Wake Up and Learn - A School Based Sleep Education and Surveillance Program: Excessive Daytime Sleepiness a Common Concern

ABSTRACT

Introduction: "Wake Up and Learn" (WUAL) is a population based preventative sleep screening and education program for 7th to 12th graders through an asynchronously delivered virtual platform. The program was intentionally developed to be completely virtually delivered for scalability, which was of advantage during COVID allowing for the program to continue to be implemented with modest delays related to school schedule changes. This is a descriptive summary of excessive daytime sleepiness over two time points during the academic school year. Materials and Methods: The 7th to 12th grade students of Montgomery school district (Pennsylvania) were given an opt-out option for participation in the WUAL program. The surveys were generated using REDcap and included the Epworth sleepiness scale-CHAD (ESS-CHAD) and the childhood sleep habits questionnaire (CHSQ). The surveys became available online via the WUAL website (wakeupandlearn.org) and the students were instructed to access the website and complete the surveys as part of class time. Surveys were completed in December 2020 for the first time and then again in April 2021 as part of the planned three times per year surveillance. Due to school schedule changes experienced related to COVID the first survey planned for beginning of the academic year was skipped. Results: A total of 344 students completed ESS-CHAD in December 2020. There were 57 students with ESS scores greater than 10 (16.5%). In April, a total of 321 students completed ESS-CHAD with 49 students (15%) having ESS scores greater than 10. Of those with abnormal scores in December 15 (26%) had persistent sleepiness, 28 (49%) improved, and 14 (25%) did not provide a completed survey in April 2021. With this said, 34 (69%) of the respondents in April 2021 were newly identified to have pathologic sleepiness. 31% with persistent EDS from December 2020. Conclusions: Excessive daytime sleepiness is common in this adolescent high school cohort, but may not remain persistent over time. The majority of students who provided follow up responses had resolution of complaints of excessive daytime sleepiness between the two time points. Alarmingly, however, 34 additional students endorsed new complaints of EDS. Further examination of trends of EDS over time in this age group is required to better determine if this pattern is replicated in different school districts. If this is replicated it will be important to further explore factors that contribute to development, persistence and recovery from EDS. It is important to note that COVID and varying school structures (i.e in-person, virtual, hybrid) may have played a role in these findings. Wake Up and Learn is an on going program with plans for further expansion into additional school districts that may provide further insights into these trends. Acknowledgements Thank you to Jazz pharmaceuticals and Janet Weis Children's Hospital for their support of the development and growth of this program.