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