Associations of sleep duration on school nights with self-rated health, overweight, and depression symptoms in adolescents: problems and possible solutions

Trajectories of sleep problems and the longitudinal associations with mental health difficulties among Chinese adolescents

OBJECTIVE

Growing research highlights the negative impact of sleep problems on adolescent mental health. However, the developmental trajectory of sleep problems during adolescence and their relationship with mental health difficulties, including both internalizing and externalizing symptoms, remain unclear. Additionally, the direction of the effects between sleep problems and mental health difficulties is not well established. This study aims to identify the developmental trajectories of sleep problems and examine their association with mental health difficulties in both internalizing and externalizing domains.

METHOD

The study involved 1,281 Chinese middle school students (645 males, mean age at initial assessment = 12.73, SD = 0.68). Data were collected at four time points (T1, T2, T3, T4) over approximately 6-month intervals, spanning from the first semester of seventh grade to the second semester of 8th grade.

RESULTS

Latent growth modeling revealed an overall increasing trend in sleep problems. Parallel latent growth modeling indicated that trajectories of sleep problems were positively related to the developmental trends of mental health difficulties, as shown by intercept-intercept and slope-slope associations. The cross-lagged panel model demonstrated significant bidirectional associations between sleep problems and internalizing symptoms. In contrast, we observed unidirectional associations between sleep problems and externalizing symptoms. Hence, sleep problems were a significant predictor of subsequent externalizing symptoms, with no significant reverse effect observed.

CONCLUSION

These findings suggest that future research should explore whether interventions targeting sleep problems can reduce the incidence of both internalizing and externalizing symptoms. Additionally, interventions aimed at internalizing symptoms may potentially improve adolescent sleep, while those targeting externalizing symptoms may not have the same effect.

Inequities in adolescent sleep health in Aotearoa New Zealand: Cross-sectional survey findings

OBJECTIVES

To investigate ethnic inequities in, and social determinants of, adolescent sleep health in Aotearoa New Zealand.

METHODS

Analysis of self-report data from a cross-sectional survey of secondary school students (12- to 18-year-olds). Analyses included weighted prevalence estimates of good and poor sleep health stratified by ethnicity, and multivariable logistic regression models concurrently adjusted for ethnicity, school year, gender, rurality, neighborhood deprivation, school decile, housing deprivation, sleeping elsewhere due to lack of adequate housing, unsafe environment, and racism.

RESULTS

Inequities in social determinants of health were evident for Māori (Indigenous peoples of Aotearoa New Zealand; n = 1528) and minoritized (Pacific n = 1204; Asian n = 1927; Middle Eastern, Latin American, and African [MELAA] n = 210; and 'Other' ethnicity n = 225) adolescents. A greater proportion of Māori, Pacific, Asian, MELAA, and 'Other' adolescents had short sleep, compared to European (n = 3070). Māori, Pacific, Asian, and MELAA adolescents were more likely to report late bedtimes (after midnight), and Māori, Pacific, and 'Other' adolescents were more likely to report early waketimes (5 AM-6 AM or earlier), on school days. Rurality, neighborhood deprivation, school-level deprivation, housing deprivation, sleeping elsewhere due to inadequate housing, unsafe environments, and racism partially, but not fully, explained associations between ethnicity and short sleep, late bedtimes, and early waketimes.

CONCLUSIONS

Ethnic inequities exist in adolescent sleep health in Aotearoa New Zealand. Socio-political actions are needed to address racism and colonialism as root causes of ethnic inequities in adolescent sleep, to ensure all young people are afforded the basic human right of good sleep health and associated mental and physical well-being.

Pre-COVID-19 short sleep duration and eveningness chronotype are associated with incident suicidal ideation during COVID-19 pandemic in medical students: a retrospective cohort study

Introduction

Cross-sectional evidence suggests that sleep problems increased the risk of suicide during the 2019 coronavirus disease (COVID-19) pandemic. However, a lack of longitudinal studies examined the relationship between pre-COVID-19 sleep duration, chronotype and incident suicide during the COVID-19 pandemic. Thus, we examined these associations in a longitudinal study of medical students.

Methods

From the Shantou College Student Sleep Cohort, a total of 333 first and second grade medical students (age 19.41 ± 0.82 years, female 61.26%), without suicidal ideation (SI) at pre-COVID-19 period, were followed up during the COVID-19 pandemic. Incident SI was defined by their response to the 9th question from the Beck Depression Inventory. Short sleep duration was defined as less than 7 h/night. The Morningness-Eveningness Questionnaire was used to evaluate the participants' chronotype. Logistic regression with adjusted odds ratios (AOR) and 95% confidence intervals (95% CI) was used to examine the association between sleep and SI.

Results

The incidence of SI during the COVID-19 pandemic was 5.71%. Logistic regressions with confounding factors adjustment showed that both short sleep duration (AOR = 4.91, 95% CI = 1.16-20.74) and eveningness (AOR = 3.80, 95% CI = 1.08-13.30) in the pre-COVID-19 period were associated with increased risk of incident SI during the COVID-19 pandemic.

Conclusion

Pre-COVID-19 short sleep duration and eveningness predict incident SI during the COVID-19 pandemic in medical students. Prolonging sleep duration may help to decrease SI during major public health crises.

Adherence to sleep recommendations is associated with higher satisfaction with life among Norwegian adolescents

BACKGROUND

Sleep plays a crucial role in the health and well-being of adolescents; however, inadequate sleep is frequently reported in numerous countries. This current paper aimed to describe sleep duration, factors impacting sleep, consequences of insufficient sleep and satisfaction with life in Norwegian adolescents, stratified by sex and by adherence to the 8-hour sleep recommendation, and to examine potential associations between adherence to the 8-hours sleep recommendation and satisfaction with life.

METHODS

This is a cross-sectional study using data from the Norwegian Ungdata Survey, collected in 2021. Adolescents from five Norwegian counties were included, comprising a total of 32,161 upper secondary school students. Study variables were collected through an electronic questionnaire administered during school hours and all data are anonymous. Descriptive data of sleep patterns are presented, and linear regressions were conducted adjusting for SES, perceived stress, physical activity level, over-the-counter analgesics use, grade level and screen time.

RESULTS

73% of adolescents did not adhere to the 8-hours of sleep recommendation per night, with similar results for girls and boys. 64% reported tiredness at school (minimum 1-2 days weekly) and 62% reported that screen time negatively affected their ability to sleep. 23% reported that gaming affected their sleep, with a higher prevalence in boys than girls. Satisfaction with life score was 7.0 ± 1.9 points (out of 10) for the total sample, with higher scores for boys (7.3 ± 1.8 points) than girls (6.9 ± 1.9 points). Regressions revealed a positive association with satisfaction with life (B = 0.31, 95% [0.15 to 0.48]) in adolescents adhering to sleep recommendation of 8h compared to the ones not adhering to the sleep recommendation.

CONCLUSIONS

Most Norwegian adolescents fail to adhere to the 8-hours of sleep recommendation and the majority feel tired at school or during activities. More than half of adolescents reported that screen time negatively affected their ability to sleep. Adhering to the sleep recommendation was associated with higher life satisfaction. Our findings highlight the importance of sufficient sleep in adolescents, while future research is needed to examine other sleep related measures on adolescents´ satisfaction with life.

Racial/ethnic disparities in sleep health among adolescents in South Korea: The role of substance use behaviours

AIM

To examine the relationship between racial/ethnic disparities and substance use behaviours (alcohol and tobacco use) and their impact on the sleep health of South Korean adolescents.

DESIGN

Secondary analysis of cross-sectional study data from the 2021 Korea Youth Risk Behaviour Web-based Survey dataset.

METHODS

Given that Korean society has historically linked its racial/ethnic identity to a shared bloodline, we categorized 2644 adolescents from the Korea Youth Risk Behaviour Web-based Survey based on their racial/ethnic status, determined by their parents' birthplaces. Using multiple linear regression, we investigated whether the impact of racial/ethnic disparities on sleep health (sleep duration, debt, and timing) varies depending on substance use behaviours (alcohol and tobacco use) after controlling for age, sex, household economic status, depressed mood, suicidal ideation, perceived excessive stress, and anxiety level.

RESULTS

Despite no statistical differences in sleep health and the prevalence of substance use between racial/ethnic groups, racial/ethnic minority adolescents experienced greater sleep debt than racial/ethnic majority adolescents when consuming alcohol. Moreover, racial/ethnic minority adolescents were more likely to report psychosocial distress and had lower parental education level.

CONCLUSION

Racial/ethnic minority adolescents were more vulnerable to the detrimental effects of alcohol use on sleep health compared to racial/ethnic majority adolescents. This heightened vulnerability may be attributed to the more pronounced psychosocial challenges and the lower socioeconomic status of parents in the racial/ethnic minority group.

IMPACT

Racial/ethnic disparities are concerning in South Korea, particularly since the negative effects of substance use on sleep health are intensified among racial/ethnic minority adolescents. Nurses and other healthcare providers should recognize the importance of addressing the social disadvantages linked to racial/ethnic disparities. Beyond just advocating for the cessation of substance use, it is crucial to address these underlying issues to reduce sleep disparities among South Korean adolescents.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

Neurobehavioral functions during recurrent periods of sleep restriction: effects of intra-individual variability in sleep duration

STUDY OBJECTIVES

To investigate whether neurobehavioral impairments are exacerbated during successive cycles of sleep restriction and recovery in young adults, and whether a variable short sleep schedule can mitigate these impairments relative to a stable one.

METHODS

Fifty-two healthy young adults (25 males, aged: 21-28) were randomly assigned to the stable short sleep group, the variable short sleep group, or the control group in this laboratory-based study. They underwent two baseline nights of 8-hour time-in-bed (TIB), followed by two cycles of "weekday" sleep opportunity manipulation and "weekend" recovery (8-hour TIB). During each manipulation period, the stable short sleep and the control groups received 6- and 8-hour TIBs each night respectively, while the variable short sleep group received 8-hour, 4-hour, 8-hour, 4-hour, and 6-hour TIBs from the first to the fifth night. Neurobehavioral functions were assessed five times each day.

RESULTS

The stable short sleep group showed faster vigilance deterioration in the second week of sleep restriction as compared to the first. This effect was not observed in the variable short sleep group. Subjective alertness and practice-based improvement in processing speed were attenuated in both short sleep groups.

CONCLUSIONS

In young adults, more variable short sleep schedules incorporating days of prophylactic or recovery sleep might mitigate compounding vigilance deficits resulting from recurrent cycles of sleep restriction. However, processing speed and subjective sleepiness were still impaired in both short sleep schedules. Getting sufficient sleep consistently is the only way to ensure optimal neurobehavioral functioning.

CLINICAL TRIAL

Performance, Mood, and Brain and Metabolic Functions During Different Sleep Schedules (STAVAR), https://www.clinicaltrials.gov/study/NCT04731662, NCT04731662.

Adherence to 24-hour movement guidelines and their association with depressive symptoms in adolescents: Evidence from Bangladesh

Healthy movement behaviours are associated with various physical and mental wellbeing; however, little is known about such associations in low- and middle-income countries. The aim of this study was to examine adherence to 24-hour (h) movement guidelines and their relationship with depressive symptoms in adolescents. Data were from 312 Bangladeshi adolescents aged 13-17 years (42% female). Meeting the guidelines was defined as: energy expenditure for physical activity (PA) ​≥ ​1 680 Metabolic Equivalent of Task (MET)-min/week, ≤ 2 ​h/day of recreational screen time (ST), and 8-10 ​h/night of sleep. Depressive symptoms were assessed using the 10-item Center for Epidemiological Studies Depression Scale (CESD-10) with a score of 10 or more indicating high depressive symptoms. Percentage of adolescents meeting the three recommendations was 2.2%, with 17.6% meeting two, and 31.2% meeting one recommendation. Generalized estimating equations showed that odds of having high depressive symptoms was a third (odds ratio [OR] ​= ​0.35, 95% confidence interval [CI], 0.19-0.57) for meeting the PA guidelines, and about a half (OR = 0.47, 95%CI, 0.18-0.87) for meeting the sleep guidelines. Odds of depressive symptoms reduced significantly for meeting PA and sleep (OR = 0.20, 95%CI, 0.09-0.59), or PA and ST (OR ​= ​0.24, 95%CI, 0.08-0.55) guidelines. About half of the adolescents did not meet any recommendations, which underscores the need for public health campaigns to promote adherence to the movement guidelines in this pediatric population. Further longitudinal research with larger sample size is recommended to explore the inter-relationships of these behaviours and their impact on health and wellbeing outcomes of adolescents in Bangladesh.

Association of Sleep Duration and Weekend Catch-Up Sleep with Suicidal Ideation among Adolescents with Atopic Dermatitis

Atopic dermatitis (AD) is a prevalent allergic disease in children that often causes sleep disturbance and which is associated with diminished quality of life and heightened susceptibility to depression and suicidality. In this study, we investigate the relationship between weekend catch-up sleep (WCUS) and mental health in a sample of 71,434 adolescents with AD and 221,057 without AD using multivariate logistic regression analysis. We hypothesized that adolescents with AD experience shorter total and daytime sleep due to pruritus, with compensatory longer WCUS. We found that the lifetime prevalence of AD was 24.4%, and that adolescents with AD slept less overall, with significantly shorter weekday and weekend sleep durations but longer weekend catch-up sleep (WCUS). Sleep dissatisfaction was markedly higher in the AD group. Interestingly, our results suggest that prolonged WCUS is a protective factor against suicidal ideation in adolescents with AD. The study highlights the importance of addressing sleep patterns in adolescents with AD to enhance mental health. Overall, our findings indicate a need for increased awareness and intervention strategies to ensure sufficient sleep and reduce the risk of suicidal ideation in this population.

Assessing 'readiness' by tracking fluctuations in daily sleep duration and their effects on daily mood, motivation, and sleepiness

STUDY OBJECTIVES

Consumer sleep trackers issue daily guidance on 'readiness' without clear empirical basis. We investigated how self-rated mood, motivation, and sleepiness (MMS) levels are affected by daily fluctuations in sleep duration, timing, and efficiency and overall sleep regularity. We also determined how temporally specific these associations are.

METHODS

119 healthy university students (64 female, mean age = 22.54 ± 1.74 years) wore a wearable sleep tracker and undertook twice-daily smartphone-delivered ecological momentary assessment of mood, motivation, and sleepiness at post-wake and pre-bedtime timings for 2-6 weeks. Naps and their duration were reported daily. Nocturnal sleep on 2471 nights were examined using multilevel models to uncover within-subject and between-subject associations between sleep duration, timing, efficiency, and nap duration on following day MMS ratings. Time-lagged analyses examined the temporal specificity of these associations. Linear regression models investigated associations between MMS ratings and sleep variability, controlling for sleep duration.

RESULTS

Nocturnal sleep durations were short (6.03 ± 0.71 h), and bedtimes were late (1:42AM ± 1:05). Within-subjects, nocturnal sleep longer than a person's average was associated with better mood, higher motivation, and lower sleepiness after waking. Effects of such longer sleep duration lingered for mood and sleepiness till the pre-bedtime window (all Ps < .005) but did not extend to the next day. Between-subjects, higher intraindividual sleep variability, but not sleep duration, was associated with poorer mood and lower motivation after waking. Longer average sleep duration was associated with less sleepiness after waking and lower motivation pre-bedtime (all Ps < .05). Longer naps reduced post-nap sleepiness and improved mood. Controlling for nocturnal sleep duration, longer naps also associated with lower post-waking sleepiness on the following day.

CONCLUSIONS

Positive connections between nocturnal sleep and nap duration with MMS are temporally circumscribed, lending credence to the construction of sleep-based, daily 'readiness' scores. Higher sleep duration variability lowers an individual's post waking mood and motivation.

CLINICAL TRIAL ID

ClinicalTrials.gov NCT04880629.

Short Sleep Duration in School-Age Children: Differential Factors on Weekdays and Weekends

OBJECTIVES

To quantify school-age children's sleep and parent-associated factors on weekdays and weekends in Singapore, and investigate school-related and parent-related factors associated with short sleep.

METHODS

In an online survey, 251 parents with a child aged 7-12 y in Singapore reported their child's sleep duration and school start time. Parent-related factors including sleep hygiene (e.g., parent-set bedtime), sleep priority (the amount of sleep respondents allowed their children to trade for other activities), and both parents' sleep durations, were also reported.

RESULTS

The prevalence of short sleep among the children was 64.5% on weekdays and 19.5% on weekends. Children's sleep duration increased from 8.42 h on weekdays to 9.45 h on weekends (p < .001). Relative to weekdays, on weekends, parents showed similar increases in sleep durations (p < .001), imposed poorer sleep hygiene on their children (reduced likelihood of setting bedtimes and increased pre-bedtime electronic device use; p < .001), and allowed their children to trade more sleep for interacting with family and friends, social media, gaming, and TV / videos (p < .001). Shorter sleep duration in children was significantly associated with earlier school start time (B = 0.80, p = .02) and poorer sleep hygiene on weekdays (B = 0.16, p < .001), but lower sleep priority (B = 0.05, p = .002) and shorter parental sleep duration on weekends (maternal: B = 0.18, p < .001, paternal: B = 0.17, p = .002).

CONCLUSIONS

Delaying school start times may be effective in increasing school-age children's sleep duration on weekdays, while family-based interventions designed to enhance sleep hygiene, priority of sleep over other activities, and parents' sleep durations can benefit children's sleep duration on both weekdays and weekends.

Using Nightly Sleep Guidelines to Address Links Between Adolescents' Self-Reported Weekly Sleep Patterns and Anxiety and Depression Symptoms

Short and long nightly sleep durations are associated with anxiety and depression symptoms among adolescents. However, studies have not used recommended hours of nightly sleep or focused on sleep patterns across weekdays and weekends in examining links with anxiety and depression symptoms. The present study included 709 adolescents in Grade 11 (402 females; 307 males) who self-reported hours of sleep on weeknights and weekends and anxiety and depression symptoms. Using the recommended 8-10 h to define average nightly sleep for adolescents, sleep patterns across weekdays and weekends were categorised into seven classes: short stable, short increasing, average decreasing, average stable, average increasing, long decreasing, and long stable. Relative to average stable sleepers, short stable, short increasing, and long stable sleepers had significantly higher anxiety and depression. Adolescents require 8-10 h of sleep on weeknights, regardless of weekends, for optimal emotional wellbeing.

24-hour movement behaviours and self-rated health in Chinese adolescents: a questionnaire-based survey in Eastern China

Objective

Although much evidence has demonstrated the benefits of adhering to the 24-hour movement guidelines, little is known about their association with self-rated health in adolescents. The objective of this study was to explore the association between adherence to the 24-hour movement guidelines (i.e., physical activity, screen time, and sleep) and self-rated health among Chinese adolescents aged 10-17 ages.

Methods

A convenient sample of 12 schools and their students were recruited for this cross-sectional study. Physical activity and screen time were assessed using a questionnaire based on the Health Behaviour in School-aged Children questionnaire, while sleep duration was used measured using the Pittsburgh Sleep Scale. Ordinal logistic regression was performed to examine the association between adherence to the 24-hour movement guidelines and self-rated health.

Results

Adolescents who adhered to more guidelines contained in the 24-hour movement guidelines reported better self-rated health. A dose-response association was observed, with the odds ratio (OR) for adhering to all three = 11.26, 95% CI [4.82-26.35]; OR for meeting two = 1.62, 95% CI [1.25-2.12]; OR for meeting one = 1.16, 95% CI [0.98-1.38]) indicating a higher probability of better self-rated health with increasing adherence. Regarding adherence to specific combination of 24-hour movement guidelines, positive associations were found for adhering to all three recommendations (OR = 11.95, 95% CI [5.06-28.19]), only MVPA (OR = 4.96, 95% CI [2.82-8.72]), MVPA + screen time (OR = 5.50, 95% CI [3.02-9.99]), and MVPA + sleep (OR = 4.63, 95% CI [2.52-8.51]).

Conclusion

This study provides evidence supporting the association between adherence to the 24-hour movement guidelines and better self-rated health among Chinese adolescents. Sufficient physical activity may be particularly important for promoting self-rated health in this population.

Associations between sleep quality and irritability: Testing the mediating role of emotion regulation

OBJECTIVES

Irritability and sleep problems are common symptoms that span a range of internalizing and externalizing mental health disorders. While poor sleep has been associated with symptoms related to irritability (e.g., anxiety and depression), few studies have directly tested the association between sleep quality and irritability and whether the association is direct or mediated by a separate mechanism.

METHOD

The present study used self-report measures to test whether sleep is associated with irritability in 458 adults aged 19-74 years (58 % female; 79 % White), and whether this association is mediated by emotion regulation. Confirmatory factor analyses were carried out to support the use of scores from these measures.

RESULTS

Controlling for anxiety and depression symptoms, results showed a direct association between poorer sleep quality and increased irritability (β = 0.25, p < .001) that was not mediated by emotion regulation.

CONCLUSIONS

Our findings underscore the important link between sleep and irritability, both of which are common features of mental health difficulties, prompting further inquiry into the directionality of the findings and potential mediators. This work has notable clinical implications for sleep as a possible intervention target for individuals with high irritability.

The gendered health consequences of persistent exposure to short sleep duration during adolescence

INTRODUCTION

Despite evidence that sleep duration is associated with adolescent health, there remain several gaps in the literature. Little is known about: (1) the extent to which persistent exposure to short sleep duration is associated with adolescent health and (2) whether this association varies by gender.

METHODS

Using six waves of longitudinal data from the 2011-2016 Korean Children and Youth Panel Survey (N = 6147), this study examined whether persistent exposure to short sleep duration is related to two adolescent health outcomes (overweight status and self-rated health). Fixed effects models were estimated to account for individual-level heterogeneity.

RESULTS

Short sleep duration was associated with being overweight and self-rated health in different ways for boys and girls. Gender-stratified analysis suggests that, for girls, the risk of being overweight increased for 5 years in a row as short sleep duration persisted. Prolonged short sleep duration also resulted in a continued decline in girls' self-rated health. For boys, persistent exposure to short sleep duration predicted a lower likelihood of being overweight up to the fourth year, but then began to recover. No association between persistent exposure to short sleep duration and self-rated health was observed for boys.

CONCLUSION

Persistent exposure to short sleep duration was found to be more harmful to the health of girls than boys. Promoting longer sleep duration during adolescence may be an effective intervention to improve adolescent health, especially for girls.

Sleep duration in schooldays is associated with health-related quality of life in norwegian adolescents: a cross-sectional study

BACKGROUND

Insufficient sleep is commonly reported in adolescence and is negatively associated with a wide range of health outcomes. A way to grasp the complicated challenge of how sleep impact different aspects of the adolescents´ everyday life is by examining the relationship between sleep duration in schooldays and weekends on different health-related quality of life (HRQOL) subscales. Furthermore, to expand the understanding of possible underlying mechanisms between sleep and HRQOL, testing for self-efficacy as a possible mediator is of importance.

METHODS

A cross-sectional study was performed among 696 adolescents aged 13-15 years from a school-based setting. All participants completed an electronic survey in their respective classrooms. The survey included demographic data, the School Sleep Habits Survey, the KIDSCREEN-27 questionnaire measuring HRQOL, and the General Perceived Self-Efficacy Scale. Statistical analyses were conducted using SPSS Statistics software including PROCESS macro by Andrew Hayes.

RESULTS

Our findings revealed overall similar sleep patterns in boys and girls including longer sleep duration in the study sample during weekends (10:09 h) than in schooldays (08:36 h). Regression analyses revealed that sleep duration in schooldays was positively and statistically associated with HRQOL subscales psychological well-being (95% CI [0.44 to 1.33]), autonomy and parents (95% CI [0.12 to 1.06]), school environment (95% CI [0.47 to 1.40]), and self-efficacy (95% CI [0.01 to 0.47]). Sleep duration in weekends revealed no associations with the HRQOL subscales, except for the HRQOL subscale psychological well-being (95% CI [0.09 to 0.85]). Mediation analyses revealed that sleep duration in schooldays explained most of the associations (64 - 75%) in 4 out 5 HRQOL subscales, except in the association with the HRQOL subscale physical well-being revealing an indirect effect of 71.9%.

CONCLUSIONS

This cross-sectional study described sleep among Norwegian adolescents and demonstrated that sleep durations in weekends and schooldays impact HRQOL and self-efficacy, revealing overall better outcome in HRQOL and self-efficacy with sufficient sleep during schooldays. These findings support the regularity of sleep and highlight the importance of sufficient sleep during schooldays, especially in a school-based sample of adolescents.

Adolescent sleep health in Africa: a scoping review protocol

INTRODUCTION

Problematic sleep is a major threat to health and quality of life among adolescents. Hence, to provide directions for research and interventions, there is a need to examine the literature on adolescent sleep health in Africa. However, available studies on adolescent sleep health in Africa have not been properly mapped. Thus, this scoping review aims to investigate the extent and type of available evidence concerning sleep health among adolescents in Africa and to highlight the relationship of adolescent sleep health with adverse mental health outcomes and cardiometabolic risk factors. The review will further highlight areas of agreement and controversies on adolescent sleep health, and identify evidence gaps that require research attention across the continent.

METHODS AND ANALYSIS

This scoping review will be conducted using Arksey and O'Malley's six-step procedure. Thus, we have prepared this protocol according to the framework for scoping reviews developed by the Joanna Briggs Institute. To identify eligible studies, we will search MEDLINE, Scopus, PsycINFO, AJOL, JSTOR, HINARI and Google Scholar. The review will include all published articles in English, French, Spanish, Portuguese and Italian languages on adolescent sleep health in Africa from the inception of the databases, while relevant information will be extracted from included studies using an adapted data extraction tool. The results will be presented using tables and charts as appropriate.

ETHICS AND DISSEMINATION

The scoping review does not require ethical approval because the publications to be used for the review are publicly available and the study does not involve contact with humans or other animals as research participants. Furthermore, clinical records will not be used for the study. Upon completion, findings from the study will be disseminated through presentations at scientific meetings and publication in a relevant peer-reviewed journal.

SCOPING REVIEW REGISTRATION

Open Science Framework (https://osf.io/5sjwq/).

Inhibitory control and mood in relation to psychological resilience: an ecological momentary assessment study

Psychological resilience, the ability to adapt to adversity, is theorized to rely on intact inhibitory control (IC) mechanisms, which underlie one's ability to maintain goal-directed behavior by inhibiting prepotent responses. However, no study to date has explored daily fluctuations of IC performance in relation to resilience. Here, we examined the association between IC and mood measured daily in relation to psychological resilience in young adults in a stressful situation. Baseline resilience was obtained from 144 female and male soldiers during their basic combat training. Then, participants completed an ecological momentary assessment protocol, in which they reported their momentary mood and completed a short IC assessment twice/day for 2 weeks. A hierarchical linear modeling analysis revealed that psychological resilience moderated the relationship between momentary IC and momentary mood, such that better IC was associated with better mood only for those with higher, but not lower, self-reported psychological resilience at baseline. These results show that psychological resilience is manifested in the everyday association between IC and mood. Furthermore, they lend important support to cognitive models of resilience and may have significant contribution to our understanding of resilient behavior in real life.Trial Registration: MOH_2018-0-13_002451.

Depression, Insomnia, and Obesity Among Post-9/11 Veterans: Eating Pathology as a Distinct Health Risk Behavior

INTRODUCTION

Understanding the interrelationships between co-occurring chronic health conditions and health behaviors is critical to developing interventions to successfully change multiple health behaviors and related comorbidities. The objective of the present study was to examine the effects of depression, insomnia, and their co-occurrence on risk of obesity and to examine the role of health risk behaviors as potential confounders of these relationships with an emphasis on eating pathologies.

METHODS

Iraq and Afghanistan conflict era veterans (n = 1,094, 51.2% women) who participated in the Women Veterans Cohort Study between July 2014 and September 2019 were categorized as having depression, insomnia, both, or neither condition. Logistic regression models were used to examine group differences in the risk of obesity. Health risk behaviors (i.e., eating pathology, physical activity, smoking, and hazardous drinking) were then assessed as potential confounders of the effects of depression and insomnia on the likelihood of obesity.

RESULTS

Obesity was most prevalent in individuals with co-occurring insomnia and depression (53.2%), followed by depression only (44.6%), insomnia only (38.5%), and neither condition (30.1%). Importantly, maladaptive eating behaviors confounded the depression-obesity association but not the insomnia-obesity association. There was no evidence that insufficient physical activity, smoking, or hazardous drinking confounded the effects of insomnia or depression on obesity.

CONCLUSIONS

These findings exemplify the complex relationships between multiple health conditions and behaviors that contribute to obesity. Elucidating these associations can enhance the precision with which interventions are tailored to efficiently allocate resources and reduce the severe health impact of obesity among veterans.

The relationship between emotional neglect and non-suicidal self-injury among middle school students in China: the mediating role of social anxiety symptoms and insomnia

 BACKGROUND: Non-suicidal self-injury (NSSI) is a vital public concern around the world, and it often starts in adolescence. Emotional neglect (EN) has been considered a distal risk factor for NSSI, but the effects of social anxiety symptoms (SA) and insomnia on this relationship have remained unclear. This study aimed to investigate the potential pathways from EN to NSSI, examining the role of SA and insomnia in this association.

METHODS

One thousand three hundred thirty seven Chinese middle school students (M_age = 13.040, SD = 0.981, 50.2% males) in China were enrolled in this cross-sectional study. Participants completed the Emotional Neglect sub-scale of Childhood Trauma Questionnaire (CTQ-SF), the Social Anxiety Scale for Adolescent (SAS-A), Athens Insomnia Scale (AIS) and non-suicidal self-injury assessment. Structural equation modelling (SEM) was used to test the possible mediation model among these variables.

RESULTS

231(17.3%) students reported NSSI history during last year and 322 (24.1%) participants reported experiences of EN. Students who experienced EN have higher rates of NSSI compared to students without EN history (29.2% vs 13.5%). EN, SA, insomnia and NSSI were positively related to each other. Furthermore, both SA and insomnia played a mediating role in the relationship between EN and NSSI, the series mediating effect of SA and insomnia on this association was also significant after controlling for demographics. Indirect effects accounted for 58.26% of the total effects (EN → NSSI).

CONCLUSIONS

Our study revealed that EN was associated with NSSI, SA and insomnia play indirect roles in the association between EN and NSSI. The findings of our research may have implications for clinicians, families, and schools in their efforts to lower the risk of NSSI in adolescents.

Early morning university classes are associated with impaired sleep and academic performance

Attending classes and sleeping well are important for students' academic success. Here, we tested whether early morning classes are associated with lower attendance, shorter sleep and poorer academic achievement by analysing university students' digital traces. Wi-Fi connection logs in 23,391 students revealed that lecture attendance was about ten percentage points lower for classes at 08:00 compared with later start times. Diurnal patterns of Learning Management System logins in 39,458 students and actigraphy data in 181 students demonstrated that nocturnal sleep was an hour shorter for early classes because students woke up earlier than usual. Analyses of grades in 33,818 students showed that the number of days per week they had morning classes was negatively correlated with grade point average. These findings suggest concerning associations between early morning classes and learning outcomes.

Association of social jetlag and eating patterns with sleep quality and daytime sleepiness in Japanese high school students

A high prevalence of excessive daytime sleepiness and poor sleep quality has been reported in adolescents, but the effects of social jetlag on sleep quality and daytime sleepiness are unclear. Therefore, we assessed the association of sleep and eating patterns with daytime sleepiness and sleep quality among a total of 756 Japanese high school students. Participants completed the Pittsburgh Sleep Quality Index to evaluate sleep quality, the Pediatric Daytime Sleepiness Scale to evaluate daytime sleepiness, and an 8-day sleep diary. Data on average sleep duration, social jetlag, midsleep on free days sleep corrected, and the differences in the first and last meal timing between school days and non-school days were obtained from participants' sleep diaries. The results reveal that social jetlag is associated with differences in the first meal timing between school days and non-school days, and that social jetlag of more than 2 hr is associated with extremely poor sleep quality and excessive daytime sleepiness in Japanese high school students. Our findings suggest that reducing social jetlag to within a 2-hr window is important to prevent poor sleep quality and excessive daytime sleepiness for this population.

Sleep Deprivation and Insomnia in Adolescence: Implications for Mental Health

Sleep changes significantly throughout the human lifespan. Physiological modifications in sleep regulation, in common with many mammals (especially in the circadian rhythms), predispose adolescents to sleep loss until early adulthood. Adolescents are one-sixth of all human beings and are at high risk for mental diseases (particularly mood disorders) and self-injury. This has been attributed to the incredible number of changes occurring in a limited time window that encompasses rapid biological and psychosocial modifications, which predispose teens to at-risk behaviors. Adolescents’ sleep patterns have been investigated as a biunivocal cause for potential damaging conditions, in which insufficient sleep may be both a cause and a consequence of mental health problems. The recent COVID-19 pandemic in particular has made a detrimental contribution to many adolescents’ mental health and sleep quality. In this review, we aim to summarize the knowledge in the field and to explore implications for adolescents’ (and future adults’) mental and physical health, as well as to outline potential strategies of prevention.

The Associations between Meeting 24-Hour Movement Guidelines (24-HMG) and Mental Health in Adolescents-Cross Sectional Evidence from China

(1) Background: This study determined the prevalence of adolescents that meet 24-HMGs alone and in combination, and their association with the risk of developing adolescent anxiety and depression. (2) Methods: Participants were drawn from 9420 K8 grade adolescents (age 14.53 ± 0.69 years; 54.78% boys) from the China Education Tracking Survey (CEPS) 2014-2015 tracking data. Data on depression and anxiety were collected from the results of the questionnaire in the CEPS for the adolescent mental health test. Compliance with the 24-HMG was defined as: physical activity time (PA) ≥ 60 min/day was defined as meeting the PA. Screen time (ST) ≤ 120 min/day was defined as meeting the ST. Adolescents aged 13 years achieved 9-11 h of sleep per night and adolescents aged 14-17 years achieved 8-10 h of sleep per night, defined as meeting sleep. Logistic regression models were used to examine the association between meeting and not meeting the recommendations and the risk of depression and anxiety in adolescents. (3) Results: Of the sample studied, 0.71% of adolescents met all three recommendations, 13.54% met two recommendations and 57.05% met one recommendation. Meeting sleep, meeting PA+ sleep, meeting ST + sleep, and meeting PA + ST + sleep were associated with a significantly lower risk of anxiety and depression in adolescents. Logistic regression results showed that differences in the effects of gender on the odds ratio (ORs) for depression and anxiety in adolescents were not significant. (4) Conclusions: This study determined the risk of developing depression and anxiety in adolescents who met the recommendations for 24-HMG alone and in combination. Overall, meeting more of the recommendations in the 24-HMGs was associated with lower anxiety and depression risk outcomes in adolescents. For boys, reducing the risk of depression and anxiety can be prioritised by meeting PA + ST + sleep, meeting ST + sleep and meeting sleep in the 24-HMGs. For girls, reducing the risk of depression and anxiety may be preferred by meeting PA + ST + sleep or meeting PA+ sleep and meeting sleep in 24-HMGs. However, only a small proportion of adolescents met all recommendations, highlighting the need to promote and support adherence to these behaviours.

Sleep and Mental Health Problems in Children and Adolescents

Previous reviews have described the links between sleep and mental health extensively. In this narrative review, we focus on literature published during the last decade investigating the links between sleep and mental health difficulties in childhood and adolescence. More specifically, we focus on the mental health disorders listed in the most recent edition of the Diagnostic and Statistical Manual of Mental Disorders. We also discuss possible mechanisms underlying these associations. The review ends with a discussion of possible future lines of enquiry.

Depression and Anxiety Mediate the Association between Sleep Quality and Self-Rated Health in Healthcare Students

OBJECTIVES

This study aimed to investigate factors associated with sleep quality in healthcare students and to determine whether depressive and anxiety symptoms may explain some of the associations between sleep quality and self-rated health.

STUDY DESIGN

This is a cross-sectional study at wave one.

METHODS

A total of 637 healthcare students were recruited via a stratified random sampling method in Hangzhou, China. The Sleep Quality Questionnaire (SQQ) and the four-item Patient Health Questionnaire (PHQ-4) were used to assess sleep quality and depressive and anxiety symptoms, respectively. Self-rated health was assessed via a self-developed questionnaire of both physical and psychological health. Structural equation modeling was used to examine the direct and indirect effects of sleep quality on self-rated health through depressive and anxiety symptoms.

RESULTS

Students engaged in part-time employment (p = 0.022), with poor perceived employment prospects (p = 0.009), and who did not participate in recreational sports (p = 0.008) had worse sleep quality. Structural equation modeling revealed a significant total effect of sleep quality on self-rated health (b = 0.592, p < 0.001), a significant direct effect of both sleep quality and depressive and anxiety symptoms on self-rated health (b = 0.277, 95% CI: 0.032-0.522), and a significant indirect effect of sleep quality on self-rated health through depressive and anxiety symptoms (b = 0.315, 95% CI: 0.174-0.457).

CONCLUSIONS

Depressive and anxiety symptoms partially explain the association between sleep quality and self-rated health. Intervening upon sleep quality, depressive, and anxiety symptoms may bolster the self-rated health of healthcare students.

Understanding the Need for Sleep to Improve Cognition

The restorative function of sleep is shaped by its duration, timing, continuity, subjective quality, and efficiency. Current sleep recommendations specify only nocturnal duration and have been largely derived from sleep self-reports that can be imprecise and miss relevant details. Sleep duration, preferred timing, and ability to withstand sleep deprivation are heritable traits whose expression may change with age and affect the optimal sleep prescription for an individual. Prevailing societal norms and circumstances related to work and relationships interact to influence sleep opportunity and quality. The value of allocating time for sleep is revealed by the impact of its restriction on behavior, functional brain imaging, sleep macrostructure, and late-life cognition. Augmentation of sleep slow oscillations and spindles have been proposed for enhancing sleep quality, but they inconsistently achieve their goal. Crafting bespoke sleep recommendations could benefit from large-scale, longitudinal collection of objective sleep data integrated with behavioral and self-reported data.

Short sleep duration and adolescent health: does weekend catch-up sleep work and for whom?

OBJECTIVES

Despite evidence that sleep duration affects adolescent health, there remain important research gaps in the literature. Little is known about (1) whether the association between weekday sleep duration and health is confounded by unobserved individual heterogeneity and (2) the extent to which weekend catch-up sleep (WCS) duration moderates this association. This study addresses these gaps.

STUDY DESIGN

Using six waves of longitudinal data from the 2011-2016 Korean Children and Youth Panel Survey (N = 6633), this study examined the relationship between weekday sleep duration, WCS duration, and two measures of adolescent health, body mass index (BMI) and self-rated health (SRH).

METHODS

We estimated fixed effects models to account for individual-level heterogeneity.

RESULTS

Fixed effects estimates suggest that part of the associations between short sleep duration and adolescent health are confounded by unobserved individual heterogeneity (62% for BMI and 30% for poor SRH), although the associations remain statistically significant. Sleeping less than 6 h increased BMI by 0.203 and the probability of reporting poor SRH by about 2 percentage points. Controlling for individual heterogeneity, however, changed the sign of the WCS duration coefficient, suggesting that a longer WCS duration is positively associated with BMI (b = 0.021). No such patterns were found for SRH.

CONCLUSIONS

Short weekday sleep duration threatens adolescent health. WCS duration is protective only for those who are most sleep deprived.

Associations between 24-h movement behaviors and self-rated health: a representative sample of school-aged children and adolescents in Okinawa, Japan

OBJECTIVES

This study aimed to determine the associations between adherence to 24-h movement behavior guidelines and self-rated health (SRH) among Japanese adolescents according to their age group.

STUDY DESIGN

This was a cross-sectional study.

METHODS

Probability proportional sampling data, which were collected from six regions of Okinawa Prefecture, Japan, considering the number of schools, included 2408 fifth-grade students (aged 10-11 years) in 31 elementary schools and 4360 eighth-grade students (aged 13-14 years) in 30 junior high schools. SRH, moderate-to-vigorous physical activity (MVPA), screen time (ST), sleep duration, and confounding factors (sex, weight status, family affluence, parental support, school satisfaction, and school demands) were self-reported.

RESULTS

The logistic regression models showed that adherence to ST and sleep recommendations in elementary school students was associated with a high prevalence of good health only, whereas adherence to only MVPA, only sleep, ST and sleep, MVPA and sleep, and all three recommendations were associated with a high prevalence of good health among junior high school students. All combinations that included achievement of the recommended sleep duration were associated with SRH.

CONCLUSIONS

Achieving 24-h movement behavior guidelines, particularly sleep recommendations, is associated with better perceived health in school-aged children, especially in adolescents.

Delayed high school start times and graduation and attendance rates over 4 years: the impact of race and socioeconomics

STUDY OBJECTIVES

The current study was designed to examine if improvements in high school graduation and attendance rates persist 4 years after start times later than 8:30 am. Socioeconomic status and race were accounted for in the graduation analysis.

METHODS

School-wide attendance and graduation records (n = 28 schools) from 1999-2017 were analyzed in August of 2021 using a repeated-measures analysis of variance at 5 points in time, 1 year predelay and 4 consecutive years postdelay start times.

RESULTS

Graduation rates for students in grade 12 (n > 47,000) after postdelay year 4 increased from 80% to 90% (P < .001) and attendance rates in grades 9-12 (n > 80,000) improved from 90% to 93% (P = .012).

CONCLUSIONS

Attendance and graduation rates for all students improved after 4 years following a delayed start. Economically disadvantaged students and Black students showed significant changes in graduation rates postdelay year 4 and White students significantly improved postdelay years 2, 3, and 4. Adolescent students, especially economically and racially disadvantaged students, have a vulnerability for obtaining adequate sleep. Delaying high school start times is a cost-effective intervention that could promote sufficient sleep and boost graduation and attendance rates.

CITATION

McKeever PM, Dodd R, O'Sullivan DM. Delayed high school start times and graduation and attendance rates over 4 years: the impact of race and socioeconomics. J Clin Sleep Med. 2022;18(11):2537-2543.

Longitudinal associations between high school sleep characteristics and young adult health outcomes

STUDY OBJECTIVES

Short sleep duration and evening chronotype are independently associated with negative health outcomes. However, it is unclear how adolescent sleep duration and chronotype are longitudinally associated with health outcomes during early adulthood.

METHODS

Participants from the NEXT Generation Health Study (n = 2,783; 54.5% female) completed measures of sleep duration (scheduled day and unscheduled day) and chronotype in high school. Sleep duration, chronotype, general health, depressive symptoms, and psychosomatic symptoms were also assessed 4 years after high school. Latent variables estimated high school scheduled-day sleep duration, unscheduled-day sleep duration, and chronotype using the during high school measures. Two path analyses tested the prospective associations between high school sleep duration (separate models for scheduled and unscheduled days) and chronotype with 4 years after high school health outcomes as mediated by concurrent sleep duration and chronotype.

RESULTS

In the scheduled-day model, longer high school sleep duration and later chronotype were associated with longer duration and later chronotype in early adulthood. Longer high school sleep duration was directly associated with fewer psychosomatic symptoms and indirectly associated with fewer depressive and psychosomatic symptoms through longer sleep duration in early adulthood. Later chronotype in high school was indirectly associated with poorer general health, greater depressive symptoms, and greater psychosomatic symptoms in early adulthood through later chronotype.

CONCLUSIONS

Findings highlight the roles of scheduled-day sleep duration and evening chronotype in shaping health outcomes and suggest the importance of chronotype and optimal sleep habits among adolescents.

CITATION

Maultsby KD, Temmen CD, Lewin D, et al. Longitudinal associations between high school sleep characteristics and young adult health outcomes. J Clin Sleep Med. 2022;18(11):2527-2536.

Independent and joint effects of sleep duration and sleep quality on suboptimal self-rated health in medical students: A cross-sectional study

Objective

Studies on the association between sleep behavior and health often ignored the confounding effects of biorhythm-related factors. This study aims to explore the independent and joint effects of sleep duration and sleep quality on suboptimal self-rated health (SRH) in medical students.

Methods

Cross-sectional study. Proportional stratified cluster sampling was used to randomly recruit students from various medical specialties at a medical university in eastern China. Our questionnaire mainly included information on basic demographic characteristics, SRH, sleep behavior, and biorhythm-related factors. The independent and joint effects of sleep duration and sleep quality on suboptimal SRH were assessed by logistic regression after controlling for potential confounders.

Results

Of 1,524 medical students (mean age = 19.9 years, SD = 1.2 years; 59.1% female), 652 (42.8%) had suboptimal SRH. Most medical students (51.5%) slept for 7 h/night, followed by ≥8 (29.1%) and ≤ 6 h (19.4%). After adjusting for basic demographic characteristics and biorhythm-related factors, compared with students who slept for ≥8 h/night, the adjusted ORs (95%CI) for those who slept 7 and ≤ 6 h/night were 1.36 (1.03, 1.81) and 2.28 (1.60, 3.26), respectively (P < 0.001 for trend); compared with those who had good sleep quality, the adjusted ORs (95%CI) for those who had fair and poor sleep quality were 4.12 (3.11, 5.45) and 11.60 (6.57, 20.46), respectively (P < 0.001 for trend). Further, compared with those who slept for ≥8 h/night and good sleep quality, those who slept ≤ 6 h and poor sleep quality had the highest odds of suboptimal SRH (OR 24.25, 95%CI 8.73, 67.34).

Conclusions

Short sleep and poor sleep quality were independently and jointly associated with higher odds of suboptimal SRH among medical students.

Time Spent on Daily Activities and Its Association with Life Satisfaction among Czech Adolescents from 1992 to 2019

Life satisfaction, an important precursor of adolescents’ well-being, is linked to daily activities. Substantial changes have been noted in adolescents’ daily activities over the years, raising the question of possible consequences for life satisfaction. This study aimed to explore changes in adolescents’ life satisfaction and their time spent on daily activities (sleeping, engaging in sports, online gaming, school commuting, time spent at school) and further investigate the associations between adolescents’ life satisfaction and these daily activities. The sample comprised 2715 adolescents from birth cohorts surveyed at four time points between 1992 and 2019. Participants were administered the Daily Activities Inventory and the Berne Questionnaire on Adolescents’ Well-Being. Robust ANOVA with post hoc tests and spline regression were employed. We found cohort differences in sleep duration (8.6 h a day on average in 1992 and 7.5 in 2019). Sleep duration of 8 h and 1 h of sports activities had a beneficial effect on life satisfaction, while more than 1 h of online gaming had a negative impact. Neither school attendance nor commuting to school was associated with adolescents’ life satisfaction. The results of this study can inform public-health policies to promote sleeping and sports habits in adolescence.

Association of weekend catch-up sleep ratio and subjective sleep quality with depressive symptoms and suicidal ideation among Korean adolescents

Circadian misalignment caused by differences in sleep duration between weekends and weekdays may be associated with adolescent mental health and sleep quality may be able to compensate for this problem. This study aimed to investigate the association between weekend catch-up sleep (CUS) ratio and sleep quality with depressive symptoms and suicidal ideation among South Korean adolescents. We used data from the Korea Youth Risk Behavior Web-based Survey 2015–2019 involving 270,619 adolescents. The weekend CUS ratio was calculated by dividing the average weekend sleep duration by the average weekday sleep duration (< 1.00, 1.00 ≤ CUS < 1.50, or ≥ 1.50). Subjective sleep quality was categorized as poor, moderate, or good. Multiple logistic regression analyses were performed. A weekend CUS ratio of < 1.00 and poor sleep quality was significantly associated with mental health. Absolutely short sleep duration (CUS < 1.00 and weekday sleep duration < 5 h) was most associated with depressive symptoms and suicidal ideation. Furthermore, adolescents with a CUS ratio of ≥ 1.50 showed increased odds of depressive symptoms despite having good sleep quality. Appropriate weekend CUS may benefit adolescents’ mental health. When investigating the relationship between adolescents’ sleep and mental health, a weekend CUS ratio should be considered in addition to sleep quality and duration.

The CLASS Study (Circadian Light in Adolescence, Sleep and School): protocol for a prospective, longitudinal cohort to assess sleep, light, circadian timing and academic performance in adolescence

BACKGROUND

During adolescence, sleep and circadian timing shift later, contributing to restricted sleep duration and irregular sleep-wake patterns. The association of these developmental changes in sleep and circadian timing with cognitive functioning, and consequently academic outcomes, has not been examined prospectively. The role of ambient light exposure in these developmental changes is also not well understood. Here, we describe the protocol for the Circadian Light in Adolescence, Sleep and School (CLASS) Study that will use a longitudinal design to examine the associations of sleep-wake timing, circadian timing and light exposure with academic performance and sleepiness during a critical stage of development. We also describe protocol adaptations to enable remote data collection when required during the COVID-19 pandemic.

METHODS

Approximately 220 healthy adolescents aged 12-13 years (school Year 7) will be recruited from the general community in Melbourne, Australia. Participants will be monitored at five 6 monthly time points over 2 years. Sleep and light exposure will be assessed for 2 weeks during the school term, every 6 months, along with self-report questionnaires of daytime sleepiness. Circadian phase will be measured via dim light melatonin onset once each year. Academic performance will be measured via national standardised testing (National Assessment Program-Literacy and Numeracy) and the Wechsler Individual Achievement Test-Australian and New Zealand Standardised Third Edition in school Years 7 and 9. Secondary outcomes, including symptoms of depression, anxiety and sleep disorders, will be measured via questionnaires.

DISCUSSION

The CLASS Study will enable a comprehensive longitudinal assessment of changes in sleep-wake timing, circadian phase, light exposure and academic performance across a key developmental stage in adolescence. Findings may inform policies and intervention strategies for secondary school-aged adolescents.

ETHICS AND DISSEMINATION

Ethical approval was obtained by the Monash University Human Research Ethics Committee and the Victorian Department of Education. Dissemination plans include scientific publications, scientific conferences, via stakeholders including schools and media.

STUDY DATES

Recruitment occurred between October 2019 and September 2021, data collection from 2019 to 2023.

Sleep duration, depressive symptoms, and digital self-harm among adolescents

BACKGROUND

This study examines the relationship between sleep duration, depression, and engagement in a novel cyber behavior, digital self-harm, among adolescents.

METHOD

Logistic regression analyses were conducted using cross-sectional data from the 2019 Florida Youth Substance Abuse Survey (N = 9,819; 48% male; avg. grade level = 9th grade [SD = 1.9]) to analyze the association between sleep duration and digital self-harm. A Karlson-Holm-Breen (KHB) analysis was used to assess whether depressive symptoms attenuate this association.

RESULTS

Bivariate results indicated that longer sleep duration was associated with lower incidence of digital self-harm. Multivariate results showed that sleep duration was inversely associated with engaging in digital self-harm, net of all covariates. Depressive symptoms attenuated the influence of sleep duration on digital self-harm by 50.72%.

CONCLUSIONS

Both insufficient sleep and depressive symptoms were associated with engagement in digital self-harm among adolescents. Prospective research is needed, however, to confirm this pathway. Practitioners and clinicians should consider discussing digital self-harm with adolescents and parents, especially if adolescents are experiencing poor sleep and depressive symptoms.

Staying vigilant during recurrent sleep restriction: dose-response effects of time-in-bed and benefits of daytime napping

Study Objectives

We characterized vigilance deterioration with increasing time-on-task (ToT) during recurrent sleep restriction of different extents on simulated weekdays and recovery sleep on weekends, and tested the effectiveness of afternoon napping in ameliorating ToT-related deficits.

Methods

In the Need for Sleep studies, 194 adolescents (age = 15–19 years) underwent two baseline nights of 9-h time-in-bed (TIB), followed by two cycles of weekday manipulation nights and weekend recovery nights (9-h TIB). They were allocated 9 h, 8 h, 6.5 h, or 5 h of TIB for nocturnal sleep on weekdays. Three additional groups with 5 h or 6.5 h TIB were given an afternoon nap opportunity (5 h + 1 h, 5 h + 1.5 h, and 6.5 h + 1.5 h). ToT effects were quantified by performance change from the first 2 min to the last 2 min in a 10-min Psychomotor Vigilance Task administered daily.

Results

The 9 h and the 8 h groups showed comparable ToT effects that remained at baseline levels throughout the protocol. ToT-related deficits were greater among the 5 h and the 6.5 h groups, increased prominently in the second week of sleep restriction despite partial recuperation during the intervening recovery period and diverged between these two groups from the fifth sleep-restricted night. Daytime napping attenuated ToT effects when nocturnal sleep restriction was severe (i.e. 5-h TIB/night), and held steady at baseline levels for a milder dose of nocturnal sleep restriction when total TIB across 24 h was within the age-specific recommended sleep duration (i.e. 6.5 h + 1.5 h).

Conclusions

Reducing TIB beyond the recommended duration significantly increases ToT-associated vigilance impairment, particularly during recurrent periods of sleep restriction. Daytime napping is effective in ameliorating such decrement.

Clinical Trial Registration

NCT02838095, NCT03333512, and NCT04044885.

School-related sedentary behaviours and indicators of health and well-being among children and youth: a systematic review

BACKGROUND

The purpose of this systematic review was to examine the associations between school-related sedentary behaviours and indicators of health and well-being in children and youth (~ 5-18 years) attending school.

METHODS

This review was conducted to inform the development of School-Related Sedentary Behaviour Recommendations. Peer-reviewed, published, or in-press articles in English were included. Reviews, meta-analyses, and case studies were excluded; all other study designs were eligible. Further, articles had to meet the a priori study criteria for population, intervention, comparator (PROSPERO ID: CRD42021227600). Embase, MEDLINE® ALL, and PsycINFO were searched. Risk of bias was assessed for individual experimental studies using the Cochrane risk of bias assessment tool, and in observational studies based on the GRADE framework and in line with previous systematic reviews examining sedentary behaviours in children. Overall quality of evidence was assessed using the GRADE framework for each outcome category and study design. Results were synthesized narratively, grouped by study design and outcome category. Further, several high-level summaries were conducted to help interpret results.

RESULTS

Evidence was synthesized from 116 reports, including 1,385,038 participants and 1173 extracted associations. More school-related sedentary behaviour was favourably associated with nearly one-third of extracted associations for cognitive (33%) and social-emotional (32%) indicators (e.g., less anxiety), but unfavourably associated with other movement behaviours (e.g., less physical activity) (35%). Active lessons were favourable (72%), compared to more school-related sedentary behaviours, when examining associations for all health and well-being indicators. More homework was favourable across all health and well-being indicators in 4% of extracted associations for primary school children, and 25% of extracted associations for secondary school children. However, ≥2 h/day of homework appeared to be unfavourable for health and well-being. Limitations for synthesized studies included generally low quality of evidence and a lack of studies in South American, African, or low-middle income countries.

CONCLUSIONS

Findings can help inform policy makers, schools, and teachers, regarding the amount of homework assigned and the introduction of active lessons into the classroom to enhance health and well-being of children. More research is needed examining school-related sedentary behaviours and indicators of health and well-being in low- and middle-income countries.

Lifestyle Behaviors and Depressive Symptoms in Chinese Adolescents Using Regression and fsQCA Models

The study was to compare the performance of the regression models and fuzzy set qualitative comparative analysis (fsQCA) models in analyzing the possible effects of sociodemographic variables (age and sex) and lifestyle behaviors (physical activity, sedentary time, sleep duration, physical education class and screen time) on depressive symptoms in adolescents. This cross-sectional surgery was conducted among 726 adolescents in Jilin Province of China, selected by random cluster sampling. The regression model showed that age, physical education (PE) class and sleep duration were associated with depressive symptoms. Meanwhile, the fsQCA models showed that shorter physical activity, PE class and sleep duration as well as longer sedentary and screen time were related to higher levels of depressive symptoms. Both regression and fsQCA models indicated that promoting lifestyle behaviors could affect depressive symptoms. Considering the differences between the two methods, they are not superior to the other method, but complementary and should be used in other studies at the same time.

The Association Between Frequent Sugar-Sweetened Beverage Intake and Sleep Duration in School Children: A Cross-Sectional Study

Background

Higher consumption of sugar-sweetened beverages (SSBs) maybe association with children's sleep pattern. However, few studies have considered this association in Asia, especially in school children. This study investigated the relationship between children's consumption frequency of such beverages and their sleep duration.

Methods

Participants aged 6–12 years were analyzed from two survey data in 2012 and 2013–2016 Nutrition and Health Surveys in Taiwan. A total of 2,628 participants were included in the analysis (2012, N = 1,267; 2013–2016, N = 1,361). Beverages weekly consumption were divided into low and high intake groups by medians cut-off points. The sleep variables were the sleep duration at night (including school days and weekends) and sleep debt. After controlling the confounders, the correlation between sugar-sweetened beverage consumption and sleep duration was examined using multinomial logistic regression analysis.

Results

The students slept for an average of 8.8 h on school days and 9.7 h on weekends. Relative to the low SSB intake group, the high intake group exhibited shorter sleep durations on school days (P < 0.001), greater sleep debt (P = 0.049). In logistic regression, high intake group were more likely to sleep for <8.5 h on school days (OR = 1.67, P = 0.002) and exhibit >2 h of sleep debt than low intake group (OR = 1.41, P = 0.022).

Conclusions

Children who had consumed sugar-sweetened beverages frequently slept for shorter durations at night on school days and exhibited greater sleep debt. The causal relationship was not clear. Nonetheless, these two factors are important in promoting children health.

Sleep Loss, Daytime Sleepiness, and Neurobehavioral Performance among Adolescents: A Field Study

The current study investigates the impact of sleep loss on neurobehavioral functioning and sleepiness in a natural setting among healthy adolescents. Fifty-nine adolescents (32 females) from grades 7 to 12 (mean age of 16.29 ± 1.86 years) participated in the study. All participants wore the actigraph for a continuous five to seven days, including school and nonschool days. Subjective sleepiness and neurobehavioral performance (using the psychomotor vigilance test and the digit symbol substitution test) were measured three times a day on two school days and one nonschool day. The results presented that sleep loss influenced subjective sleepiness reports, showing higher sleepiness scores following sleep loss than following sufficient night sleep. Neurobehavioral functioning across all measurements was also significantly worse following sleep loss. Furthermore, participants performed worse on weekday morning assessments than on assessments at other times of the day following sleep loss. These findings suggest that sleep loss in natural settings has a significant impact on neurobehavioral performance and subjective sleepiness. Our findings have essential implications for public policy on school schedules.

A Comprehensive Review of the Literature on Sleep Difficulties and Suicidality in Youth to Inform an Integrative Developmental Model and Future Directions

Purpose of Review

Suicide is currently the second leading cause of death among youth. Identification of modifiable near-term risk factors can inform suicide prevention strategies. One promising, readily assessed factor is sleep. We critically review the literature on sleep and suicidal thoughts and behaviors among youth.

Recent Findings

Most studies examining the youth sleep-suicidality relationship are from epidemiological samples in which both sleep problems and suicidality were assessed over variable timeframes using limited items from scales not designed to measure these constructs. Nonetheless, these data overwhelmingly support an association between suicidality and a range of sleep difficulties (e.g., insomnia, short/long sleep, weekend oversleep), above and beyond depressive symptoms. Limited studies include clinical samples or prospective designs. We review potential mechanisms and present a developmentally-informed integrative model.

Summary

Literature supports a clear association between sleep difficulties and youth suicidality. Future directions include prospective longitudinal studies and targeted prevention efforts.

Equal Benefits? An Examination of the Potential Consequences of Later School Start Times for Adolescents and Their Mental Health

BACKGROUND

Given the documented benefits of later school start times on adolescents' mental health, the aim of the current study was to examine if the association between school start times and depressive symptoms differed across adolescents from families of different socioeconomic status levels.

METHODS

Using a cross-sectional design, the current study incorporated an online survey for high school students and their parents across the United States, with average sleep duration measured through a 7-day sleep diary. A total of 193 adolescent (Mean_age  = 15.7 years old, SD = .94; 54.4% female; 71% white) and parent (Mean_age  = 47.6 years old, SD = 5.4; 80% female; 79% white) dyads participated. Adolescents reported on depressive symptoms, sleep quality and duration, chronotype, and demographic covariates; parents reported on school start times and socioeconomic status.

RESULTS

Results suggested that only in adolescents from higher socioeconomic status families (+1 SD) did the association between later start times and fewer depressive symptoms emerge as significant.

CONCLUSIONS

Although more school start times research is needed to understand its impact across diverse groups of students, current findings suggest a disproportionate benefit of reduced depression for youth from families of higher socioeconomic status with having a later start time.

Clustering of Physical Activity, Sleep, Diet, and Screen-Based Device Use Associated with Self-Rated Health in Adolescents

BACKGROUND

Little is known about how the interplay among health-related behaviors impacts self-rated health (SRH). We examined the clustering of physical activity (PA), sleep, diet, and specific screen-based device use, and the associations between the emergent clusters and SRH among Brazilian adolescents.

METHOD

The data used in this cross-sectional study were from the baseline of the Movimente Program. Self-reported data were analyzed. SRH was recorded as a 5-point scale (from poor to excellent). Daily duration of exposure to the computer, the television, the cell phone, and games; PA; sleep; and weekly consumption of fruits and vegetables and ultra-processed foods were included in a Two-Step cluster analysis. Multilevel ordered logistic regressions assessed the associations between the clusters and SRH.

RESULTS

The data of 750 students (girls: 52.8%, 13.1 ± 1.0 years) were analyzed. Good SRH was more prevalent (52.8%). Three clusters were identified: the Phubbers (50.53%; characterized by the longest cell phone use duration, shortest gaming and computer use, lowest PA levels, and low consumption of fruits and vegetables), the Gamers (22.80%; longest gaming and computer use duration, PA < sample average, highest intake of ultra-processed foods), and a Healthier cluster (26.67%; physically active, use of all screen-based devices < sample average, and healthier dietary patterns). For both Gamers (-0.85; 95% CI -1.24, -0.46) and Phubbers (-0.71; 95% CI -1.04, -0.38), it was found a decrease in the log-odds of being in a higher SRH category compared with the Healthier cluster.

CONCLUSION

Specific clusters represent increased health-related risk. Assuming the interdependence of health-related behaviors is indispensable for accurately managing health promotion actions for distinguishable groups.

Psychological Consequences of Experienced Stress in Childhood — Phenomena of "Abandonment" and "Involvement"

The article deals with the fundamental problem of psychology, devoted to the theoretical analysis of the specifics of the child's experience of stressful situations with different levels of traumatization. Along with the lack of childhood stress understanding and research, the very principles of differentiation between every day and traumatic stress remain the least studied. In the theory of post-traumatic stress, it has been proven that one of the criteria for the danger/safety of a life situation is a person's subjective evaluation of the life threat degree. Such an assessment is based on the individual's representations of psychological safety and its components, such as "internal comfort", "experience/awareness" and "positive environment". In the course of a theoretical analysis of the problem of child's stress, we have shown in the article that a child's feeling of internal comfort and stability depends on the degree of the environment activity, its ability not only to protect the child, but also to provide additional opportunities. In accordance with the purpose of the work, the primary emphasis is not on the resourcefulness of the child's social environment, but on its limitation — the phenomena of "abandonment" and "involvement", which are analyzed taking into account a specific context — the impact on the child of everyday stressors and stressors of high intensity. The methodological basis of the study was the system (B.F. Lomov) and subject-activity approaches (S.L. Rubinshtein, A.V. Brushlinsky and others), the dynamic approach to the study of personality (L.I. Antsyferova). Focusing on these approaches has allowed us to consider the child stress in accordance with a whole system of factors (the nature of the stressor, supporting/non-supporting social environment, etc.). The methods of abstraction, formalization and interpretation are used as theoretical procedures. On the basis of an expert assessment, the features of reactions to everyday stress (situations of interaction of a child with parents and peers) are highlighted, which, unlike traumatic stress (situations of an extreme nature), are not determined by the impact of a specific stressor, but arise as a response to a latent cause of a diffuse nature associated with violation of social and information safety of the child. Manifestations of everyday stress act as a child's reaction to the feeling of "abandonment", which turns out to be associated with emotional, social and informational deprivation, with the leveling or distortion by adults of the child's social roles (the role structure of interaction). The feeling of being "involved" in the context of a traumatic event is accompanied by physical deprivation and a more intense experience of emotional deprivation (emotional rejection), including the child in non-normative social relations and imposing obligations on him that do not correspond to the level of the child's physical, social and mental maturity. The phenomena of abandonment and involvement are analyzed using examples of various situations of everyday and psycho-traumatic nature.

Sleep Quality Among Adolescents and Its Relation to Inhalant, Khat, and Internet Use, and Physical Illness: A Community-Based Exploratory Cross-Sectional Study

Sleep-related health problems are under investigated among adolescents in low-income countries, including our country, Ethiopia. Therefore, this study aimed to assess the sleep quality and its associated factors among adolescents aged 10 to 19 years in Ethiopia. A community-based cross-sectional study was conducted among 799 adolescents from May 27 to July 27, 2021, using a systematic random sampling technique. Sleep quality was assessed by using the Petersburg sleep quality index. The data was entered into Epi-data version 3.1 and exported to the Statistical Package for Social Science (SPSS) Version 21. A logistic regression model was used, and variables with a P-value less than .05 in the final fitting model were stated as independent predictors of poor sleep quality (PSQ). About 1 in 3 adolescents (38%) had a poor sleep quality. The rates of inhalant, khat, and internet use disorders were 16%, 38%, and 18%, respectively. Also, 27.4% of adolescents used alcohol as a sleep medication, and 75% of adolescents with internet addiction had PSQ. Moreover, adolescents with physical illness had about 4 times higher odds of association with PSQ (AOR = 3.76 and 95% CI = 2.30-6.15%CI), and inhalant use disorder (AOR = 1.98 and 95% CI = 1.29-3.04%CI), internet addiction (AOR = 3.33 and 95% CI = 2.09-5.30%CI), and khat use disorder (AOR = 1.74 and 95% CI = 1.11-2.73%CI), were positively associated with PSQ. PSQ was higher among adolescents, and problematic inhalants, khat, and internet use and physical illness were risk factors for PSQ.

Nonlinear relationship between sleep duration and non-suicidal self-injurious behaviour among Chinese adolescents

BACKGROUND

Previous studies have shown a positive association between sleep deprivation and non-suicidal self-injury (NSSI) among adolescents, but few studies have described the effects of oversleeping and weekend catch-up sleep on NSSI. The present study aimed to explore the nonlinear relationship between sleep duration and NSSI among Chinese adolescents.

METHODS

Data from China's National Adolescent Health Surveillance for the years 2014 to 2015 were collected from 15,713 students located across four provinces in China. A self-report questionnaire was used to assess sleep duration and 12-month NSSI. Binomial logistic regression models were used to examine the association between NSSI and sleep duration. The locally estimated scatter plot smoothing (LOESS) method was used to explore the associations of total NSSI number with sleep duration, and binomial regression analysis was used to test this relationship.

RESULTS

About 68.5% of adolescents reported sleeping less than 8 h on weeknights, while 37.8% of adolescents slept more than 10 h per night during weekends. The 12-month prevalence rate of NSSI was 29.4%. Compared to adolescents who reported weekend catch-up sleep of 0-1 h, those who slept < 0 h (adjusted odds ratio [aOR] = 1.38, 95% Confidence Interval [95% CI]: 1.16-1.64) had a higher risk of NSSI. Males who reported ≥3 h of weekend catch-up sleep had significantly increased odds of NSSI (aOR = 1.20, 95%CI: 1.01-1.42). Notably, a positive U-shaped association was observed between the sleep duration and the total NSSI number.

CONCLUSIONS

The findings reveal a nonlinear relationship between sleep duration and NSSI among Chinese adolescents. Therefore, it is necessary to be vigilant and screen for sleep duration among adolescents in NSSI treatment or prevention.

The Canadian 24-hour movement guidelines and self-rated physical and mental health among adolescents

OBJECTIVE

The Canadian 24-hour movement guidelines for children and youth recommend a minimum of 60 min/day of moderate-to-vigorous physical activity, no more than 2 h/day of recreational screen time, and 8-11 h/night of sleep depending on age. The objective of this study was to examine the associations of meeting combinations of these recommendations with self-rated physical and mental health.

METHODS

This study used data from the 2017 (n = 5739) and 2019 (n = 6960) cycles of the Ontario Student Drug Use and Health Survey (OSDUHS), a biennially repeated cross-sectional study of Ontario students in grades 7 through 12. Multivariable ordered logistic regression models were adjusted for age, gender, ethnoracial background, subjective socio-economic status, and body mass index z-scores.

RESULTS

Similar patterns were seen in the 2017 and 2019 samples. Compared with meeting none of the recommendations, meeting different combinations of recommendations in the 2019 sample was associated with positive self-rated physical and mental health. A dose-response gradient between the number of recommendations met and self-rated physical (p < 0.001) and mental (p < 0.001) health was observed, with meeting one (AOR: 1.82; 95% CI: 1.58-2.09), two (AOR: 3.54; 95% CI: 2.98-4.22), or three recommendations (AOR: 6.34; 95% CI: 4.46-9.02) being increasingly associated with positive self-rated physical health compared with meeting none; and meeting one (AOR: 1.51; 95% CI: 1.33-1.71), two (AOR: 2.70; 95% CI: 2.31-3.17), or three recommendations (AOR: 3.58; 95% CI: 2.57-4.98) being increasingly associated with positive self-rated mental health compared with meeting none.

CONCLUSION

Meeting the 24-hour movement guidelines is associated with better self-rated physical and mental health among adolescents.

In-person vs home schooling during the COVID-19 pandemic: Differences in sleep, circadian timing, and mood in early adolescence

During the COVID-19 pandemic, schools around the world rapidly transitioned from in-person to remote learning, providing an opportunity to examine the impact of in-person vs remote learning on sleep, circadian timing, and mood. We assessed sleep-wake timing using wrist actigraphy and sleep diaries over 1-2 weeks during in-person learning (n = 28) and remote learning (n = 58, where n = 27 were repeat assessments) in adolescents (age M ± SD = 12.79 ± 0.42 years). Circadian timing was measured under a single condition in each individual using salivary melatonin (Dim Light Melatonin Onset; DLMO). Online surveys assessed mood (PROMIS Pediatric Anxiety and Depressive Symptoms) and sleepiness (Epworth Sleepiness Scale - Child and Adolescent) in each condition. During remote (vs in-person) learning: (i) on school days, students went to sleep 26 minutes later and woke 49 minutes later, resulting in 22 minutes longer sleep duration (all P < .0001); (ii) DLMO time did not differ significantly between conditions, although participants woke at a later circadian phase (43 minutes, P = .03) during remote learning; and (iii) participants reported significantly lower sleepiness (P = .048) and lower anxiety symptoms (P = .006). Depressive symptoms did not differ between conditions. Changes in mood symptoms were not mediated by sleep. Although remote learning continued to have fixed school start times, removing morning commutes likely enabled adolescents to sleep longer, wake later, and to wake at a later circadian phase. These results indicate that remote learning, or later school start times, may extend sleep and improve some subjective symptoms in adolescents.

Parental perception and guideline awareness of children's lifestyle behaviours at ages 5 to 14 in Singapore

INTRODUCTION

There are limited data on the descriptive lifestyle behaviour of school-age children in Singapore.

METHODS

A total of 100 parents of children ages 5 to 14 participated in a parents' proxy-reported survey. Frequency of moderate physical activity (PA) and vigorous PA was assessed, while t-tests or chi-square test was used to examine differences between weekdays and weekends for sleep, screen viewing time (SVT) and sedentary behaviour (SB).

RESULTS

Of the 100 children (68% of Chinese ethnicity, 59% boys, mean age 9.1±2.9 years), 31% were overweight or obese, with body mass index z-score of >1. For moderate and vigorous PA participation in a typical week, 32.0% and 43.0%, respectively, did not participate, while median (interquartile range) days of participation were 3 (2-3) days/week and 2 (1-3) days/week for a duration of 60 (interquartile range 30-120) minutes/session. When comparing weekends with weekdays, the means (standard deviation) of both SVT and sleep duration were higher on weekends (SVT: 4.1 [2.9] versus 3.3 [3.1] hours/day, P=0.07; sleep: 8.8 [1.5] vs 8.3 [1.3] hours/day, P=0.02), while there were no significant differences for SB. A higher proportion of children had SB of ≥10 hours/day and slept <8 hours/day on weekdays compared with on weekends (SB: 23.5% vs 20.6%, P>0.05; sleep:18.8% vs 2.1%, P<0.05), while the proportion exceeding SVT of 2 hours/day were higher on weekends than on weekdays (63.8% vs 45.4%, P=0.03). Overall, there was higher parental awareness of sleep guidelines (80.0%), but lower awareness of PA (51.0%) and SVT (59.0%) guidelines.

CONCLUSION

Lifestyle behaviours were suboptimal in Singapore children compared with existing overseas guidelines, indicating a need for an integrated guideline with greater dissemination.