A survey of junior high school students' sleep habit and lifestyle in Okinawa

Association between sleep habits/disorders and emotional/behavioral problems among Japanese children

Actual sleep status and the association between sleep habits/disorders and emotional/behavioral problems among children in the development stage have not been fully clarified. A questionnaire survey was conducted on the sleep habits/disorders (Brief Child Sleep Questionnaire; BCSQ) and emotional/behavioral problems (Strengths and Difficulties Questionnaire; SDQ) of 87,548 children enrolled in ordinary classes in nine grade levels from the first grade of elementary school to the third grade of junior high school from December 2009 to April 2010. As school grade increased, children's bedtimes were delayed and sleep duration was reduced by 2.0 h over the nine grade levels. Based on the BCSQ, 18.3% of children were judged to have some type of sleep disorder, and about 30% to 40% of children had sleep symptoms at bedtime, during sleep, and at wake time. Multiple regression analysis showed that emotional and behavioral problems were associated with presence of any sleep symptom, longer sleep latency, and longer awake time after sleep onset, whereas total sleep time was not. Sleep symptoms at wake time were most strongly associated with emotional and behavioral problems. Status of sleep habits/disorders should be considered when interpreting emotional/behavioral problems in school-age children.

Effects of a sleep education program with self-help treatment on sleeping patterns and daytime sleepiness in Japanese adolescents: A cluster randomized trial

Subjective insufficient sleep and delayed sleep-wake patterns have been reported as the primary causes for daytime sleepiness, a reasonably significant and prevalent problem for adolescents worldwide. Systematic reviews have indicated that the success of sleep education programs has thus far been inconsistent, due to the lack of a tailored approach that allows for evaluation of individual differences in behavior patterns. One way to resolve this problem is to assess the individual sleep behaviors of adolescents by using a checklist containing the recommended behaviors for promoting sleep health. Such self-help education programs have already been implemented for elementary school children, school nurses and the elderly. The present study aimed to verify the effects of a sleep education program with supplementary self-help treatment, based on a checklist of sleep-promoting behaviors, in addition to evaluation of changes in sleeping patterns, sleep-promoting behaviors and daytime sleepiness in adolescents. A cluster randomized controlled trial involving 5 Japanese junior high schools was conducted, and 243 students (sleep education: n = 122; waiting list: n = 121; 50.6% female; 7th grade) were included in the final analysis. The sleep education group was provided with information on proper sleep health and sleep-promoting behaviors. The students in this group were asked to practice one sleep-promoting behavior as a goal for 2 weeks and to monitor their practice using sleep diaries. Both pre- and post-treatment questionnaires were administered to students in order to assess knowledge of sleep-promoting behaviors, sleeping patterns and daytime functioning. Students in the sleep education group showed significant improvement in their knowledge of sleep health (F1,121 = 648.05, p < 0.001) and in their sleep-promoting behaviors (F1,121 = 55.66, p < 0.001). Bedtime on both school nights (F1,121 = 50.86, p < 0.001) and weekends (F1,121 = 15.03, p < 0.001), sleep-onset latency (F1,121 = 10.26, p = 0.002), total sleep time on school nights (F1,121 = 12.45, p = 0.001), subjective experience of insufficient sleep (McNemar χ(2)(1) = 4.03, p = 0.045) and daytime sleepiness (McNemar χ(2)(1) = 4.23, p = 0.040) were also improved in the sleep education group. In contrast, no significant improvement in these variables was observed for students in the waiting-list group. In conclusion, the sleep education program with self-help treatment was effective not only in increasing sleep knowledge but also in improving sleep-promoting behavior and sleeping patterns/reducing daytime sleepiness for students in the sleep education group, in comparison with the waiting-list group.

Changes in healthy childhood lifestyle behaviors in Japanese rural areas

BACKGROUND

Unhealthy lifestyles during childhood constitute a public health problem in Japan. However, current health education in Japan is ineffective in counteracting them. Previous studies contend that healthy lifestyles in children vary by academic grade and sex. This study examined changes throughout childhood suggests some intervention points for lifestyle education.

METHODS

The participants were 2833 elementary and junior high school students living in Japanese rural areas. Data on 26 variables assigned to 5 subfactors were collected. We estimated the composite score of each subfactor on the basis of item response theory. A 2-way ANOVA and a graph review were performed to explore the differences and changes by sex and grade.

RESULTS

Most of the main effects for sex and grade were statistically significant. Lifestyle behaviors acquired early in elementary school were lost as students progressed to higher grades.

CONCLUSIONS

The research indicated the following emphases: (1) Physical activity and leisure habits should be focused on girls and hygiene habits on boys; (2) Continuous education for a healthy lifestyle is essential to maintain good health among children; (3) Education for healthy lifestyle can be classified into 2 important stages such as for dietary and sleeping habits, education from the upper grades of elementary school is important, whereas for other routine activities, reeducation in junior high school is effective.

Skipping breakfast is correlated with impaired fasting glucose in apparently healthy subjects

Regular food consumption plays a critical role in normal glucose homeostasis. Today, a few studies have evaluated the level of fasting glucose in individuals who skip breakfast, which should theoretically lead to a lack of supplementary energy and thereby increase the risk for subsequent hypoglycemia. The prevalence of suspected habitual skipping breakfast (SHSB) (at least three times weekly) was evaluated with a simple question, along with measurement of fasting plasma glucose level and assessment of cardiovascular and lifestyle risk factors in a cross-sectional study of 2,331 asymptomatic adults who had never been treated with insulin or oral anti-diabetic drugs. The overall prevalence of SHSB was 16.3% (20.1% for men and 9.4% for women, P<0.0001, χ2-test). Compared with a normal fasting glucose level, an impaired fasting glucose (IFG) level (100–125 mg/dl), but not high fasting glucose (≥126 mg/dl), was significantly associated with SHSB, and this association remained after adjustment for relevant confounders [odds ratio (95% CI): 1.75 (1.33–2.30) and 2.10 (0.93–4.71), respectively]. Age (inversely), current smoker, late dinner just before sleeping, infrequent exercise, and high C-reactive protein (≥1.8 mg/L) were independently associated with SHSB. In a subgroup of subjects who underwent a 75g-oral glucose tolerance test (n = 1,315), isolated IFG (n = 272) was solely significantly associated with SHSB. Our results suggest that IFG, subtle inflammatory state, and high-risk lifestyle factors for diabetes and cardiovascular disease may have an association in asymptomatic adults who habitually skip breakfast.

Sleep in adolescents: the perfect storm

A reduction in sleep amount from late childhood through the second decade has long been known; however, the weight of current evidence holds that sleep need does not decline across this span. This article will describe how the loss of sleep through adolescence is not driven by lower need for sleep but arises from a convergence of biologic, psychological, and socio-cultural influences.

Sleep patterns and school performance of Korean adolescents assessed using a Korean version of the pediatric daytime sleepiness scale

PURPOSE

Korean adolescents have severe nighttime sleep deprivation and daytime sleepiness because of their competitive educational environment. However, daytime sleep patterns and sleepiness have never been studied using age-specific methods, such as the pediatric daytime sleepiness scale (PDSS). We surveyed the daytime sleepiness of Korean adolescents using a Korean translation of the PDSS.

METHODS

We distributed the 27-item questionnaire, including the PDSS and questions related to sleep pattern, sleep satisfaction, and emotional state, to 3,370 students in grades 5-12.

RESULTS

The amount of nighttime sleep decreased significantly with increasing age. During weekday nights, 5-6(th) graders slept for 7.95±1.05 h, 7-9(th) graders for 7.57±1.05 h, and 10-12(th) graders for 5.78±1.13 h. However, the total amounts of combined daytime and nighttime sleep during weekdays were somewhat greater, 8.15±1.12 h for 5-6(th) graders, 8.17±1.20 h for 7-9(th) graders, and 6.87±1.40 h for 10-12(th) graders. PDSS scores increased with age, 11.89±5.56 for 5-6(th) graders, 16.57±5.57 for 7-9(th) graders, and 17.71±5.24 for 10-12(th) graders. Higher PDSS scores were positively correlated with poor school performance and emotional instability.

CONCLUSION

Korean teenagers sleep to an unusual extent during the day because of nighttime sleep deprivation. This negatively affects school performance and emotional stability. A Korean translation of the PDSS was effective in evaluating the severity of daytime sleepiness and assessing the emotional state and school performance of Korean teenagers.

Exploring the daily activities associated with delayed bedtime of Japanese university students

University students show delayed sleep-wake patterns, i.e., later bed- and rise-times, and this pattern is known to be associated with various malfunctions. There may be a variety of daily activities associated with their delayed sleep patterns, such as watching TV. However, it is unclear to what extent each activity possesses an impact on their sleep patterns. The purpose of this study was to determine the daily activities associated with delayed bedtime in Japanese university students who live with or without their families. Three hundred and thirty-one participants were required to record the timing and duration of their sleep and daily activities, and the data from the 275 students (160 men and 115 women; 19.01 +/- 1.66 years) who completely filled forms were used for analysis. The results of multiple regression analyses suggested that interpersonal communication late at night is one of the major factors leading to the delayed bedtime of students living away from home. Among those living with their families, indoor activities such as watching TV and using the Internet were related to their delayed bedtimes. Attending classes and having a morning meal were related to the earlier bedtimes of the students living away from home, but there were no activities associated with those of the students living with their families. These results suggest that ensuring attendance at morning classes and having appropriate mealtimes, as well as restricting the use of visual media and socializing activities at night, are necessary for preventing late bedtimes in university students.

Correlates for poor sleepers in a Los Angeles high school

BACKGROUND AND PURPOSE

We explored sleep patterns including morning-evening preference and their associations with other lifestyle determinants among high school students.

PARTICIPANTS AND METHODS

We conducted a cross-sectional survey of students grades 9-12 from a private high school in the United States. One hundred and thirty-one students completed an online survey comprising 23 original, investigator-created questions, a mood scale, the Pittsburgh Sleep Quality Index (PSQI), and the Horne-Ostberg Morningness-Eveningness Questionnaire (MEQ).

RESULTS

We found that 80% of students reported a sleep deficit. As defined by the PSQI, 69% of girls and 58% of boys in this sample were poor sleepers. Eveningness was a strong predictor of poor sleep, particularly among students aged 15 years (odds ratio [OR] 9.92; 95% confidence interval [CI], 1.52-64.8), among whom poor sleep quality was also associated with a higher body mass index (BMI) (OR, 6.97; 95% CI, 1.01-48.2).

CONCLUSIONS

Our pilot study suggests that morningness-eveningness is a strong predictor of sleep quality among high school students.

Sleep practices, attitudes, and beliefs in inner city middle school children: a mixed-methods study

The objective of this study was to utilize both semi-quantitative and qualitative data to examine the sociodemographic, social environmental, and behavioral context of sleep practices in a group of 64 middle school students enrolled in a summer camp program. Participants completed the Sleep Habits Survey; semi-structured interviews were used to collect data regarding sleep knowledge, perceived barriers to healthy sleep, consequences of inadequate sleep, sources of sleep information, and suggestions for improved sleep. Environmental and social factors figured prominently as perceived barriers to healthy sleep. Many of the respondents mentioned adult guidance regarding sleep habits as potentially helpful. Identification of predictive factors for insufficient sleep may be helpful in developing interventions to change sleep health risk behaviors in middle school populations.

Prevalence and correlates of excessive daytime sleepiness in high school students in Korea

The purpose of the present study was to determine the prevalence of excessive daytime sleepiness (EDS) and its associations with sleep habits, sleep problems, and school performance in high school students in South Korea. A total of 3871 students (2703 boys and 1168 girls with a mean age of 16.8 years and 16.9 years, respectively) aged 15-18 years in the 11th grade of high school completed a questionnaire that contained items about individual sociodemographic characteristics, sleep habits, and sleep-related problems. The overall prevalence of EDS was 15.9% (14.9% for boys and 18.2% for girls). Mean reported total sleep time was similar in EDS and non-EDS (6.4 +/- 1.6 and 6.4 +/- 1.3 h/day, respectively). The increased risk of EDS was related to perceived sleep insufficiency (P < 0.001), teeth grinding > or = 4 days/week (P < 0.001), witnessed apnea > or = 1-3 days/week (P < 0.01), nightmares > or = 4 days/week (P < 0.05), low school performance (P < 0.01), and two or more insomnia symptoms (P < 0.05). Students with low school performance had a 60% excess in the odds of EDS compared to those whose school performance was high. These findings suggest that EDS is associated with multiple sleep-related factors in adolescents. Whether interventions to modify associated correlates can alter EDS warrants consideration, especially because it may also improve academic performance in high school students.

Sleep problems in adolescence. A study of senior high school students in Greece

OBJECTIVES

The aim of this study was to evaluate sleep habits and sleep-related problems in high school adolescent students in Greece through the Athens Insomnia Scale and to assess the relation of these problems to demographic and other variables.

METHODS

The Athens Insomnia Scale 5-item version (AIS-5) was administered to 713 adolescent senior high school students in the Greater Athens Area. Data such as age, sex, school records, and time spent per week in school-related and extracurricular activities were collected.

RESULTS

The sample's mean sleep duration was 7.5 h, mean bedtime 00.20 a.m. and wake-up time 7.15 a.m. Total sleep time was not affected by gender, but was influenced by time spent in various activities. Sleep complaints were related to delayed sleep, onset latency and insufficient total duration of sleep. Of the respondents, 30% estimated that their sleep onset latency was markedly delayed and 30% reported that their total sleep time was markedly insufficient. Girls complained more than boys, while correlations showed that students with lower academic performance and those in second grade were more likely to have higher AIS-5 scores.

CONCLUSIONS

The results show that the sleep time of high school students is dependent on practical matters such as school schedule and other activities, while sleep complaints are related to female gender, bad school performance as well as to the second grade. The difference between actual sleep time and sleep complaints should be considered when studying the sleep of adolescents.

Sleep quality, sleep propensity and academic performance

We examined associations between measures of sleep propensity on the Epworth Sleepiness Scale, sleep quality on the Pittsburgh Sleep Quality Index and academic performance by GPA and grades in introductory psychology for 414 students. In the total sample, neither sleep propensity nor sleep quality correlated with GPA or introductory psychology grades. However, among students carrying a full course load, those reporting poor sleep quality performed less well on academic measures than those reporting a better quality of sleep. Further research is needed to assess the moderating influence of overall demands of daytime functioning on the association between sleep quality and academic performance.

Prevalence and correlates of habitual snoring in high school students

STUDY OBJECTIVES

To examine the prevalence and correlates of habitual snoring in senior high school students in Korea.

DESIGN

A cross-sectional survey.

SETTING

Ten high schools in the southern part of Seoul, Korea.

PARTICIPANTS

A total of 3,871 high school students (2,703 male students and 1,168 female students; age range, 15 to 18 years; mean age: male students, 16.8 years; female students, 16.9 years) who were attending the 11th grade.

MEASUREMENTS AND RESULTS

Data were collected on sociodemographic characteristics, school performance, and patterns of sleep and sleep-related disturbances. The overall prevalence of habitual snoring was 11.2% (boys, 12.4%; girls, 8.5%). The mean total sleep time was similar in habitual snorers vs nonsnorers (6.4 and 6.3 h per day, respectively). Frequency of snoring increased significantly with body mass index (BMI) [p < 0.001], cigarette smoking (p < 0.01), prevalence of witnessed apnea (p < 0.001), and Epworth sleepiness scale score (p < 0.001). The frequency of snoring increased with a decline in school performance (p < 0.001). For those whose school performance was low, there was a 35% excess in the odds of habitual snoring vs those whose school performance was high (odds ratio, 1.35; 95% confidence interval, 1.01 to 1.78).

CONCLUSIONS

These findings suggest that chronic habitual snoring is associated with multiple factors in adolescents. Whether interventions to modify BMI and smoking can alter snoring habits and related clinical problems warrants further study, particularly as it also may improve academic performance in high school students.

The effects of nocturnal life on endocrine circadian patterns in healthy adults

We observed the 24-hour patterns of endocrine in medical students who lived either a diurnal life or nocturnal life. Nocturnal life was designed by skipping their breakfast but consuming much (>50% of their daily food intake) in the evening and at night with the sleep from 0130 h to 0830 h the next morning. After 3 weeks in the experimental life, the 24-hour plasma concentrations of melatonin, leptin, glucose and insulin were measured every three hours. Both plasma melatonin and leptin showed peaks at 0300 h in the diurnal lifestyle group, and the night peaks decreased in the nocturnal lifestyle group. The changes in the patterns of melatonin and leptin were highly consistent with that of night-eating syndrome (NES). Plasma glucose increased after all meals in both groups. Its concentration maintained a high level in the nocturnal lifestyle group between midnight and early morning while insulin secretion decreased markedly during this period. Furthermore, the strong association between glucose and insulin in the diurnal lifestyle group after meals was damaged in the nocturnal lifestyle group. It was suggested that nocturnal life leads to the impairment of insulin response to glucose. Taking these results together, nocturnal life is likely to be one of the risk factors to health of modern people, including NES, obesity and diabetes.

Sleep habits, excessive daytime sleepiness and school performance in high school students

A questionnaire survey was carried out to examine the sleep habits and excessive daytime sleepiness (EDS) of 3871 high school students with a mean age of 16.8 years in Korea. The results showed that mean total sleep time was 6.3 h/day for male students and 6.5 h/day for female students, which may be insufficient for adolescence during puberty. The overall prevalence of EDS (defined as an Epworth sleepiness scale score of >10) was 15.9% (14.9% for boys and 18.2% for girls). The prevalence of EDS increased significantly (P < 0.001) with a decline in school performance.

An examination of sleep health, lifestyle and mental health in junior high school students

The factors that influence sleep health and mental health in junior high school students' lifestyles was examined. The proportion of students who replied that they feel bad in the morning, and who do not have breakfast was significantly higher in poor sleepers. The proportion of students who regularly take exercise was significantly lower among poor sleepers. Compared with good sleepers, poor sleepers had a higher number of illnesses and their General Health Questionnaire score was worse. The study's results suggest that sleep health is closely related to both physical and mental health, and that habits such as exercise, and regular sleeping and eating, are important for maintaining and improving students' sleep health.

Sleep habits of students attending elementary schools, and junior and senior high schools in Akita prefecture

It is widely accepted that students in Japan sleep fewer hours than what they actually need. However, epidemiological data on sleep habits among students are scarce. The sleep habits and related problems among 1650 students in Akita prefecture were studied. The results revealed that schoolchildren attending elementary schools seemed to sleep for a sufficient number of hours, whereas students attending junior or senior high schools were not sleeping enough. In particular, approximately half of the students attending senior high schools answered that they slept 6 h or less on weekdays and nodded off during classes more than twice a week.

Association of sleep and academic performance

Poor school performance by adolescent students has been attributed in part to insufficient sleep. It is recognized that a number of factors lead to diminished total sleep time and chief among these are early school start times and sleep phase delay in adolescence. Political initiatives are gaining momentum across the United States to require later school start times with the intent of increasing total sleep time and consequently improving school performance. Later school start times come with significant costs and impact other activities of families and communities. The decision to implement later school start times cannot be made lightly and deserves support of well-performed research on the impact of these changes. A study evaluating the association of academic performance and total sleep time was performed in middle school and high school students in a suburban Maryland school system. Preliminary results of this study show no correlation of total sleep time with academic performance. Before mandating costly changes in school schedules, it would be useful to perform further research to determine the effects of increasing sleep time on the behaviors of adolescent students.