sleep and total sleep disturbance. Controlling for other variables, the odds of being classified with clinically elevated parent-reported sleep disturbance were 6.20 times greater for adolescents with ADHD. Findings provide some of the clearest evidence yet that adolescents with ADHD experience more sleep problems and sleepiness than their peers without ADHD. It may be especially important to assess for sleep problems in adolescents with ADHD and to evaluate whether existing sleep interventions are effective, or can be optimized, for use in adolescents with ADHD who also have sleep problems.

Age at menarche, menstrual problems, and daytime sleepiness in Chinese adolescent girls.

Menstrual problems and daytime sleepiness are prevalent in adolescent girls. Little is known about the associations between age at menarche, menstrual problems, and daytime sleepiness. This study aimed to examine the associations of age at menarche and menstrual problems with daytime sleepiness among Chinese adolescent girls. Of 11,831 adolescents who participated in the baseline survey of Shandong Adolescent Behavior & Health Cohort (SABHC), 5,813 were girls and included for the analysis. A structured self-administered questionnaire was used to collect information about menstrual problems, sleep, mental health, and demographics. Daytime sleepiness was measured by the Chinese Adolescent Daytime Sleepiness Scale (CADSS). The mean age of the girls was 15.02 (SD = 1.44) years. The prevalence rates of mild, moderate, and severe daytime sleepiness were 20.5%, 16.7%, and 5.5%, respectively. After adjusting for adolescent and family covariates (age, body mass index, physical health, physical exercise, sleep duration, sleep problems, anxious/depressive symptoms, and family social economic status), sometimes irregular (odds ratio [OR] = 1.24, 95% confidence interval [CI] = 1.01 to 1.52), often irregular menstruation (OR = 1.58, 95% CI = 1.17 to 2.12), moderate (OR=1.39, 95% CI = 1.12 to 1.72), and severe (OR = 1.46, 95% CI = 1.04 to 2.04) menstrual pain were significantly associated with increased risk of daytime sleepiness. Our findings suggest that menstrual irregularity and menstrual pain are associated with increased risk of daytime sleepiness. These findings emphasize the importance of evaluating and intervening menstrual problems for preventing daytime sleepiness in adolescent girls.

SUBJECTIVE SLEEP NEED AND DAYTIME SLEEPINESS IN ADOLESCENTS.

ABSTRACTObjective: To analyze the contribution of subjective sleep need for daytime sleepiness in adolescents, and to compare questions about sleep, age and body mass index between adolescents who considered to sleep enough and those who reported the need for more sleep.Methods: This is a descriptive, epidemiological and cross-sectional study. Data collection was performed in August 2016, with 773 adolescents aged 14-19 years old, from Paranaguá, Paraná, Southern Brazil. The analysis included the following variables: time in bed, half-sleep phase, sleep need, social jetlag, daytime sleepiness, body mass index and physical activity.Results: The prevalence of adolescents with subjective need for sleep was 73.0%, with an average need of 1.7 extra hours of sleep. These adolescents woke up earlier (p<0.001) and slept less on school days (p<0.001). The need for more sleep was associated with higher daytime sleepiness scores (rho=0.480; p<0.001) and with later half-sleep phase (rho=0.200; p<0.001). No correlation was identified between the sleep need and time in bed (rho=-0.044; p=0.225). The subjective sleep need was the variable with the greatest explanatory power for daytime sleepiness (24.8%; p<0.001). In addition, the less adolescents practiced physical activity, the higher their daytime sleepiness scores (rho=-0.117; p<0.001).Conclusions: The subjective sleep need has an important role in explaining daytime sleepiness among adolescents. Adolescents who needed to sleep more reported waking up early and experienced sleep deprivation during class days; they also woke up later on the weekends and experienced more daytime sleepiness, compared to those who believed they had enough sleep.