Pre-pandemic sleep behavior and adolescents' stress during Covid-19: a prospective longitudinal study.

OBJECTIVE: To prospectively document changes in adolescents' sleep before versus during the COVID-19 pandemic, and to examine their impact on adolescents' perceived stress. METHODS: Sixty-two typically developing adolescents participated in the study before (Time 1: January 15 to March 13, 2020) and during (Time 2: May 15 to June 30, 2020) the COVID-19 pandemic in Canada. At Time 1, each participant's sleep pattern was assessed in the home environment using actigraphy and sleep logs for seven consecutive nights. Adolescents completed a battery of questionnaires in which they reported on their sleep schedule, duration, and quality, as well as their activities at bedtime, their daytime sleepiness, and their social/emotional behavior. The participants' parents provided demographic information. At Time 2, each participant completed a sleep log, the same battery of questionnaires regarding sleep, and the Perceived Stress Scale. RESULTS: (1) Adolescents' reported sleep was of longer duration and on a delayed schedule during the COVID-19 pandemic compared to pre-pandemic. (2) A larger proportion of adolescents reported meeting or exceeding the recommended amount of sleep during the COVID-19 pandemic compared to pre-pandemic sleep. (3) "Social jet lag" disappeared during the COVID-19 pandemic. (4) A shorter reported sleep duration and higher level of arousal at bedtime at Time 1 were significant predictors of adolescents' perceived stress at Time 2-during the COVID-19 pandemic. (5) A higher levels of arousal at bedtime and lower reported sleep quality at Time 2 were concurrently associated with higher levels of perceived stress among adolescents, even when we controlled for the levels of pre-pandemic emotional or behavioral issues, sleep duration, or sleep quality. CONCLUSION: Sleep duration and cognitive-emotional arousal, which are both modifiable behaviors, were associated with adolescents' perceived stress during the COVID-19 pandemic. These behaviors could be useful targets for preventive interventions aiming to reduce adolescents' stress in the face of stressogenic situations, such as the COVID-19 pandemic.

The impact of COVID-19 related school shutdown on sleep in adolescents: a natural experiment.

OBJECTIVE: During the outbreak of the COVID-19 pandemic in 2020, high schools closed or transitioned to remote teaching. The aim of this study was to describe how the COVID-19 related school shutdown impacted the sleep behaviors of typically developing adolescents. METHODS: A qualitative study was conducted between April 28 and June 3, 2020 with 45 adolescents using one-on-one semi-structured phone interviews. RESULTS: The "natural experiment" caused by the shutdown of schools due to the COVID-19 pandemic led to a 2-h shift in the sleep of typically developing adolescents, longer sleep duration, improved sleep quality, and less daytime sleepiness compared to those experienced under the regular school-time schedule. DISCUSSION: These findings are consistent with previous studies showing that delaying high school start times could be an effective way to extend sleep duration, improve sleep quality, reduce daytime sleepiness and lower adolescents' stress during the school year. As many countries look for ways to reduce the number of interactions between students in schools so that physical distancing is feasible, following teens' delayed sleep biology could offer an affordable solution. For example, staggering arrival times by delaying school start time for older adolescents compared with younger adolescents can reduce the total number of students attending school at the same time. This strategy offers a practical means to reduce school density and the number of interactions between students which are needed to reduce the potential transmission of COVID-19 in schools, while improving adolescents sleep health.

Sleep Duration Is Associated with Academic Achievement of Adolescent Girls in Mathematics.

PURPOSE: To examine the associations between objective measures of sleep during the school week and academic achievement in mathematics and languages in typically developing adolescent girls. METHODS: Eighty adolescent girls aged 12-17 years (M=14.74, SD=1.3) participated. For five consecutive weeknights, sleep was assessed in the home environment using an actigraph. Academic achievement was assessed using report card grades. RESULTS: Girls who obtained on average less sleep than the recommended amount of 8 to 10 hrs per night had significantly lower grades in mathematics compared to girls who obtained the recommended amount (77.61 vs 86.16, respectively; ηp 2=0.11). Hierarchical regression analyses adjusted for age, pubertal status, and socioeconomic status revealed that longer average sleep time was significantly associated with higher grades in mathematics (B=4.78, 95% CI [2.03,7.53]). No significant associations were found between sleep variables and grades in languages. CONCLUSION: Longer average weekday sleep duration is associated with academic achievement of adolescent girls in mathematics.

Using Parental Report to Identify Children at Risk for Poor Sleep and Daytime Problems.

OBJECTIVE: To examine objective sleep patterns and the daytime behavioral, emotional and academic functioning of school-age children above and below the clinical cutoff score for the Child Sleep Habits Questionnaire (CSHQ), which is a parental-report-based measure of sleep disturbances. PARTICIPANTS: 48 boys and 74 girls aged 7-11 years. METHODS: Participants' sleep was assessed in their home environment using a miniature actigraph (AW-64 series; Mini-Mitter, Sunriver, OR, USA) for five consecutive weeknights. The parents provided their child's report card and completed a battery of questionnaires that included the CSHQ, the Child Behavior Checklist, a demographic questionnaire and a health questionnaire. RESULTS: Children that were above the cutoff score of the CSHQ had later objectively measured sleep schedule, were less likely to obtain the recommended amount of sleep for their age, had higher levels of internalizing and externalizing symptoms and a higher prevalence of clinical levels of externalizing and internalizing problems, had lower grades in English and French as a Second Language, and were more likely to fail these subjects. Discriminant analysis revealed that information from the objective sleep and emotional/behavioral and academic measures could significantly discriminate between those with or without parent-reported sleep disturbance. CONCLUSION: Parental reports of sleep disturbances can be used to identify children at increased risk for sleep, emotional, behavioral and academic problems. Such questionnaires should be incorporated into clinical practice and school-based evaluations with the goal of identifying undiagnosed children who might be at risk for poor adjustment related to night- and daytime difficulties.

School-based sleep health education in Canada.

BACKGROUND & OBJECTIVE: Canadian Ministries of Health and Education across all provinces aim to support and maximize the mental and physical health of students to ensure their ability to fulfill their academic potential. Chronic sleep loss affects all of these domains. However, tools to optimize youth sleep are generally lacking. METHODS: This manuscript explains the rationale for the integration of sleep health education into schools, describes the barriers to sleep health education, outlines efforts made to address them in Canada, and discusses future directions for sleep health education in Canada. RESULTS: There is unequivocal evidence that sleep plays critical roles in achieving the key goals to which Canadian schools are committed. Sleep restriction and poor sleep habits resulting from hectic, demanding, unbalanced lifestyles; pressure for academic success; participation in extracurricular activities; and the low priority given to sleep over competing activities are prevalent in Canadian youth of all ages and may significantly impair their learning, well-being, and health. Attempts to integrate sleep health education into school curricula meet with multiple barriers. Some of these barriers can be overcome by using community-based participation to develop and implement school-based sleep health education programs. CONCLUSION: Successful school-based sleep health promotion programs hold the promise of having a long-lasting positive impact on students' physical and mental health, academic performance and daytime functioning.

An actigraphic study of the sleep patterns of younger and older school-age children.

OBJECTIVE: Sleep is viewed as being relatively consistent across the school-age period (6-13 years of age), however this claim has not been empirically supported. The objective of this study was to document the duration, schedule, variability, and week versus weekend discrepancies of sleep in three distinct age groups within the school-age period. METHODS: Participants were divided by age: Cycle 1, 6 and 7 years; Cycle 2, 8 and 9 years; and Cycle 3, 10 and 11 years. For seven consecutive nights, sleep was assessed in the home environment using an actigraph. RESULTS: Compared to children of Cycle 1, those of Cycles 2 and 3 showed increasing and significant delays in sleep start time, increasingly shorter assumed and actual sleep durations, and larger night-to-night variability of sleep. Of the children in Cycles 1, 2, and 3, 96%, 87.7%, and 51.3%, respectively, were found to spend the recommended 9-11 h in bed. However, the actigraphic 'true sleep' measure revealed that only 17%, 7%, and 2.5% of these children, respectively, obtained the recommended amount of sleep. CONCLUSION: Sleep duration, schedule, and variability change significantly across the school-age period.

Determinants of sleep behavior in adolescents: A pilot study.

PURPOSE: To identify determinants of sleep behavior in adolescents of middle to high socioeconomic status. METHODS: Eighteen students (9 boys, 9 girls) with a mean age of 14.9±1.5years were interviewed using a standardized script inspired by the theory of planned behavior. Interviews were audio-recorded and anonymously transcribed verbatim. In addition, participants completed a survey assessing demographic and health characteristics and their sleep duration was measured using actigraphy. RESULTS: Adolescents listed a few positive benefits of healthy sleep and described a large number of immediate negative consequences caused by sleep deprivation. Strong positive/negative emotions were barriers to healthy sleep. The use of electronic devices at bedtime and sports participation were described as both barriers to and facilitators of healthy sleep. Participants indicated their intention to sleep more and to use relaxing activities at bedtime. Some intended to advance their bedtime, but none intended to stop using electronic devices at bedtime. Most participants stated that it would be easy to turn off phones but difficult to turn off movies at bedtime, and many believed that their parents and peers were against engaging in risky sleep behavior. CONCLUSIONS: Interventions that seek to alter adolescents' ability to regulate affect and address their beliefs regarding the use of electronic devices at bedtime, combined with information regarding the long-term impact of sleep health, may improve the effectiveness of sleep promotion programs for adolescents.

School-based sleep education program improves sleep and academic performance of school-age children.

STUDY OBJECTIVE: The objective of this study was to develop and evaluate the effectiveness of a school-based sleep education program aimed at improving the sleep and academic performance of school-age children. METHODS: Using a community-based participatory research approach, we created a school-based sleep education program, "Sleep for Success"™ (SFS), composed of four distinct modules that addressed the children, their family and community, the school staff, and decision makers within the school setting. Implementation was carried out in three elementary schools. Seventy-one students participated in the evaluation of the program. The effectiveness of the SFS program was evaluated using non-randomized controlled before-and-after study groups (intervention and control) assessed over two time points (pre- and post-program implementation). Before (baseline) and after implementation, sleep and academic performance were measured using actigraphy and report card marks, respectively. RESULTS: In the intervention group, true sleep was extended by 18.2 min per night, sleep efficiency improved by 2.3%, and sleep latency was shortened by 2.3 min, and report card grades in mathematics and English improved significantly. No changes were noted in the control group. CONCLUSION: Participation in the sleep education program was associated with significant improvements in children's sleep and academic performance.

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.