Cognitive, Behavioral, and Functional Consequences of Inadequate Sleep in Children and Adolescents

https://doi.org/10.1016/j.pcl.2011.03.002Get rights and content

Section snippets

Methodological considerations

This review focuses on data collected in children and adolescents. There is a large and well-developed literature on sleep deprivation in adults that can provide initial guidance for pediatric research, but cannot be extrapolated to children without studying children, for several reasons. Whereas the large majority of adult experimental studies have examined the impact of 1 to 2 nights of complete sleep deprivation, it is reasonable to question how these findings generalize to children, whose

Correlational and case-control studies

The largest research base that links sleep in children to daytime functioning comes from correlational studies in epidemiologic samples. As summarized in recent major reviews,13, 14, 15, 16 children’s quantity and/or quality of sleep repeatedly has been shown to correlate with their levels of daytime sleepiness and performance at school. The strength of that association may vary by student age and sex; one recent meta-analysis of sleep and school functioning reported that studies of younger

Quasi-experimental studies

As summarized in Table 1, there have been several quasi-experimental studies in which scientists have carefully observed that in middle- and high-school students, sleep duration was systematically influenced by school start times. In an impressive illustration of how public policy can affect health, starting school later in the morning is associated with students getting more sleep, regardless of whether comparing across schools (between groups),51, 52, 53, 54 within a group of students over

Experimental studies

Since 1896, hundreds of publications have documented the impact of experimental sleep deprivation or restriction on adults’ sleep-wake regulation, affect regulation, cognitive performance, real-world functioning (eg, driving), and neuronal activity.58 In contrast, as of late 2010, there had been only 7 analogous published studies of pediatric populations, all in print since 1980 (Table 2). These studies so far allow for 5 broad conclusions.

First, compared with when they are well-rested,

Adding a developmental context

The findings presented so far are important, but few address developmental issues that are particularly salient during childhood, such as the parallel development of the brain and its cognitive and behavioral functions, as well as unique contexts involving children.

Developmental changes are evident in the brain throughout the life span, but the most dramatic neurodevelopment occurs during childhood, guided by an interaction between genetic programming and environmental factors.65, 66 Chronic or

Summary

Findings from studies that used complementary research methods have converged to strongly suggest that inadequate sleep quality and quantity are causally linked to sleepiness, inattention, and probably other cognitive and behavioral deficits that affect daytime functioning, with potential implications for long-term development. Important research questions remain, but the available data not only support the integration of sleep screening and interventions into routine clinical care (see related

First page preview

First page preview
Click to open first page preview

References (101)

  • L.M. O’Brien

    The neurocognitive effects of sleep disruption in children and adolescents

    Child Adolesc Psychiatr Clin N Am

    (2009)
  • R. Gruber et al.

    Short sleep duration is associated with poor performance on IQ measures in healthy school-age children

    Sleep Med

    (2010)
  • J. Lopez et al.

    Rapid eye movement sleep deprivation decreases long-term potentiation stability and affects some glutamatergic signaling proteins during hippocampal development

    Neuroscience

    (2008)
  • E. Gozal et al.

    Developmental differences in cortical and hippocampal vulnerability to intermittent hypoxia in the rat

    Neurosci Lett

    (2001)
  • R.E. Dahl et al.

    Pathways to adolescent health sleep regulation and behavior

    J Adolesc Health

    (2002)
  • M. Jaspers et al.

    Early findings of preventive child healthcare professionals predict psychosocial problems in preadolescence: the TRAILS study

    J Pediatr

    (2010)
  • A.M. Gregory et al.

    Etiologies of associations between childhood sleep and behavioral problems in a large twin sample

    J Am Acad Child Adolesc Psychiatry

    (2004)
  • A.M. Gregory et al.

    Sleep problems in childhood: a longitudinal study of developmental change and association with behavioral problems

    J Am Acad Child Adolesc Psychiatry

    (2002)
  • M.M. Wong et al.

    Childhood sleep problems, early onset of substance use and behavioral problems in adolescence

    Sleep Med

    (2009)
  • M.J. Thorpy

    History of sleep and man

  • P.N. Stearns et al.

    Children’s sleep: sketching historical change

    J Soc Hist

    (1996)
  • M.A. Carskadon et al.

    Regulation of sleepiness in adolescents: update, insights, and speculation

    Sleep

    (2002)
  • O.G. Jenni et al.

    Homeostatic sleep regulation in adolescents

    Sleep

    (2005)
  • I.G. Campbell et al.

    The increase in longitudinally measured sleepiness across adolescence is related to the maturational decline in low-frequency EEG power

    Sleep

    (2007)
  • G. Fallone et al.

    How well do school-aged children comply with imposed sleep schedules at home?

    Sleep

    (2002)
  • D.W. Beebe et al.

    Feasibility and behavioral effects of an at-home multi-night sleep restriction protocol for adolescents

    J Child Psychol Psychiatry

    (2008)
  • D.W. Beebe

    Assessing neurobehavioral outcomes in childhood sleep disordered breathing: a primer for non-neuropsychologists

  • G.A. Gioia et al.

    BRIEF – Behavior Rating Inventory of Executive Function

    (2000)
  • I.S. Baron

    Neuropsychological evaluation of the child

    (2004)
  • G. Fallone et al.

    Effects of acute sleep restriction on behavior, sustained attention, and response inhibition in children

    Percept Mot Skills

    (2001)
  • C. Drake et al.

    The pediatric daytime sleepiness scale (PDSS): sleep habits and school outcomes in middle-school children

    Sleep

    (2003)
  • A.R. Wolfson et al.

    Evidence for the validity of a sleep habits survey for adolescents

    Sleep

    (2003)
  • P.S. Keller et al.

    Children’s attachment to parents and their academic functioning: sleep disruptions as moderators of effects

    J Dev Behav Pediatr

    (2008)
  • S.D. Mayes et al.

    Nonsignificance of sleep relative to IQ and neuropsychological scores in predicting academic achievement

    J Dev Behav Pediatr

    (2008)
  • D.W. Beebe et al.

    The association between sleep-disordered breathing, academic grades, and cognitive and behavioral functioning among overweight subjects during middle to late childhood

    Sleep

    (2010)
  • E.J. Paavonen et al.

    Short sleep duration and behavioral symptoms of attention-deficit/hyperactivity disorder in healthy 7- to 8-year-old children

    Pediatrics

    (2009)
  • A. Sadeh et al.

    Sleep, neurobehavioral functioning, and behavior problems in school-age children

    Child Dev

    (2002)
  • E.J. Paavonen et al.

    Sleep quality, duration and behavioral symptoms among 5–6-year-old children

    Eur Child Adolesc Psychiatry

    (2009)
  • F. Pizza et al.

    Sleep quality and motor vehicle crashes in adolescents

    J Clin Sleep Med

    (2010)
  • C. Koulouglioti et al.

    Inadequate sleep and unintentional injuries in young children

    Public Health Nurs

    (2008)
  • J.A. Owens et al.

    Sleep disturbance and injury risk in young children

    Behav Sleep Med

    (2005)
  • E.M. O’Brien et al.

    Sleep and risk-taking behavior in adolescents

    Behav Sleep Med

    (2005)
  • J.A. Owens

    Sleep disorders and attention-deficit/hyperactivity disorder

    Curr Psychiatry Rep

    (2008)
  • X. Liu et al.

    Insomnia and hypersomnia associated with depressive phenomenology and comorbidity in childhood depression

    Sleep

    (2007)
  • X. Liu et al.

    Sleep disturbances and correlates of children with autism spectrum disorders

    Child Psychiatry Hum Dev

    (2006)
  • M. Moore et al.

    Relationships among sleepiness, sleep time, and psychological functioning in adolescents

    J Pediatr Psychol

    (2009)
  • A.R. Wolfson et al.

    Sleep schedules and daytime functioning in adolescents

    Child Dev

    (1998)
  • K. Fredriksen et al.

    Sleepless in Chicago: tracking the effects of adolescent sleep loss during the middle school years

    Child Dev

    (2004)
  • M. El-Sheikh et al.

    Children’s sleep and adjustment over time: the role of socioeconomic context

    Child Dev

    (2010)
  • D.W. Beebe

    Neurobehavioral effects of childhood sleep-disordered breathing (SDB): a comprehensive review

    Sleep

    (2006)
  • Cited by (0)

    This work was supported by grant No. R01 HL092149 from the National Institutes of Health.

    View full text