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Clinical Trial
. 2017 May 1;40(5):zsx046.
doi: 10.1093/sleep/zsx046.

Daytime Sleepiness Increases With Age in Early Adolescence: A Sleep Restriction Dose-Response Study

Ian G Campbell  1 , Christopher S Burright  1 , Amanda M Kraus  1 , Kevin J Grimm  2 , Irwin Feinberg  1
Affiliations
Clinical Trial

Daytime Sleepiness Increases With Age in Early Adolescence: A Sleep Restriction Dose-Response Study

Ian G Campbell et al. Sleep. .

Abstract

Study objectives: Daytime sleepiness increases across adolescence. This increase is commonly attributed to insufficient sleep durations resulting from increasingly limited time in bed. We tested the effects of 3 sleep schedules on daytime sleepiness and whether these effects changed with age in early adolescence.

Methods: In 77 children ranging in age from 9.9 to 14 years, objective (multiple sleep latency test [MSLT]) and subjective (Karolinska sleepiness scale [KSS]) sleepiness was measured following 4 consecutive nights of either 7, 8.5, or 10 hours in bed. All participants completed all 3 sleep schedules. The order in which they completed the schedules was not randomized but was accounted for in all statistical analyses.

Results: Time in bed restriction decreased sleep duration and increased objective and subjective daytime sleepiness. Although the sleep durations did not change with age, the likelihood of falling asleep during the MSLT increased with age. Nevertheless, sleep restriction produced a greater increase in MSLT-measured sleepiness in younger participants. Subjective sleepiness measured with the KSS increased with shorter sleep duration, but this effect did not change with age.

Conclusions: Increasing objective daytime sleepiness in early adolescence cannot simply be attributed to reduced sleep due to restricted sleep schedules. We propose that some of the increased daytime sleepiness of adolescents is a consequence of adolescent brain reorganization driven by synaptic pruning which decreases the intensity of waking brain activity.

Keywords: MSLT; brain maturation.; sleep deprivation.

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Figures

Figure 1
Figure 1
The percentage of participants asleep is plotted against multiple sleep latency test (MSLT) minute for participants younger than 11.8 years (top) and those older than 12.7 years (bottom). Participants were least likely to fall asleep during the MSLT following 4 nights with 10-h (short dashed line) time in bed (TIB). Likelihood of falling asleep increased when TIB was restricted to 8.5 h (long dashed lined) and increased further with TIB restricted to 7 h (solid line). Likelihood of falling asleep increased with age. The benefit of extending TIB decreased with age.
Figure 2
Figure 2
Age effects on the percentage of participants who fell asleep by the 20th minute of the MSLT. Percentage asleep is plotted against time in bed (TIB). Likelihood of falling asleep was greatest for oldest participants (short dashed line) at all TIB durations. The youngest group (solid line) showed the greatest improvement from extending TIB to 10h.
Figure 3
Figure 3
The percentage of participants asleep is plotted against MSLT minute for boys (solid) and girls (dashed). There was clearly no sex difference in objective daytime sleepiness.
Figure 4
Figure 4
The percentage of participants asleep is plotted against MSLT minute by age-groups (top) and Tanner stage groups (bottom). Statistical analyses showed that age was a more potent determinant of daytime sleepiness.
Figure 5
Figure 5
Karolinska Sleepiness Scale (KSS) score decreased with increased TIB. Average (±SE) KSS score is plotted against TIB for participants younger than 11.8 years (solid line, triangles), participants between 11.8 and 12.7 years (long dashed line, squares) and participants older than 12.7 years of age (short dashed line, circles). KSS score did not differ by age.
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