Background: Sleep debt attributable to late bedtime and short sleep duration among adolescents is associated with a wide range of detrimental physical and mental health outcomes.Objectives: This ...study aimed (a) to verify effects of a sleep education package on sleep duration, bedtime, sleep debt, irritability, and target behavior in high school students, and (b) to estimate the posterior probability that practice of target behaviors was associated with improvements in these sleep problems with findings of a single-arm trial.Methods: A single-arm trial involving two high schools was conducted, and 478 students (56.1% female; 10th grade) were included in the final analysis. They were provided with information on proper sleep health and sleep-promoting behaviors. The students were asked to practice three sleep-promoting behaviors as a goal for 5 weeks. Both pre- and post-treatment questionnaires were administered to students in order to assess sleep-promoting behavior, sleeping patterns and irritability. Subsequently, a post hoc Bayesian analysis of data from an above trial was conducted to estimate probability of treatment benefit with sleep-promoting behaviors.Results: Students showed significant improvements in sleep duration and bedtime on school nights and sleep debt with a nearly small effect size (Cohen's d = －0.35, －0.18 and －0.25, respectively) and in their target behaviors. Subjective experience of sleep duration ≥7 hours, school nights bedtime after 0:00 a.m. and sleep debt ≥100 min was also improved significantly. In contrast, no significant improvement in these variables on weekend and subjective experience of irritability was observed. Bayesian statistics with the above findings revealed that the posterior probability of improvement of target behaviors for sleep duration and bedtime on school-nights and sleep debt were from 18.2% to 87.4%. Among them, the sleep-promoting behaviors with a posterior probability of approximately 70% were keeping wake-up time on weekends within 2 hours of that on school days (the posterior probability = 77.1%, 84.0% and 85.7%, respectively), avoiding taking a nap immediately after returning home from school (77.6%, 74.3% and 87.4%, respectively), and getting up at a fixed time every day (65.3%, 73.8% and 73.8%, respectively).Conclusion: The present study suggested that the sleep education package was effective in improving high school students' sleep patterns and sleep-promoting behaviors. Furthermore, the results of this study indicated that in order to improve their sleep problems it was essential to confirm their lifestyle and promote them to set appropriate goals. We hope that this sleep education package is utilized as a sleep support for students with similar sleep problems.
Background: Sleep debt attributable to short sleep duration among adolescents is associated with a wide range of detrimental physical and mental health outcomes.Objective: This cross-sectional study ...was conducted to assess sleep/wake patterns among high school students based on the perspective of sleep debt and to explore sleep-promoting behaviors for alleviating sleep debt, late bedtime and insufficient sleep.Methods: A total of 2,195 students in five high schools completed a self-administered questionnaire including demographic information, sleep/wake patterns, subjective insufficient sleep, excessive daytime sleepiness, irritability and sleep-promoting behaviors. We defined sleep debt as“the cumulative hours of sleep loss with respect to a subject-specific daily need for sleep”, and calculated it using the following equation: weekend sleep duration minus. weekday sleep duration. We then classified the students into two-groups based on a weighted mean（100min）of the discrepancy of sleep duration between weekday and weekend those with or without sleep debt of ≥100minResults: Students with the sleep debt went to bed 24min later on weekday, and slept 28min shorter on weekday than those without the sleep debt, but there was no significant difference in weekday wake-up times between the two groups. Contrary to weekday, students with the sleep debt went to 29min later, woke up 129 min later and slept 107min longer on weekends than those without the sleep debt. Furthermore, prevalence of insufficient sleep（70.7% vs. 54.2%）, excessive daytime sleepiness（49.5% vs. 41.5%）, irritability（29.6% vs. 24.7%）, breakfast skipping（19.5% vs. 12.5%）and nodding off during the day（71.6% vs. 60.4%）was observed more frequently in students with the sleep debt than in those without the sleep debt. Logistic analyses with a generalized linear mixed model revealed that practice of 12 sleep-promoting behaviors, such as getting up at a fixed time every morning（OR=0.81, 95% CI: 0.66-0.99）, exposing oneself to sunlight in the morning（OR=0.76, 95% CI: 0.64-0.89）, and not going out to brightly-lit places, such as convenience stores, after 9：00 pm（OR=0.70, 95% CI: 0.53-0.93）, were associated with a lower odds ratio of having the sleep debt, late bedtime or insufficient sleep.Conclusion: Late bedtimes, less weekday and longer weekend sleep durations, and late weekend wake-up time were observed in students with the sleep debt. Our results suggest that 12 sleep-promoting behaviors, all of which are items contributing to advance bedtime and/or to ensure sleep duration, play an important role in alleviating the sleep debt, late bedtime and insufficient sleep in high school students. We hope that this sleep-promoting behavior menu is utilized as a sleep support for students with similar sleep problems.
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