Insufficient Sleep Among Adolescents Linked With Impaired Behavioral and Social Well-Being

Insufficient sleep among 2 adolescent groups aged 6-12 and 13-17 was linked with decreased childhood flourishing, a measurement of behavioral and social well-being that affects school performance, as well as, physical and mental health, according to a study to be presented at the 2019 American Academy of Pediatrics (AAP) National Conference & Exhibition.

Study results will be presented on October 26 at AAP 2019 in New Orleans, Louisiana, which runs from October 25-29.

Childhood flourishing, a measurement that describes a child’s approach to learning and overall behavioral and social well-being, was hypothesized by researchers as a variable affected by the amount of sleep obtained. Lead study author Hoi See Tsao, MD, FAAP, pediatric emergency fellow affiliated with Hasbro Children's Hospital, described how chronic sleep loss has become a serious public health issue among children. “Insufficient sleep among adolescents, for example, is associated with physical and mental health consequences including increased risk of depression and obesity, and negative effects on mood, attention, and academic performance,” said Tsao.

Researchers sought to examine the association between sleep sufficiency and childhood flourishing markers through analyzing parental responses for 6 to 17-year old children (n=49,050) from the combined 2016-2017 National Survey of Children’s Health. Parental responses were attributed to 5 childhood flourishing markers in the study, which were examined individually and as a combined measure:

• Shows interest and curiosity in learning new things
• Cares about doing well in school
• Does all required homework
• Works to finish tasks he or she starts
• Stays calm and in control when faced with a challenge

Based on prior research, the more flourishing markers children have, the more likely they are to have healthy behaviors and fewer risk behaviors. These markers were assessed in relation to questions on sleep where parents answered questions on how many hours of sleep a randomly selected child in their household slept on an average weeknight. The study defined sufficient sleep among adolescents aged 6-12 as ≥9 hours and ≥8 hours for adolescents aged 13-17, based on AAP guidelines.

• Logistic regression with complex survey design and applied weight in Stata used for measurement
• Model adjusted for age, sex, race, ethnicity, federal poverty level, time spent in front of a television, time spent with computers, cell phones, video games with other electronic devices, adverse childhood experiences, and mental health conditions

Study results exhibited a distinct correlation between insufficient sleep and impeded childhood flourishing as 7779 of the 24,701 (36.4%) 6-12 year-old children with reported insufficient sleep had a 15% increase in the odds of not demonstrating the combined flourishing measure (adjusted odds ratio (aOR)=1.15; 95% CI, 1.00-1.33), while 7315 of the 24,349 (31.9%) of 13-17 year-old children with reported insufficient sleep had a 35% increase (aOR=1.35; 95% CI, 1.17-1.56).

For all individual flourishing markers, children aged 6-12 with reported insufficient sleep were shown to have a definite increase in the odds of not showing interest and curiosity in learning new things (aOR=1.61; 95% CI. 1.34-1.94), not caring about doing well in school (aOR=1.45; 95% CI, 1.23-1.71), not doing all required homework (aOR=1.44; 95% CI, 1.24-1.68), and not working to finish tasks started (aOR=1.18; 95% CI, 1.03-1.35).

Children aged 13-17 similarly showed statistically significant increases in the odds of not showing interest and curiosity in learning new things (aOR=1.34; 95% CI. 1.14-1.58), not doing all required homework (aOR=1.36; 95% CI, 1.17-1.58), not working to finish tasks started (aOR=1.20; 95% CI, 1.03-1.40), and not staying calm and in control when faced with a challenge (aOR=1.34; 95% CI, 1.16-1.54).

“Our research shows that children who get enough sleep are more likely to demonstrate measures of childhood flourishing in comparison to children with insufficient sleep,” said Tsao.

In a separate interview, Tsao described how parents can assist in the process of regulating sleep by establishing regular bedtime routines, turning off technology, and utilizing pediatricians. “Primary care pediatricians are trained to counsel about healthy sleep habits and bedtime routines for children. Parents should therefore utilize their children’s pediatricians as resources and allies to help them establish good sleep habits for their kids,” said Tsao.

School start times was also a topic discussed by Tsao as the current AAP guidelines recommend that middle and high schools start at 8:30 am or later to align school schedules to a teenager’s natural circadian or biological sleep rhythms. California recently passed a new law that will go into effect July 1, 2022, pushing back middle school start times to 8 am or after, and high school start times to 8:30 am or after, which speaks to increased adherence to the recommendations. However, Tsao notes that it will take a unified effort to ensure that children develop and reach their full potential.

“Pediatricians can counsel about healthy sleep habits and bedtime routines for children regularly during patient visits. Teachers can increase awareness by incorporating the importance of sleep into their health curriculum and empowering children to make changes in their own lives, such as by avoiding digital media usage at least 30 minutes before bedtime. Parents can also model healthy sleep behaviors for children at home. The media and public health sector also play an important role in raising awareness and changing social norms, including by highlighting resources to access accurate information on sleep supported by scientific research,” said Tsao.

Reference

Tsao HS, Gjelsvik A, Sojar SH, et al. Sounding the alarm on the importance of sleep: the negative impact of insufficient sleep on childhood flourishing. Presented at: American Academy of Pediatrics, AAP 2019 National Conference & Exhibition; October 26, 2019; New Orleans, LA.