Elsevier

Sleep Medicine

Volume 12, Issue 2, February 2011, Pages 110-118
Sleep Medicine

Review Article
Recent worldwide sleep patterns and problems during adolescence: A review and meta-analysis of age, region, and sleep

https://doi.org/10.1016/j.sleep.2010.11.008Get rights and content

Abstract

Adolescent sleep health is becoming increasingly recognized internationally as a significant concern, with many countries reporting high incidences of sleep disturbance in our youth. Notwithstanding the value of findings obtained from each large-scale survey of adolescent sleep performed within individual countries, the field lacks synthesis and analysis of adolescent sleep studies into a single review. This review presents findings from a meta-analysis of 41 surveys of worldwide adolescent sleep patterns and problems published in the last decade (1999–2010). Sleep patterns tended to delay with increasing age, restricting school-night sleep. Notably, Asian adolescents’ bedtimes were later than peers from North America and Europe, resulting in less total sleep time on school nights and a tendency for higher rates of daytime sleepiness. Weekend sleep data were generally consistent worldwide, with bedtimes 2+ hours later and more total sleep time obtained. We note a worldwide delayed sleep–wake behavior pattern exists consistent with symptoms of Delayed Sleep Phase Disorder, which may be exacerbated by cultural factors. Recommendations for future surveys of adolescent sleep patterns are discussed and provided in light of current methodological limitations and gaps in the literature.

Introduction

Sleep problems during adolescence are common. Recently, Crowley et al. [1] reviewed literature over the past 30 years on the sleep parameters of adolescents in the USA in light of how parameters change through this period. However, no review has covered adolescent sleep surveys worldwide. Consequently the aim of this paper is to review and contrast the recent literature on surveys of adolescent sleep patterns (bedtimes, sleep duration) and problems across the globe, thus possibly providing insights into cultural differences and similarities between countries. This review concludes by demonstrating that many studies have assessed symptoms of Delayed Sleep Phase Disorder (DSPD) [2], [3] and provides recommendations for future surveys so that prevalence estimates of this sleep disorder during adolescence may be determined worldwide.

Section snippets

Literature search and inclusion criteria

Surveys of adolescent sleep problems were searched using the search term “adolescent sleep” in the following electronic databases and on-line journal home pages: OVID Psyc Articles, PubMed, Behavioral Sleep Medicine, Journal of Clinical Sleep Medicine, Journal of Pediatrics, Journal of Sleep Research, Pediatrics, Sleep, and Sleep Medicine. Additionally, reference lists of reviews of adolescent sleep problems were used to find further surveys. Inclusion criteria included: the studies contain

Typical sleep parameters and their measurement

Unlike the sleep patterns of children and adults, adolescent sleep is typically more variable across our 7-day week, with school-night sleep shorter than sleep on weekends. What appears to be associated with this variability in sleep duration is a developmental delay of not only bedtimes, but specifically sleep times. That is, sleep onset time (SOT) and wake-up time (WUT) become increasingly later during adolescence. When this delayed SOT couples with the need to attend school the following

Daytime sleepiness

Adolescent daytime sleepiness (DS) has been measured in a variety of ways including the number of daytime or classroom naps [8], [21], [22], the desire to have more sleep [23], morning sleepiness [24], [25], [26], and oversleeping [8]. The Epworth Sleepiness Scale (ESS) [27], designed to measure adult DS, has measured DS in adolescents [28], [29], [30], and scores of 10 or greater indicate DS in adults and adolescents [27], [28], [30]. Nevertheless, some argue the ESS is considered an

Delayed Sleep Phase Disorder

From the review of these 41 studies, it is clear that adolescent sleep is typified by late BTs and WUTs, resulting in restricted and insufficient TST on school nights, with weekend TST being extended and “normal.” Consequences of insufficient sleep include daytime sleepiness, plus a host of broader problems in various areas of functioning. Insomnia, and particularly SOI, appears common. It is worth noting here that these aforementioned sleep problems highly resemble symptoms of Delayed Sleep

Conclusions and recommendations

A systematic review and analysis of adolescent sleep patterns and problems across the world is currently needed, and this review of 41 studies published in the past decade demonstrates a number of insights into age- and culturally-related influences on adolescent sleep. First, there is a moderate-to-strong age influence on adolescent school-night bedtimes and total sleep time worldwide, with older adolescents going to bed later and obtaining less sleep. Second, this effect is amplified for

Conflict of Interest

The ICMJE Uniform Disclosure Form for Potential Conflicts of Interest associated with this article can be viewed by clicking on the following link: doi:10.1016/j.sleep.2010.11.008.

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