The effect of brain-derived neurotrophic factor Val66Met polymorphism on adolescent activity and rest rhythms, circadian preferences and attentional performance.

As sleep deprivation is a general public health issue reported by the Center for Disease Control, it becomes an even more detrimental problem in adolescent years with potential consequences of physical, mental, and academic impairments leading to chronic health issues such as obesity, metabolic dysfunction, and increased cardiovascular morbidity into adulthood. The reasons behind the epidemic of insufficient sleep during adolescence are complex and multifactorial which include the biological and central changes in sleep regulation in teenage years as well as early high school start times (SST) determined by state legislation and local school districts. This important public health issue of sleep loss in adolescents has led increased research and policy changes about the ideal SST. Studies have shown that later SSTs are associated with positive student outcomes, including improved academic performance, mental health, and physical health, along with increased public safety and long-term economic gains. In light of this scientific evidence, the average teenager is best suited to wake at 8:00 AM or later. In this review article, we aim to summarize the literature and raise awareness on long-term effects of insufficient sleep in teenagers, school start times (and its potential delay), as well as general health recommendations.

Effects of Sleep Deprivation and Early School Start Times on Adolescent Health

Summary One of the most striking changes in the regulation of sleep–wake behaviour during adolescence is circadian phase delay. Light exposure synchronises circadian rhythms, impacting sleep regulation, however, the influence of real‐life light exposure on sleep variations remains less clear. We aimed to describe the sleep and light exposure patterns of high school students with comparable schedules and socio‐economic backgrounds, and to evaluate whether there was any association between them, considering chronotype. We analysed five school days and two free days of actigraphy records, from 35 adolescents (24 female, mean age: 16.23 ± 0.60). The sample was described using the Sleep Regularity Index (SRI), chronotype (actigraphy MSFsc), and self‐reported diurnal preference (Morning/Evening Scale). Regression models were constructed to assess the impact of light exposure (daytime and nighttime) on subsequent sleep episodes; and to confirm whether the associations could be an indirect consequence of chronotype. Despite following similar routines, the SRI varied considerably (48.25 to 88.28). There was compatibility between the actigraphy proxy for chronotype and the self‐reported diurnal preference, extracted using the circadian rhythm scale for adolescents. Less light exposure during the day was associated with later sleep onset and shorter sleep duration. An increase of 100 lux in average daytime light exposure advance of 8.08 minutes in sleep onset and 7.16 min in sleep offset. When the regressions were controlled for chronotype, these associations persisted. These findings facilitate discussions regarding the behavioural aspect of the impact of real‐life light exposure on sleep and its potential as a target for interventions aiming to enhance adolescents’ sleep quality. 

Associations between real‐life light exposure patterns and sleep behaviour in adolescents

Background During adolescence, sleep and circadian timing shift later, contributing to restricted sleep duration and irregular sleep-wake patterns. The association of these developmental changes in sleep and circadian timing with cognitive functioning, and consequently academic outcomes, has not been examined prospectively. The role of ambient light exposure in these developmental changes is also not well understood. Here, we describe the protocol for the Circadian Light in Adolescence, Sleep and School (CLASS) Study that will use a longitudinal design to examine the associations of sleep-wake timing, circadian timing and light exposure with academic performance and sleepiness during a critical stage of development. We also describe protocol adaptations to enable remote data collection when required during the COVID-19 pandemic. Methods Approximately 220 healthy adolescents aged 12–13 years (school Year 7) will be recruited from the general community in Melbourne, Australia. Participants will be monitored at five 6 monthly time points over 2 years. Sleep and light exposure will be assessed for 2 weeks during the school term, every 6 months, along with self-report questionnaires of daytime sleepiness. Circadian phase will be measured via dim light melatonin onset once each year. Academic performance will be measured via national standardised testing (National Assessment Program-Literacy and Numeracy) and the Wechsler Individual Achievement Test—Australian and New Zealand Standardised Third Edition in school Years 7 and 9. Secondary outcomes, including symptoms of depression, anxiety and sleep disorders, will be measured via questionnaires. Discussion The CLASS Study will enable a comprehensive longitudinal assessment of changes in sleep-wake timing, circadian phase, light exposure and academic performance across a key developmental stage in adolescence. Findings may inform policies and intervention strategies for secondary school-aged adolescents. Ethics and dissemination Ethical approval was obtained by the Monash University Human Research Ethics Committee and the Victorian Department of Education. Dissemination plans include scientific publications, scientific conferences, via stakeholders including schools and media. Study dates Recruitment occurred between October 2019 and September 2021, data collection from 2019 to 2023.

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The CLASS Study (Circadian Light in Adolescence, Sleep and School): protocol for a prospective, longitudinal cohort to assess sleep, light, circadian timing and academic performance in adolescence

Abstract High-level cognitive function is essential for academic performance in adolescents. While obtaining sufficient sleep duration has been shown to support cognitive function less is known about the role of sleep regularity in cognitive function. We investigated how sleep regularity relates to self-report cognitive function in 179 Year 7 students (M±SD=12.81±0.41 years, 56% females) in Australia. Sleep/wake timing was measured via wrist actigraphy and daily sleep diaries over two-school-weeks. Sleep regularity was measured using the Sleep Regularity Index (SRI) calculated via actigraphy measured sleep (SRI range = 58-95). Self-report cognitive function was measured using the PROMIS Paediatric Cognitive Function questionnaire, which requires participants to self-report cognitive performance over the last four-weeks. Academic skills were measured using two-subtests (reading comprehension and numerical operations) from the Weschler Individual Achievement Test – Third Edition (WIAT-III). We found that adolescents with more regular sleep self-reported better subjective cognitive function (β = .39, p = .001), even when controlling for age, sex, circadian phase assessed using DLMO, and total sleep time. In contrast, average total sleep time (range = 5.78-11.30 hours) alone was not associated with subjective cognitive function (β = .06, p = .99). Higher self-reported cognitive function was also associated with improved reading and numerical ability on the WIAT-III (β = .42, p =.04; β = .37, p =.02, respectively). The SRI did not predict performance on the WIAT (p >.05). Our findings suggest regular sleep may be important in supporting optimal cognitive functioning. These results have important implications for learning adolescence.

/pdf/o044-the-association-of-the-sleep-regularity-index-with-jxybq0o0.pdf

O044 The association of the sleep regularity index with subjective cognitive function and academic skills in adolescents

Abstract Background Circadian phase and sleep-wake timing delays are hallmark adolescent development features. These delays contribute to shorter sleep duration in combination with early school schedules. Both delayed circadian phase and insufficient sleep are associated with increased prevalence/severity of mood problems. This study examined associations between circadian phase, sleep duration, and mood in early adolescence. Methods 157 Year 7 Australian students (M±SD=12.81±0.40 years, 56.7% female) wore actiwatches and completed sleep diaries for two weeks in school term. Circadian phase was measured via salivary dim light melatonin onset (DLMO) on the final Friday of sleep monitoring. PROMIS Paediatric Depression and Anxiety measured depression/anxiety symptom severity. Sleep duration/efficiency were calculated using actigraphy and self-reports. Multiple linear regression quantified the relationships between sleep duration and efficiency and circadian phase and mood (depression/anxiety) associations, adjusting for sex. Results DLMO occurred at the expected time for early adolescents [continuous decimal time; M±SD=20.52±1.20; range:17.52-24.03]. Sleep duration (p=.03), but not sleep efficiency (p=.89), moderated associations between DLMO and depression (but not anxiety; p-values>.08). Simple slope analyses showed that in individuals with shorter average sleep duration, a one-hour circadian phase delay was associated with 1.84 t-score increase in depressive symptom severity (p=.03). These associations were non-significant in individuals with longer average sleep duration (p=.44). Conclusion Although delayed circadian phase is a developmental norm, its association with increased depressive symptom severity was ameliorated in young adolescents who obtained longer sleep duration. Addressing sleep duration, a modifiable protective factor (e.g., by delaying school start times), may yield mood-related benefits for adolescents.

/pdf/o019-the-association-between-later-circadian-timing-and-2zyakh4j.pdf

O019 The Association between Later Circadian Timing and Higher Depressive Symptoms in Early Adolescence is Ameliorated by Longer Sleep Duration

Abstract Introduction Individuals attending sleep services commonly present with comorbid psychiatric symptoms. This study reports our ongoing effort to characterise presenting psychiatric symptom profiles of individuals seeking treatment at a sleep clinic and classify heterogenous subgroups within a large sample. Method Data were collected at a university-based multidisciplinary sleep clinic via opt-out consent. Prior to treatment, individuals completed the Cross-Cutting Symptom Measure (CCSM), which provides a transdiagnostic symptom profile by measuring 13 domains of mental health (e.g., anger, anxiety, depression, psychosis, mania, memory). Additional questions on demographics and the Morningness-Eveningness Questionnaire Reduced (rMEQ) were also administered. Results 1263 participants (52.9% male; age M±SD= 43.53±16.06) completed the CCSM and were analysed. Latent class analysis revealed 3 distinct profiles: Low-Symptom subgroup (n=655, 51.9%) reported mild affective and somatic symptoms; Psychopathology subgroup (n=342, 27.1%) reported moderate to severe psychopathology including psychosis, dissociation, and suicidality, in conjunction with severe affective, obsessive-compulsive, and somatic symptoms, and significant interference with memory and personality functioning; Affective-Disturbance subgroup (n=266, 21.1%) reported moderate affective and somatic symptoms, and some interference with memory and personality functioning. The three subgroups did not differ significantly on key demographics or the rMEQ. Discussion There was heterogeneity in psychiatric symptoms experienced by sleep clinic patients. Affective and somatic disturbances were common across subgroups whilst severe psychopathology appeared in a sizeable (one in four) proportion of patients. These findings solidified the need for careful assessment of a wide range of psychiatric symptoms to inform treatment planning in sleep services.

https://academic.oup.com/sleepadvances/article-pdf/3/Supplement_1/A63/46874119/zpac029.174.pdf

P104 Exploring the heterogeneity of psychiatric symptom profiles in sleep clinic patients using a cross-cutting dimensional approach

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The CLASS Study (Circadian Light in Adolescence, Sleep and School): protocol for a prospective, longitudinal cohort to assess sleep, light, circadian timing and academic performance in adolescence

O044 The association of the sleep regularity index with subjective cognitive function and academic skills in adolescents

O019 The Association between Later Circadian Timing and Higher Depressive Symptoms in Early Adolescence is Ameliorated by Longer Sleep Duration

P104 Exploring the heterogeneity of psychiatric symptom profiles in sleep clinic patients using a cross-cutting dimensional approach