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

Childhood sleep: physical, cognitive, and behavioral consequences and implications

BACKGROUND

Sleep problems in children have been increasingly recognized as a major public health issue. Previous research has extensively studied and presented many risk factors and potential mechanisms for children's sleep problems. In this paper, we aimed to identify and summarize the consequences and implications of child sleep problems.

DATA SOURCES

A comprehensive search for relevant English language full-text, peer-reviewed publications was performed focusing on pediatric sleep studies from prenatal to childhood and adolescence in a variety of indexes in PubMed, SCOPUS, and Psych Info published in the past two decades. Both relevant data-based articles and systematic reviews are included.

RESULTS

Many adverse consequences are associated with child sleep deficiency and other sleep problems, including physical outcomes (e.g., obesity), neurocognitive outcomes (e.g., memory and attention, intelligence, academic performance), and emotional and behavioral outcomes (e.g., internalizing/externalizing behaviors, behavioral disorders). Current prevention and intervention approaches to address childhood sleep problems include nutrition, exercise, cognitive-behavioral therapy for insomnia, aromatherapy, acupressure, and mindfulness. These interventions may be particularly important in the context of coronavirus disease 2019. Specific research and policy strategies can target the risk factors of child sleep as well as the efficacy and accessibility of treatments.

CONCLUSIONS

Given the increasing prevalence of child sleep problems, which have been shown to affect children's physical and neurobehavioral wellbeing, understanding the multi-aspect consequences and intervention programs for childhood sleep is important to inform future research direction as well as a public health practice for sleep screening and intervention, thus improving sleep-related child development and health.

Effectiveness of school-based sleep promotion programs for adolescents: a systematic review protocol

OBJECTIVE

This systematic review will assess the effectiveness of school-based sleep promotion programs on sleep knowledge, hygiene, quality, behavior, and efficiency in adolescents.

INTRODUCTION

Adolescents need to sleep between 8 and 10 hours per night; however, most sleep fewer hours due to peer and school pressure, stress, and excessive use of electronic devices at night. Sleep deprivation can lead to cardiovascular problems, issues with stress management, and suicidal ideation. Schools are an ideal space to implement intervention programs, providing the opportunity to reach a large number of adolescents. Considering the negative impacts of poor sleep, it is essential to assess the effectiveness of school-based sleep promotion programs on sleep knowledge, hygiene, quality, behavior, and efficiency.

INCLUSION CRITERIA

Studies with adolescents (10-19 years old) exposed to school-based sleep promotion programs will be included. Studies in English, Spanish, and Portuguese will be considered, with no time limits.

METHODS

Nine databases, CINAHL, Cochrane Central Register of Controlled Trials, ERIC (all via EBSCOhost), MEDLINE (PubMed), LILACS, SciELO, Psychology and Behavioral Sciences Collection, Web of Science Core Collection, and Scopus, will be searched from inception to identify relevant studies. Two independent reviewers will perform the study selection, critical appraisal using JBI tools, and data extraction. Studies will, where possible, be pooled in meta-analysis. Heterogeneity will be assessed using the standard χ 2 and I2 tests. Statistical analyses will be performed using the random effects model. If fewer than 5 studies are included, the fixed effects model will be used. The Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach will be used to grade the certainty of evidence and a Summary of Findings will be created.

REVIEW REGISTRATION

PROSPERO CRD42023374838.

Protective Effects of Melatonin in High-Fat Diet-Induced Hepatic Steatosis via Decreased Intestinal Lipid Absorption and Hepatic Cholesterol Synthesis

BACKGRUOUND

The preventative effect of melatonin on the development of obesity and the progression of fatty liver under a high-fat diet (HFD) has been well elucidated through previous studies. We investigated the mechanism behind this effect regarding cholesterol biosynthesis and regulation of cholesterol levels.

METHODS

Mice were divided into three groups: normal chow diet (NCD); HFD; and HFD and melatonin administration group (HFD+M). We assessed the serum lipid profile, mRNA expression levels of proteins involved in cholesterol synthesis and reabsorption in the liver and nutrient transporters in the intestines, and cytokine levels. Additionally, an in vitro experiment using HepG2 cells was performed.

RESULTS

Expression of hepatic sterol regulatory element-binding protein 2 (SREBP-2), 3-hydroxy-3-methylglutaryl coenzyme A reductase (HMGCR), and low-density lipoprotein receptor (LDLR) demonstrated that melatonin administration significantly reduces hepatic cholesterol synthesis in mice fed an HFD. Expression of intestinal sodium-glucose transporter 1 (SGLT1), glucose transporter 2 (GLUT2), GLUT5, and Niemann-pick C1-like 1 (NPC1L1) demonstrated that melatonin administration significantly reduces intestinal carbohydrate and lipid absorption in mice fed an HFD. There were no differences in local and circulatory inflammatory cytokine levels among the NCD, HFD, and HFD+M group. HepG2 cells stimulated with palmitate showed reduced levels of SREBP, LDLR, and HMGCR indicating these results are due to the direct mechanistic effect of melatonin on hepatocytes.

CONCLUSION

Collectively, these data indicate the mechanism behind the protective effects of melatonin from weight gain and liver steatosis under HFD is through a reduction in intestinal caloric absorption and hepatic cholesterol synthesis highlighting its potential in the treatment of obesity and fatty liver disease.

An Independent Evaluation of the Psychometric Properties of the Russian Version of the Pediatric Daytime Sleepiness Scale (PDSS)

Background

The quality of sleep significantly impacts children's day-to-day performance, with at least 20% reporting issues with sleepiness. Valid tools for assessing the quality of sleep are needed.

Objective

In this study, we assessed the psychometric properties of the Russian version of the Pediatric Daytime Sleepiness Scale (PDSS). The initial adaptation of the PDSS was conducted on a sample from the Arctic regions of Russia. This location may have influenced the scale's generalizability due to variations in natural daylight across different areas of the country.

Design

To rectify this, we gathered a comprehensive, geographically diverse sample from Russia. This combined dataset comprised 3772 participants between 10 to 18 years of age, from nine different regions of Russia.

Results

We confirmed the unifactorial structure of the PDSS, which showed no regional effects. The psychometric analysis indicated that one item from the 8item PDSS could be removed, thereby improving the scale's model fit. We also observed gender and age impacts on sleep quality: boys reported fewer sleep-related issues than girls, and younger children reported fewer problems than older children.

Conclusion

This study validates the usefulness and reliability of the Russian version of the PDSS, thereby enhancing its general applicability. Furthermore, we replicated previously reported age and sex effects on the sleep quality of school-aged children.

Factors that influence morningness-eveningness and daytime sleepiness: A cross-cultural comparison of Iranian and Brazilian adolescents

As adolescents get older, they become more evening oriented and, because they are usually expected to wake early to attend school, they often present daytime sleepiness, which is associated with negative outcomes. It is still unclear if this is similar cross-culturally. Here, we studied morningness-eveningness and daytime sleepiness in early adolescence from two different developing nations (Brazil and Iran). A total sample of 697 Iranian and Brazilian early adolescents (9- to 15-year-old; 358 boys) from Tehran, Iran, and São Paulo, Brazil, varying in age and parental schooling (a proxy of socioeconomic status: SES) completed the Morningness-Eveningness Scale for Children (MESC) and the Pediatric Daytime Sleepiness Scale (PDSS) and reported their total sleep time on school nights. They also filled in the Pubertal Developmental Scale to determine their pubertal status. A negligible cross-cultural difference in morningness-eveningness was found, indicating that Brazilians showed a slight circadian-phase delay compared with Iranians throughout all tested ages. There was also seen a very slight increase in phase delay as early adolescents aged, indicative of more eveningness. However, there were no country differences in daytime sleepiness once total sleep time during school nights was controlled for, which was the only factor that affects PDSS scores.

Disparity between Subjective Health Perception and Lifestyle Practices among Korean Adolescents: A National Representative Sample

Background

The relationship between subjective health perception (SHP) and lifestyle practices brings into question the future health status of an individual. Recognition of the disparity between one's health consciousness to the real practices encourages change and promotes development of better health programs. The adolescent stage is the best time to identify this disparity wherein lifestyle practices are still being developed. In Korea, adolescents experienced significant shifts in lifestyle due to the fast economic growth and the breakthrough of the digital era. Thus, determining the disparity between SHP and lifestyle practices among Korean adolescents poses a great deal of interest and importance.

Methods

Utilizing the 2019 Korea Youth Risk Behavior Web-based Survey (KYRBS), self-reported data with a national representative sample-57,303 respondents-of Korean adolescents in the 7-12^th grades, was used from a multistage sampling, stratification, and clustering was obtained. SHP and lifestyle practices were collected and analyzed.

Results

The findings revealed that most respondents with poor diet, exercise, and sleep behaviors perceived themselves to be normal, healthy, or extremely healthy, which resulted in a negative correlation between SHP and lifestyle behaviors-except in the case of substance use.

Conclusion

There is a significant disparity between Korean adolescents' SHP and lifestyle practices. This highlights the need for lifestyle interventions and re-education among Korean adolescents. Their current lifestyle practices may extend into adulthood, thereby increasing the risks of cardiovascular and other lifestyle-induced diseases.

Changes in Sleep Patterns in Korean Early Adolescents during Sexual Maturation

Purpose: Teenagers’ sleep patterns show physiological delays influenced by sexual maturation and other external time-related factors. However, Korean adolescents show differences in the onset of pubertal development and have shorter sleep durations than other adolescents worldwide. Therefore, we assessed sleep patterns and sexual maturation in Korean early adolescents to evaluate changes in sleep patterns in relation to sexual maturation in early adolescents with sleep deprivation.Methods: From March to August 2017, we surveyed children aged 10 to 12 years in Seongnam (Seongnam Atopy Project). We evaluated items related to sleep and sexual maturation, assessed sleep duration and sleepiness scale scores, and analyzed the relationships of sleep parameters with sex, height, weight, and sexual maturation rating (SMR).Results: In total, 620 children were included. Sleep duration was 8.63±0.81 hours in boys and 8.40±0.98 hours in girls. Sleep started from PM 11:00±AM 0:47 in boys and PM 11:13±AM 1:06 in girls, and ended at AM 7:38±AM 0:27 in boys and AM 7:34±AM 0:27 in girls. After adjusting for sex and standardized body mass index, bedtime was delayed as the SMR increased (mean delay for each rating increase, 0.251 hours; P=0.001; 95% confidence interval [CI], 0.105 to 0.397). SMR did not influence the wake-up time, although sleep duration decreased as the SMR increased (mean decrease for each rating increase, 0.258 hours; P=0.001; 95% CI, –0.403 to –0.114). The sleepiness scale scores showed no relationship with SMR. Conclusion: Sleep patterns, especially sleep duration and bedtimes, show changes with sexual maturation in adolescents, who are vulnerable to sleep deprivation.

Association between Self-Perceived Periodic Limb Movement during Sleep and Excessive Daytime Sleepiness Depend on Restless Leg Symptoms in Korean Adolescents

Although periodic limb movement during sleep (PLMS) and restless legs syndrome (RLS) are common in children and adolescents, they are relatively overlooked as a target of treatment. PLMS has been evaluated as having a lower clinical significance than RLS. This study examined the relationship of socio-behavioral factors of PLMS in Korean adolescents and checked whether PLMS is associated with excessive daytime sleepiness (EDS), depending on whether restless legs symptoms accompany it. In a cross-sectional study, 25,789 adolescents between 12 and 18 years of age (15.76 ± 1.73 years; female 51.49%) were evaluated using an online survey. Various self-report questionnaires were used to assess PLMS and RLS symptoms, EDS, sleep habits, and various socio-behavioral factors. The prevalence of self-perceived PLMS and restless legs symptoms were 903 (3.50%) and 1311 (5.08%), respectively. Of the 1311 participants, 399 had self-perceived PLMS. The odds ratios (ORs) for self-perceived PLMS in participants with restless legs symptoms were: males (OR = 1.528; 95% CI: 1.145–2.040), usually/always experienced apnea apnea (OR, 3.006; 95% CI, 1.954–4.624), increased proneness to Internet addiction (OR = 1.013; 95% CI: 1.001–1.025), sometimes/often consuming coffee (OR = 1.312; 95% CI: 1.015–1.695), EDS (OR = 0.826; 95% CI: 0.488–1.398), and perceived insufficient sleep (OR = 1.143; 95% CI: 0.835–1.565). The male gender, witness apnea, consuming coffee, and being prone to Internet addiction were identified as factors significantly associated with self-perceived PLMS in participants with restless legs symptoms. However, EDS and insufficient sleep were associated with self-perceived PLMS in the absence of restless legs symptoms.

Evaluation of a Brief Sleep Intervention Designed to Improve the Sleep, Mood, and Cognitive Performance of Esports Athletes

This study evaluated a brief sleep intervention designed to improve the sleep, mood, and cognitive performance of professional electronic sports (esports) athletes from three major esports regions (i.e., Asia, North America, and Oceania). Fifty-six esports athletes from South Korea (N = 34), the United States (N = 7), and Australia (N = 15) completed the study. Participants completed an initial 2-week pre-intervention phase to establish a baseline, followed by a 2-week intervention phase that involved a group sleep education class, 1:1 session with a trained clinical psychologist, and daily biofeedback. A wrist activity monitor and daily sleep diary were used to monitor sleep during both phases, while at pre- and post-intervention, participants completed a battery of sleep and mood questionnaires and underwent cognitive performance testing. Sleep knowledge increased from pre- to post-intervention (d = 0.83 [95% CI −1.21, −0.43], p =< 0.001), while there were modest improvements in sleep diary estimates (i.e., sleep onset latency (Mdiff = −2.9 min, p = 0.02), sleep onset time (Mdiff = −12 min, p = 0.03), and sleep efficiency (Mdiff = 1.1%, p = 0.004)) and wrist activity monitor estimates (i.e., sleep onset time (Mdiff = −18 min, p = 0.01)). Insomnia severity scores decreased significantly (d = 0.47 [95% CI 0.08, 0.84], p = 0.001), while sleepiness scores increased but not meaningfully (d = 0.23 [95% CI −0.61, 0.14], p = 0.025). However, there was no significant change in mood (i.e., depression and anxiety) or cognitive performance scores (i.e., mean reaction time or lapses). Sleep interventions for esports athletes require further investigation. Future research should examine whether a stepped-care model, whereby increasing therapeutic input is provided as needed, can optimize sleep, mood, and cognitive performance outcomes.

Factor structure and psychometric properties of the Persian versions of the Pediatric Daytime Sleepiness Scale and Morningness-Eveningness Scale for Children

BACKGROUND

The Pediatric Daytime Sleepiness Scale (PDSS) and the Morningness-Eveningness Scale for Children (MESC) are widely used to measure two important facets of sleep patterns, but neither have been adapted and validated for use in Iran. The purpose of this study was to examine the psychometric properties and factor structure of the Persian versions of the PDSS and the MESC in a sample of Iranian adolescents.

MATERIALS AND METHODS

The Persian versions of PDSS and MESC were translated and administered to a representative sample (n = 407) of Iranian early adolescents, aged 9-15 years, who attended school in morning shifts. The factor structure of both scales, found in prior studies, was tested using Confirmatory Factor Analyses to assess their validity and reliability.

RESULTS

The results revealed that the model fit indices of the one factor solution of the PDSS and the two factor solution of the MESC were acceptable to good. A high Pearson correlation was found between raw and latent factor scores for the PDSS and the two factors derived from the MESC (i.e., Morningness and Planning). Furthermore, the higher the PDSS score (more daytime sleepiness), the lower the MESC scores (more eveningness), indicating criterion validity of the scales showing the expected increase in daytime sleepiness in evening oriented adolescents who wake up early for attending school.

CONCLUSION

The Persian versions of the PDSS and the MESC can be considered reliable and valid tools for evaluating, respectively, daytime sleepiness and morningness-eveningness in the adolescent population of Iran.

Associations between sleep and academic performance in US adolescents: a systematic review and meta-analysis

This systematic review and meta-analysis aim to investigate the relationship between sleep and academic performance in students enrolled in secondary education programs in the United States. The study team conducted a literature search of 4 databases-PubMed, Embase, CINAHL, and ERIC-on September 19 and repeated December 17, 2020. Studies were included if they were observational, published in a peer-reviewed, non-predatory journal, available in full-text, written in English, included adolescents enrolled in an organized academic program, took place in the US, and evaluated the effect of sleep duration and/or sleep quality on academic performance. After excluding reviews, editorials, interventions, and those targeting diagnostic groups, 14 studies met inclusion criteria. Risk of bias was assessed using the NIH Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies; 12 studies were found to be good or high quality, 2 were adequate/fair or poor quality. A meta-analysis of 11 of the included studies revealed that sleep duration (r = 0.03; 95%CI -0.027, 0.087; p = 0.087) and sleep quality (r = 0.089; 95%CI 0.027, 0.151; p = 0.005) had negligible correlations with academic performance (non-significant and significant, respectively). Inconsistencies in definitions, methods, and measures utilized to assess sleep duration, sleep quality, and academic performance constructs may offer insight into seemingly conflicting findings. Given the pivotal role sleep plays in development, future investigations utilizing validated and objective sleep and academic performance measures are needed in adolescents.

Social Jetlag and Excessive Daytime Sleepiness from a Sample of Russian Children and Adolescents

PURPOSE

Insufficient nocturnal sleep is a primary source of excessive daytime sleepiness. Most previous research has focused on the disparity between sleep demands and study start times in adolescents. Fewer studies have focused on elementary schoolchildren. We hypothesize that late sleep timing is connected to excessive daytime sleepiness in a sample of Russian children and adolescents. The major goals of our study were to evaluate excessive daytime sleepiness in Russian schoolchildren and adolescents using the Russian version of the Pediatric Daytime Sleepiness Scale (PDSS) and to estimate its relationship with sleep-wake parameters using the Munich Chronotype Questionnaire (MCTQ).

MATERIALS AND METHODS

Student subjects were from public educational facilities in the Republic of Karelia. They completed both the PDSS and the Munich Chronotype Questionnaire to estimate sleep parameters and chronotype (MSFsc). Five hundred and eleven students provided data for the PDSS and sleep-wake variables, and 479 for the full MCTQ data.

RESULTS

The overall prevalence of Excessive Daytime Sleepiness (EDS) in our sample was 18%. The total PDSS score was inversely correlated with sleep length on school nights and was independent of respondents' sex. Higher PDSS scores were associated with later bedtimes on school days and free days, and shorter sleep duration on school days. Late chronotype and more pronounced social jetlag were both positively correlated with high PDSS scores. A negative correlation was found between chronotype and the duration of the sleep period on weekdays (p < 0.001) and a positive correlation was found on weekends (p < 0.001). Longer average sleep duration was positively related to less daytime sleepiness.

CONCLUSION

This study suggests that excessive daytime sleepiness is chronotype-dependent. School start times could be shifted to a later hour to prolong sleep and reduce EDS.

Assessment of vitamin D, exercise, and lipid profile associated with excessive daytime sleepiness in school children

Previous research reported associations of excessive daytime sleepiness (EDS) with a low vitamin D level, obesity, and sexual maturity. The aim of this study was to identify the association and rank the importance of these with EDS. This study examined 618 children who were 10-12 year-old. The pediatric daytime sleepiness scale (PDSS) was used to evaluate EDS and sleep patterns. EDS was defined as a total PDSS score above 17. We ranked the importance of the relationship of these factors with EDS using random forest analysis. EDS (n = 111, 18%) was positively associated with more advanced pubertal stage in girls, chronic cough, urticaria, and allergic rhinitis. Multivariable analysis with adjustment for confounding indicated that children with low level of 25-hydroxyvitaminD₃ (25(OH)D₃ (<20 ng/mL) and high-density lipoprotein-cholesterol (HDL-C) (<40 mg/dL) levels had an increased risk of EDS (25(OH)D₃:adjusted odds ratio [aOR] = 1.73; 95% confidence interval [CI]: 1.06 to 2.81; P = 0.028; HDL-C: aOR = 2.84; 95% CI: 1.05 to 7.68; P = 0.039). Random forest analysis indicated that 25(OH)D₃ level, exercise, and body mass index (BMI) were over three. This study indicated high levels of 25-(OH)D₃ and HDL-C and performing regular exercise decreased the risk of EDS.

Evidence Base Update on Assessing Sleep in Youth

BACKGROUND

Sleep is vital to youth well-being and when it becomes disturbed - whether due to environmental or individual factors - mental and physical health suffer. Sleep problems can also be a symptom of underlying mental health disorders. Assessing different components of sleep, including quality and hygiene, can be useful both for identifying mental health problems and for measuring changes in well-being over time. However, there are dozens of sleep-related measures for youth and it can be difficult to determine which to select for a specific research or clinical purpose. The goal of this review was to identify sleep-related measures for clinical and/or research use in youth mental health settings, and to update the evidence base on this topic.

METHOD

We generated a list of candidate measures based on other reviews and searched in PubMed and PsycINFO using the terms "sleep" AND (measure OR assessment OR questionnaire) AND (psychometric OR reliability OR validity). Search results were limited to studies about children and adolescents (aged 2-17) published in English. Additional criteria for inclusion were that there had to be at least three publications reporting on the measure psychometrics in community or mental health populations. Sleep measures meeting these criteria were evaluated using the criteria set by De Los Reyes and Langer (2018).

RESULTS

Twenty-six measures, across four domains of sleep - insomnia, sleep hygiene, sleepiness, sleep quality - met inclusion criteria. Each measure had at least adequate clinical utility. No measure(s) emerged as superior across psychometric domains.

CONCLUSION

Clinicians and researchers must evaluate sleep measures for each use case, as the intended purpose will dictate which measure is best. Future research is necessary to evaluate measure performance in transdiagnostic mental health populations, including youth with serious mental illness.

Relationships between Extra-School Tutoring Time, Somatic Symptoms, and Sleep Duration of Adolescent Students: A Panel Analysis Using Data from the Korean Children and Youth Panel Survey

As private tutoring has expanded worldwide, it has been noted that private tutoring and associated emotional distress can affect sleep duration and the health of adolescent students. However, the relationships between extra-school tutoring time, somatic symptoms, defined as physical symptoms of emotional distress, and sleep duration in adolescents has rarely been determined. The aim of this study was to identify these relationships in adolescent students. Data from the Korean Children and Youth Panel Survey were analyzed to address the research questions. Weekday sleep duration, extra-school tutoring time, and somatic symptoms were measured using adolescents’ self-report questionnaires. A multilevel, structural equation model was utilized to test the relationships between these variables and was deemed appropriate considering the repeated measure of the panel data. After controlling for respondent sex, parent working status and education level, and family structure, adolescents’ extra-school tutoring time and level of somatic symptoms were associated with sleep duration during weekdays. Furthermore, the association between extra-school tutoring time and sleep duration was partially mediated by somatic symptoms. Korean adolescent students slept less than the recommended duration. Intervention programs that increase parental interest and attention in adolescent students’ lives, not only focused on academic achievement but also emotional distress is needed. Researchers and policymakers should understand recommended age-appropriate sleep duration and the educational culture and provide balanced strategies between the consideration of the effect of private education on academic achievement and the need to guarantee physical and mental health in adolescent students.

Psychometric properties of the Russian version of the Pediatric Daytime Sleepiness Scale (PDSS)

Insufficient sleep could severely impair both cognitive and learning skills. More prominent changes are found in children and adolescents. Tools used to estimate sleepiness in the adult population are commonly inappropriate for children. The objective of our study was to provide a reliable instrument to measure excessive sleepiness for upcoming studies in Russian-speaking children, applying the Russian version of Pediatric Daytime Sleepiness Scale (PDSS). The following tasks were resolved in our study: translation, validation, and analysis of psychometric properties of the Russian adaptation of the PDSS by standard tests. After the semantic validation of the instrument through a multi-stage translation process we checked its psychometric validation. A total of 552 students, consisting of N = 285 for the exploratory factor analysis (EFA), N = 267 for the confirmatory factor analysis (CFA) and N = 204 for test-retest analysis of public elementary schools located in Northern Russia completed the PDSS and Munich Chronotype Questionnaire to estimate sleep parameters in the classroom during the lessons. Response rate was 90%; excluded cases contained no data. Further, 204 of our participants completed the PDSS in a 3 months interval to check the test-retest reliability. Internal consistency was measured by Cronbach's alpha coefficients and CFA was used to test factorial validity of the tool. Concurrent validity and test-retest reliability were assessed via intra-class coefficient. Internal consistency of the PDSS scale was high (Cronbach's α = 0.8). The construct validity of the PDSS was supported by CFA (factor loadings were from 0.438 to 0.727) and the test-retest reliability demonstrated by the intra-class coefficient was 0.70. The total PDSS score was independent of sex. The mean total value of PDSS was 11.95 ± 6.24. Higher scores on PDSS were negatively correlated with sleep duration. Thus, the construct validity of the instrument remains valid and could be used for Russian-speaking youth samples in the evaluation of daytime sleepiness. It could be useful in future applications by sleep scientists and health practitioners.

Effects of school time on sleep duration and sleepiness in adolescents

Delaying the time of start of school allows for longer sleep duration, better mood, and better school performance. In South Korea, a campaign was launched in 2014 to delay the school start time to 9 a.m. We analyzed the campaign’s effects on adolescents’ total sleep duration, sleepiness (presented as weekend catch-up sleep), emotions, and school performance. Based on data from 2013, changes of sleep patterns, emotions, and academic achievement in adolescents were evaluated using the 2012–2016 Korea Youth Risk Behavior Web-based survey from two educational districts: Gyeonggi (fully participated in the delayed school start time campaign; intervention group) and Daegu/Gyeongbuk/Ulsan (DGU, never participated; control group). The primary outcomes were sleep duration, time of sleep onset, and difference in sleep duration between weekdays and the weekend. Secondary outcomes were the proportional changes of mood, stress, and school performance. The sleep duration of students in the intervention group temporarily increased in 2015. However, because there was a simultaneous delay in time of sleep onset, sleep duration returned to pre-campaign levels in 2016. Although sleep duration did not increase, weekend catch-up sleep decreased by approximately 19 minutes for students in the intervention group. Meanwhile, in the control group sleep duration tended to decrease over the same period. The impact of the campaign on students' emotions and school performance could not be confirmed. This study demonstrated that delaying the school start time to 9 a.m. reduced duration of weekend catch-up sleep with a transient increase in sleep duration in adolescents.

Moderating effects of depressive symptoms on the relationship between problematic use of the Internet and sleep problems in Korean adolescents

BACKGROUND

Adolescence is a period of marked sleep pattern changes and sleep problems, which may result from both endogenous and exogenous factors. Among the various factors affecting adolescent sleep, depression and problematic Internet use (PIU) have received considerable attention. We examined if there is a different PIU effect on sleep between depressed group and non-depressed groups.

METHODS

Data for a total of 766 students' between 7th and 11th grades were analyzed. We assessed various variables related sleep to problems and depression and compared those variables between an adolescent group with problematic Internet use (PIUG) and an adolescent group with normal Internet use (NIUG).

RESULTS

One hundred fifty two participants were classified as PIUG, and 614 were classified as NIUG. Compared with the NIUG, the members of the PIUG were more prone to insomnia, excessive daytime sleepiness and sleep-wake behavior problems. The PIUG also tended to include more evening types than the NIUG. Interestingly, the effect of Internet use problems on sleep problems appeared to be different according to the presence or absence of the moderating effect of depression. When we considered the moderating effect of depression, the effect of Internet use problems on sleep-wake behavior problems, insomnia and excessive daytime sleepiness increased with increasing Young's Internet Addiction Scale (IAS) scores in the non-depressed group. However, in the depressed group, the effects of Internet use problems on sleep-wake behavior problems and insomnia did not change with increasing Internet use problems, and the effect of Internet use problems on excessive daytime sleepiness was relatively decreased with increasing Internet use problems in the depressed group.

CONCLUSIONS

This study demonstrated that the effect of PIU on sleep presented differently between the depressed and non-depressed groups. PIU is associated with poorer sleep in non-depressed adolescents but not in depressed adolescents. This finding might be observed because PIU may be the biggest contributor to sleep problems in the problematic Internet user without depression, but in the problematic Internet user with depression, depression might be a more important contributor to sleep problems; thus, the influence of PIU on sleep effect might be diluted.

Smartphone addiction risk and daytime sleepiness in Korean adolescents

AIM

Smartphone overuse can cause not only mobility problems in the wrists, fingers and neck but also interference with sleep habits. However, research on smartphone addiction and sleep disturbances is scarce. Therefore, we aimed to investigate daytime sleepiness in association with smartphone addiction risk in Korean adolescents.

METHODS

A cross-sectional survey method was used in this study. The Pediatric Daytime Sleepiness Scale was used to assess daytime sleepiness, and the Korean Smartphone Addiction Proneness Scale index was used to evaluate the degree of risk for smartphone addiction.

RESULTS

The analyses were performed in 1796 adolescents using smartphones, including 820 boys and 976 girls. The at-risk smartphone users made up 15.1% of boys and 23.9% of girls. Our multivariate analyses demonstrated that students who were female, consumed alcohol, had lower academic performance, did not feel refreshed in the morning and initiated sleep after 12 am were at a significantly higher risk of smartphone addiction. The at-risk smartphone user group was independently associated with the upper quartile Pediatric Daytime Sleepiness Scale score in students with the following factors: Female gender, alcohol consumption, poor self-perceived health level, initiating sleep after 12 am, longer time taken to fall asleep and duration of night sleep less than 6 h.

CONCLUSIONS

The quality of sleep in adolescence affects growth, emotional stability and learning skills. Therefore, the management of smartphone addiction seems to be essential for proper sleeping habits. There is a critical need to develop a means of preventing smartphone addiction on a social level.

Factor structure of the Brazilian version of Pediatric Daytime Sleepiness Scale

The present study aimed to analyze the construct validity of the Pediatric Daytime Sleepiness Scale (PDSS) for the evaluation of the daytime sleepiness construct in adolescents through confirmatory factorial analysis. The cross-sectional study was carried out with a sample of 773 adolescents aged 14 to 19 years, enrolled in the state schools of Paranaguá, Paraná, Brazil. We investigated the sex, age, school year, study shift, occupational status, socioeconomic level and daytime sleepiness. The PDSS questions were not normal (p <0.001) and the mean total score was 14.87 (5.62). With Schwarz's BIC adjustment indicators = 142,389 and Akaike's AIC = 105,389, the model reached the criteria of the global adjustment indicators of the model in the confirmatory analysis, in which RMSEA = 0.020; CFI = 0.986; TLI = 0.977; SRMR = 0.021, with 17 degrees of freedom, KMO = 0.8504 and Cronbach's Alpha = 0.737, with three correlations. We conclude that the construct validity of the PDSS remains valid and confirms its factor structure with only one factor. Thereby, it was verified that the operationalization of the construct sleepiness of adolescents through this scale is adequately conceptualized to the behavior of the age group.

ANALYSIS OF DAYTIME SLEEPINIESS IN ADOLESCENTS BY THE PEDIATRIC DAYTIME SLEEPINESS SCALE: A SYSTEMATIC REVIEW

Objective:

To systematically review the use of the Pediatric Daytime Sleepiness Scale (PDSS) in the analysis of daytime sleepiness in children and adolescents.

Data source:

The electronic databases PubMed and SciELO were consulted between 2003 and 2015. As inclusion criterion, studies were considered in English, Spanish and Portuguese, original articles of any type of design, articles with a sample of children and/or adolescents, articles that used the PDSS. Duplicate articles, articles with no relation to the theme, articles with another investigated population, and articles that the parents answered the instrument for their children were excluded. To find the material with these features, the terms “Daytime sleepiness” AND “adolescents” and “Daytime sleepiness” AND “children” were used in the searches. In addition, the descriptor “Pediatric Daytime Sleepiness Scale” was used to filter more specifically.

Data synthesis:

Initially, 986 studies related to daytime sleepiness were identified. Considering the inclusion criteria, we analyzed 26 studies composed of 18,458 subjects aged 0 to 37 years. The diurnal sleepiness score ranged from 6.7±0.6 to 25.7±0.6 points. In general, all included studies investigated other sleep variables in addition to daytime sleepiness, such as: sleep duration, sleep quality, sleep hygiene or sleep disorders (narcolepsy and cataplexy), respiratory disorders, neurological and developmental disorders.

Conclusions:

There was a moderate use of PDSS to evaluate daytime sleepiness. This instrument allows the monitoring of factors that influence excessive daytime sleepiness in children and adolescents.

Parental Perceptions, Experiences, and Desires of Music Therapy

Music therapy (MT) is a therapeutic practice where a therapist uses music to enhance the life quality for their patients. Children have an innate enjoyment of music, making music an effective medium for exploring their potential. In this study, we explore the parental perception of MT through an online survey. Contrary to the public perception that MT only addresses emotional needs, 47 out of 59 parents reported seeing improvements in other areas including behavioral, cognitive, linguistic, and social changes. All but one parent indicated that they would recommend MT to others. The survey results further revealed that even parents of children participating in MT had misconceptions regarding MT, which we describe in the paper. Parents reported inaccessibility and cost as other major limitations surrounding MT adoption. We conclude by discussing how technology solutions could mitigate issues with definition, distance, and cost, while maintaining the benefits of MT.

Inverse relationship between sleep duration and myopia

PURPOSES

To investigate the association between sleep duration and myopia.

METHODS

This population-based, cross-sectional study using a nationwide, systemic, stratified, multistage, clustered sampling method included a total of 3625 subjects aged 12-19 years who participated in the Korean National Health and Nutrition Examination Survey 2008-2012. All participants underwent ophthalmic examination and a standardized interview including average sleep duration (hr/day), education, physical activity and economic status (annual household income). Refractive error was measured by autorefraction without cycloplegia. Myopia and high myopia were defined as ≤-0.50 dioptres (D) and ≤-6.0 D, respectively. Sleep durations were classified into 5 categories: <5, 6, 7, 8 and >9 hr.

RESULTS

The overall prevalence of myopia and high myopia were 77.8% and 9.4%, respectively, and the overall sleep duration was 7.1 hr/day. The refractive error increased by 0.10 D per 1 hr increase in sleep after adjusting for potential confounders including sex, age, height, education level, economic status and physical activity. The adjusted odds ratio (OR) for refractive error was 0.90 (95% confidence interval [CI], 0.83-0.97) per 1 hr increase in sleep. The adjusted OR for myopia was decreased in those with >9 hr of sleep (OR, 0.59; 95% CI, 0.38-0.93; p for trend = 0.006) than in those with <5 hr of sleep. However, high myopia was not associated with sleep duration.

CONCLUSIONS

This study provides the population-based, epidemiologic evidence for an inverse relationship between sleep duration and myopia in a representative population of Korean adolescents.

Sleep Promotion Program for Improving Sleep Behaviors in Adolescents: A Randomized Controlled Pilot Study

Aims. The purpose of this pilot trial was to determine the efficacy of sleep promotion program to adapt it for the use of adolescents studying in various schools of Mangalore, India, and evaluate the feasibility issues before conducting a randomized controlled trial in a larger sample of adolescents. Methods. A randomized controlled trial design with stratified random sampling method was used. Fifty-eight adolescents were selected (mean age: 14.02 ± 2.15 years; intervention group, n = 34; control group, n = 24). Self-report questionnaires, including sociodemographic questionnaire with some additional questions on sleep and activities, Sleep Hygiene Index, Pittsburgh Sleep Quality Index, The Cleveland Adolescent Sleepiness Questionnaire, and PedsQL™ Present Functioning Visual Analogue Scale, were used. Results. Insufficient weekday-weekend sleep duration with increasing age of adolescents was observed. The program revealed a significant effect in the experimental group over the control group in overall sleep quality, sleep onset latency, sleep duration, daytime sleepiness, and emotional and overall distress. No significant effect was observed in sleep hygiene and other sleep parameters. All target variables showed significant correlations with each other. Conclusion. The intervention holds a promise for improving the sleep behaviors in healthy adolescents. However, the effect of the sleep promotion program treatment has yet to be proven through a future research. This trial is registered with ISRCTN13083118.

Psychometric Properties of Turkish Version of Pediatric Daytime Sleepiness Scale (PDSS-T)

PURPOSE

The aim of the research was to evaluate the psychometric properties of the Pediatric Daytime Sleepiness Scale-Turkish Version (PDSS-T).

METHODS

The researchers chose a study sample of 522 grade 5-11 students. Data were collected using a demographic data collection form and the PDSS-T.

RESULTS

Cronbach α for the scale was .79 and Kaiser-Meyer-Olkin coefficient was .78. Item-total correlations for the scale varied between .53 and .73 (p < .001). The indices of model fit were determined to be the root mean square error of approximation at .07, the goodness of fit index at .97, and the comparative fit index at .97.

CONCLUSIONS

The study's results showed that PDSS-T is a valid and reliable instrument for detecting Turkish-speaking children's and adolescents' daytime sleepiness. PDSS-T is convenient for professionals to prevent and manage daytime sleepiness.

Sleep-patterns, sleep hygiene behaviors and parental monitoring among Bahrain-based Indian adolescents

Introduction:

Sleep plays an important role in adolescent's health and undergoes substantial changes with puberty and physical maturation with a preference for later bed times. Evidence shows that many adolescents are not obtaining the required amounts of sleep which is 9.25 h, due to inadequate sleep practices, academic and societal demands. This study aims at describing the (1) sleep patterns of adolescents on school days and weekends, (2) sleep hygiene practices and the extent of parental monitoring and (3) gender and grade level differences in sleep duration and sleep hygiene practices among Indian adolescents in Bahrain.

Materials and Methods:

Study used a descriptive correlational design. A total of 145 adolescents from 11 to 17 years from grade 6 to 12 were selected using convenience sampling. Data was collected from November 2012 to March 2013. A structured questionnaire for sleep patterns and Mastin et al.'s Sleep Hygiene Index for assessing sleep hygiene practices were used.

Results:

The adolescents’ total sleep duration was 7.07 ± 1.13 hours. A highly significant difference in sleep duration on school days and weekends between adolescents of various grade levels (P < 0.001 and 0.001, respectively) and between parental monitoring at the time of getting up on school days and sleep duration (P value 0.026 at 0.05 level of significance) was found. Gender was not significant with the sleep duration, and also with Sleep Hygiene Index scores.

Conclusion:

The results suggest that there is a high prevalence of insufficient sleep and irregular bed-time schedule among Indian adolescents in Bahrain. Interventions directed toward improving sleep and promoting good sleep hygiene strategies are required to improve the physical and emotional health of adolescents.

Sleep efficiency (but not sleep duration) of healthy school-age children is associated with grades in math and languages

OBJECTIVE

The objective of this study was to examine the associations between objective measures of sleep duration and sleep efficiency with the grades obtained by healthy typically developing children in math, language, science, and art while controlling for the potential confounding effects of socioeconomic status (SES), age, and gender.

STUDY DESIGN

We studied healthy typically developing children between 7 and 11 years of age. Sleep was assessed for five week nights using actigraphy, and parents provided their child's most recent report card.

RESULTS

Higher sleep efficiency (but not sleep duration) was associated with better grades in math, English language, and French as a second language, above and beyond the contributions of age, gender, and SES.

CONCLUSION

Sleep efficiency, but not sleep duration, is associated with academic performance as measured by report-card grades in typically developing school-aged children. The integration of strategies to improve sleep efficiency might represent a successful approach for improving children's readiness and/or performance in math and languages.

Functional consequences of inadequate sleep in adolescents: a systematic review

During adolescence, changes in sleep patterns due to biological and environmental factors are well documented. Later bedtimes and inadequate sleep, i.e., short and disrupted sleep patterns, insomnia and daytime sleepiness, have become increasingly common. Accumulating evidence suggests that sleep plays a crucial role in healthy adolescent development. This review systematically explores descriptive evidence, based on prospective and cross sectional investigations, indicating that inadequate sleep is associated with negative outcomes in several areas of health and functioning, including somatic and psychosocial health, school performance and risk taking behavior. Findings highlight the need for longitudinal investigations aimed at establishing the underpinnings of these associations and for developing and implementing interventions designed to achieve healthier and more balanced sleep patterns in the adolescent population.