Cognitive, Behavioral, and Functional Consequences of Inadequate Sleep in Children and Adolescents
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
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This work was supported by grant No. R01 HL092149 from the National Institutes of Health.