A composite measure of sleep health predicts concurrent mental and physical health outcomes in adolescents prone to eveningness

Abstract

Background: Sleep health can be characterized using multiple dimensions, including regularity, satisfaction, alertness, timing, efficiency, and duration. This study provides a preliminary derivation of a Sleep Health Composite score in adolescents with eveningness chronotype and examined its associations with mental and physical health outcomes.

Methods: Participants were 176 adolescents (mean age 14.77 years, 58% female) who participated in a randomized controlled trial examining the Transdiagnostic Sleep and Circadian intervention. At study entry, the sample was characterized by evening circadian preference, later bedtime, and increased risk in 1 of 5 health domains (emotional, cognitive, behavioral, social, and physical). The Sleep Health Composite was derived using 7-day sleep diary and self-report rating scales. Each dimension was categorized as "good" or "poor" using cut-offs informed by prior studies and expert consensus. Mental and physical health outcomes were assessed using self-report rating scales, semistructured clinical interviews, parent report, or biometric measurement.

Results: Sleep duration and satisfaction dimensions were most commonly rated as poor. Greater sleep health, as indexed by greater Sleep Health Composite score, was concurrently associated with lower risk in emotional, cognitive, and social domains, as well as fewer physical symptoms and reduced odds for obesity and current mood or anxiety disorders.

Conclusions: Sleep health is an important correlate of mental and physical health outcomes in adolescents. The Sleep Health Composite has potential application as an outcome measure in treatment studies of sleep and circadian problems.

Keywords: Adolescents; Anxiety; Depression; Evening circadian preference; Obesity; Sleep health.

Fig. 1.

Means of the five health risk domains over the Sleep Health Composite Score. Positive and larger values for the 5 health risk domains composite scores indicate greater risk; negative and smaller values indicate lower risk. Sleep Health Composite Score = 0 was not plotted because there were only 3 observations.

Fig. 2.

Negative associations between Sleep Health Composite and 5 health risk domains. Graphs show fitted regression lines with 95% confidence intervals. Higher Sleep Health Composite Score indicates better sleep health. Positive and larger health risk composite score indicates greater risk in that domain; negative and smaller health risk composite score indicates lower risk in that domain.