Adolescent Sleepiness Research Articles

Subjective and objective daytime sleepiness in schoolchildren and adolescents: results of a community-based study

ObjectivesWe aimed to assess subjective and objective sleepiness in schoolchildren and adolescents by using questionnaires and the Pupillographic Sleepiness Test (PST). MethodsAn observational, cross-sectional, community-based study was performed. Participants were recruited and balanced by age and gender from schools using stratified random sampling. Sleep problems and subjective sleepiness were assessed using parent- and self-reported questionnaires. Objective sleepiness was assessed in schools under standardized conditions by using the PST and by calculating the natural logarithm of the pupillary unrest index (lnPUI). ResultsIn total 163 children (82 boys; age range, 6.6–17.8years) were enrolled. Age and sleep problems were predictors of subjective sleepiness. Nine PST recordings (5.5%) were excluded due to artifacts (feasibility, 94%). Gender, sleep problems, and sleep duration were predictors of objective sleepiness. Compared to adults (age range, 20–60years), the lnPUI was higher in children (mean±standard deviation [SD], 1.5±0.4 vs 2.0±0.4; P<.001) and showed significant gender differences. There was no agreement between measures of subjective sleepiness and the lnPUI (r<0.3). After excluding children with sleep problems, preliminary reference values (mean±SD) for the lnPUI were 2.01±0.43 for boys and 1.93±0.43 for girls, respectively. ConclusionsThe PST is a feasible method in schoolchildren and adolescents. Sleep problems are predictors of both subjective and objective sleepiness; there is no agreement between the latter. Results of the PST are influenced by sleep duration and specific pediatric gender-stratified reference values are definitively needed.

The relationships between asthma control, daytime sleepiness, and quality of life among children with asthma: a path analysis

We aimed to examine the relationships between asthma control, daytime sleepiness, and asthma-specific health-related quality of life (HRQOL) among children with asthma. Path analyses were conducted to test if daytime sleepiness can mediate the effect of asthma control status on asthma-specific HRQOL. 160 dyads (pairs) of asthmatic children and their parents were collected for analyses. The Asthma Control and Communication Instrument (ACCI) was used to categorize adequate and poor asthma control status. The Cleveland Adolescent Sleepiness Questionnaire (CASQ) was used to measure children's daytime sleepiness, including sleep in school, awake in school, sleep in evening, and sleep during transport. The Patient-Reported Outcomes Measurement Information System (PROMIS) Asthma Impact Scale was used to measure asthma-specific HRQOL. Poorly controlled asthma was associated with daytime sleepiness and impaired asthma-specific HRQOL. Asthma control status was directly associated with asthma-specific HRQOL (P<.05), whereas sleep in school and sleep in evening domains of daytime sleepiness significantly mediated the relationship between poor asthma control and impaired HRQOL (P<.01). Asthma control status was associated with pediatric asthma-specific HRQOL, and the association was significantly mediated by daytime sleepiness. Healthcare providers need to address pediatric sleep needs related to poor asthma control to reduce the negative impact on HRQOL.

EXCESSIVE DAYTIME SLEEPNESSAND CARDIOMETABOLIC RISK FACTORS IN CHILDREN AND TEENAGERS WITH OVERWEIGHT

Introdução: atualmente, é observada tendência exacerbada para sonolência diurna excessivaem crianças e adolescentes com excesso de peso. A obesidade e os distúrbios do sono, têmefeito conjunto nas doenças cardiovasculares e no diabetes mellitus. Objetivo: avaliar aprevalência de sonolência diurna excessiva e sua associação com fatores de riscocardiometabólicos. Método: estudo de corte transversal realizado em serviço público, referênciaem atendimento a crianças e adolescentes com excesso de peso no período de junho de 2011a março de 2013, em Campina Grande/PB. A amostra foi composta por 140 crianças e adolescentesde cinco a 18 anos. Foi realizada antropometria, aferida a pressão arterial, aplicado questionáriosobre hábitos do sono, Escala de Sonolência de Epworth e realizados exames laboratoriais(perfil lipídico, glicemia, insulina, HOMA-RI, hemoglobia glicada, proteína C-reativa ultrassensívele leptina). Os dados foram analisados pelo SPSS (v.17), através dos testes do Qui-quadrado, devariância e da correlação de Pearson, com nível de significância de 5%. Resultados: A prevalênciade sonolência diurna excessiva foi de 19,3% e foi maior nas meninas. naqueles com SDE foiobservado maior percentual de alteração nos níveis de LDL, HbA1c e PCR-u, porém sem significânciaestatística. Conclusões: a presença de sonolência na amostra estudada foi prevalente e a aquelescom esta condição apresentaram resultados metabólicos menos favoráveis.

Subjective Sleepiness and Sleep Quality in Adolescents are Related to Objective and Subjective Measures of School Performance

This study investigated the relation between sleep and school performance in a large sample of 561 adolescents aged 11–18 years. Three subjective measures of sleep were used: sleepiness, sleep quality, and sleep duration. They were compared to three measures of school performance: objective school grades, self-reported school performance, and parent-reported school performance. Sleepiness – “I feel sleepy during the first hours at school” – appeared to predict both school grades and self-reported school performance. Sleep quality on the other hand – as a measure of (un)interrupted sleep and/or problems falling asleep or waking up – predicted parent-reported school performance. Self- and parent-reported school performance correlated only moderately with school grades. So it turns out that the measures used to measure either sleep or school performance impacts whether or not a relation is found. Further research on sleep and school performance should take this into account. The findings do underscore the notion that sleep in adolescence can be important for learning. They are compatible with the hypothesis that a reduced sleep quality can give rise to sleepiness in the first hours at school which results in lower school performance. This notion could have applied value in counseling adolescents and their parents in changing adolescents’ sleep behavior.

Are educational interventions able to prevent excessive daytime sleepiness in adolescents?

This study evaluated the effect of an educational sleep program (ESP) on adolescent sleep patterns and daytime sleepiness. Twenty-one adolescents (13–14 years old) participated in the study. Two groups were formed: experimental (n = 10), subjected to the educational program for sleep (EPS); and Control (n = 11), not subjected to the EPS. Sleep/wake cycle (SWC) data were recorded with actigraphy; subjective sleepiness levels and psychomotor performance were assessed before and after the ESP. The data on sleep patterns, psychomotor performance and subjective sleepiness levels were compared by two-way ANOVA for dependent samples; treatment (before vs. after intervention) and group (control vs. experimental) were considered factors. The results did not show any EPS effect on the adolescents' sleep/wake patterns, subjective sleepiness levels or psychomotor performance. Further studies with different ESPs and ESP strategies should be carried out to evaluate the validity of such programs as a countermeasure to prevent excessive daytime sleepiness among adolescents.

The impact of increasing sleep restriction on cortisol and daytime sleepiness in adolescents

Sleep restriction is a widespread phenomenon, specifically in adolescents. This study investigated the impact of increasing sleep restriction in adolescents on cortisol levels and daytime sleepiness. Eighty-eight healthy adolescents were randomized to five sleep restriction protocols (four consecutive nights with 9, 8, 7, 6, or 5 h time in bed). Polysomnography (baseline and last experimental night) and multiple sleep latency test (day 6) data were obtained. Saliva cortisol levels were assessed half-hourly in the evening before and in the morning after the baseline and the last experimental night. Four nights of sleep restriction in healthy adolescents lead to a linear increase of objective sleepiness, but had no significant effect on evening or morning cortisol levels. The lack of detrimental effects of sleep restriction on cortisol levels might be due to compensation mechanisms during sleep.

Efficacy of modafinil on excessive daytime sleepiness in Prader–Willi syndrome

Excessive daytime sleepiness is a frequent and a highly disruptive symptom to the daily routine of children with Prader-Willi Syndrome (PWS) and their families. The objective of the study was to evaluate the efficacy of modafinil, a central stimulant, on excessive daytime sleepiness in children and adolescents with PWS. The efficacy of modafinil was evaluated in this open label pilot study comparing the Epworth sleepiness scale before and after treatment. Ten patients with molecularly confirmed PWS and a complaint of excessive daytime sleepiness underwent a night-time sleep recording and multiple sleep latency tests. One patient was excluded because of severe obstructive sleep apnea syndrome. Nine patients (4 males) with median age of 16 years (8-21) received modafinil at a starting dose of 100 mg/day. We found that all patients had excessive daytime sleepiness with an Epworth sleepiness scale at 14 (11-20) and mean sleep latency on multiple sleep latency tests at 5 (3-6) minutes. Moreover, six patients had at least two sleep-onset rapid eye movement periods showing a narcolepsy-like phenotype. Modafinil significantly improved sleepiness in all patients on the Epworth sleepiness scale from 14 (11-20) to 4 (3-12), (P = 0.007). Body mass index of the patients did not change significantly under treatment. No side effects were reported, and the drug was well-tolerated. We posit that this open label case series shows good efficacy of modafinil in nine children and adolescents with PWS.

P03-389 - An evaluation study of the Epworth sleepiness scale adapted for children and adolescents: a tool for case finding of pediatric excessive daytime sleepiness (EDS)

Child and adolescent sleepiness is an important public health issue with potentially serious consequences on attention, learning, behaviour, and quality of life. For some individuals, sleepiness may be due to a sleep disorder which requires clinical investigation and subsequent treatment. A reliable measure of child and adolescent sleepiness is needed and a version of the Epworth Sleepiness Scale has been adapted for use in child and adolescent populations.The adapted Epworth Scale is a questionnaire which aims to identify the chance of falling asleep in 10 different situtations. This questionnaire is normally used in a clinical context as a diagnostic tool. The objective of this study was to investigate whether the adapted Epworth Scale could be used to screen for sleep disorders in a similar manner to the adult scale. This presentation describes a validation study of the adapted Epworth Scale in a population of college students. 9,005 Parisian college students (50.4% female) completed an on-line questionnaire. The mean age was 12.7 years (sd = 1.35). The response rate was greater than 95% for each item of the adapted Epworth score. The mean score was 8.6 / 30 (sd = 4.62).We suggest that the adapted Epworth Scale could be used as a tool for case finding of excessive daytime sleepiness in schools. If the adapted scale is to be used for this purpose, subjects with high scores should be offered investigation to exclude underlying sleep disorders such as narcolepsy, primary hypersomnia or ADHD.

256 - Daytime sleepiness in children and adolescents across the weight spectrum

256 - Daytime sleepiness in children and adolescents across the weight spectrum

The Effect of Presleep Video-Game Playing on Adolescent Sleep

Video-game use before bedtime has been linked with poor sleep outcomes for adolescents; however, experimental evidence to support this link is sparse. The present study investigated the capacity of presleep video-game playing to extend sleep latency and reduce subjective feelings of sleepiness in adolescents. The arousing psychophysiologic mechanisms involved and the impact of presleep video-game playing on sleep architecture were also explored. Thirteen male adolescent "evening types" (mean age = 16.6 years, SD = 1.1) participated in a counterbalanced, within-subjects design with experimental (active video gaming) and control (passive DVD watching) conditions. The experiment was conducted in the Flinders University Sleep Research Laboratory. Relative to the control condition, presleep video-game playing increased sleep-onset latency (Z= 2.45, p= .01) and reduced subjective sleepiness (Z = 2.36, p = .02)-but only slightly. Video gaming was related to changes in cognitive alertness (as measured by a power: p < 0.01) but not physiologic arousal (as measured by heart rate: p > 0.05). Contrary to previous findings, sleep architecture was unaffected (both rapid eye movement and slow wave sleep: p > 0.05). Results suggest the direct effect of presleep video-game playing on adolescent sleep may be more modest than previously thought, suggesting that surveys linking stimulating presleep activities to poor sleep need substantiating with empirical evidence.

Sonolência diurna excessiva em adolescentes: prevalência e fatores associados

OBJETIVO: Analisar pesquisas sobre sonolência diurna excessiva em adolescentes e apresentar, por meio de revisão sistemática, as prevalências e os fatores associados. FONTES DE DADOS: Foram analisados estudos encontrados nas bases de dados PubMed e SciELO, que apresentassem resultados originais, sem restrições de período e idioma na pesquisa. SÍNTESE DOS DADOS: A prevalência de sonolência diurna excessiva encontrada variou entre 7,8 e 55,8%. As escalas Epworth Sleepiness Scale e a School Sleep Habits Survey foram os principais instrumentos utilizados. Associações da sonolência diurna excessiva com problemas relacionados ao sono, como o ranger de dentes, apneia e insônia, dentre outros, foram descritas com maior frequência nos estudos analisados. A associação de outros possíveis fatores de cunho biológico, ambiental e comportamental com a sonolência diurna excessiva não foi descrita com clareza. CONCLUSÕES: Vários fatores, como o comportamento sedentário e hábitos alimentares, foram pouco investigados e apresentaram resultados divergentes quando analisados como variáveis associadas à sonolência diurna excessiva. Uma carência de investigações epidemiológicas com amostras brasileiras foi identificada

Adolescents and Emerging Adults' Sleep Patterns: New Developments

Adolescents and Emerging Adults' Sleep Patterns: New Developments

Family Disorganization, Sleep Hygiene, and Adolescent Sleep Disturbance

The link between sleep hygiene and adolescent sleep is well documented, though evidence suggests contributions from other factors, particularly the family environment. The present study examined whether sleep hygiene mediated the relationship between family disorganization and self-reported sleep onset latency, total sleep time, and daytime sleepiness in adolescents. Participants were 217 adolescents, aged 13 to 18 (M = 14.9, SD = 1.0) years, (43% male), recruited from four high schools in South Australia. Sleep hygiene fully mediated the relationship between family disorganization and sleep onset latency (z = 2.77, p < .01) and daytime sleepiness (z = 3.47, p < .01). Only partial mediation was evident for total sleep time (z = 2.50, p < .05). These findings suggest that consideration should be given to the family environment when assessing sleep disturbance in adolescents, and subsequently implementing interventions.

Internet overuse and excessive daytime sleepiness in adolescents

The purpose of this study was to examine the association of Internet overuse with excessive daytime sleepiness (EDS). A total of 2336 high school students in South Korea (boys, 57.5%; girls, 42.5%) completed the structured questionnaire. The severity of Internet addiction was evaluated using Young's Internet addiction test. The proportions of boys who were classified as Internet addicts and possible Internet addicts were 2.5% and 53.7%, respectively. For girls, the corresponding proportions were 1.9% and 38.9%, respectively. The prevalence of EDS was 11.2% (boys, 11.2%; girls, 11.1%). When Internet addicts were compared with non-addicts, they consisted of more boys, drank alcohol more, and considered their own health condition as poor. But smoking was not related with Internet addiction. The prevalence rate of EDS for Internet addicts was 37.7%, whereas that for possible Internet addicts and non-addicts was 13.9% and 7.4%, respectively. The prevalence of insomnia, witnessed snoring, apnea, teeth grinding, and nightmares was highest in Internet addicts, middle in possible addicts, and lowest in non-addicts. With adjustment for duration of Internet use, duration of sleep time, age, gender, smoking, taking painkillers due to headache, insomnia symptoms, witnessed apnea, and nightmares, the odds of EDS were 5.2-fold greater (95% confidence interval [CI]: 2.7-10.2) in Internet addicts and 1.9-fold greater (95%CI: 1.4-2.6) in possible Internet addicts compared to non-addicts. Internet addiction is strongly associated with EDS in adolescents. Clinicians should consider examining Internet addiction in adolescent cases of EDS.

Relationships Among Sleepiness, Sleep Time, and Psychological Functioning in Adolescents

This study examined associations among adolescent sleepiness, sleep duration, variability in sleep duration, and psychological functioning (symptoms of anxiety, depression, externalizing behaviors, and perceived health). This was a cross-sectional analysis of data from a community-based cohort study of sleep and health. Participants were 247 adolescents (48.6% female, 54.3% ethnic minority, mean age of 13.7 years). Sleep duration and variability in sleep duration were measured by actigraphy and sleepiness was measured by adolescent questionnaire. Primary outcomes were measured by parent, teacher, and adolescent questionnaires. Sleepiness was associated with higher scores on measures of anxiety (Adjusted partial r(2) = .28, p < .001), depression (Adjusted partial r(2) = .23, p < .001), and perceived health (indicating more negative outcomes) (Adjusted partial r(2) = .19, p < .01). Significant associations between sleep duration or variability in sleep duration with psychological variables were not found. Findings highlight the inter-relationships between sleepiness and psychological functioning and the potential importance of addressing sleepiness in health and psychological evaluations of adolescents.

Insomnia, Sleepiness, and Depression in Adolescents Living in Residential Care Facilities

The main objective of this study was to document sleep patterns and disturbances reported by youths temporarily living in residential care facilities. A secondary objective was to examine the relationships between sleep disturbances and mood and daytime sleepiness. A self-reported questionnaire on sleep patterns and habits assessing duration, frequency, and consequences of sleep difficulties, the Beck Depression Inventory-2, and the Epworth Sleepiness Scale were administered to a sample of 66 adolescents. Results suggest a high rate of sleep disturbances in this sample, with 41% reporting insomnia symptoms and 21% meeting diagnostic criteria for an insomnia syndrome. Those with more severe insomnia syndrome showed more severe depressive symptoms and daytime consequences.

Associations of executive function with sleepiness and sleep duration in adolescents.

Sleep deprivation and sleepiness are associated with poorer school performance, impaired neurobehavioral functioning, and behavioral problems. To determine if adolescents with high levels of sleepiness or short sleep duration have impaired executive functioning. Ours was a cross-sectional analysis of data from 236 healthy adolescents in a community-based cohort study. Sleepiness was measured by using a modified version of the Epworth Sleepiness Scale. Participants underwent 5- to 7-day wrist actigraphy at home before overnight polysomnography. Exposure variables were excessive sleepiness (Epworth Sleepiness Scale > or = 11) and weekday mean sleep duration. The main outcome measures were the global executive composite scale from the Behavior Rating Inventory of Executive Function and the tower test-total achievement score from the Delis-Kaplan Executive Functioning System. Participants (N = 236) were 13.7 +/- 0.8 years of age, and 52.1% were boys. Mean weekday sleep duration was 7.70 +/- 1.03 hours; 11% slept <6.5 hours on average on weekdays, and 26% reported excessive sleepiness. In unadjusted analyses, sleepy adolescents had poorer executive functioning on the Behavior Rating Inventory of Executive Function global executive composite scale and the Delis-Kaplan Executive Functioning System tower test-total achievement. Analyses adjusted for potential confounders resulted in a modest attenuation of the association with the Behavior Rating Inventory of Executive Function and a larger attenuation for the Delis-Kaplan Executive Functioning System. Caregiver education modified the association between sleepiness and the Behavior Rating Inventory of Executive Function outcomes. Among sleepy adolescents, those with less-educated caregivers had greater impairment on the Behavior Rating Inventory of Executive Function global executive composite scale. Sleep duration was not significantly associated with executive functioning outcomes. Decrements in selected executive function scales are associated with subjective sleepiness, but not sleep duration, in adolescents. The association between sleepiness and executive functioning is strongest among adolescents with primary caregivers who have lower levels of education, suggesting an increased susceptibility. Pediatricians and public health officials should consider sleepiness as a potentially important contributor to adolescent functioning.

Sleep patterns and daytime sleepiness in adolescents and young adults with Williams syndrome

Sleep disorders are common in individuals with neurodevelopmental disorders and may adversely affect daytime functioning. Children with Williams syndrome have been reported to have disturbed sleep; however, no studies have been performed to determine if these problems continue into adolescence and adulthood. This study examined overnight sleep patterns and daytime sleepiness in 23 adolescents and adults with Williams syndrome age 25.5 (8.0) years [mean (SD)]. Interviewer-administered sleep questionnaires were used to evaluate nighttime sleep behaviours and daytime sleepiness. Wrist actigraphy was used to evaluate sleep patterns. Although individuals in our sample averaged 9 h in bed at night, daytime sleepiness and measures of sleep disruption were common and comparable to those of other populations with neurodevelopmental disorders. These measures included reduced sleep efficiency [74.4 (7.0)%] with prolonged sleep latency [37.7 (37.3) min], increased wake time after sleep onset [56.1 (17.6) min], and an elevated movement and fragmentation index [14.3 (4.6)]. Adolescents and young adults with Williams syndrome were found to be sleepy despite averaging 9 h in bed at night. Implications are discussed for associated causes of sleep disruption and future polysomnographic evaluation.

The Cleveland Adolescent Sleepiness Questionnaire

Developed the Cleveland Adolescent Sleepiness Questionnaire (CASQ), a brief, self-completed instrument to measure excessive daytime sleepiness in adolescents. Cross-sectional analysis. A subsample of 411 adolescents 11-17 years of age recruited from area schools, churches, and "control" participants in a sleep disordered breathing cohort study; a second subsample of 62 adolescents with diagnosed sleep disordered breathing also participating in the sleep disordered breathing study. Participants completed the CASQ along with two other available measures of daytime sleepiness and other sleep parameters (sleep duration on school nights, sleep duration on non-school nights, and sleep debt, defined as non-school night sleep duration minus school-night sleep duration). Demographic information was obtained from a caregiver-completed questionnaire. The CASQ was developed using exploratory factor analysis, followed by confirmatory factor analysis using structural equation modeling techniques. Goodness-of-fit measures for the final 16-item scale structure ranged from good to excellent. The CASQ's internal consistency was good (alpha = 0.89). Correlations between the CASQ, two other measures of daytime sleepiness, and sleep parameters gave preliminary evidence of the CASQ's construct validity. The CASQ shows promise as a valid measure of daytime sleepiness in adolescents.

Excessive Sleepiness in Adolescents and Young Adults: Causes, Consequences, and Treatment Strategies

Adolescents and young adults are often excessively sleepy. This excessive sleepiness can have a profound negative effect on school performance, cognitive function, and mood and has been associated with other serious consequences such as increased incidence of automobile crashes. In this article we review available scientific knowledge about normal sleep changes in adolescents (13-22 years of age), the factors associated with chronic insufficient sleep, the effect of insufficient sleep on a variety of systems and functions, and the primary sleep disorders or organic dysfunctions that, if untreated, can cause excessive daytime sleepiness in this population.