Pediatric Daytime Sleepiness Scale Research Articles

0493 Daytime Sleepiness in Children with Asthma: Is it really the lungs?

Abstract Introduction Insufficient nocturnal sleep is the most common reason of excessive daytime sleepiness. Children with asthma are at increased risk for sleep disruption secondary to nocturnal respiratory symptoms and medication effects, as well as more common behavioral pediatric sleep challenges. Not yet clear is the relative contribution of asthma severity versus behavioral factors to daytime sleepiness in a sample of children (8-17 years) with asthma. Methods This survey-based study was conducted in the outpatient pulmonology clinic at Nemours Children’s Hospital, Delaware between 2018-2021. Children with asthma were eligible if they had a diagnosis of asthma, spoke English, and did not have a developmental disorder. Participants completed four surveys: Pediatric Daytime Sleepiness Scale (PDSS, higher scores=more sleepiness), Pediatric Quality of Life Inventory (PEDS-QL, higher scores=better quality of life), PROMIS Pediatric Anxiety short form (higher scores=more anxiety symptoms), and an investigator-designed survey assessing sleep-related technology use. Asthma factors (e.g., asthma severity, lung function [FEV1], number of prescribed asthma medications) were obtained from the electronic medical record. Descriptives and multiple regression analyses were conducted to identify asthma severity and behavioral predictors of daytime sleepiness, controlling for demographics. Results Study participants (N=100) were mean age 12.1 years [SD=2.6], 54% male, and 45% Black. Persistent asthma was common (87%), with a mean of 4.2 (SD=2.5) prescribed asthma medications, and mean FEV1 of 97% (SD=17.8). On behavioral surveys patients scored: PDSS (M=14.13; range=0-31; SD=6.7), PEDS-QL (M=77.38; range=15.6-100; SD=18.6), and PROMIS (M=14.92; range=8-35; SD=7.2). 74% reported cell phone usage within 1 hour of bedtime. Multiple regression models showed that an increased number of prescribed medications (beta=0.168, p=0.042), lower patient-reported quality of life (beta=-0.310, p=0.004), increased anxiety symptoms (beta=0.203, p=0.05) and bedtime cellphone use (beta=0.290, p=0.003) were significantly associated with daytime sleepiness in children with asthma. Conclusion A greater number of behavioral than asthma severity factors related to daytime sleepiness in children with asthma. Strategies to reduce anxiety and bedtime cellphone use may be plausible behavioral targets to improve sleep in children with asthma. Further research to examine these associations longitudinally, and in children with more severe asthma, is warranted. Support (If Any) None

0838 Cheyne-Stokes Breathing in a Pediatric Patient with Dilated Cardiomyopathy and Muscular Dystrophy Prior to Heart Transplant

Abstract Introduction Cheyne-Stokes breathing (CSB) has rarely been identified in the pediatric population. Neuromuscular diseases (NMD) such as Duchene Muscular Dystrophy (DMD) can predispose patients to sleep-disordered breathing including central sleep apnea (CSA) and CSB. Sleep-disordered breathing in children with NMD may not have symptoms; thus, treatment can be delayed. Currently, there is limited data to support resolution of CSB in DMD with dilated cardiomyopathy post-transplant. Report of Cases: We present a 15-year old female with a significant history of both dilated cardiomyopathy and DMD who presented with acute on chronic heart failure. Due to her disease progression, she was listed for heart transplant. Prior to her transplant, she completed an inpatient polysomnography (PSG) to rule out sleep-disordered breathing due to concerns of snoring and dyspnea during sleep. Her Pediatric Daytime Sleepiness Scale score (PDSS) was 8. The polysomnogram recorded moderate obstructive sleep apnea (OSA) and central sleep apnea (CSA) consistent with Cheyne-Stokes breathing along with rare premature ventricular contractions (PVCs). Patient was started on BPAP of 13/8 cm H2O with a back-up rate of 12 breaths per minute after titration study. The patient subsequently received a heart transplant in which the patient’s dyspnea and snoring resolved. Post-transplant PSG pending to reassess the severity of sleep-disordered breathing. Conclusion Though CSA can be seen in children, CSB is rarely seen in children with either heart failure or muscular dystrophy. When CSB is observed, the cornerstone of treatment is correcting the underlying cause. This patient demonstrated CSB with symptoms that improved with BPAP and now post-heart transplant. When both heart failure and neuromuscular disease are involved, close monitoring for clinical symptoms along with screening for CSB is important and may affect overall quality of life and recovery. Support (If Any)

Impact of pandemic lockdown on learning behaviour and sleep quality in German students: Results of an online survey before and during the pandemic.

BackgroundThis study addresses the effects of the coronavirus disease 19 (COVID-19) restriction measures on sleep and bedtime habits of N = 637 German university students.MethodsThe questionnaire was distributed online during two different time periods in 2020 (February 27–March 21) and in 2021 (February 27–March 27). The first data collection phase was immediately before the first strict lockdown to contain the COVID-19 pandemic in Germany, and the second data collection phase was during the second lockdown. The survey was composed of validated questionnaires and additional questions regarding the changes in sleep/bedtimes and the status of lectures during the lockdown phase.ResultsThe average Pediatric Daytime Sleepiness Scale (PDSS) score in the sample decreased during the lockdown phase, corresponding to the fact that students were less burdened with daytime sleepiness. Moreover, the sample had earlier rise and earlier bedtimes on free days during the lockdown period. Furthermore, the increase in flexible learning times brought about by the pandemic negatively impacted the students’ lifestyle and increased irregularities in sleeping habits.ConclusionSignificant changes in sleeping patterns seem to be attributable to the pandemic lockdown as found in this self-reported student survey. While daytime sleepiness decreased and earlier overall bedtimes were noted, the impact on the irregularity of sleeping and learning patterns seems to be the most notable finding, as this affects overall quality of life and learning performance. Further studies are needed to validate these findings.

Validity of chronotype questionnaires in adolescents: Correlations with actigraphy.

There are only a few validated chronotype and morningness-eveningness questionnaires for adolescents. We evaluated three such questionnaires, namely Morningness-Eveningness Stability Scale improved; reduced Morningness-Eveningness Questionnaire for Children and Adolescents; and Composite Scale of Morningness in adolescents against actigraphy. Fifty-fivehealthy 13- to 16-year-old adolescents completed the Morningness-Eveningness Stability Scale improved, reduced Morningness-Eveningness Questionnaire for Children and Adolescents, Composite Scale of Morningness, and Pediatric Daytime Sleepiness Scale, and provided a 7-day actigraphy and sleep diary recording about their sleep-wake patterns. We examined the correlations between sleep-wake and activity parameters, and the questionnaires. The influence of age and sex on chronotype classification was studied using uni- and multivariate analyses. All three chronotype questionnaires showed good internal consistency and convergent validity. Spearman correlations reflected less daytime sleepiness, earlier sleep times, midpoints of sleep, and acrophase in morning-oriented participants. Evening-oriented participants had more sleepiness and later respective sleep-wake times. Chronotype classification differed significantly between questionnaires. The Composite Scale of Morningness classified more participants as morning types when compared with the reduced Morningness-Eveningness Questionnaire for Children and Adolescents (12 versus 7, respectively), and fewer adolescents as evening types (5 versus 9, respectively). Age and sex had no significant influence on questionnaire scores. The Morningness-Eveningness Stability Scale improved, reduced Morningness-Eveningness Questionnaire for Children and Adolescents, and Composite Scale of Morningness are valid instruments to determine circadian preference in adolescents; however, chronotype classification from the Composite Scale of Morningness and reduced Morningness-Eveningness Questionnaire for Children and Adolescents cannot be used interchangeably.

Instruments For Assessment Of Excessive Daytime Sleepiness In Brazilian Children And Adolescents: Systematic Review

Objective:To systematically review the literature on the instruments used to assess excessive daytime sleepiness (EDS) in Brazilian children and adolescents.Data source:A systematic review of the literature was performed in the databases MEDLINE PubMed, Scopus, Web of Science, LILACS, Scielo and SPORTDiscus, with no time limit for searches. The eligibility criteria were studies published in English and Portuguese, original articles that used questionnaires to assess EDS and whose sample consisted of Brazilian children and/or adolescents. As search strategy, the following terms were combined with Boolean operators “OR” and/or “AND”: drowsiness, disorders of excessive somnolence, excessive daytime sleepiness, day sleepiness, midday sleepiness, daytime sleepiness, adolescents, Brazil, Brazilian adolescents, and children.Data synthesis:Sixteen articles were selected, in which nine different instruments were applied to 8.240 children and adolescents from the South, Southeast, Midwest and Northeast regions of Brazil. The mean of methodological quality of studies was 16.1±1.9 points. The instruments most frequently used were the Pediatric Daytime Sleepiness Scale (PDSS) and Karolinska Sleepiness Scale (KSS), but only PDSS was shown reliable to assess EDS in Brazilian children and adolescents.Conclusions:The PDSS was the only instrument considered reliable to assess EDS in Brazilian children and adolescents. Further research on EDS in children and adolescents are suggested to perform the validation of other instruments for Brazil and present internal consistency values.

Evaluation of sleep characteristics of children and adolescents with type 1 diabetes mellitus.

ABSTRACTObjective:To evaluate sleep characteristics of children and adolescents with type 1 diabetes mellitus (T1DM) and their relationship with glycemic control.Methods:A cross-sectional study was conducted at a public hospital in São Paulo, Brazil. It included 86 patients with T1DM, aged between 10 and 18 years old, who were on insulin therapy, had performed at least three measurements of capillary blood glucose throughout the day, and had normal thyroid function. The clinical, anthropometric, and laboratory data of each patient were evaluated. The Pediatric Daytime Sleepiness Scale (PDSS) and the Munich Chronotype Questionnaire (MCTQ) were used to assess the sleep characteristics.Results:The mean level of glycated hemoglobin (HbA1c) was 9.2±2.1%, and it was higher in adolescents than in children. The mean score of PDSS was 13.9±4.7. Patients with HbA1c<7.5% had lower PDSS scores and longer sleep duration on weekdays than patients with HbA1c≥7.5%. HbA1c levels were negatively correlated with chronotype values and sleep duration on weekdays and positively correlated with social jet lag. Patients who had had T1DM for less than three years had a higher prevalence of daytime sleepiness. The regression analysis showed that higher HbA1c (≥7.5%) and shorter time since the diagnosis of T1DM increased the chance of daytime sleepiness, regardless of age and sex.Conclusions:Patients with higher HbA1c had more daytime sleepiness, a morning chronotype, shorter sleep duration on weekdays and a more significant social jet lag. The shorter diagnosis time for T1DM and greater levels of HbA1c increased the chance of daytime sleepiness.

Correlation Between Nutritional Status, Cognitive Function and Daytime Sleepiness of Schoolchildren in Terengganu, Malaysia

This cross-sectional study aimed to determine the correlation between nutritional status, cognitive function and daytime sleepiness of schoolchildren in Kuala Nerus, Terengganu. It involved 85 schoolchildren aged 9 to 12 years. Nutritional status was determined through anthropometric measurements, biochemical analyses for hemoglobin, urinalysis and urinary iodine concentration (UIC). While cognitive performance was tested using Raven’s Colored Progressive Matrices (R-CPM). The daytime sleepiness of the respondents was assessed using the Pediatric Daytime Sleepiness Scale (PDSS). It was found that 16.5% of the respondents were stunted while 4.7%, 12.9% and 17.7% were obese, overweight and wasted, respectively. In addition, 37.7% of the respondents were anemic and the median UIC was 177.0 µg/l, which was categorized as normal for children. The majority (37.6%) of the respondents had an average cognitive level. Furthermore, the mean for daytime sleepiness based on PDSS score for overall respondents was categorized under an average level that was 14.1 score. In the present research, results found that all of the factors examined in this study were not correlated with respondents’ cognitive function. As the majority of the children had average to low levels of cognitive functions, it is recommended to investigate further factors associated with cognitive functions and, subsequently, to design and deliver appropriate intervention.

Social jetlag among Japanese adolescents: Association with irritable mood, daytime sleepiness, fatigue, and poor academic performance

ABSTRACT Social jetlag, a form of circadian misalignment, has been suggested to induce several clinical symptoms such as mental/physical health problems. However, evidence on the association of social jetlag with general daytime functioning (e.g., school life) is limited. This cross-sectional study aimed to 1) estimate the distribution of social jetlag exceeding one hour and 2) comprehensively explore the associations between social jetlag and irritable mood, daytime sleepiness, and poor academic performance among Japanese adolescents. The study included 4,782 students aged 12–15 years, from 13 junior high schools, who completed a self-administered questionnaire. Social jetlag was calculated as the difference in the midpoint of sleep between weekdays and weekends and was categorized as follow: negative, <1 h, 1–2 h, or ≥2 h. Outcomes were irritable mood, daytime sleepiness, and academic performance, which were analyzed with generalized linear mixed models to examine the relations with social jetlag, with adjustments for potential confounders like sleep quality. The distribution of social jetlag of ≥1 h was 51.1%, including 1–2 h (35.8%) and ≥2 h (15.3%). Its most frequently observed duration was 0 to <1 h (41.0%), followed by negative social jetlag (7.9%). The full adjusted model revealed that social jetlag of ≥1 h was associated with elevated risk of irritable mood, daytime sleepiness, and poor academic performance, while negative social jetlag was associated only with poor academic performance. Social jetlag was highly prevalent among Japanese adolescents and could be a major risk factor for irritable mood, daytime sleepiness, and poor academic performance. Abbreviations: BMI, Body mass index; DLMO, Dim light melatonin onset; CIs, Confidence intervals; MSF, The midpoints of sleep on free days; MSFsc, Sleep-corrected MSF; MSW, The midpoints of sleep on weekdays; PDSS, The Pediatric Daytime Sleepiness Scale.

O048 The CF elephant in the adolescent room: a cross sectional study of sleep and mood in adolescents with cystic fibrosis

Abstract Background Mental health issues are of increasing burden within the adolescent CF population, with known impacts from sleep disturbance. There are limited studies examining mediators of this relationship. We aimed to investigate the relationship between sleep quality and mood in adolescents with CF alongside a range potential mediating factors including socioeconomic and family influences in adolescents. Study Design Adolescents with CF aged 10–18 and their parents at a Victorian tertiary paediatric CF centre were eligible. Adolescents-parent pairs cross sectionally completed age appropriate online questionnaires assessing sleep (Pediatric Daytime Sleepiness Scale, Sleep Disturbance Scale for Children), mood (Global Anxiety Disorder-7, Patient Health Questionnaire-9, Beck’s Depression Inventory, Brigid Jordan CF screen), health-related quality of life (CF Questionnaire-Revised), family dynamics (Family Assessment Device, Family Management Measure), CF respiratory symptoms (CF Respiratory Symptom Score), and treatment adherence. Socioeconomic status and impacts from pandemic lockdowns were also surveyed. Progress to date 45 CF adolescents-parent pairs have been recruited. Questionnaires have been distributed and awaiting return of results for analysis. Intended outcome and impact We anticipate demonstrating the known association between impaired sleep quality and elevated mood scores. We will also make commentary on associations with a range of social factors (family dynamics, socioeconomic status) as well as parental mental health. Discussion will also include impacts on treatment adherence, HRQOL and respiratory symptom scores. Results from this pilot will inform the upcoming AREST CF prospective longitudinal study where the bidirectional relationships between factors studied can be further explored.

O047 Sleep quality and fatigue in children and adolescents with multiple sclerosis

Abstract Background Fatigue is common in children and adolescents with multiple sclerosis (MS) and its aetiology is assumed to be multifactorial, however, its relationship to sleep quality in this population remains unknown. This study aims to examine the prevalence of fatigue and sleep disturbance in this population and their relationship to mood, quality of life, physical activity, and MS disease characteristics. Methods Children with pediatric onset multiple sclerosis (POMS) aged 0–18 were recruited. Subjective sleep quality was assessed by the Pediatric Daytime Sleepiness Scale (PDSS), Sleep Disturbance Scale for Children (SDSC) and OSA-18. All children were referred for polysomnography (PSG) including transcutaneous CO2 and video monitoring. Fatigue was assessed using the PedsQL Multidimensional Fatigue Scale (PedsQL-MFS). Progress to date: Fifteen children with relapsing remitting MS (mean age 15.73±1.44, mean EDSS score 1.11±1.12) have been enrolled to date. 73% of children were fatigued according to the PedsQL-MFS (mean transformed score 52.04). 67% and 60% of children scored higher than the clinical cutoff for the PDSS (17.87) and SDSC (42.73) respectively. However, all children scored within the normal range for the OSA-18 (34.00). To date, eleven children have completed PSG. Intended outcome and impact: This is the first study utilising PSG to objectively assess sleep quality in children with POMS. Findings from this study will document the magnitude of sleep disturbance in this population and have implications for the management of fatigue and other related impairments observed in paediatric MS.

O049 Sleep quality and its impact on children with primary ciliary dyskinesia

Abstract Background PCD is a rare, progressive disease resulting in upper respiratory manifestations and abnormal lung mechanics that increase one’s risk of obstructive sleep apnoea. This study aims to characterise the sleep quality of children with PCD and its impacts on mood and HRQOL. Methods Children with PCD aged 0–19 years with stable respiratory symptoms were recruited. Subjective sleep quality was assessed by the Sleep Disturbance Scale for Children (SDSC), OSA-18, and Paediatric Daytime Sleepiness Scale (PDSS). Mood and depressive symptoms were assessed via QOL-PCD and Children’s Depressive Inventory (CDI) as age-appropriate. Pulmonary function testing was performed via spirometry and Multiple Breath Washout. Patients underwent an ENT assessment. All children completed one night of polysomnography including transcutaneous CO2 and video monitoring. Progress to date: Twenty participants (45% female) have been recruited with a mean age of 8.5 years. Mean (±SD) FEV1 is 76.5±22.9%. 73% of children assessed have chronic rhinosinusitis. Clinically significant scores for SDSC were observed in 79% of patients and in 30% of patients for OSA-18. 38% of children reported clinically significant scores for PDSS. To date, 7 children have completed polysomnography. Intended outcome and impact: This is the first study to characterise sleep quality and the impact of sleep disturbance in Australian children with PCD. We aim to identify clinical markers of poor sleep quality to better inform the development of a sleep screening program for use in paediatric PCD clinics.

Brain tumours result in sleep disorders in children and adolescents

Background and objectivesSleep disturbances are frequently reported in children with brain tumours. The objective of our cross-sectional study was to systematically examine sleep in these children. We hypothesised that children with tumours involving the sleep-wake-regulatory areas have an altered sleep-wake-regulation. MethodsSixty-one patients aged 0–18 years and with a diagnosis of a primary brain or cervical medullary tumour were included. They were categorised based upon tumour location into two groups – those affecting the sleep-wake regulatory regions, i.e. brain stem, basal forebrain, hypothalamus, thalamus, and posterior fossa compressing the brain stem and those that did not. Sleep history, questionnaire surveys, polysomnography, and multiple sleep latency test were used, as indicated clinically. Surveys included Pediatric Daytime Sleepiness Scale, Children's Sleep Habits Questionnaire, Strengths and Difficulties Questionnaire, and Pediatric Quality of Life Inventory, Multidimensional Fatigue Scale and Generic Core Scale. ResultsPatients with tumours involving the sleep-wake regulatory areas were sleepier/more fatigued (p = 0.03). Sleep apnoea was observed in 86% of all the patients and comorbid narcolepsy in 8%, without group differences (p ≥ 0.12). Patients with tumours involving the sleep-wake-regulatory areas had more emotional problems (p = 0.04), were more affected by mental health problems (p < 0.001), and had poorer quality of life (p ≤ 0.03). ConclusionsMany children with brain tumours suffer from disturbed sleep, poor mental health, and low quality of life. We recommend that systematic sleep evaluation is included in their routine care along with psychological and social support.

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.

Evaluating Sleep Disturbances in Children With Rare Genetic Neurodevelopmental Syndromes

BackgroundAdequate sleep is important for proper neurodevelopment and positive health outcomes. Sleep disturbances are more prevalent in children with genetically determined neurodevelopmental syndromes compared with typically developing counterparts. We characterize sleep behavior in Rett (RTT), Angelman (AS), and Prader-Willi (PWS) syndromes to identify effective approaches for treating sleep problems in these populations. We compared sleep-related symptoms across individuals with these different syndromes with each other, and with typically developing controls. MethodsChildren were recruited from the Rare Diseases Clinical Research Network consortium registries; unaffected siblings were enrolled as related controls. For each participant, a parent completed multiple sleep questionnaires including Pediatric Sleep Questionnaire (Sleep-Disordered Breathing), Children's Sleep Habits Questionnaire (CSHQ), and Pediatric Daytime Sleepiness Scale. ResultsSleep data were analyzed from 714 participants, aged two to 18 years. Young children with AS had more reported sleep problems than children with RTT or PWS. Older children with RTT had more reported daytime sleepiness than those with AS or PWS. Finally, all individuals with RTT had more evidence of sleep-disordered breathing when compared with individuals with PWS. Notably, typically developing siblings were also reported to have sleep problems, except for sleep-related breathing disturbances, which were associated with each of the genetic syndromes. ConclusionsIndividuals with RTT, AS, and PWS frequently experience sleep problems, including sleep-disordered breathing. Screening for sleep problems in individuals with these and other neurogenetic disorders should be included in clinical assessment and managements. These data may also be useful in developing treatment strategies and in clinical trials.

Effects of Automated Diurnal Variation in Electronic Screen Temperature on Sleep Quality in Young Adults: A Randomized Controlled Trial

ABSTRACT Objective Determine whether automated changes in electronic screen color temperature of personal electronic devices is associated with changes in objective and self-reported indices of sleep and mental health in young adults, as well as determine feasibility and acceptability of the experimental manipulation. Participants A single-blind randomized controlled trial was conducted at a large public university in the Pacific Northwest region of the United States. Fifty-five participants (female=78%, mean age=19.45 years) who reported using a smartphone and/or laptop computer two hours before bedtime were randomized into either an experimental group (EG; n=29) or active control group (ACG; n=26). Methods Both the EG and ACG had installed on their devices a piece of software that automatically lowers the color temperature of these devices’ screens as the day progresses (“f.lux”). However, only the EG had the blue-light-reducing features activated, and participants were blind to condition. Before and after the one-week long experimental manipulation period, participants completed the Pittsburgh Sleep Quality Index (PSQI), Pediatric Daytime Sleepiness Scale (PDSS), Pre-Sleep Arousal Scale (PSAS), and Patient Health Questionnaire (PHQ) and wore an actiwatch for seven consecutive nights. Results Participants in the EG did not show greater improvement in objective sleep, self-reported sleep, or mental health compared to participants in the ACG. Participants in the EG rated the software as more distracting and purposely disabled the software more often compared to participants in the ACG. Conclusions Automated diurnal variation in electronic screen temperature in personal devices did not improve sleep or mental health in young adults.

Social Jetlag and Excessive Daytime Sleepiness from a Sample of Russian Children and Adolescents.

PurposeInsufficient nocturnal sleep is a primary source of excessive daytime sleepiness. Most previous research has focused on the disparity between sleep demands and study start times in adolescents. Fewer studies have focused on elementary schoolchildren. We hypothesize that late sleep timing is connected to excessive daytime sleepiness in a sample of Russian children and adolescents. The major goals of our study were to evaluate excessive daytime sleepiness in Russian schoolchildren and adolescents using the Russian version of the Pediatric Daytime Sleepiness Scale (PDSS) and to estimate its relationship with sleep-wake parameters using the Munich Chronotype Questionnaire (MCTQ).Materials and MethodsStudent subjects were from public educational facilities in the Republic of Karelia. They completed both the PDSS and the Munich Chronotype Questionnaire to estimate sleep parameters and chronotype (MSFsc). Five hundred and eleven students provided data for the PDSS and sleep-wake variables, and 479 for the full MCTQ data.ResultsThe overall prevalence of Excessive Daytime Sleepiness (EDS) in our sample was 18%. The total PDSS score was inversely correlated with sleep length on school nights and was independent of respondents’ sex. Higher PDSS scores were associated with later bedtimes on school days and free days, and shorter sleep duration on school days. Late chronotype and more pronounced social jetlag were both positively correlated with high PDSS scores. A negative correlation was found between chronotype and the duration of the sleep period on weekdays (p < 0.001) and a positive correlation was found on weekends (p < 0.001). Longer average sleep duration was positively related to less daytime sleepiness.ConclusionThis study suggests that excessive daytime sleepiness is chronotype-dependent. School start times could be shifted to a later hour to prolong sleep and reduce EDS.

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.

Daily light exposure, sleep–wake cycle and attention in adolescents from different urban contexts

Objectiveto compare daily light exposure, activity-rest rhythm, sleep–wake cycle (SWC) and attention in Brazilian students living in different levels of urbanization. Methods115 adolescents (74 girls), aged 14–18 years (mean 15.5 ± 0.7 years), from the first years of high school have participated. The SWC was evaluated by actimetry and a Sleep Diary for 10 days. Besides, the “Health and Sleep” Questionnaire, the Morningness and Eveningness Scale for adolescents, the Pittsburgh Sleep Quality Index, and the Pediatric Daytime Sleepiness Scale were answered. Attention was assessed by a Continuous Performance Task. ResultsIn the less urbanized region, there were a greater exposure to light during the day accompanied by a higher proportion of morning-types and less occurrence of excessive daytime sleepiness. Otherwise, in the more urbanized region, adolescents showed a trend to sleep less in weekdays and presented more irregularity in sleep duration between weekdays and weekend, with 83 ± 15% of sleep efficiency, 01:04 ± 1:30 h of WASO and 7 ± 6.7 awakenings per night on the weekdays, suggestive of poor sleep quality. Despite of this, they showed better attentional performance: more correct responses (tonic and phasic alertness, and sustained attention) and less omissions (for all components). Regardless of the degree of urbanization, there was partial sleep deprivation, irregular sleep schedules and poor sleep quality in adolescents. ConclusionsThe daily light exposure and activity-rest profiles, SWC and attention in adolescents varied according to the degree of urbanization. Besides, the negative impacts of early school starting times leading to sleep deprivation, irregular sleep times and poor sleep quality were observed irrespective of the degree of urbanization, reinforcing that the early school starting time at morning is a strong temporal challenge for teenagers, having negative impacts on cognition and academic performance.

A Longitudinal Study of Subjective Daytime Sleepiness Changes in Elementary School Children Following a Temporary School Closure Due to COVID-19.

Excessive daytime sleepiness is increasingly being recognized as a major global health concern. However, there have been few studies related to sleepiness and its associated factors in elementary school children. In Japan, all schools were closed from February to May 2020 to prevent coronavirus disease 2019 (COVID-19) outbreaks. The aim of this study was to identify changes in the subjective sleepiness of pupils during the 1.5-year period and to elucidate factors associated with changes in sleepiness. Questionnaire surveys about pupils’ sleep habits and the Japanese version of the Pediatric Daytime Sleepiness Scale (PDSS-J) were conducted longitudinally at one elementary school in June 2019, January 2020, and June 2020. The average ∆PDSS score was 0.94 ± 5.51 (mean ± standard deviation) from June 2019 to January 2020 and −1.65 ± 5.71 (t[498] = 6.13, p < 0.01) from January 2020 to June 2020. Univariate and multivariate logistic regression analyses revealed that decreasing social jetlag was associated with decreasing PDSS scores (OR = 0.77, 95% CI: 0.62–0.96, p = 0.02) during the school closure. A less restrictive school schedule secondary to a COVID-19-related school closure decreased sleepiness in children and was associated with decreasing social jetlag.

Sleep, academic achievement, and cognitive performance in children with attention-deficit hyperactivity disorder: A polysomnographic study.

The objective of this study was to examine the influence of parent-reported and polysomnography (PSG)-measured sleep patterns on the academic and cognitive performance of children with attention-deficit hyperactivity disorder (ADHD). We assessed 91 children (18 girls) diagnosed with ADHD aged 7-11years (29 ADHD-Inattentive, 32 ADHD-Hyperactive/Impulsive, and 31 ADHD-Combined). The Paediatric Sleep Questionnaire (PSQ) and Paediatric Daytime Sleepiness Scale (PDSS) were used to assess subjective sleep quality, as perceived by parents, and objective sleep variables were assessed by PSG. Cognitive performance was evaluated using the Wechsler Intelligence Scale for Children (WISC), and the final average grade of the last school year was used as a measure of academic performance. Academic performance was predicted by the following sleep variables: Sleep time, time in bed, night awakenings, and daytime sleepiness. The best predictors of cognitive performance in children with ADHD were rapid eye movement latency, light sleep, periodic limb movements index (PLMs), awakenings, and daytime sleepiness. In conclusion, sleep parameters are closely associated with the academic and cognitive functioning of children with ADHD.