The Association of Sleep Duration with Grade Point Averages and Absences Among 9th Graders in Georgia, USA.

This study aimed to examine the association between sleep measures (self-reported sleep duration and weekend catch-up sleep) and grade point average (GPA) and absences among 9th grade students from two racially and economically diverse high schools in a semi-rural county of north-central Georgia. Linear and Poisson regression models estimated the association between sleep measures and GPA and absences (separately), respectively. Analyses adjusted for gender, race/ethnicity, free/reduced-price school lunch status, and parental education. Sleep duration was significantly associated with both GPA and absences, such that for every one additional hour of sleep, GPA increased by 0.8 percentage points (b=0.8, 95% CI:0.1,1.5) while the number of absences was lower by 6% (b=-0.05; OR=0.94, 95% CI:0.91,0.98). Weekend catch-up sleep was also significantly and positively associated with absences (b=0.04; OR=1.04, 95% CI; 1.02, 1.07). Increasing sleep may be a strategy to improve GPA and reduce absences among teenagers. Future research should identify effective measures to lengthen sleep.

Neighborhood Disadvantage Is Associated with Lower Quality Sleep and More Variability in Sleep Duration among Urban Adolescents.

Differential social and contextual environments may contribute to adolescent sleep disparities, yet most prior studies are limited to self-reported sleep data and have not been conducted at a national level, limiting the variation in neighborhood contexts. This study examined the association between neighborhood disadvantage and objective measures of adolescent sleep. A racially and geographically diverse sample of American adolescents (N = 682) wore wrist-worn accelerometers, "actigraphs," for ≥ 5 nights. Neighborhood disadvantage was calculated using a standardized index of neighborhood characteristics (proportion of female-headed households, public assistance recipients, households in poverty, adults without high school degrees, and unemployed). Adolescents in more disadvantaged neighborhoods spent more time awake after falling asleep (4.0 min/night, p < .05), a greater percentage of nighttime sleep intervals awake (1%, p < .01), and had less consistent sleep duration (11.6% higher standard deviation, p < .05). Sleep duration and timing did not differ across neighborhood groups. These findings demonstrate that adolescents who live in more disadvantaged neighborhoods have lower quality, less consistent sleep.

Drowsy driving and teen motor vehicle crashes: Impact of changing school start times.

INTRODUCTION: Motor vehicle crashes (MVC) are the second leading cause of death for adolescents in the United States, with drowsy driving a major contributing factor. Early school start times have been identified as a significant factor that reduces adolescent sleep duration, which in turn contributes to drowsy driving and MVC. This paper examined the longitudinal impact of delaying secondary school start times on self-reported student drowsy driving and teen MVC. METHODS: Secondary school students (10th and 11th grade, 51.7% female, 67.8% White) in the United States completed annual surveys 1 year before and 2 years after implementation of later school start times (70-min delay, n range 1642-2452 per year), reporting frequency of drowsy driving (less than once/week vs. at least once/week). Teen (16-18 years) MVC data from the Colorado Department of Transportation for the 2 years before and 2 years after later start time implementation were compared for Arapahoe County (where start times changed) and neighboring Adams County and Douglas County (where start times did not change). RESULTS: With later start times, there was a significant drop in the percent of students who reported frequent drowsy driving (pre-change: 32.6%, post-change: 21.9%, follow-up: 22.8%). Weekday teen MVC rates went down in Arapahoe County (p = .04) during the school year, while no change or increases in MVC rates were seen in neighboring counties. CONCLUSIONS: Healthy school start times are important for adolescent health and safety, with study findings highlighting the downstream effects of increased sleep duration following a 70-min delay in secondary school start times on adolescent drowsy driving and teen MVC rates.

Parenting Behaviors and Family Conflict as Predictors of Adolescent Sleep and Bedtime Media Use.

Inadequate sleep in adolescents has been linked to an increase in screen-based media use, especially at bedtime. Parents can play a critical role in regulating adolescent media use and promoting healthy sleep, yet few studies have evaluated parental effects on these outcomes. This study examined the effects of general and media-specific parenting behaviors and family conflict on adolescent sleep outcomes, both directly and indirectly through bedtime media use. Data were collected from 345 middle-schoolers (Mage = 12.65 ± 0.67 years; 47% female; 59% White) at two time points, six months apart. The findings revealed that parental involvement had a significant positive effect on sleep duration that was mediated by bedtime media use. Family conflict had a direct positive effect on daytime sleepiness. Adolescent sleep interventions could benefit from a parenting component focused on positive involvement and fostering a family climate conducive to sleep.

A daily diary study of sleep chronotype among Mexican-origin adolescents and parents: Implications for adolescent behavioral health.

The current study used daily assessments of sleep to examine stability and change in sleep chronotype in adolescents and their parents. The study assessed adolescent sleep chronotype according to age, gender, and parent chronotype, and evaluated its associations with emotional and behavioral problems in youth. Participants included of 417 Mexican American adolescents (Mage = 16.0 years, Range = 13.9-20.0) and 403 caregivers, who reported bed and wake times daily for 2 consecutive weeks at two time points spaced 1 year apart. In addition, adolescents completed established self-report questionnaires of emotional and behavioral problems. Chronotype was computed as the midsleep point from bed to wake time on free days, correcting for sleep debt accumulated across scheduled days. Multilevel modeling showed a curvilinear association between adolescent age and chronotype, with a peak eveningness observed between ages 16 to 17. Adolescent and parent chronotypes were contemporaneously correlated, but each was only moderately stable over the 1-year period. Later adolescent chronotype was contemporaneously associated with more substance use in all adolescents. Individual development and the family context shape sleep chronotype in adolescents and parents. Sleep chronotype is implicated in adolescent behavioral health.

Investigating the association between sleep quality and diffusion-derived structural integrity of white matter in early adolescence.

INTRODUCTION: Poor sleep quality has been linked to reduced neural connectivity through decreased white matter (WM) structural integrity. WM tract development has been shown to continue throughout adolescence with studies reporting positive correlations between diffusion-derived estimates of structural integrity and reduced sleep quality in adult samples. Few studies have investigated this relationship exclusively within a sample of young adolescents. METHODS: N = 51 participants aged 12 years (M = 151.5 months, SD = 4 months) completed a self-report questionnaire which included the Pittsburgh Sleep Quality Index (PSQI) and underwent Diffusion Tensor Imaging (DTI) as part of their baseline assessment in the Longitudinal Adolescent Brain Study (LABS) being undertaken in Queensland, Australia. Fractional anisotropy (FA) were extracted using Tract-Based Spatial Statistics (TBSS) to investigate associations between sleep quality and WM integrity across the brain. RESULTS: Significant correlations were found between the posterior limb of the internal capsule and the PSQI total sleep quality and sleep latency scores. There was also a significant difference in sleep duration between male and female participants. CONCLUSION: These findings provide an important insight of the impact that sleep may have on early adolescent WM development. Ongoing longitudinal assessment of sleep on WM development across adolescence is likely to provide further important information about how WM maturation relates to variations in sleep quality as circadian rhythm changes occur during middle and late adolescence.

So Much to Do Before I Sleep: Investigating Adolescent-Perceived Barriers and Facilitators to Sleep.

Adolescent sleep deprivation is a pressing public health issue in the United States as well as other countries. The contexts of adolescents' lives are changing rapidly, but little is known about the factors that adolescents themselves believe affect their sleep. This study uses a social-ecological framework to investigate multiple levels of perceived influence on sleep patterns of urban adolescents. Data were drawn from interviews and surveys conducted in three California public high schools. Most participants identified homework as their primary barrier to sleep, particularly those engaged in procrastinating, multitasking, or those with extracurricular demands. Results indicate that the home context has important implications for adolescent sleep, including noise, household rules, and perceived parent values. These findings identify important areas for future research and intervention, particularly regarding the roles of parents.

Adolescents who perceive fewer consequences of risk-taking choose to switch off games later at night.

AIM: Technology use by adolescents close to bedtime commonly leads to sleep problems, and individual factors predicting those at heightened risk are under studied. We investigated whether risk-taking perceptions influenced length of adolescent technology use at bedtime and whether being aware of time moderated this association. METHODS: We recruited 16 males and five females, with a mean age of 17.6 years, from school and university populations to assess adolescent technology use and bedtimes. They were assessed for trait risk-taking using the Cognitive Appraisal of Risky Events questionnaire and had unrestrained access to a video game on two separate nights, counterbalanced for clock present or clock absent conditions. The adolescents' self-selected bedtime provided a measure of the level of technology use and was the dependent variable. RESULTS: Adolescents who perceived fewer negative consequences of risky activities on the Cognitive Appraisal of Risky Events played the video game longer and went to bed later than those who perceived more negative consequences (p = 0.03). There was no influence on bedtimes from perceived benefits of risk-taking or clock presence. CONCLUSION: Adolescents who perceived fewer negative consequences of risk-taking were more likely to stay up later using technology, facing a heightened risk of displaced sleep.

Multidimensions of sleep health among in-school adolescents in rural and urban areas in southwestern Nigeria.

INTRODUCTION: Previous studies have focused on sleep inequities among disadvantaged populations in high-income countries. However, little is known about the differences in sleep health among adolescents in Africa. We aimed to compare the multidimensions of sleep health in adolescents living in rural vs. urban communities in Nigeria. METHODS: This cross-sectional study enrolled adolescents aged 13-19 in six rural and six urban schools in Osun State, Nigeria. We measured the prevalence of poor sleep quality (Pittsburgh Sleep Quality Index score >5), daytime sleepiness (Epworth Sleepiness Scale for Children and Adolescents score >10), and risk of sleep apnea (Teen STOPBANG). We compared the sleep health variables between the rural and urban populations using multivariable logistic regression. RESULTS: Of the 900 participants (51% rural; 59% female; average age (SD)= 15.1(1.4) years), 79% had short sleep duration (<8.5 hours), 14.9% poor sleep quality, 9.6% excessive daytime sleepiness and 9.8% risk of sleep apnea. Urban adolescents had a higher prevalence of poor sleep quality (p = .004), short sleep duration (p < .001), daytime sleepiness (p = .044), and risk of sleep apnea (p = .006) compared to rural adolescents. The adjusted odds of having poor sleep quality (p = .008) and daytime sleepiness (p = .007) were about 2-fold higher among urban compared to rural adolescents. Later school end time, having single/separated parent(s), absence of parental setting of bedtime were independently associated with poorer sleep health. CONCLUSION: Adolescents in rural communities had better sleep health than adolescents in urban communities. There is a need to develop interventions to improve the sleep quality and overall sleep health of urban-dwelling adolescents.

Perceptions around sleep hygiene practices and beliefs among urban Black adolescents and their caregivers during the COVID-19 pandemic.

OBJECTIVE: This study gathered adolescent and caregiver perspectives on sleep hygiene practices and beliefs for Black families living in low-resourced urban communities. METHODS: Semistructured interviews were conducted with adolescents (n = 9) and caregivers (n = 9) from January-March 2021, during the COVID-19 pandemic. Interview questions included adolescent's current sleep habits, barriers, and home and neighborhood influences. Trained researchers coded data using inductive analysis and a constant comparative method to derive themes. RESULTS: Two themes focused on sleep hygiene practices, including items used to facilitate sleep (e.g., melatonin, electronics) and COVID-19 consequences on sleep schedules. Two themes focused on sleep hygiene beliefs, including a common value on the importance of sleep and influences on caregiver's bedtime rules. CONCLUSIONS: Findings provide important insights on sleep hygiene practices and beliefs in a historically marginalized population of Black adolescents and caregivers in urban communities to inform targeted sleep interventions, policies, and programs for optimal sleep and well-being.

Psychometric properties of the Adolescent Sleep Hygiene Scale.

This study evaluated the psychometric properties of the Adolescent Sleep Hygiene Scale (ASHS), a self-report measure assessing sleep practices theoretically important for optimal sleep. Data were collected on a community sample of 514 adolescents (16-19; 17.7 ± 0.4 years; 50% female) participating in the late adolescent examination of a longitudinal study on sleep and health. Sleep hygiene and daytime sleepiness were obtained from adolescent reports, behavior from caretaker reports, and sleep-wake estimation on weekdays from wrist actigraphy. Confirmatory factor analysis indicated the empirical and conceptually based factor structure were similar for six of the eight proposed sleep hygiene domains. Internal consistency of the revised scale (ASHSr) was α = 0.84; subscale alphas were: physiological: α = 0.60; behavioural arousal: α = 0.62; cognitive/emotional: α = 0.81; sleep environment: α = 0.61; sleep stability: α = 0.68; daytime sleep: α = 0.78. Sleep hygiene scores were associated positively with sleep duration (r = 0.16) and sleep efficiency (r = 0.12) and negatively with daytime sleepiness (r = -0.26). Results of extreme-groups analyses comparing ASHSr scores in the lowest and highest quintile provided further evidence for concurrent validity. Correlations between sleep hygiene scores and caretaker reports of school competence, internalizing and externalizing behaviours provided support for convergent validity. These findings indicate that the ASHSr has satisfactory psychometric properties for a research instrument and is a useful research tool for assessing sleep hygiene in adolescents.

Adolescent sleep defects and dopaminergic hyperactivity in mice with a schizophrenia-linked Shank3 mutation.

Shank3 is a shared risk gene for autism spectrum disorders and schizophrenia. Sleep defects have been characterized for autism models with Shank3 mutations; however, evidence has been lacking for the potential sleep defects caused by Shank3 mutation associated with schizophrenia and how early in development these defects may occur. Here we characterized the sleep architecture of adolescent mice carrying a schizophrenia-linked, R1117X mutation in Shank3. We further employed GRABDA dopamine sensor and fiber photometry to record dopamine release in the nucleus accumbens during sleep/wake states. Our results show that homozygous mutant R1117X mice have significantly reduced sleep in the dark phase during adolescence, altered electroencephalogram power, especially during the rapid-eye-movement sleep, and dopamine hyperactivity during sleep but not during wakefulness. Further analyses suggest that these adolescent defects in sleep architecture and dopaminergic neuromodulation tightly correlate with the social novelty preference later in adulthood and predict adult social performance during same-sex social interactions. Our results provide novel insights into the sleep phenotypes in mouse models of schizophrenia and the potential use of developmental sleep as a predictive metric for adult social symptoms. Together with recent studies in other Shank3 models, our work underscores the idea that Shank3-involved circuit disruptions may be one of the shared pathologies in certain types of schizophrenia and autism. Future research is needed to establish the causal relationship among adolescent sleep defects, dopaminergic dysregulation, and adult behavioral changes in Shank3 mutation animals and other models.

Sleep quality and its relationship with school schedules and mental health of Nigerian secondary school adolescents.

STUDY OBJECTIVES: This study aimed to determine the sleep quality of in-school Nigerian adolescents and its association with their schooling and mental health outcomes. METHODS: The study was a descriptive cross-sectional study. It was conducted among adolescents attending public and private secondary schools within the Ife Central Local Government, Osun State, southwestern Nigeria. A multistage sampling technique was used to select study participants. The Pittsburgh Sleep Quality Index, 9-item Patient Health Questionnaire (PHQ-9), and 7-item General Anxiety Disorder questionnaires were used to determine sleep quality, depression, and anxiety, respectively. RESULTS: We studied 448 adolescents aged between 10 and 19 years with a mean age of 15.0 ± 1.8 years. The majority of our respondents (85.0%) had poor sleep quality. More than half of the respondents (55.1%) had insufficient sleep during weekdays, while only 34.8% had insufficient sleep during weekends. The school closing time and school type showed a statistically significant association with sleep quality (P = .039 and .005, respectively). The odds of having poor sleep quality increased by 2-fold among adolescents in private schools when compared with those in public schools (adjusted odds ratio = 1.97, 95% confidence interval = 1.069-3.627). Using multiple linear regression, only depression showed a statistically significant association with sleep quality at 95% confidence interval (CI = 0.073 to 0.219, P < .001), such that for every unit change in depression scores (PHQ-9), there will be a corresponding increase of 0.103 in sleep quality. CONCLUSIONS: Sleep quality is poor in adolescents and adversely associated with their mental health. This should also be addressed in the development of appropriate interventions. CITATION: Olorunmoteni OE, Fehintola FO, Seun-Fadipe C, Komolafe MA, Mosaku KS. Sleep quality and its relationship with school schedules and mental health of Nigerian secondary school adolescents. J Clin Sleep Med. 2023;19(11):1895-1904.

Sleep tight! Adolescent sleep quality across three distinct sleep ecologies.

Background and objectives: Good sleep quality, associated with few arousals, no daytime sleepiness and self-satisfaction with one's sleep, is pivotal for adolescent growth, maturation, cognition and overall health. This article aims to identify what ecological factors impact adolescent sleep quality across three distinct sleep ecologies representing a gradient of dense urbanity to small, rural environments with scarce artificial lighting and no Internet. Methodology: We analyze variation of sleep efficiency, a quantitative measure of sleep quality-defined as the ratio of total time spent asleep to total time dedicated to sleep-in two agricultural indigenous populations and one post-industrial group in Mexico (Campeche = 44, Puebla = 51, Mexico City = 50, respectively). Data collection included actigraphy, sleep diaries, questionnaires, interviews and ethnographic observations. We fit linear models to examine sleep efficiency variation within and between groups. Results: We found that sleep efficiency varied significantly across sites, being highest in Mexico City (88%) and lowest in Campeche (75%). We found that variation in sleep efficiency was significantly associated with nightly exposure to light and social sleep practices. Conclusions and implications: Our findings point toward contextual cost-benefits of sleep disruption in adolescence. We highlight the need to prioritize research on adolescent sleep quality across distinct developmental ecologies and its impact on health to improve adolescent wellbeing through evidence-based health practices.

Cognitive control, bedtime patterns, and testing time in female adolescent students: behavioral and neuro-electrophysiological correlates.

Introduction: Shorter and/or disrupted sleep during adolescence is associated with cognitive and mental health risks, particularly in females. We explored the relationship between bedtime behavior patterns co-varying with Social Jet Lag (SJL) and School Start Times (SST) and neurocognitive performance in adolescent female students. Methods: To investigate whether time of day (morning vs. afternoon), early SSTs and days of the school week can be correlated with neurocognitive correlates of sleep insufficiency, we recruited 24 female students aged 16-18 to report sleep logs, and undergo event-related electroencephalographic recordings on Monday, Wednesday, mornings, and afternoons. Using a Stroop task paradigm, we analyzed correlations between reaction times (RTs), accuracy, time of day, day of week, electroencephalographic data, and sleep log data to understand what relationships may exist. Results: Participants reported a 2-h sleep phase delay and SJL. Stroop interference influenced accuracy on Monday and Wednesday similarly, with better performance in the afternoon. For RTs, the afternoon advantage was much larger on Monday than Wednesday. Midline Event-Related Potentials (ERPs) yielded higher amplitudes and shorter latencies on Wednesday morning and Monday afternoon, in time windows related to attention or response execution. A notable exception were delayed ERP latencies on Wednesday afternoon. The latter could be explained by the fact that delta EEG waves tended to be the most prominent, suggesting heightened error monitoring due to accumulating mental fatigue. Discussion: These findings provide insights into the interaction between SJL and SST and suggest evidence-based criteria for planning when female adolescents should engage in cognitive-heavy school activities such as tests or exams.

Continuing Nursing Research During a Pandemic.

The coronavirus disease-2019 pandemic disrupted traditional research practices with the cessation of face-to-face contact with study participants. Researchers needed to respond with alternative methods to continue nurse-led clinical research. A rapid pivot to remote processes for recruitment, enrollment, data collection, and participant incentives can enable research to continue despite restrictions on in-person activities. Technology offers innovative methods in meeting current research needs but is not without challenges and continued need for ethics evaluation.

Pediatric sleep: current knowledge, gaps, and opportunities for the future.

This White Paper addresses the current gaps in knowledge, as well as opportunities for future studies in pediatric sleep. The Sleep Research Society's Pipeline Development Committee assembled a panel of experts tasked to provide information to those interested in learning more about the field of pediatric sleep, including trainees. We cover the scope of pediatric sleep, including epidemiological studies and the development of sleep and circadian rhythms in early childhood and adolescence. Additionally, we discuss current knowledge of insufficient sleep and circadian disruption, addressing the neuropsychological impact (affective functioning) and cardiometabolic consequences. A significant portion of this White Paper explores pediatric sleep disorders (including circadian rhythm disorders, insomnia, restless leg and periodic limb movement disorder, narcolepsy, and sleep apnea), as well as sleep and neurodevelopment disorders (e.g. autism and attention deficit hyperactivity disorder). Finally, we end with a discussion on sleep and public health policy. Although we have made strides in our knowledge of pediatric sleep, it is imperative that we address the gaps to the best of our knowledge and the pitfalls of our methodologies. For example, more work needs to be done to assess pediatric sleep using objective methodologies (i.e. actigraphy and polysomnography), to explore sleep disparities, to improve accessibility to evidence-based treatments, and to identify potential risks and protective markers of disorders in children. Expanding trainee exposure to pediatric sleep and elucidating future directions for study will significantly improve the future of the field.

Practice Tools for Screening and Monitoring Insomnia in Children and Adolescents with Autism Spectrum Disorder.

Between 50-80% of children with autism spectrum disorder (ASD) have insomnia, which adversely affects their mental and physical health. However, there is no consensus to-date on suitable tools for insomnia screening and monitoring in daily clinical practice. An expert panel of child neuropsychiatry and sleep specialists, with expertise in children with neurodevelopmental disabilities, recommends: (1) performing insomnia screening of all children with ASD; (2) considering discussion or referral to a sleep specialist when comorbid sleep disorders are suspected. The panel further developed structured, brief screening and monitoring tools to facilitate insomnia screening and management in daily practice, monitor treatment effectiveness and standardize and compare outcomes across clinical settings to improve care and well-being of children with ASD and their families.

Bedtime procrastination and chronotype differentially predict adolescent sleep on school nights and non-school nights.

OBJECTIVES: Bedtime procrastination (BTP) refers to the tendency to delay sleep beyond an intended bedtime, in favor of continuing evening activities. BTP has been associated with negative sleep outcomes (later timing, shorter duration, poorer quality), and is viewed as a problem of exercising self-control. BTP could be particularly challenging in adolescents, given the combined effects of increasing bedtime autonomy, later chronotype, and a still developing self-control capacity. Thus far, research on BTP has only been based on self-report measures. Here we examined the influence of BTP on adolescent sleep, using objective measures of sleep. METHODS: About 121 adolescents aged 14-19 years completed a survey on BTP, sleep quality, chronotype, and mental health. Subsequently, habitual sleep was actigraphically monitored for up to 2 weeks, and participants completed a temporal discounting task (a proxy for impulsivity). Associations between BTP, chronotype, and actigraphy-measured sleep were examined for school nights and non-school nights separately. RESULTS: Greater BTP was associated with poorer subjective sleep, eveningness chronotype, and higher daytime fatigue, as well as higher anxiety/depression scores. Measured using actigraphy, greater BTP predicted later bedtimes and shorter sleep duration on school nights, even when controlling for chronotype. On non-school nights, eveningness chronotype, but not BTP, predicted later bedtimes and wake-up times. BTP was not correlated with temporal discounting. CONCLUSIONS: Bedtime procrastination exerts significant influence on subjective and objective sleep measures in adolescents. Its effects are most prominent on school nights and can be separated from the effects of chronotype, which has stronger effects on sleep timing on non-school nights.

A case of Kleine-Levin syndrome successfully treated with Escitalopram.

Kleine-Levin syndrome (KLS) is an extremely rare relapsing-remitting neuropsychiatric condition characterized by recurrent incidents of major hypersomnolence along with hyperphagia, hypersexual behavior, and mood or cognitive disturbances alternating with asymptomatic periods. Here, we present a case of a young male chiefly presenting with recurring episodes of acute onset behavioral changes. The patient's episodes were characterized by repetitive incidents of prolonged sleep for more than 20 h, followed by social withdrawal and apathy. He was diagnosed with KLS because of the periodic patterns of hypersomnolence accompanied by other cognitive and mood disturbances and lacked characteristics of central hypersomnolence disorders or atypical depression. There are varying success rates among medications such as lithium, stimulants such as modafinil, antiepileptics such as carbamazepine and valproate. Similarly, the use of antidepressants such as tricyclic agents and selective serotonin reuptake inhibitors has largely been negative. Our case report addresses a patient with KLS who was successfully treated with 20 mg of Escitalopram.