This article summarizes correlational, case-control, quasi-experimental, and experimental studies that have examined whether sleep during childhood and adolescence is related to daytime functioning. ...Published findings suggest that inadequate sleep quality and/or quantity can cause sleepiness, inattention and, very likely, other cognitive and behavioral deficits that significantly impact children and adolescents in functional settings. This article then integrates findings from longitudinal studies within a developmental psychopathology model. Important questions remain, but evidence supports the integration of sleep screening and interventions into routine clinical care and also supports advocacy for public policy changes to improve the sleep of children and adolescents.
Background
The relationship between inadequate sleep and mood has been well‐established in adults and is supported primarily by correlational data in younger populations. Given that adolescents often ...experience shortened sleep on school nights, we sought to better understand the effect of experimentally induced chronic sleep restriction on adolescents’ mood and mood regulation.
Methods
Fifty healthy adolescents, ages 14–17, completed a 3‐week sleep manipulation protocol involving a baseline week, followed by a sleep restriction (SR) condition (6.5 hr in bed per night for five nights) and healthy sleep duration (HS) condition (10 hr in bed per night for five nights). The study used a randomized, counterbalanced, crossover experimental design. Participants’ sleep was monitored at home via self‐report and actigraphy. At the end of each condition, participants and their parents completed questionnaires of mood and mood regulation. To assess for expectancy effects, we also analyzed parent and teen ratings of hyperactivity/impulsivity, which prior research suggests is not sensitive to SR in adolescents. Wilcoxon Signed Rank tests compared questionnaire outcomes across the two conditions.
Results
Participants averaged 2.5 more hours of sleep per night during HS relative to SR. Compared with HS, adolescents rated themselves as significantly more tense/anxious, angry/hostile, confused, and fatigued, and as less vigorous (p = .001–.01) during SR. Parents and adolescents also reported greater oppositionality/irritability and poorer emotional regulation during SR compared with HS (p < .05). There were no cross‐condition differences in depression or hyperactivity/impulsivity (p > .05).
Conclusions
Findings complement prior correlational study results to show that after only a few days of shortened sleep, at a level of severity that is experienced regularly by millions of adolescents on school nights, adolescents have worsened mood and decreased ability to regulate negative emotions.
To comprehensively review research on the association between childhood sleep-disordered breathing (SDB) and neurobehavioral functioning.
Qualitative and quantitative literature review.
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The findings of 61 studies of the relationship between childhood SDB and neurobehavioral functioning were critically evaluated and synthesized. There is strong evidence that childhood SDB is associated with deficits in behavior and emotion regulation, scholastic performance, sustained attention, selective attention, and alertness. There is also evidence that SDB has minimal association with a child's typical mood, expressive language skills, visual perception, and working memory. Findings have been insufficient to draw conclusions about intelligence, memory, and some aspects of executive functioning. Mechanisms by which SDB might result in neurobehavioral morbidity are being explored, but clinical symptoms such as chronic snoring remain the best predictors of morbidity. Short-term SDB treatment outcome studies are encouraging, but the long-term outcomes are not known. Failing to treat SDB appears to leave children at risk for long-term neurobehavioral deficits.
Childhood SDB is associated with neurobehavioral morbidity. Applying commonly used guidelines for causal inference, even in the absence of a much-needed randomized clinical trial, there is strong evidence of association, consistent findings, and specificity of effect. There is suggestive evidence that this association fits the expected temporal pattern and that SDB is a biologically plausible cause of neurobehavioral deficits. Clinicians should be alert to the coexistence of SDB symptoms and concerns about a child's academic progress, attention, arousal, or behavior or emotion regulation.
Summary Substantial research attention has been devoted to understanding the importance and impact of sleep in children and adolescents. Traditionally, this has focused on mean sleep variables (e.g., ...a child’s “typical” or average sleep duration), yet research increasingly suggests that intraindividual variability (IIV) of sleep/wake patterns (sometimes referred to as sleep variability or night-to-night variability) regularly occurs and may have implications for adjustment. A systematic search of five electronic databases identified 52 empirical studies published between 2000 and 2015 that examined correlates of sleep IIV in children and adolescents, with a recent increase in the publication rate of such studies. Identified studies were often atheoretical and included post hoc analyses, though IIV in select aspects of sleep does appear to be associated with increasing age/pubertal status, non-White race, physical and neurodevelopmental conditions (e.g., attention-deficit/hyperactivity disorder; autism), psychopathology symptoms (e.g., anxiety, depression, inattention), body weight, stress, aspects of cognitive functioning, and poorer sleep functioning/habits. The limited intervention work examining sleep IIV in adolescents is promising, though studies are needed using more rigorous intervention designs. Clinical sleep recommendations may not only need to address overall sleep duration and sleep habits but also the stability of sleep duration and timing. It will be important for future research examining sleep IIV in children and adolescents to use a developmental framework in advancing theory pertaining to the causes, mechanisms, moderators, and outcomes of sleep IIV in youth, and a conceptual model is proposed to help guide such efforts.
Examine the effect of experimental sleep restriction (SR) on adolescents' subjective hunger and perceived appeal of sweet/dessert foods versus other foods. A secondary goal was to replicate previous ...findings on the effects of SR on dietary intake.
Randomized cross-over sleep restriction-extension paradigm.
Sleep was obtained and monitored at home. Outcome measures were gathered during office visits.
31 typically-developing adolescents aged 14-17 years.
The three-week protocol consisted of a baseline week, followed randomly by five consecutive nights of SR (6.5 hours in bed) versus healthy sleep duration (HS; 10 hours in bed), a 2-night wash-out period, and a 5-night cross-over.
Sleep was monitored via actigraphy. The morning after each experimental condition, teens rated their hunger, underwent a 24-hour diet recall interview, and rated the appeal of a series of pictures of sweet/dessert foods (e.g., ice cream, candy) and non-sweets (meat, eggs, fruits, vegetables).
Teens rated pictures of sweet/dessert foods to be more appealing after SR than after HS (Cohen's d = .41, t = 2.07, p = .045). The sleep manipulation did not affect self-reported hunger or the appeal of non-sweet foods (p >.10). Consistent with our prior work, intake of overall calories was 11% higher and consumption of sweet/dessert servings was 52% greater during SR than HS.
Adolescent SR appears to increase the subjective appeal of sweet/dessert foods, indicating a potential mechanism by which SR might contribute to weight gain and the risk for obesity and chronic illness.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Abstract Purpose To experimentally test whether chronic sleep restriction, which is common among adolescents, is causally related to poor learning, inattentive behaviors, and diminished arousal in a ...classroom-like situation. Methods Sixteen healthy adolescents underwent a sleep manipulation that included, in counterbalanced order, five consecutive nights of sleep deprivation (6 ½ hours in bed) versus five nights of healthy sleep duration (10 hours in bed). At the end of each condition, participants viewed educational films and took related quizzes in a simulated classroom. Eight participants also underwent video and electroencephalography monitoring to assess levels of inattentive behaviors and arousal, respectively. Results As compared with the healthy sleep condition, sleep-deprived participants had lower quiz scores ( p = .05), more inattentive behaviors ( p < .05), and lower arousal ( p = .08). Conclusions These pilot data complement previous correlational reports by showing that chronic sleep restriction during adolescence can cause inattention, diminished learning, and lowered arousal in a simulated classroom.
To examine the relationship between sleep and dietary intake in adolescents using an experimental sleep restriction protocol.
Randomized crossover sleep restriction-extension paradigm.
Sleep obtained ...and monitored at home, diet measured during an office visit.
Forty-one typically developing adolescents age 14-16 years.
The 3-week protocol consisting of a baseline week designed to stabilize the circadian rhythm, followed randomly by 5 consecutive nights of sleep restriction (6.5 hours in bed Monday-Friday) versus healthy sleep duration (10 hours in bed), a 2-night washout period, and a 5-night crossover period.
Sleep was monitored via actigraphy and teens completed validated 24-hour diet recall interviews following each experimental condition.
Paired-sample t-tests examined differences between conditions for consumption of key macronutrients and choices from dietary categories. Compared with the healthy sleep condition, sleep-restricted adolescents' diets were characterized by higher glycemic index and glycemic load and a trend toward more calories and carbohydrates, with no differences in fat or protein consumption. Exploratory analyses revealed the consumption of significantly more desserts and sweets during sleep restriction than healthy sleep.
Chronic sleep restriction during adolescence appears to cause increased consumption of foods with a high glycemic index, particularly desserts/sweets. The chronic sleep restriction common in adolescence may cause changes in dietary behaviors that increase risk of obesity and associated morbidity.
Examine the prevalence, patterns, and persistence of parent-reported sleep problems during the first 3 years of life.
Three hundred fifty-nine mother/child pairs participated in a prospective birth ...cohort study. Sleep questionnaires were administered to mothers when children were 6, 12, 24, and 36 months old. Sleep variables included parent response to a nonspecific query about the presence/absence of a sleep problem and 8 specific sleep outcome domains: sleep onset latency, sleep maintenance, 24-hour sleep duration, daytime sleep/naps, sleep location, restlessness/vocalization, nightmares/night terrors, and snoring.
Prevalence of a parent-reported sleep problem was 10% at all assessment intervals. Night wakings and shorter sleep duration were associated with a parent-reported sleep problem during infancy and early toddlerhood (6-24 months), whereas nightmares and restless sleep emerged as associations with report of a sleep problem in later developmental periods (24-36 months). Prolonged sleep latency was associated with parent report of a sleep problem throughout the study period. In contrast, napping, sleep location, and snoring were not associated with parent-reported sleep problems. Twenty-one percent of children with sleep problems in infancy (compared with 6% of those without) had sleep problems in the third year of life.
Ten percent of children are reported to have a sleep problem at any given point during early childhood, and these problems persist in a significant minority of children throughout early development. Parent response to a single-item nonspecific sleep query may overlook relevant sleep behaviors and symptoms associated with clinical morbidity.
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