Effects of sleep manipulation on cognitive functioning of adolescents: A systematic review

The impact of online classes on sleep, physical activity, and cognition functioning among physical education students

Introduction

Online education has become a crucial component of teachers' professional development, and universities incorporate innovative pedagogical approaches to enhance teachers' training. These approaches have proven invaluable, particularly during the COVID-19 pandemic. This study investigates the impact of online versus face-to-face learning environments on sleep quality, physical activity, and cognitive functioning among physical education students.

Methods

Utilizing a unique methodological approach that combines wrist actigraphy, the Pittsburgh Sleep Quality Index, and the Cambridge Neuropsychological Test Automated Battery, we provide a comprehensive assessment of these variables. Over 4 weeks, 19 male students participated in alternating online and face-to-face class formats.

Results

Our results reveal no significant differences in sleep quality or cognitive function between learning environments. However, notable findings include significant differences in Paired Associates Learning and weekday step counts in the face-to-face setting.

Discussion

These insights suggest that while online learning environments may not adversely affect sleep or cognitive functions, they could impact certain aspects of physical activity and specific cognitive tasks. These findings contribute to the nuanced understanding of online learning's implications and can inform the design of educational strategies that promote student well-being.

Neurocognitive consequences of adolescent sleep disruptions and their relationship to psychosis vulnerability: a longitudinal cohort study

Adolescence is a key period for neurocognitive maturation where deviation from normal developmental trajectories may be tied to adverse mental health outcomes. Cognitive disruptions have been noted in populations at risk for psychosis and are known to accompany periods of sleep deprivation. This study aims to assess the role of cognition as a mediator between sleep disruptions and psychosis risk. A cohort of 3801 high school students (51% female, mean age = 12.8, SD = 0.45 years) was recruited from 31 Montreal high schools. Measures of sleep, psychotic-like experiences, inhibition, working memory, perceptual reasoning, and delayed recall were collected from participants on a yearly basis over the five years of their high school education. A multi-level model mediation analysis was performed controlling for sex and time squared. Response inhibition was shown to be associated with, and to mediate (B = -0.005, SD = 0.003, p = 0.005*) the relationship between sleep disruptions (B = -0.011, SD = 0.004, p < 0.001*) and psychotic-like experiences (B = 0.411, SD = 0.170, p = 0.005*). Spatial working memory deficits on a given year were associated with a higher frequency of psychotic-like experiences that same year (B = -0.046, SD = 0.018, p = 0.005*) and the following year (B = -0.051, SD = 0.023, p = 0.010*), but were not associated with sleep disturbances. No significant associations were found between our variables of interest and either delayed recall or perceptual reasoning at the within person level. Findings from this large longitudinal study provide evidence that the association between sleep disruptions and psychosis risk is specifically mediated by inhibitory rather than general cognitive impairments. The association of spatial working memory, response inhibition, and sleep disruptions with psychotic-like experiences suggests that these factors may represent potential targets for preventative interventions.

A population-based study exploring association of parasomnia symptoms with sleep onset delay among school-aged children

OBJECTIVE

Parasomnia is potentially implicated in sleep pattern and sleep architecture, however, evidence is quite limited. This study aimed to investigate the association between parasomnia symptoms and sleep onset delay among children through a large epidemiological study.

METHODS

Two rounds of cross-sectional studies were conducted among 21,704 children aged 3-11; one taking place in Shanghai and the other in Sanya, Hainan province. Children's sleep characteristics were evaluated using the Children's Sleep Habits Questionnaire (CSHQ). Propensity score matching was adopted to balance the difference of covariates, and the logistic regression models were implemented to examine the associations between parasomnia symptoms and sleep onset delay.

RESULTS

A total of 38.2 % of children had sleep onset delay. Parasomnias, especially non rapid eye movement (NREM) and rapid eye movement (REM) parasomnia symptoms, were associated with an increased risk of sleep onset delay (Sleep Walking: OR = 1.55; Sleep Terror: OR = 1.34; Nightmare: OR = 1.37, all p˂0.001). The similar findings were observed in stratified analyses according to sleep duration, and the association was pronounced in sleep sufficiency group (Sleep Walking: OR = 1.62; Sleep Terror: OR = 1.35; Nightmare: OR = 1.35, all p˂0.001). Moreover, a dose-dependent pattern was observed, in which cumulative parasomnia symptoms were associated with increasing risk of sleep onset delay (2 symptoms: OR = 1.19; ≥3 symptoms: OR = 1.40; by comparison with ≤1 symptom). All these findings were also similarly observed in the propensity score matching sample. Moreover, the associations were generally established in both Shanghai and Sanya children.

CONCLUSIONS

Parasomnia symptoms were associated with a higher risk of sleep onset delay independently of sleep duration among children. More studies are needed to enrich the current evidence, thus further clarifying the association and interaction among different sleep parameters.

The relationship between COVID-19 stress and test anxiety in art students: the chain mediating roles of intolerance of uncertainty and sleep quality

BACKGROUND

The global spread of COVID-19 has brought immense physiological and psychological distress to students, such as test anxiety and poor sleep quality. This study aims to explore the relationship between COVID-19 stress and test anxiety and the mediating roles of intolerance of uncertainty and sleep quality between them.

METHODS

A study was conducted in China during the late stage of the pandemic. A total of 936 Chinese art students (age M = 18.51, SD = 2.11, 46.6% female) completed the Coronavirus Stress Measure (CSM), the 12-item Intolerance of Uncertainty (IUS-12), the Brief Version of the Pittsburgh Sleep Quality Index (B-PSQI), and the Test Anxiety Inventory (TAI). A chain mediation model analysis was conducted to examine the mediating effects of intolerance of uncertainty and sleep quality on the association with COVID-19 stress and test anxiety.

RESULTS

COVID-19 stress was positively associated with test anxiety (β = 0.50, p < 0.001). The intolerance of uncertainty and sleep quality partially and serially mediated the relationship between COVID-19 stress and test anxiety (β = 0.01, 95% CI = 0.01 to 0.02).

CONCLUSION

These findings suggest that art students' intolerance of uncertainty and sleep quality partially and serially mediate the relation between COVID-19 stress and test anxiety. The results have significant implications for the intervention and prevention of test anxiety, providing additional evidence for the relationship between COVID-19 stress and test anxiety.

Altered neuronal response to visual food stimuli in adolescents undergoing chronic sleep restriction

STUDY OBJECTIVES

Poor sleep in adolescents can increase the risk of obesity, possibly due to changes in dietary patterns. Prior neuroimaging evidence, mostly in adults, suggests that lacking sleep results in increased response to food cues in reward-processing brain regions. Needed is a clarification of the mechanisms by which food reward processing is altered by the kind of chronic sleep restriction (SR) typically experienced by adolescents. This study aimed to elucidate the impact of sleep duration on response to visual food stimuli in healthy adolescents using functional neuroimaging, hypothesizing increased reward processing response after SR compared to a well-rested condition.

METHODS

Thirty-nine healthy adolescents, 14-17 years old, completed a 3-week protocol: (1) sleep phase stabilization; (2) SR (~6.5 h nightly); and (3) healthy sleep (HS) duration (~9 h nightly). Participants underwent functional MRI while performing a visual food paradigm. Contrasts of food versus nonfood responses were compared within-subject between conditions of SR and HS.

RESULTS

Under SR, there was a greater response to food stimuli compared to HS in a voxel cluster including the left ventral tegmental area and substantia nigra. No change in food appeal rating due to the sleep manipulation was detected.

CONCLUSIONS

Outcomes of this study suggest that SR, as commonly experienced by healthy adolescents, results in the elevated dopaminergic drive of the reward network that may augment motivation to seek food in the context of individual food appeal and inhibitory profiles. Countermeasures that reduce food salience could include promoting consistent HS habits.

The Role of Sleep for Age-Related Differences in Neurobehavioral Performance

This study investigated developmental changes from childhood to adulthood in neurobehavioral performance and sleep measures. While many studies have examined age-related changes between childhood and adolescence and from mid-to-late adulthood, young adulthood has been overlooked. The main aim of this study was to investigate the effects of sleep loss on developmental changes in neurobehavioral performance and sleepiness in a natural setting. A total of 119 children, adolescents, and young adults (38 children aged 6-9; 38 adolescents aged 13-19; and 43 young adults aged 20-27) wore an actigraph for a continuous five-weekday night. Subjective sleepiness (Karolinska Sleepiness Scale) and neurobehavioral performance (using the psychomotor vigilance test and the digit symbol substitution test) were measured on five school days. The results showed that adolescents and young adults outperformed children on both the digit symbol substitution test and the psychomotor vigilance test measures. However, adolescents committed more errors of commission on the psychomotor vigilance test and reported higher levels of subjective sleepiness. The results are discussed in relation to brain maturation in various cognitive functions.

Sleep characteristics and adolescent physical activity-related injuries in sports clubs, leisure time and schools

OBJECTIVE

Sleep has been identified as an important factor in relation to physical activity-related injury (PARI) in adolescents. The study aimed to explore associations between sleep duration, sleep problems and PARI among Slovak adolescents in three different settings: sports clubs, leisure time and schools.

METHODS

We analysed data from the cross-sectional Health Behaviour in School-aged Children study conducted in 2022 on a representative sample of 10 163 Slovak adolescents aged from 10.5 to 18.3 (mean age 13.4 (SD=1.5); 50.9% boys). Data were collected through self-administered online questionnaires completed by respondents in schools during the classes. Multiple logistic regression models were used to assess associations between sleep duration during schooldays and weekends, sleep problems and PARI in sports clubs, leisure time and schools.

RESULTS

Adolescents with normal sleep duration during schooldays and those who reported no problems with falling asleep, waking up at night and day sleepiness had a higher chance of not being injured during PA in sports clubs, leisure time and schools compared with adolescents with short sleep duration and sleep problems. Sufficient sleep duration during the weekend increased the probability of not having PARI in leisure time and schools, with the strongest association between long sleep duration and PARI in leisure time.

CONCLUSION

Good sleep quality and sufficient sleep duration were found to play a protective role in relation to PARI in adolescents. The findings suggest implementing sleep interventions in PARI prevention programmes, which must be considered a key component of adolescent PA promotion.

Race/Ethnicity Inequities in the Association Between Movement Behaviors and Suicidal Thoughts/Ideation Among Adolescents

OBJECTIVE

We aimed to analyze the associations between movement behaviors (physical activity, screen time, and sleep), independently and jointly, and suicidal thoughts/ideation among Brazilian adolescents according to race/ethnicity.

METHODS

This cross-sectional study surveyed 4,081 adolescents aged 15-19 years (49.9% females) across all Brazilian geographic regions. Data were collected using a self-administered questionnaire. Within the sample, 31.0% (n = 1,264) self-reported as White and 69.0% (n = 2,817) as Black. Adolescents who declared one or more times/week suicidal thoughts/ideation were considered as a risk group. Accruing moderate-to-vigorous physical activity during leisure time, reduced recreational screen time, and good sleep quality were the exposures investigated. We evaluated both additive and multiplicative interactions between race/ethnicity and movement behaviors. Binary logistic regression was used to estimate the odds ratio (OR), marginal means effects, and 95% confidence intervals (95% CIs).

RESULTS

Black adolescents who met 1 (OR: 0.34; [95% CI: 0.22-0.52]), 2 (OR: 0.17 [0.11-0.27]), or 3 (OR: 0.13 [0.07-0.26]), and White adolescents who met 1 (OR: 0.35 [0.21-0.57]), 2 (OR: 0.14 [0.08-0.26]), or 3 (OR: 0.11 [0.04-0.31]) of the movement behavior targets had lower odds of suicidal thoughts/ideation than Black adolescents who did not meet any of the movement behavior targets. Black adolescents who did not meet any of the movement behavior targets had higher suicidal thoughts/ideation odds than the other adolescent's groups.

CONCLUSIONS

We identified an inverse association between meeting individuals and combinations of movement behavior targets with suicidal thoughts/ideation. Among Black adolescents who did not meet any targets, these associations were more evident.

Neurocognitive Effects of Sleep Disruption in Children and Adolescents

A main childhood task is learning. In this task, the role of sleep is increasingly demonstrated. Although most literature examining this role focuses on preadolescence and middle adolescence, some studies apply napping designs in preschoolers. Studies overall conclude that without proper sleep a child's cognitive abilities suffer, but questions on how and to what extent linger. Observational studies show the hazards of potential confounders such as an individual's resilience to poor sleep as well as developmental risk factors (eg, disorders, stressors). A better understanding of cognitive sleep neuroscience may have a big impact on pediatric sleep research and clinical applications.

Poor sleep quality and its associated neurocognitive function in children with obesity with or without obstructive sleep apnea

OBJECTIVE

To evaluate the associations of OSA severity, snoring symptoms, subjective sleep quality, and daytime sleepiness with executive functioning and behaviors in children with obesity.

METHODS

This was a cross-sectional study of children aged 8-18 years with obesity and symptoms suggestive of OSA. All participants underwent an overnight polysomnography and completed a set of questionnaires to assess their sleep-related breathing disordered (SRBD) symptoms [Pediatric Sleep Questionnaire (SRBD-PSQ)], sleep quality [Pittsburgh Sleep Quality Index (PSQI)], executive function [Behavior Rating Inventory of Executive Function (BRIEF)], and inattention and hyperactivity symptoms (Conners-3 Parent Short Form).

RESULTS

A total of 85 children (62% male, mean age: 13.9 ± 3.0 years) were included in this analysis, of whom 36, 16, and 33 were categorized into the non-OSA (obstructive apnea hypopnea index, OAHI < 1.5/h), mild OSA (OAHI 1.5-5/h), and moderate-severe OSA (OAHI ≥ 5/h) groups, respectively. Of 85 participants, 27 (32%) were classified with poor sleep quality (PSQI composite score ≥ 8). From multiple linear regression analyses, poor sleep quality and sleepiness were both independently associated with higher BRIEF behavioral regulation T-score, metacognition T-score, and global executive composite T-score in the fully adjusted model. In addition, poor sleep quality was also independently associated with higher Conners-3 inattention and executive functioning T-scores, while greater sleepiness was also associated with a higher learning problem T-score. The presence of OSA and snoring were not associated with any cognitive outcomes.

CONCLUSIONS

Subjective sleep quality and daytime sleepiness, but not OSA severity and snoring symptoms, were independently associated with executive functioning and behavioral problems in children with obesity.

Weekday breakfast habits and mood at the start of the school morning

BACKGROUND

Good nutrition, regular physical activity, and adequate sleep are important for promoting health. However, it is not well characterized how these lifestyle behaviours are associated with mood at the start of school days.

AIM

To identify the weekday health-related behaviours (breakfast intake, physical activity, and sleep) of Singaporean adolescents and explore their associations with mood at the beginning of the school morning.

METHODS

365 adolescents (52.3% boys, 47.7% girls) aged 14-19 years (M = 16.9, SD = 1.3 years) completed a survey set on breakfast habits, physical activity participation, sleep duration, and mood.

RESULTS

More than one-third (38.6%) of participants never (15.0%) or irregularly (23.6%) consumed breakfast on weekdays. Adolescents consuming breakfast irregularly reported significantly higher negative mood scores than regular breakfast consumers (p = .002; d = .404). Almost two-thirds (64.1%) of adolescents did <60 min of moderate-to-vigorous physical activity (MVPA) on weekdays and reported lower positive morning mood scores than those who ≥60 min of MVPA (p = .014; d = .284). Although most (88.3%) adolescents slept <8 h each night, sleep duration was not related to either positive mood or negative mood.

CONCLUSION

The present study suggests that eating breakfast on a regular basis and completing for ≥60 min of weekday MVPA are useful behaviours to start school days in a better mood. Parents and health educators should recognise the importance of establishing these habits and support students by instigating practical approaches so they can achieve a regular breakfast intake and physical activity engagement.

For Whom (and When) the Time Bell Tolls: Chronotypes and the Synchrony Effect

Circadian rhythms are powerful timekeepers that drive physiological and intellectual functioning throughout the day. These rhythms vary across individuals, with morning chronotypes rising and peaking early in the day and evening chronotypes showing a later rise in arousal, with peaks in the afternoon or evening. Chronotype also varies with age from childhood to adolescence to old age. As a result of these differences, the time of day at which people are best at attending, learning, solving analytical problems, making complex decisions, and even behaving ethically varies. Across studies of attention and memory and a range of allied areas, including academic achievement, judgment and decision-making, and neuropsychological assessment, optimal outcomes are found when performance times align with peaks in circadian arousal, a finding known as the synchrony effect. The benefits of performing in synchrony with one's chronotype (and the costs of not doing so) are most robust for individuals with strong morning or evening chronotypes and for tasks that require effortful, analytical processing or the suppression of distracting information. Failure to take the synchrony effect into consideration may be a factor in issues ranging from replication difficulties to school timing to assessing intellectual disabilities and apparent cognitive decline in aging.

Protocol for a randomised controlled trial evaluating the effect of a CBT-I smartphone application (Sleep Ninja®) on insomnia symptoms in children

BACKGROUND

Sleep is necessary for healthy development and mental wellbeing. Despite this, many children do not get the recommended duration of sleep each night, and many experience sleep problems. Although treatable, existing interventions for sleep disturbance are time-consuming, burdensome for families, and focus on providing behavioural strategies to parents rather than upskilling children directly. To address this gap, we modified Sleep Ninja®, an evidence-based cognitive behavioural therapy for insomnia (CBT-I) smartphone app for adolescent sleep disturbance, to be appropriate for 10 to 12 year olds. Here, we describe the protocol for a randomised controlled trial to evaluate the effect of Sleep Ninja on insomnia and other outcomes, including depression, anxiety, sleep quality, and daytime sleepiness, and explore effects on the emergence of Major Depressive Disorder (MDD), compared to an active control group.

METHODS

We aim to recruit 214 children aged 10 to 12 years old experiencing disturbed sleep. Participants will be screened for inclusion, complete the baseline assessment, and then be randomly allocated to receive Sleep Ninja, or digital psychoeducation flyers (active control) for 6-weeks. The primary outcome, insomnia symptoms, along with depression, anxiety, sleep quality, and daytime sleepiness will be assessed at 6-weeks (primary endpoint), 3-months, and 9-months post-baseline (secondary and tertiary endpoints, respectively). A mixed model repeated measures analytic approach will be used to conduct intention-to-treat analyses to determine whether reductions in insomnia and secondary outcomes are greater for those receiving Sleep Ninja relative to the control condition at the primary and secondary endpoints. The difference in relative risk for MDD onset will be explored at 9-months and compared between conditions.

DISCUSSION

This is the first clinical trial examining the effects of a CBT-I smartphone app in children experiencing sleep disturbance. Results will provide empirical evidence about the effects of Sleep Ninja on insomnia and other mental health outcomes.

TRIAL REGISTRATION

Australian New Zealand Clinical Trials Registry (ACTRN12623000587606).

UNIVERSAL TRIAL NUMBER

U1111-1294-4167.

Sleep and dropout from upper secondary school: A register-linked study

OBJECTIVE

The present study investigates the association between sleep in late adolescence and completion of upper secondary school.

METHODS

The data are drawn from the youth@hordaland study, a large population-based study conducted in 2012, linked with official educational data in Norway (N = 8838).

RESULTS

High school dropout was more prevalent among adolescents who had insomnia (20.6%) compared to those without insomnia (14.3%; adjusted risk ratios = 1.50; 95% confidence intervals: [2.19-2.92]). There was also a higher rate of school dropout among those who had symptoms of delayed sleep-wake phase (21%) compared to those without delayed sleep-wake phase (14.3%); adjusted risk ratios = 1.43, 95% confidence intervals: (1.28-1.59). School noncompleters were also characterized by reporting 44 minutes shorter sleep duration, longer sleep onset latency, and wake after sleep onset (both approx. 15 minutes) compared to school completers.

CONCLUSION

The importance of sleep for high school dropout rates highlights the importance of including sleep as a risk indicator and a possible target for preventive interventions in late adolescence.

Examining Daily Associations Among Sleep, Stress, and Blood Pressure Across Adulthood

BACKGROUND

Sleep can have consequential effects on people's health and well-being, and these effects may vary among younger and older adults.

PURPOSE

The goal of the present study was to investigate how sleep relates to physiologic and stress responses in daily life across adulthood.

METHODS

We used an Ecological Momentary Assessment method in a large sample of participants (N = 4,359; Mage = 46.75, SD = 12.39; 69.30% male, 29.85% female) who completed morning sleep diaries, reported subjective stress, and recorded their heart rate and blood pressure for 21 days. Sleep was assessed with self-reports of duration, efficiency, and quality.

RESULTS

Using multilevel modeling, between-person analyses showed that sleep duration, efficiency, and quality were negatively related to morning heart rate and stress, such that people who slept longer, more efficiently, or better experienced lower heart rate and stress compared to those who slept shorter, less efficiently, or worse. Within-person analyses showed that sleep duration, efficiency, and quality predicted morning heart rate, blood pressure (though less consistently), and stress. That is, people experienced lower heart, blood pressure, and stress following nights when they slept longer, more efficiently, or better than they typically did. These within-person relationships were moderated by age, such that the effects of better and longer sleep on lower morning heart rate, blood pressure, and stress were stronger among younger than older adults.

CONCLUSION

These findings suggest that daily variations in sleep show immediate associations with stress and physiologic responses, but these daily variations have a stronger relationship among younger compared to older adults.

Electronic device and social network use and sleep outcomes among adolescents: the EHDLA study

BACKGROUND

Considering the evident risk in the literature between the use of screen devices and sleep, there are still few studies on the relationship between each electronic screen device, media programs and sleep duration and sleep-related problems among adolescents and which variables interfere in these relationships. Therefore, this study has the following objectives: (1) to determine which are the most common electronic display devices related to sleep time and outcomes and (2) to determine which are the most common social network applications, such as Instagram and WhatsApp, associated with sleep outcomes.

METHODS

This was a cross-sectional study with 1101 Spanish adolescents between 12 and 17 years old. Age, sex, sleep, psychosocial health, adherence to the Mediterranean diet (MD), sport practice, and time spent on screen devices were assessed by an ad hoc questionnaire. Linear regression analyses were applied, adjusting for several covariables. Poisson regression was applied between the sexes. A p value < 0.05 was considered statistically significant.

RESULTS

Cell phone use was more associated with sleep time (13%). In boys, time spent on cell phones (prevalence ratio [PR] = 1.09; p < 0.001) and videogames (PR = 1.08; p = 0.005) had a higher prevalence ratio. When psychosocial health was included in the models, we found the greatest association (Model 2: PR = 1.15; p = 0.007). For girls, time spent on the cell phone was significantly associated with sleep-related problems (PR = 1.12; p < 0.001), and adherence to the MD became the second most important in the model (PR = 1.35; p < 0.001), followed by psychosocial health and cell phone use (PR = 1.24; p = 0.007). Time spent on WhatsApp was associated with sleep-related problems only among girls (PR = 1.31; p = 0.001) and was the most important variable in the model along with MD (PR = 1.26; p = 0.005) and psychosocial health (PR = 1.41; p < 0.001).

CONCLUSIONS

Our results suggest a relationship between cell phones, video games, and social networks with sleep-related problems and time.

A serial mediation model of social media addiction and college students' academic engagement: the role of sleep quality and fatigue

BACKGROUND

It has been documented that social media addiction (SMA) has a detrimental effect on college students' academic engagement. However, the mechanisms underlying this association are not well understood. This study aimed to determine the serial mediation effects of sleep quality and fatigue on the relationship between SMA and academic engagement among college students.

METHODS

A cross-sectional survey was conducted with 2661 college students (43.3% males, mean age = 19.97 years). The participants completed the Bergen Social Media Addiction Scale, the Utrecht Student Work Engagement Scale for Students, the Pittsburgh Sleep Quality Index, and the Fatigue Assessment Scale. The serial mediation effects were examined using Model 6 in the Hayes' PROCESS macro for SPSS.

RESULTS

The results showed that SMA among college students had a direct negative relationship with their academic engagement (Effect = - 0.051, 95% CI: -0.087 to - 0.015). In addition, sleep quality and fatigue mediated the relationship between SMA and academic engagement both independent and serially, with the independent mediation effect of sleep quality being - 0.031 (95% CI: -0.048 to - 0.016), the independent mediation effect of fatigue being - 0.109 (95% CI: -0.133 to - 0.088), and the serial mediation effect of sleep quality and fatigue being - 0.080 (95% CI: -0.095 to - 0.066). The total indirect effect of the three mediation paths was 80.9%.

CONCLUSIONS

Decreased academic engagement caused by SMA can be aggravated by poor sleep quality and fatigue. Strengthening supervision and intervention in social media use among college students, supplemented by attention to psychosomatic health, including sleep quality and fatigue could promote their engagement in academic work.

Recovery sleep attenuates impairments in working memory following total sleep deprivation

Introduction

The detrimental effects of sleep deprivation (SD) on cognitive function and quality of life are well known, and sleep disturbances are a major physical and mental health issue worldwide. Working memory plays an important role in many complex cognitive processes. Therefore, it is necessary to identify strategies that can effectively counteract the negative effects of SD on working memory.

Methods

In the present study, we utilized event-related potentials (ERPs) to investigate the restorative effects of 8 h of recovery sleep (RS) on working memory impairments induced by total sleep deprivation for 36 h. We analyzed ERP data from 42 healthy male participants who were randomly assigned to two groups. The nocturnal sleep (NS) group completed a 2-back working memory task before and after normal sleep for 8 h. The sleep deprivation (SD) group completed a 2-back working memory task before and after 36 h of total sleep deprivation (TSD) and after 8 h of RS. Electroencephalographic data were recorded during each task.

Results

The N2 and P3 components-which are related to working memory-exhibited low-amplitude and slow-wave characteristics after 36 h of TSD. Additionally, we observed a significant decrease in N2 latency after 8 h of RS. RS also induced significant increases in the amplitude of the P3 component and in the behavioral indicators.

Discussion

Overall, 8 h of RS attenuated the decrease in working memory performance caused by 36 h of TSD. However, the effects of RS appear to be limited.

Physical Activity Patterns, Circadian Rhythms, and Aggressive and Suicidal Behavior among a Larger Sample of the General Population Aged 15 to 34 Years

BACKGROUND

From a psychological perspective, aggressive behavior, non-suicidal self-injury and suicidal behavior could be considered dysfunctional coping strategies. Poor sleep patterns may further increase such dysfunctional coping. In contrast, regular physical activity may have the power to counteract such dysfunctional coping. Given this background, the aim of the present study was to combine categories of circadian rhythms as a proxy of normative sleep patterns and categories of physical activity patterns, and to associate these categories with aggressive behavior, non-suicidal self-injury and suicidal behavior among a larger sample of adolescents and young adults, aged 15 to 34 years.

METHOD

A total of 2991 (55.6% females) individuals aged 15 to 34 years of the so-called Ravansar non-communicable disease cohort study (RaNCD) took part in this study. Participants completed self-rating questionnaires covering circadian-related sleep patterns, regular physical activity, socio-demographic information and dimensions of aggression, non-suicidal self-injury and suicidal behavior.

RESULTS

In a first step, both sleep patterns (circadian rhythm disorder: yes vs. no) and physical activity patterns (high vs. low) were dichotomized. Next, participants were assigned to one of four prototypical clusters: No circadian sleep disorders and high physical activity ("Hi-Sleep-Hi-PA"); no circadian sleep disorders and low physical activity ("Hi-Sleep-Lo-PA"); circadian sleep disorders and high physical activity ("Lo-Sleep-Hi-PA"); circadian sleep disorders and low physical activity ("Lo-Sleep-Lo-PA"). Projecting these four clusters on dimensions of aggressive behavior, non-suicidal self-injury and suicidal behavior, the following findings were observed: Participants of the "Hi-Sleep-Hi-PA" reported the lowest scores for aggressive behavior, self-injury and suicidal behavior, compared to participants of the "Lo-Sleep-Lo-PA" cluster. No differences for aggressive behavior, self-injury and suicidal behavior were observed among participants of the "Hi-Sleep-Lo-PA" and the "Lo-Sleep-Hi-PA" clusters.

CONCLUSIONS

It appeared that the combination of favorable circadian sleep patterns and high physical activity patterns was associated with lower aggressive behavior, lower self-injury and suicidal behavior as proxies of favorable psychological functioning. In contrast, persons reporting high circadian sleep disorders and low physical activity patterns appeared to demand particular attention and counseling for both their lifestyle issues (sleep and physical activity) and their dysfunctional coping strategies.

Sleep interventions for children with attention deficit hyperactivity disorder (ADHD): A systematic literature review

OBJECTIVE/BACKGROUND

Healthy sleep is particularly important for children with attention deficit hyperactivity disorder (ADHD), as sleep disturbances might aggravate disease symptoms. This review aims to synthesize and report evidence on the effectiveness of sleep interventions in increasing sleep, quality of life (QoL), and ADHD symptoms among children with ADHD.

PATIENTS/METHODS

The systematic literature review follows the Cochrane Collaboration methodology recommendations for literature reviews. Four databases were used based on the population, intervention, control and outcome (PICO) framework. Controlled trials with minimum 20 children in each group, aged 6-18, and published from 2005 and onwards were included. Results from the studies were reported in forest plots and three of the seven review outcomes were synthesized in meta-analyses.

RESULTS

The search identified 7710 records; of which 4808 abstracts were screened. After fulltext-screening of 99 papers, eight papers from five studies were included. The studies included behavioral sleep interventions and pharmacological interventions using melatonin and eszopiclone. For six of the seven outcomes, the effect sizes were small to moderate and the certainty of the evidence was low. For one outcome, sleep disturbances, the effect size was a moderate -0.49 standardized mean differences (95% confidence interval -0.65;-0.33), with a moderate certainty of evidence for the behavioral interventions for children aged 5-13 years with ADHD.

CONCLUSIONS

This review identified few and heterogeneous studies. A moderate certainty of evidence for a moderate effect size was only obtained for sleep disturbances from the behavioral interventions. A low certainty of the evidence for a moderate effect size was found for the total sleep time from the pharmacological intervention using melatonin and one behavioral intervention, which indicates that these sleep interventions impact sleep quantity and quality among children with ADHD.

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.

A Non-Randomized Trial Investigating the Impact of Brown Rice Consumption on Gut Microbiota, Attention, and Short-Term Working Memory in Thai School-Aged Children

While dietary fiber has been shown to influence the composition of gut microbiota and cognitive function in adults, much less is known about the fiber-microbiome-cognition association in children. We profiled gut microbiota using quantitative PCR (qPCR) and evaluated cognitive function using the Corsi block-tapping test (CBT) and the psychomotor vigilance test (PVT) before, during, and after the dietary intervention of 127 school-aged children in northern Thailand. While we found that Sinlek rice (SLR) consumption did not significantly alter the abundance of gut microbiota or the cognitive performance of school-aged children, we did find age to be associated with variations in both the gut microbiota profiles and cognitive outcomes. Gammaproteobacteria was significantly lower in the control and SLR groups during the middle time points of both phases (Weeks 4 and 61), and its abundance was associated with age. Cognitive performance using CBT and PVT were also found to be age-sensitive, as older children outperformed younger children on both of these cognitive assessments. Finally, a multiple factor analysis (MFA) revealed that age and cognitive performance best explain individual variation in this study. Collectively, these findings further describe the influence of host variables on the microbial profiles and cognitive outcomes of school-aged children consuming Sinlek rice in Thailand.

Does the fit of personal protective equipment affect functional performance? A systematic review across occupational domains

OBJECTIVE

To explore the effect of personal protective equipment (PPE) fit on functional performance across a range of occupational domains.

BACKGROUND

PPE introduces an ergonomic, human systems integration, and mass burden to the wearer, and these factors are thought to be amplified if PPE is ill-fitting. However, few studies have considered the role of fit (static, dynamic, and cognitive) when evaluating PPE-related performance detriments in occupational settings.

METHOD

A systematic literature review was conducted to identify relevant studies, which were then critically appraised based on methodological quality and collated to compare key findings and present evidence-based recommendations for future research directions across a range of occupational domains.

RESULTS

16 published studies met the inclusion criteria, 88% of which found that the fit of PPE had a statistically significant effect on occupational performance. Poorly sized PPE resulted in slower or increased reaction time; decreased range of motion or mobility; decreased endurance or tolerance; decreased pulmonary function; and altered muscle activation. Limited research met the inclusion criteria and those that did had risks of bias in methodology quality.

CONCLUSION

Future research evaluating the effect of PPE on performance in occupational settings should aim to recruit a more representative population; consider sex as a covariate; quantify and evaluate PPE fit and performance when integrated with all relevant equipment items; include outcome measures related to all three categories of fit (static, dynamic, cognitive); and assess performance of operationally relevant tasks.

Association between sleep habits and behavioral problems in early adolescence: a descriptive study

Background

Sleep habits are related to children's behavior, emotions, and cognitive functioning. A strong relationship exists between sleep habits and behavioral problems. However, precisely which sleep habits are associated with behavioral problems remains unclear. Therefore, the purpose of this study is to clarify the relationship between sleep habits and behavioral problems in early adolescence.

Methods

This study used data from a larger longitudinal research, specifically, data from the year 2021. First-year junior high school students (12–14 years) in Japan were surveyed; their parents (N = 1288) completed a parent-report questionnaire. The main survey items were subject attributes, the Pittsburgh Sleep Quality Index (PSQI), and the Strength and Difficulties Questionnaire (SDQ).

Results

Of the 652 valid responses received, 604 individuals who met the eligibility criteria (no developmental disability in the child and completion of all survey items) were included in the analysis. To examine the relationship between sleep habits and behavioral problems, logistic regression analysis using the inverse weighted method with propensity score was conducted with sleep habits (sleep quality, time to fall asleep, sleep duration, sleep efficiency, sleep difficulty, use of sleeping pills, difficulty waking during the day, and sleep disturbances) as explanatory variables and behavioral problems (overall difficulty in SDQ) as objective variables. The propensity score was calculated by employing the logistic regression using the inverse weighted method based on propensity scores. Propensity scores were calculated based on gender, family structure, household income, and parental educational background. The results showed that behavioral problems tended to be significantly higher in the group at risk for sleep quality, sleep difficulties, daytime arousal difficulties, and sleep disturbances than in the group with no risk.

Conclusion

The results suggest that deterioration in sleep quality, sleep difficulties, daytime arousal difficulties, and sleep disturbances may increase the risk of behavioral problems in adolescents.

Sleep and Breathing Disturbances in Children With Leigh Syndrome: A Comparative Study

BACKGROUND

Leigh syndrome (LS) is a progressive neurodegenerative mitochondrial disease characterized by necrotizing lesions affecting different parts of the central nervous system, especially in the brainstem and basal ganglia. Lesions in this area may involve respiratory and sleep centers, resulting in the clinically significant disturbances seen-but poorly characterized-in LS. The purpose of the present study is to characterize and compare the physiologic responses to respiratory disturbances quantified by polysomnography metrics of children with LS with age-sex- and apnea-hypopnea index (AHI)-matched patients with obstructive sleep apnea (OSA), a common clinical population with similar burden of sleep-disordered breathing.

METHODS

Retrospective comparative study of polysomnographic data from six patients with LS were reviewed and compared with 18 age-sex-AHI-matched patients with OSA, with particular attention to cardiorespiratory and sleep architecture metrics.

RESULTS

Sleep architecture and stage duration were conserved in LS and OSA groups, but increased wake after sleep onset was seen among the first group. The LS group exhibited both obstructive and central sleep apnea. The group also had significantly greater values of heart rate, ≥3% oxygen desaturation index, and lower values of sleep efficiency, respiratory arousal index, and total sleep time when compared with the OSA group.

CONCLUSIONS

Patients with LS exhibited significantly more sleep-related cardiorespiratory disturbances and sleep fragmentation when compared with neurotypical children with OSA. Given that these findings are plausibly detrimental to health and development, sleep evaluation in patients with similar conditions should be encouraged for early management.

24-h movement behaviours in Spanish youth before and after 1-year into the covid-19 pandemic and its relationship to academic performance

Most studies have shown a decline in the adherence to 24-Hour Movement Guidelines because of Covid-19 lockdown. However, there is little evidence regarding changes 1-year after the pandemic in these guidelines and their possible impact on academic performance. The study aims were: (1) to examine the possible changes in 24-Hour Movement Guidelines for youth (i.e., at least 60 min per day of moderate-to-vigorous physical activity, ≤ 2 h per day of recreational screen time, and 9 to 11 h of sleep per day for children and 8 to 10 h for adolescents) before and after 1-year into the Covid-19 pandemic, and (2) to examine the possible changes in the relationship between 24-Hour Movement Behaviours (physical activity, screen time, and sleep duration) and academic performance before and after 1-year into the Covid-19. This is a repeated cross-sectional study in two different samples of young Spanish at different times. Firstly, a total of 844 students (13.12 ± 0.86; 42.7% girls) completed a series of valid and reliable questionnaires about physical activity levels, recreational screen time, sleep duration and academic performance before Covid-19 pandemic (March to June 2018). Secondly, a different sample of 501 students (14.39 ± 1.16; 55.3% girls) completed the same questionnaires 1-year after Covid-19 pandemic (February to March 2021). Adherence to the three 24-Hour Movement Guidelines was significantly lower 1-year after into the Covid-19 pandemic (0.2%) than before the pandemic (3.3%), while adherence to none of these three recommendations was significantly higher 1-year after the Covid-19 pandemic (66.3%) than before the pandemic (28.9%). The positive relationship between physical activity levels and academic performance was no longer significant after 1-year into Covid-19 pandemic (β = − 0.26; p < 0.001). 1-year after Covid-19 pandemic, the relationship between recreational screen time (β = − 0.05; p > 0.05) and sleep duration (β = 0.05; p < 0.001) with academic performance did not change compared to pre-pandemic. The results suggest that 24-Hour Movement Behaviours have worsened among young people 1-year after Covid-19 pandemic compared to pre-pandemic period. Moreover, the physical activity benefits associated in terms of academic performance seem to have disappeared because of the Covid-19 pandemic. Therefore, there is a public health problem that requires priority and coordinated action by schools, policy makers, and researchers to mitigate the adverse effects of the pandemic on 24-Hour Movement Behaviours.

Effects of partial sleep deprivation on prefrontal cognitive functions in adolescents

Purpose

The effect of sleep deprivation on cognitive functions associated with the frontal lobe, such as attention, executive functions, and working memory, is not well known. This study aimed to investigate the effect of partial sleep deprivation in adolescents on the cognitive tasks of the frontal lobe, including visuospatial working memory, processing speed, sustained attention, executive functions, and short-term visual memory.

Methods

Participants were recruited from voluntary students of Çukurova University. Eighteen adolescents underwent four consecutive nights of monitored sleep restriction (6-6.5 h/night) and four nights of sleep extension (10-10.5 h/night) in a counterbalanced order and separated by a washout period. Following each sleep period, the cognitive performance was assessed, at a fixed morning time, using a computerized neuropsychological test battery based on frontal lobe functions tasks, which was a timed test providing both accuracy and reaction time outcome measures.

Results

Only the spatial working memory performance of cognitive tasks was found to be statistically lower in the restricted-sleep condition than in the extended-sleep condition (p < 0.05). No significant difference was found in the performance of cognitive tasks evaluating simple attention, constant attention, executive functions, and cognitive flexibility.

Conclusions

The findings of this study indicated that partial sleep restriction negatively affects specifically working memory and strategic thinking skills among cognitive functions based on the frontal lobe. Especially the visuospatial working memory and strategic thinking skills of adolescents might be susceptible to chronic partial sleep deprivation.

Effects of sleep duration on neurocognitive development in early adolescents in the USA: a propensity score matched, longitudinal, observational study

BACKGROUND

Although the American Academy of Sleep Medicine suggests at least 9 h of sleep per day for 6-12-year-olds, children in recent generations often report sleeping less than this amount. Because early adolescence is a crucial period for neurocognitive development, we aimed to investigate how insufficient sleep affects children's mental health, cognition, brain function, and brain structure over 2 years.

METHODS

In this propensity score matched, longitudinal, observational cohort study, we obtained data from a population-based sample of 9-10-year-olds from 21 US study sites in the ongoing Adolescent Brain Cognitive Development (ABCD) study. Participants were categorised as having sufficient sleep or insufficient sleep on the basis of a cutoff of 9 h sleep per day. Using propensity score matching, we matched these two groups of participants on 11 key covariates, including sex, socioeconomic status, and puberty status. Participants were excluded from our analysis if they did not pass a baseline resting-state functional MRI quality check or had missing data for the covariates involved in propensity score matching. Outcome measures retrieved from the ABCD study were behavioural problems, mental health, cognition, and structural and resting-state functional brain measures, assessed at baseline and at 2-year follow-up. We examined group differences on these outcomes over those 2 years among all eligible participants. We then did mediation analyses of the neural correlates of behavioural changes induced by insufficient sleep.

FINDINGS

Between Sept 1, 2016, and Oct 15, 2018, 11 878 individuals had baseline data collected for the ABCD study, of whom 8323 were eligible and included in this study (4142 participants in the sufficient sleep group and 4181 in the insufficient sleep group). Follow-up data were collected from July 30, 2018, to Jan 15, 2020. We identified 3021 matched sufficient sleep-insufficient sleep pairs at baseline and 749 matched pairs at 2-year follow-up, and observed similar differences between the groups in behaviour and neural measures at both timepoints; the effect sizes of between-group differences in behavioural measures at these two timepoints were significantly correlated with each other (r=0·85, 95% CI 0·73-0·92; p<0·0001). A similar pattern was observed in resting-state functional connectivity (r=0·54, 0·45-0·61; p<0·0001) and in structural measures (eg, in grey matter volume r=0·61, 0·51-0·69; p<0·0001). We found that cortico-basal ganglia functional connections mediate the effects of insufficient sleep on depression, thought problems, and crystallised intelligence, and that structural properties of the anterior temporal lobe mediate the effect of insufficient sleep on crystallised intelligence.

INTERPRETATION

These results provide population-level evidence for the long-lasting effect of insufficient sleep on neurocognitive development in early adolescence. These findings highlight the value of early sleep intervention to improve early adolescents' long-term developmental outcomes.

FUNDING

National Institutes of Health.

Melatonin usage in children and young adults, a registry-based cohort study

Sleep disorder is common in children and adolescents, particularly in those with attention deficit hyperactivity disorder (ADHD) or autism spectrum disorder (ASD). While non-pharmacological treatment is first line, occasionally an add-on of an oral drug is needed. The endogenous hormone melatonin is increasingly used for sleep disorders in children and adolescents. In this registry-based cohort study we follow dispensation of melatonin in young individuals, 0-25 years of age, in Stockholm, Sweden during 2016-2019. In all 9980 individuals, were dispensed melatonin in 2016 and followed for 3 years. Child psychiatrist was the most common prescribing specialty, 55% of all prescriptions. Only 20% had a recorded diagnosis of sleep disorder. The majority, 65% had a neuro psychiatric diagnose. Half of the individuals had at least 4 prescribed drugs dispensed during the follow-up. Almost half of our cohort were dispensed melatonin during the entire study period and doses and volumes of drug dispensed increased by 50 and 100%, respectively. Continuous medication was most common among children 6-12 years, where 7 out of 10 individuals were still adherent after three years. As long-term safety data is lacking, we find this concerning, and this illustrates the need of long-term follow-up of melatonin use in children and young individuals.

Association between Sleep Duration and Physical Fitness in Children Aged 3-6 Years: A Cross-Sectional Study from China

Aim: To explore associations between sleep duration and physical fitness (PF) of children aged 3−6 years. Methods: This study investigated the sleep duration and PF data of children aged 3−6 years by stratified random sampling. The restricted cubic spline model and binary logistic regression analysis were mainly used for the empirical analysis of the correlation effect between sleep duration and PF. The final data had a total of 21,857 children, of which 11,245 (51.45%) were boys and 10,612 (48.55%) were girls. Results: The PF level of the children in this study showed a relatively positive level (pass rate = 93.6%), and 19.7% of them had abnormal sleep duration; the results of the restricted cubic spline showed an inverted U-shaped association between the level of PF and the risk of abnormal sleep duration (X2 = 28.13, p < 0.0001). The results of logistic regression analysis showed that children with abnormal sleep duration were more likely to have a low PF, body morphology and motor ability levels at an OR (95% CI) of 1.077 (1.023−1.133), 1.077 (1.016−1.142) and 1.035 (1.08−1.062), respectively. The results of the bias correlation analysis showed varying degrees of correlation between sleep duration and various components of children’s PF. Conclusion: Insufficient or excessive amounts of sleep were significantly associated with PF in children, with abnormal sleep duration leading to reduced levels of PF and its components.

Sleep, sedentary behavior, and physical activity in Brazilian adolescents: Achievement recommendations and BMI associations through compositional data analysis

Physical activity, sedentary behavior (SB), and sleep are habitual human behaviors (HHB) which are modifiable throughout the different life phases. Therefore, it is necessary to analyze how the time distribution throughout the day among HHB may be associated with body mass index (BMI). These results could provide inferences which can guide interventions that trigger changes in adolescent behaviors in favor of their health. The objective of this study was to verify the proportion of adolescents who meet the recommendation of sleep, moderate to vigorous physical activity (MVPA), and screen time (ST); to analyze the associations between HHB and BMI, and to determine possible changes in BMI associated with time reallocation between different HHB. Daily HHB recommendations (yes/no) were analyzed by frequency distribution. Compositional data analyses were used to examine the association between HHB and the BMI z-score (zBMI) with covariates (sex, age, and socioeconomic status). Compositional isotemporal substitution models estimated the change in zBMI associated with HHB reallocations from 15 to 120 minutes. A total of 185 adolescents were included (15 to 18 years, 50.8% boys). Thus, total sleep time, SB, light physical activity (LPA) and MVPA were measured by 24-hour accelerometry for seven consecutive days. ST, demographic characteristics, and socioeconomic status were assessed using a questionnaire. Sleep, MVPA, and ST recommendations were achieved by 32.97%, 8.10%, and 1.08% of the sample, respectively. No adolescent was able to achieve all of the daily recommendations. Age was significantly and positively associated with zBMI (p<0.001). Simply replacing 75, 90, and 120 minutes of MVPA by LPA led to an estimated significant increase in zBMI (95CI% z-value, 0.01 to 1.49). The HHB relocation estimates in 24h did not show positive effects on zBMI, nor did it increase the time engaged in MVPA, which may raise the hypothesis that other parameters related to obesity and their related interactions need to be better understood.

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.

Nighttime Sleep Awakening Frequency and Its Consistency Predict Future Academic Performance in College Students

Although the relationship between sleep and academic performance has been extensively examined, how sleep predicts future academic performance (e.g., 2-3 years) remains to be further investigated. Using wearable smartwatches and a self-report questionnaire, we tracked sleep activities of 45 college students over a period of approximately half a month to see whether their sleep activities predicted their academic performance, which was estimated by grade point average (GPA). Results showed that both nighttime sleep awakening frequency and its consistency in the tracking period were not significantly correlated with the GPA for the courses taken in the sleep tracking semester (current GPA). However, both nighttime sleep awakening frequency and its consistency inversely predicted the GPA for the rest of the courses taken after that semester (future GPA). Moreover, students with more difficulty staying awake throughout the day obtained lower current and future GPAs, and students with higher inconsistency of sleep quality obtained lower future GPA. Together, these findings highlight the importance of nighttime sleep awakening frequency and consistency in predicting future academic performance, and emphasize the necessity of assessing the consistency of sleep measures in future studies.

TNF signaling pathway-mediated microglial activation in the PFC underlies acute paradoxical sleep deprivation-induced anxiety-like behaviors in mice

Acute sleep deprivation is a common condition in modern life and increases anxiety symptoms in healthy individuals. The neuroinflammatory response induced by microglial activation could be an important contributing factor, but its underlying molecular mechanisms are still unclear. In the present study, we first found that acute paradoxical sleep deprivation (PSD) induced by the modified multiple platform method (MMPM) for 6 h led to anxiety-like behavior in mice, as verified by the open field test, elevated plus maze test, light-dark box test, and marble burying test. In addition, bioinformatic analysis suggested an important relationship between acute sleep deprivation and brain inflammatory signaling pathways. Key genes enriched in the TNF signaling pathway were confirmed to be altered during acute PSD by qPCR and Western blot analyses, including the upregulation of the prostaglandin-endoperoxide synthase 2 (Ptgs2) and suppressor of cytokine signaling 3 protein (Socs3) genes and the downregulation of the cysteine-aspartic acid protease 3 (Casp3) gene. Furthermore, we found that microglial cells in the prefrontal cortex (PFC) were activated with significant branch structure changes and that the cell body area was increased in the PSD model. Finally, we found that minocycline, a tetracycline with anti-inflammatory properties, may ameliorate the anxiogenic effect and microglial activation. Our study reveals significant correlations of anxiety-like behavior, microglial activation, and inflammation during acute PSD.

A systematic review of sleep deprivation and neurobehavioral function in young adults

AIM

To examine the effect of sleep deprivation (total and partial) on neurobehavioral function compared to a healthy sleep opportunity (7-9 h) in young adults 18-30 years.

BACKGROUND

More than one-third of young adults are sleep deprived, which negatively affects a range of neurobehavioral functions, including psychomotor vigilance performance (cognitive), affect, and daytime sleepiness.

METHODS

A systematic review of randomized controlled trials (RCTs) on sleep deprivation and neurobehavioral function. Multiple electronic databases (Cochrane Central Registry of Controlled Trials [CENTRAL], PubMed, PsycINFO, CINAHL, and Web of Science) were searched for relevant RCTs published in English from the establishment of each database to December 31, 2020.

RESULTS

Nineteen RCTs were selected (N = 766, mean age = 23.7 ± 3.1 years; 44.8% female). Seven were between-person (5 were parallel-group designs and 2 had multiple arms), and 12 were within-person designs (9 were cross over and 3 used a Latin square approach). Total sleep deprivation had the strongest detrimental effect on psychomotor vigilance performance, with the largest effects on vigilance tasks in young adults in the included studies.

CONCLUSION

Acute sleep deprivation degrades multiple dimensions of neurobehavioral function including psychomotor vigilance performance, affect, and daytime sleepiness in young adults. The effect of chronic sleep deprivation on the developing brain and associated neurobehavioral functions in young adults remains unclear.

Sleep EEG characteristics associated with total sleep time misperception in young adults: an exploratory study

Background

Power spectral analysis (PSA) is one of the most commonly-used EEG markers of cortical hyperarousal, and can help to understand subjective–objective sleep discrepancy (SOD). Age is associated with decreased sleep EEG activity; however, the PSA of young adults is currently limited. Thus, this study aimed to examine the correlation of spectral EEG power with total sleep time (TST) misperception in young patients.

Methods

Forty-seven young adults were recruited and underwent a polysomnography recording in a sleep laboratory. Clinical records and self-report questionnaires of all patients were collected, and were used to categorize patients into a good sleeper (GS) group (n = 10), insomnia with a low mismatch group (IWLM, n = 19) or participant with a high mismatch group (IWHM, n = 18). PSA was applied to the first 6 h of sleep.

Results

IWHM patients exhibited a higher absolute power and relative beta/delta ratio in the frontal region compared to the GS group. No significant difference was observed between the IWLM and GS groups. No significant difference in the above parameters was observed between the IWHM and IWLM groups. Moreover, The SOD of TST was positively correlated with frontal absolute power and the relative beta/delta ratio (r = 0.363, P = 0.012; r = 0.363, P = 0.012), and absolute beta EEG spectral power (r = 0.313, P = 0.032) as well as the number of arousals.

Conclusions

Increased frontal beta/delta ratio EEG power was found in young patients with a high mismatch but not in those with a low mismatch, compared with good sleepers. This suggests that there exists increased cortical activity in IWHM patients. In addition, the frontal beta/delta ratio and the number of arousals was positively correlated with the SOD of TST.

Neural correlates of sleep quality in children: Sex-specific associations shown by brain diffusion tractography

BACKGROUND AND PURPOSE

Sleep quality is important for healthy growth and development of children. We aimed to identify associations between sleep disturbances in healthy children without clinical diagnosis of sleep disorders and brain white matter (WM) microstructure using an advanced diffusion-weighted magnetic resonance imaging (DW-MRI) based tractography analysis, and to explore whether there are sex differences in these associations.

METHODS

Brain DW-MRI data were collected from sixty-two 8-year-old children (28 boys, 34 girls) whose parents also completed Children's Sleep Habits Questionnaire (CSHQ). Track-weighted imaging (TWI) measures were computed from the DW-MRI data for 37 WM tracts in each subject. Sex-specific partial correlation analyses were performed to evaluate correlations between TWI measures and a set of sleep disturbance scores derived from the CSHQ.

RESULTS

Significant correlations (P < .05, FDR-corrected; r: .48-.67) were identified in 13 WM tracts between TWI and sleep disturbance scores. Sexually dimorphic differences in correlations between sleep disturbance scores and WM microstructure measurements were observed. Specifically, in boys, daytime sleepiness positively correlated with track-weighted mean or radial diffusivity in 10 WM tracts (bilateral arcuate fasciculus, left cingulum, right middle longitudinal fasciculus, and three bilateral segments of superior longitudinal fasciculus). In girls, total CSHQ score, night walking, or sleep onset delay negatively correlated with track-weighted fractional anisotropy or axial diffusivity in 4 WM tracts (bilateral inferior longitudinal fasciculus and uncinate fasciculus).

CONCLUSIONS

The findings suggest that sleep disturbances without clinical diagnosis of sleep disorders are associated with lower WM microstructural integrity in children. Additionally, the associations possess unique patterns in boys and girls.

SLEEP: intervention with weighted blankets for children with attention deficit hyperactivity disorder (ADHD) and sleep problems: study protocol for a randomised control trial

INTRODUCTION AND OBJECTIVES

Children with attention deficit hyperactivity disorder (ADHD) have an increased risk of sleep problems. Weighted blankets are one possible non-pharmacological intervention for these problems in this group of children. However, the effectiveness of weighted blankets is insufficiently investigated. This study aims to investigate the effectiveness of weighted blankets in terms of sleep, health-related outcomes and cost-effectiveness as well as to explore children's and parents' experiences of a sleep intervention with weighted blankets.

METHODS AND ANALYSIS

This study is a randomised placebo-controlled crossover trial comparing the effect of weighted fibre blankets (active) with fibre blankets without weight (control). Children aged 6-13 years, recently diagnosed with uncomplicated ADHD with verified sleep problems, were included in the study. The study period is 4 weeks for each condition, respectively, and then an 8-week follow-up. A total of 100 children diagnosed with ADHD and sleep problems will enter the study. The primary outcomes are sleep and cost per quality-adjusted life years. The secondary outcomes are health-related quality of life, ADHD symptoms, psychological distress and anxiety. Interviews with a subsample of the participating children and parents will be conducted for exploring the experiences of the intervention.

ETHICS AND DISSEMINATION

Ethical approval of the trial has been obtained from the Swedish Ethical Review Authority (number 2019--2158) and conforms to the principles outlined in the Declaration of Helsinki (WMA, 2013). Results will be reported as presentations at peer-review conferences, in articles in peer-review journals and meetings with healthcare providers.

TRIAL REGISTRATION NUMBER

NCT04180189.

A lifestyle score in childhood and adolescence was positively associated with subsequently measured fluid intelligence in the DONALD cohort study

PURPOSE

Lifestyle scores which combine single factors such as diet, activity, or sleep duration showed associations with cognitive decline in adults. However, the role of a favourable lifestyle in younger age and the build-up of cognitive reserve is less clear, which is why we investigated longitudinal associations between a lifestyle score in childhood and adolescence and fluid intelligence obtained on average 6 years later.

METHODS

In the DONALD cohort, a lifestyle score of 0 to 4 points including healthy diet and duration of moderate-to-vigorous physical activity, sedentary behaviour and sleep was repeatedly assessed in participants aged 5 and 19 years. Data on fluid intelligence were assessed via a German version of the culture fair intelligence test (CFT), using CFT 1-R in children 8.5 years of age or younger (n = 62) or CFT 20-R in participants older than 8.5 years (n = 192). Multivariable linear regression models were used to investigate prospective associations between the lifestyle score and the fluid intelligence score.

RESULTS

Mean lifestyle score of all participants was 2.2 (0.7-4) points. A one-point increase in the lifestyle score was associated with a higher fluid intelligence score (4.8 points [0.3-7.3], p = 0.0343) for participants completing the CFT 20-R. Furthermore, each additional hour of sedentary behaviour was associated with a lower fluid intelligence score (- 3.0 points [- 5.7 to - 0.3], p = 0.0313). For younger participants (CFT 1-R), no association was found in any analysis (p > 0.05).

CONCLUSION

A healthy lifestyle was positively associated with fluid intelligence, whereby sedentary behaviour itself seemed to play a prominent role.

Padrão de sono em crianças de 12 a 36 meses de idade

Resumo Objetivo Avaliar o padrão de sono de crianças de 12 a 36 meses. Método Estudo transversal, realizado em uma amostra de 808 crianças com 12–36 meses de idade, que frequentavam creches no distrito de Viseu, Portugal. Coleta de dados realizada por meio de questionário aplicado aos pais, entre novembro de 2018 e setembro de 2019. Estudo aprovado pela comissão de ética do Instituto de Ciências Biomédicas Abel Salazar, Portugal. Resultados Verificou-se que durante a semana as crianças dormiam, por dia, entre 9h 30m e 18h (M=12h 25m ±1h 02m) e no fim de semana, entre 9h e 19h (M=12h 49m ±1h 15m). No fim de semana, as crianças deitavam-se e acordavam mais tarde que à semana (M=21h 42m ±40m, M=8h 15m ±50m, respetivamente). A maioria não dormia a sesta da manhã, somente a da tarde. Conclusão Os resultados indicam que a maioria das crianças (91,5% semana; 85,6% fim de semana) dorme o número de horas recomendado. As mais novas são as que dormem mais. Implicações para a prática É importante que, nas consultas de vigilância de saúde, os enfermeiros realizem educação para a saúde direcionada aos pais sobre a relevância de manter um padrão de sono adequado à criança.

Disruptive Behaviors and Intellectual Disability: Creating a New Script

BACKGROUND

Terms currently used to describe the so-called challenging and disruptive behaviors (CBDs) of children with intellectual disabilities (ID) have different connotations depending on guiding contextual frameworks, such as academic and cultural settings in which they are used. A non-judgmental approach, which does not attempt to establish existing categorical diagnoses, but which describes in a neutral way, is missing in the literature. Therefore, we tried to describe CDBs in youth with ID in an explorative study.

METHODS

Interviews with families investigated the CDBs of five youth with Down syndrome. At home, families tracked youth's sleep/wake behaviors and physical activity. Youth were observed in a summer school classroom. The collected information and suggested explanatory models for observed CDBs were reviewed with the families.

RESULTS

We grouped CDBs as challenging, if they were considered to be reactive or triggered, or unspecified, if no such explanatory model was available. A third category was created for light-hearted CDBs: goofy, acknowledging the right to laugh together with peers. We found some relationships between sleep, physical activity, and CDBs and developed an explorative approach, supporting a child-centered perspective on CDBs.

CONCLUSION

The controversial discussions on terminology and management of CDBs in the literature demonstrate the need for a non-judgmental approach. Such an explorative approach, allowing non-professionals to not label, has been missing. The fact that, up to now, the light-hearted behaviors of an individual with ID have not been integrated in commonly-used behavioral checklists as their natural right, proves our concept and indicates that a paradigm change from judgment-based to exploratory-driven approaches is needed.

Self-Reported Sleep and Executive Function in Early Primary School Children

The study investigated the associations between children’s self-reported habitual sleep disturbance and multidimensional executive function (EF). Two hundred and four 7–9-year-old typically developing children completed the Sleep Self-Report and finished the Red-Blue Test, Wisconsin Card Sorting Test, and Backward Digit Span Test, indexing different EF components including inhibitory control, cognitive flexibility, and working memory. Results revealed that all the three EF components were significantly correlated with sleep. However, cognitive flexibility was no longer significantly related to sleep when the other EF components – inhibitory control and working memory – were controlled for. Meanwhile, inhibitory control, as well as working memory, was still significantly related to sleep after controlling for the other EF components. Results suggest that children’s self-reported sleep might be associated directly with inhibitory control and working memory, but indirectly with cognitive flexibility.

Parents' Experiences of Weighted Blankets' Impact on Children with Attention-Deficit/Hyperactivity Disorder (ADHD) and Sleep Problems-A Qualitative Study

Sleep disturbances are common among children with attention-deficit/hyperactivity disorder (ADHD). While pharmacological treatment has increased dramatically, parents often prefer non-pharmacological interventions. Research on experiences of weighted blankets and their effect in sleep improvement is scarce. The aim of this study was to explore parents' experiences of weighted blankets for children with ADHD and sleep problems, and the impact on their children's sleep. The explorative design was based on qualitative content analysis. Interviews were conducted with a purposeful sample of 24 parents of children with ADHD and sleep problems, after completing a sleep intervention with weighted blankets for 16 weeks. Parents reported that children sleeping with weighted blankets: (1) achieved satisfactory sleep, including improved sleep onset latency, sleep continuity, and sleep routines; (2) achieved overall well-being, including improved relaxation and reduced anxiety; and (3) mastered everyday life, including improved balance in life, family function, and participation in school and leisure activities. This study brings forward novel aspects of the effects of improved sleep among children with ADHD. The findings contribute to the understanding of potential positive effects of an intervention with weighted blankets critical for clinical practice to improve sleep, well-being, and everyday life of children with ADHD and their families.

Sleep problems predict next-day suicidal thinking among adolescents: A multimodal real-time monitoring study following discharge from acute psychiatric care

Suicidal thoughts and behaviors (STBs) are major public health concerns among adolescents, and research is needed to identify how risk is conferred over the short term (hours and days). Sleep problems may be associated with elevated risk for STBs, but less is known about this link in youth over short time periods. The current study utilized a multimodal real-time monitoring approach to examine the association between sleep problems (via daily sleep diary and actigraphy) and next-day suicidal thinking in 48 adolescents with a history of STBs during the month following discharge from acute psychiatric care. Results indicated that specific indices of sleep problems assessed via sleep diary (i.e., greater sleep onset latency, nightmares, ruminative thoughts before sleep) predicted next-day suicidal thinking. These effects were significant even when daily sadness and baseline depression were included in the models. Moreover, several associations between daily-level sleep problems and next-day suicidal thinking were moderated by person-level measures of the construct. In contrast, sleep indices assessed objectively (via actigraphy) were either not related to suicidal thinking or were related in the opposite direction from hypothesized. Together, these findings provide some support for sleep problems as a short-term risk factor for suicidal thinking in high-risk adolescents.

Serum micronutrient status, sleep quality and neurobehavioural function among early adolescents

OBJECTIVE

To examine associations between serum micronutrients and neurobehavioural function and the mediating role of sleep quality in early adolescents.

DESIGN

In this cross-sectional study, peripheral blood samples were analysed for Fe and Zn levels. The Pittsburgh Sleep Quality Index and Penn Computerized Neurocognitive Battery were used to assess sleep quality and neurobehavioural function, respectively. The logistic/linear regressions and generalised structural equation modelling were performed to estimate the associations.

SETTING

Jintan, China.

PARTICIPANTS

In total, 226 adolescents (106 females) from the Jintan Child Cohort study.

RESULTS

Adolescents with low Fe (<75 μg/dl) (OR = 1·29, P = 0·04) and low Zn (<70 μg/dl) (OR = 1·58, P < 0·001) were associated with increased odds for poor sleep quality. Adolescents with low Fe and Zn were associated with fast (Fe: β = -1353·71, P = 0·002, Zn: β = -2262·01, P = 0·02) but less-accurate (Fe: β = -0·97, P = 0·04; Zn: β = -1·76, P = 0·04) performance on non-verbal reasoning task and poor sleep quality partially mediated the associations between low Fe/Zn and non-verbal reasoning (P < 0·05). Additionally, low Fe was associated with a slower reaction on spatial processing task (β = 276·94, P = 0·04), and low Zn was associated with fast (β = -1781·83, P = 0·03), but error-prone performance (β = -1·79, P = 0·04) on spatial processing ability and slower reaction speed (β = 12·82, P = 0·03) on the attention task. We observed similar trends using a cut-off point of 75 μg/dl for low serum Zn, except for the association with attention task speed (P > 0·05).

CONCLUSION

Fe and Zn deficiencies may possibly be associated with poor sleep and neurobehavioural function among early adolescents. Poor sleep may partially mediate the relationship between micronutrients and neurobehavioural function.

Food Insecurity and Sleep Disturbance Among 223,561 Adolescents: A Multi-Country Analysis of Cross-Sectional Surveys

This study was to investigate the association between food insecurity (FI) and sleep disturbance among adolescents. Based on the cross-sectional data of the Global School-based Student Health Survey, this study analyzed self-reported data from adolescents in 68 countries. Multivariate logistic regression and meta-analysis were used to evaluate the association between FI and sleep disturbance. The final sample included 223,561 adolescents. The prevalence of severe FI and sleep disturbance was 6.4% and 8.0%, respectively. Severe FI was significantly associated with a higher risk of sleep disturbance in 48 of the 68 countries after adjusting for covariates, with a pooled OR (95% CI) of 1.94 (1.79–2.09). Overall, the association between FI and sleep disturbance was similar across countries and gender, though a large level of heterogeneity existed across upper- and middle-income countries. Identifying adolescents suffering from FI and remedying the FI severity may be important to improve sleep quality in global adolescents.

The Acute Readiness Monitoring Scale: Assessing Predictive and Concurrent Validation

To complement and enhance readiness-monitoring capability, the Acute Readiness Monitoring Scale (ARMS) was developed: a widely applicable, simple psychometric measure of perceived readiness. While this tool may have widespread utility in sport and military settings, it remains unknown if the ARMS demonstrates predictive and concurrent validity. Here, we investigated whether the ARMS is: (1) responsive to an acute manipulation of readiness using sleep deprivation, (2) relates to biological markers of readiness [cortisol/heart-rate variability (HRV)], and (3) predicts performance on a cognitive task. Thirty young adults (aged 23 ± 4 years; 18 females) participated. All participants engaged in a 24-h sleep deprivation protocol. Participants completed the ARMS, biological measures of readiness (salivary cortisol, HRV), and cognitive performance measures (psychomotor vigilance task) before, immediately after, 24-, and 48-h post-sleep deprivation. All six of the ARMS subscales changed in response to sleep deprivation: scores on each subscale worsened (indicating reductions in perceived readiness) immediately after sleep deprivation, returning to baseline 24/48 h post. Lower perceived readiness was associated with reduced awakening responses in cortisol and predicted worse cognitive performance (slower reaction time). No relationship was observed between the ARMS and HRV, nor between any biological markers of readiness (cortisol/HRV) and cognitive performance. These data suggest that the ARMS may hold practical utility in detecting, or screening for, the wide range of deleterious effects caused by sleep deprivation; may constitute a quick, cheap, and easily interpreted alternative to biological measures of readiness; and may be used to monitor or mitigate potential underperformance on tasks requiring attention and vigilance.

Is adherence to 24-Hour Movement Guidelines associated with a higher academic achievement among adolescent males and females?

OBJECTIVES

This study aims to examine the independent and combined associations of 24-Hour Movement Guidelines for physical activity, screen time, and sleep duration with academic achievement in adolescent males and females.

DESIGN

Cross-sectional study.

METHODS

1290 Spanish adolescents (565 females), aged 11 to 16 years (13.06 ± 0.84), participated in this study. Self-reported physical activity, screen time, and sleep duration questionnaires were assessed. Academic achievement was calculated as an average score of the adolescents'' grades in first language (Spanish), first foreign language (English), and mathematics subjects. A multiple linear regression model was used to examine the association between meeting 24-Hour Movement Guidelines and academic achievement. Covariates included age, sex, socioeconomic status, body mass index, and cardiorespiratory fitness.

RESULTS

Not meeting any of the three 24-Hour Movement Guidelines was associated with lower academic achievement in the whole sample (p < 0.001). Meeting physical activity and sleep duration guidelines, both independently and together, was associated with higher academic achievement in the whole sample (p < 0.001). Meeting at least two recommendations was associated with higher academic achievement in males (p < 0.01). However, trend analysis revealed that participants who met two or three recommendations had higher academic achievement compared to those who met one or none of these recommendations (p < 0.05). All these results were similar for males and females.

CONCLUSIONS

Our findings suggest the importance of promoting more than one 24-Hour Movement Guidelines, mainly physical activity and sleep duration, which seems to contribute positively to increased academic performance in adolescents.

Designing adolescent sleep interventions with stakeholder input

OBJECTIVE

Few sleep promotion programs for adolescents have involved stakeholders as part of the intervention development, which may contribute to their limited accessibility, scalability, acceptability, and feasibility. Specifically asking stakeholders for their input on how to modify factors impacting sleep is critical, as is identifying strategies for motivating sleep behavior change. We report qualitative feedback from stakeholders interested in improving adolescent sleep, data collected specifically to inform the development of an adolescent sleep promotion program.

PARTICIPANTS

We conducted 9 focus groups (3 each for young adults (n = 8, ages 21-25), parents of adolescents (n = 12), and healthcare providers working with adolescents (n = 29) following a semistructured approach.

DESIGN

Participants reported on contributors to good and poor sleep; motivators for improving sleep; strategies for promoting and sustaining behavior change; and feasibility of a proposed sleep promotion program. We coded and thematically analyzed focus group transcripts using inductive and deductive approaches.

RESULTS

Moderate engagement in activities (eg, a job, sports) was seen as a contributor to good sleep, while having too many or too few activities was thought to contribute to poor sleep. Linking improved sleep with personalized outcomes of interest can enhance motivation for changing sleep. Strategies for behavior change should rely on increasing internal motivation, personalizing intervention content, and having parents model desired behaviors.

CONCLUSIONS

Key stakeholders are critical to the development of acceptable interventions that can be implemented effectively in real-world settings. Future work should test whether the identified themes contribute to increased feasibility, scalability, and effectiveness of sleep programs.