Sleep and Student Performance at SchoolHoward Taras, William Potts-Datema

ABSTRACT: To review the state of research on the association between sleep among school-aged children and academic outcomes,the authors reviewed published studies investigating sleep, school performance, and cognitive and achievement tests. Tables withbrief descriptions of each study’s research methods and outcomes are included. Research reveals a high prevalence amongschool-aged children of suboptimal amounts of sleep and poor sleep quality. Research demonstrates that suboptimal sleep affectshow well students are able to learn and how it may adversely affect school performance. Recommendations for further research arediscussed. (J Sch Health. 2005;75(7):248-254)

Health professionals frequently remind educators ofthe correlation between healthy behaviors and educa-

tional outcomes. However, evidence for this connection isnot always apparent or readily available. The increasingemphasis on accountability for schools has amplified theimportance of demonstrating connections between stu-dents’ health and their academic performance. An under-standing of the impact of student health on educationaloutcomes has major implications. Among them are rami-fications for how schools address health concerns, such asthe focus of their school health programs.

The National Coordinating Committee on SchoolHealth and Safety (NCCSHS), comprising representativesof several federal departments and national nongovern-mental organizations, encourages school districts torespond to evolving challenges by developing coordinatedschool health programs. To enhance awareness of existingevidence linking health and school performance and toidentify gaps in knowledge, the NCCSHS is reviewingthe state of research in related areas. The project involvesa literature search of peer-reviewed, published researchreporting on the relationship between students’ health andtheir performance in school. Compilations of researcharticles that explore the association between academicperformance and health include various chronic conditions(eg, asthma, diabetes), nutrition, and physical activity.This article summarizes what is known on the associationof sleep with academic outcomes among school-agedchildren.

BACKGROUND ON SLEEPMost children need at least 9 hours of restful sleep

each night.1 However, for many reasons, school-aged chil-dren may receive less than the recommended number ofhours of sleep. These reasons include the working, eating,and bedtime patterns of students and their families, earlyschool start times, and childhood sleep disorders such asdisrupted sleep from snoring or breathing pauses. A num-ber of research articles have reported on the prevalence of

suboptimal sleep in school-aged children and the associa-tion of quality and quantity of sleep with school perfor-mance and measures of cognitive ability.

SELECTION OF SLEEP ARTICLESOnly articles meeting the following criteria were

selected for review: (1) study subjects were school-agedchildren (5-18 years); (2) the article was published inthe past 10 years (1994-2004) in a peer-reviewed journal;and (3) the research included at least 1 of the followingoutcomes—school attendance, academic achievement, ameasure of cognitive ability (such as general intelligence,memory), and attention. The outcome of students’ levelof attention was acceptable only if measured objectively.Studies were identified using MedLine and similar Inter-net-based searches. If a full article could not be retrieved,studies with detailed abstracts were included. Many stud-ies cited in this review had major outcome measures otherthan those pertinent to the objectives of this project.These alternative outcomes may not be described at all orare briefly mentioned.

LITERATURE REVIEWInvestigators are attempting to answer several ques-

tions: How much sleep are students getting? Do inade-quate amounts or quality of sleep affect educationaloutcomes or cognitive performance? What is the effect ofsleep-disordered breathing on students? Is daytime sleepi-ness associated with school performance?

Tables 1-3 contain lists of articles on sleep that met theinclusion criteria. A brief description of the experimentaldesign and the outcome also is included for each. Table 1lists general articles on sleep in school-aged children.

The largest number of articles studied sleep disordersand sleep habits and patterns, particularly among adoles-cents. Many studies on sleep disorders are on sleep-disor-dered breathing. Most are relatively recent and includecontrol groups. Research findings appear to be relativelyconsistent, although outcome measures differ. An excel-lent review by Blunden et al2 in 2001 of 13 articles dem-onstrated that reduced attention, memory, intelligence, andincreased problematic behavior resulted from sleep-relatedobstructive breathing. With the exception of 1 study in thisreview, children in all studies improved in neurocognitive,behavioral, and/or school performance after an adenoid-tonsillectomy. Articles listed in Table 2 are those not re-viewed by Blunden et al that investigate the same issues.Like the conclusions of Blunden et al, the findings of thesestudies raise concern because of the high prevalence of

Howard Taras, MD, Professor, (htaras@ucsd.edu), Division of CommunityPediatrics, University of California, San Diego, Gilman Drive #0927,La Jolla, CA 92093-0927; and William Potts-Datema, MS, Director,(wpottsda@hsph.harvard.edu), Partnerships for Children’s Health, HarvardSchool of Public Health, 677 Huntington Ave, 7th Floor, Boston, MA 02115.This article is 1 of 6 articles that are part of a project of the National Coor-dinating Committee on School Health and Safety (NCCSHS). This NCCSHSproject was funded by the US Department of Health and Human Services,Department of Education, and US Department of Agriculture. Opinions ex-pressed in this article are not necessarily shared by these federal agenciesor other institutions that comprise NCCSHS membership.

248 d Journal ofSchool Health d September 2005, Vol. 75, No.7

sleep-disordered breathing among elementary school studentpopulations. Most articles demonstrate an effect on neuro-cognitive ability. Fewer demonstrate effects on academicperformance. It is encouraging that academic achievementamong children with disordered breathing improves aftercorrective measures are taken, such as surgery or tonsillec-tomy/adenoidectomy. If minor sleep disorders, such as snor-ing, can be identified and managed prior to or during theschool-age years, significant improvement in educationaloutcomes may ensue.

Table 3 lists published research that investigates sleeppatterns among children and adolescents. The researchfindings raise several important issues for educators. Theonset of adolescence appears to be accompanied bya decrease in sleep in a 24-hour period among many youthat this stage of life. The academic consequences of thesechanges in sleep habits are inconclusive. Data collectionin studies performed to date is based more on surveillance

of parents, teachers, or students—a methods that requiressome level of validation.

Some school districts have pushed back school start timesfor adolescents, and the issue of school starting times iswidely debated among parents of adolescents and school ad-ministrators. Unfortunately, published peer-reviewed studiesthat investigate the benefits of such modifications are virtu-ally absent in the literature. Experimental conditions of sleeprestriction and deprivation appear to impair neuropsycholog-ical performance related to higher-level cognitive functionsand attention. But reversal of this through changed schoolstart times has yet to be proven.

An excellent article by Fallone et al3 reviewed many ofthe studies included in this collection and concluded thatvarying definitions of ‘‘good’’ versus ‘‘poor’’ sleep limit theability to compare studies. A review of the literature wasperformed by Wolfson and Carskadon4 in 2003. Thesereviewers noted that a majority of studies in this field rely

Table 1General Articles on Sleep in School-Aged Children

Reference (Origin) Experimental Design Outcome

Eliasson A, Eliasson A, King J,Gould B, Eliasson A. Association ofsleep and academic performance.Sleep Breath. 2002;6(1):45-48.(United States)

Teachers administered a 1-pagequestionnaire to 1000 students in 9ththrough 12th grades in a number ofschools in 1 community as well as to200 7th graders. Self-reported GradePoint Average (GPA) included inquestionnaire.

90% of students feel groggy at schoolfrom sleepiness, 40% very groggy.Average sleep time 6.7 hours/nighton weekdays (7.7 on weekends). Nocorrelation between sleep time andacademic performance in any grade.

Kahn A, Van de Merckt C, Rebuffat E,et al. Sleep problems in healthypreadolescents. Pediatrics.1989;84(3):542-546.(Belgium)

Parents of 972 3rd- to 5th-gradechildren completed questionnairesabout their own and their children’ssleeping habits and schooling.

Sleep difficulties lasting more than6 months were present in 43%of children. Among the 132 poorsleepers, 21% failed 1 or more yearsof school—a significantly higherpercentage than found among thosewithout sleep problems. 28%expressed a desire for counseling.

Link SC, Ancoli-Israel S. Sleep and theteenager. Sleep Res. 1995;24A:184.(United States)

150 high school students (mean age16 years) were given a questionnairethat included sleep questions andGPA.

High GPA correlated significantly withwaking up later on school days, earlyrising on weekends, less time takento fall asleep, fewer nightawakenings, and fewer daytime napson school days.

Meijer AM, Habekothe HT, Van DenWittenboer GL. Time in bed, qualityof sleep and school functioningof children. J Sleep Res.2000;9(2):145-153.(Netherlands)

449 students (9-14 years) responded toclassroom questionnaires, includingBourdon-Vos pencil/paper testmeasured attention, SchoolPerception Questionnaire of schoolfunctioning, and a sleepquestionnaire. Study also controlledfor psychosomatic and neuroticcomplaints that could influence theassociation between sleep andschool functioning (usinga standardized questionnairemeasuring these characteristics).

15% report sleep problems, 43% havedifficulty getting up in the morning,and 25% do not feel rested at school.Regression analyses demonstratedthat although sleep characteristics donot have an impact on concentration,they do have a significant impact onsome aspects of school functioning,in particular, children’s motivation toachieve in school.

Journal of School Health d September 2005, Vol. 75, No.7 d 249

Table2

ArticlesonDisorderedSleep(Continuedonnextpage)

Reference(O

rigin)

ExperimentalDesign

Outcome

AliNJ,PitsonD,StradlingJR.Sleepdisordered

breathing:effects

ofadeno-tonsillectomyon

behaviorandpsychologicalfunctioning.EurJ

Pediatr.1996;155:56-62.

(UnitedKingdom)

33children(6-12years)whosnoredandwere

onawaitinglistforhavingtheiradenoidsand

tonsils

removedwere

visitedathomeand

monitoredduringsleepwithavideoand

oxim

etry(m

easure

ofairexchangeand

oxygenation).Ofthese,12hadevidenceof

sleepdisturbancesecondary

toairway

obstructionand11ofthoseremainingonthe

waitinglistwere

matchedbyageandsexwith

the12.Another10controlchildrenwere

studiedaswell.Allchildrenwere

studiedfor

intelligence(W

ISC-R

),attention(continuous

perform

ancetest),andtests

ofim

pulsivityand

behaviorwere

perform

edbefore

surgery

and

3-6

monthsaftersurgery.

Childrenwithsleep-disorderedbreathing

improvedin

aggression,inattention,

hyperactivity,andvigilanceaftersurgery,but

notonintelligence.Theother2groupsdid

not

changeonpre-andposttests,orchangedfor

onlyhyperactivebehaviorandvigilance.

AndreouG,KarapetsasA,AgapitouP,

GourgoulianisK.Verbalintelligenceandsleep

disorders

inchildrenwithADHD.PerceptMot

Skills.2003;96(3

Pt2):1283-1288.

(Greece)

18children(8-13years)withADHDwere

matchedwith18age-andsex-m

atched

controlchildren.Measureswere

ADHD

assessments,fiveverbalscalesoftheWISC-

III(intelligencescale),andpolysomnographic

studiesofsleep.

Poorqualityofsleepwasfoundonchildrenwith

ADHD(apnea,desaturatedhemoglobin,and

awakeningsassociatedwithlim

bactivityand

snoring).Thesechildrenhadlowperform

ance

(ofupto

20points)ontheWISC-IIIverbal

scores.

BlundenS,LushingtonK,KennedyD,Martin

J,

DawsonD.Behaviorandneurocognitive

perform

ancein

childrenaged5-10years

who

snore

comparedto

controls.JClin

Exp

Neuropsych.2000;22(5):554-568.

(Australia)

16childrenreferredto

ENT/pulm

onary

clinicfor

snoringevaluation(m

eanage7.2).Matched

with16controlsforageandsex.WISC(and

WPPSI-Rforpreschoolers),WRAML,

Auditory

ContinuousPerform

anceTestand

Child

BehaviorChecklistmeasured

intelligence,memory

andlearning,attention

andbehavior.Sleepmeasuredusingparents’

7-daysleeplog,polysomnography,and

asleepdisturbancescale.

Comparedto

controls,childrenwhosnored

(butwhodid

notnecessarilyhaveobstructive

sleepapnea)showedsignificantlyim

paired

attention,lowermemory

andintelligence

scores(althoughmemory

andintelligence

were

within

norm

alrange).Mild

sleep-

disorderedbreathingaffecteddaytime

functioning.

Chervin

RD,ClarkeDF,HoffmanJL.School

perform

ance,race,andothercorrelatesof

sleep-disorderedbreathingin

children.Sleep

Med.2003;4:21-27.

(UnitedStates)

Students

in2ndand5th

gradesin

1school

districtrecruitedbysendingletters

home.

Sleep-disorderedbreathingwasmeasured

usingavalidatedparentquestionnaire.School

perform

ancewasmeasuredusingteachers’

ratings(5-pointscale)andyear-endReading

andMath

assessments.

146parents

completedthequestionnaireson

theirchildren.Sleep-disorderedbreathingwas

associatedwithpoorteacherrating.Sleep-

disorderedbreathingwasnotsignificantly

associatedwithReadingorMath

assessment

scores.

250 d Journal of School Health d September 2005, Vol. 75, No.7

Table

2ArticlesonDisorderedSleep

(Continuedfrom

previouspage)

Reference(O

rigin)

ExperimentalDesign

Outcome

GozalD

.Sleep-disorderedbreathingandschool

perform

ancein

children.Pediatrics.

1998:102(3);616-620.

(UnitedStates)

1st-gradechildrenrankedin

thelowest10th

percentile

ofclasswere

identified(297).

Parents

completedaquestionnaireon

obstructivesleepapnea;childrenreceived

overnightrecordingsofsleepandrespiratory

function/gasexchangeatnight.Parents

of

childrenwithabnorm

alresultswere

encouragedto

seeksurgicalcorrection.

Schoolsprovidedacademicgradesfor

2successiveyears.

Gasexchangedifficulty,indicativeofobstructive

sleepapnea,occurredfrequentlyamong1st

graders

withacademicdifficulty(18%).Those

withgasexchangeproblemswhoreceived

atonsillectomy/adenoidectomysignificantly

improvedtheirgrades(2.4-2.9)thefollowing

year,whereasthoseelectingnotto

get

recommendedsurgery

hadnosignificant

increase.Noacademicim

provements

occurredin

thosewithoutevidence

ofobstructivesleepapnea.

OwensJ,SpiritoA,MarcotteA,McGuinnM,

BerkelhammerL.Neuropsychologicala

nd

behavioralcorrelatesofobstructivesleep

apneasyndromein

children:aprelim

inary

study.SleepBreath.2000;4(2):67-77.

(UnitedStates)

18children(age7.3

years)withobstructive

sleepapneawere

testedforanumberof

neuropsychologicfunctions:generalcognitive

functioning(M

cCarthyScales);language

(PeabodyPicture

Vocabulary);executive

functioning,suchasplanningand

organization;andattention,memory

(Memory

Scale

ofMcCarthyScale),andvisual

perceptionandvisualm

otorintegration.Motor

andbehavioralm

easures(parentratings)

were

alsoconducted.Eightchildrenwho

receivedanadenoid-tonsillectomywere

reevaluated.

Modestim

pairments

inexecutivefunctioning,

attention,andmotorskillswere

found.There

waslittlecorrelationbetweentheseverity

of

theobstructivesleepapnea(asmeasuredby

ApneaHypopneaIndex)andthelevelo

ffunctioning.Tests

did

notsignificantlyim

prove

aftersurgery,althoughsomeapproached

statisticalsignificanceforim

provement.

RobertsRE,RobertsCR,ChenLG.Functioning

ofadolescents

withsymptomsofdisturbed

sleep.JYouth

Adolesc.2001;30:1-18.

(UnitedStates)

Data

from

alargeschool-basedsurveyof5423

students

(grades6-8)were

usedto

examine

theassociationbetweenlevelsoffunctioning

andsymptomsofinsomnia

(aperiodofat

least2weeksofhavingtrouble

fallingasleep,

stayingasleep,orawakeningtooearly)and

‘‘hypersomnia’’(atleast2weeksofsleeping

toomuch).

Approxim

ately6%,12%,and3%

ofstudent

populationreportedhypersomnia

only,

insomnia

only,andboth

(respectively).Using

thosewithoutsleepproblemsasareference

groupandlogisticregressionanalysis,the

authors

foundthatreportedabsencedueto

illnesswassignificantlyincreasedamong

students

whohadinsomnia

andthosewith

both

hypersomnia

andinsomnia.

ADHD,AttentionDeficit/HyperactivityDisorder;WISC-III,WechslerIntelligenceScale

forChildren—

ThirdEdition;WISC-R

,WechslerIntelligenceScale

forChildren—

Revised;

WPPSI-R,WechslerPreschoola

ndPrimary

Scale—

Revised;WRAML,WideRangeAssessmentofMemory

and

Learning—

SecondEdition.

Journal ofSchool Health d September 2005, Vol. 75, No.7 d 251

Table3

ArticlesonSleepHabitsandSleepDeprivation(Continuedonnextpage)

Reference(O

rigin)

ExperimentalDesign

Outcome

AllenRP.Socialfactors

associatedwiththeamountof

schoolw

eeksleeplagforseniors

inanearlystarting

suburbanhighschool.SleepRes.1992;21:114.

(UnitedStates)

Allstudents

attending12th

gradein

ahumanbehavior

classin

1‘‘earlystarting’’school(7:40AM)were

surveyedanonymouslyforsleeppatterns,partying

habits,grades,alcoholconsumption,andotherhabits.

Thosestudents

whowentto

bedlateronweekends

(ie,theydid

not‘‘catchup’’onsleeplostduringthe

weekasaresultofanearlystart)hadpoorergrades.

Ausualw

eekendbedtimeafter2:30AM

wasreported

by15%

ofstudents

withAandB1

grades,and35%

of

thosereportingaveragegrades.

DrakeC,NickelC

,BurduvaliE,Roth

T,JeffersonC,

PietroB.Thepediatricdaytimesleepinessscale

(PDSS):sleephabitsandschoolo

utcomes.Sleep.

2003;26(4):455-458.

(UnitedStates)

450students

(age11-15)respondedto

awrittensurveyof

sleepandschoola

chievementandsleepiness.

Significantlinearrelationshipsfoundbetweensleeptime

anddaytimesleepiness.Significantlinearrelationships

foundbetweendaytimesleepinessandschool

achievement.Sleepinessacrossgradelevelsindicated

thatsleepinessincreasedsignificantlywithgradelevel.

Epstein

R,ChillagN,Lavie

P.Startingtimesofschool:

effects

ondaytimefunctioningoffifth-gradechildrenin

Israel.Sleep.1998;21(3):250-256.

(Israel)

5th-gradepupils

(10-12years

old)from

28classesin

18schoolsthroughoutIsraelw

ere

dividedinto

‘‘early

risers’’(N

¼232),whostartedschoola

t7:10AM

(42%)

atleast2timesaweek,and‘‘regularrisers’’(N

¼340),

whoalwaysstartedschoola

t8:00AM

(58%).Children

completedself-administeredquestionnairesconcerning

sleephabitsduringschoold

ays,weekends,and

holidays,daytimefatigue,sleepiness,anddifficulties

concentratingandpayingattentionin

school.

Meansleeptimeofthe‘‘earlyrisers’’wassignificantly

shorterthanthatofthe‘‘regularrisers.’’Earlyrisers

complainedsignificantlymore

aboutdaytimefatigue

andsleepiness,andaboutattentionandconcentration

difficultiesin

school.Theircomplaints

were

independentofthereportedhours

ofsleep.

FalloneG,AceboC,ArnedtJT,SeiferR,CarskadonMA.

Effects

ofacute

sleeprestrictiononbehavior,sustained

attention,andresponseinhibitionin

children.Percept

MotSkills.2001;93:213-229.

(UnitedStates)

82children(age8-15)completed5nights

ofbaseline

sleepandthenrandomlyassignedto

optimized(10

hours)orrestricted(4

hours)sleepin

anovernightlab.

Behavior,perform

ance,andsleepinesswere

assessed

thefollowingday.Students

reportedsleepinessand

were

givenseveralo

bservationmeasuresof

attentiveness.

Althoughsleeprestrictionwasassociatedwithincreased

child

reportsofsleepinessandinattentivebehaviors,

there

wasnosignificantim

pairedperform

anceontests

ofresponseinhibitionandofsustainedattention.

FredriksenK,RhodesJ,ReddyR,WayN.Sleeplessin

Chicago:trackingtheeffects

ofadolescentsleeploss

duringthemiddle

schoolyears.Child

Dev.

2004;75(1):84-95.

(UnitedStates)

2259students

(age10through14overthecourseofthe

study)were

givenasurveyannually

for3consecutive

years

bytheirmiddle

schoolteacher.Sleep,depressive

symptoms,self-esteem,andacademicoutcomeswere

self-reportedbythestudents.Astatisticalm

odelw

as

usedto

determ

inewhetherfewerhours

ofsleepcaused

poorgrades,lowerself-esteem,anddepressiveaffect

orwhetherthesecausedpoorsleep.

Girlsinitially

reportedmore

sleepthanboys,yetreported

asharperdeclineoverthecourseof3years

thanboys.

Girlsreportedhighergradesthanboysinitially

andover

the3years.Students

whoinitially

reportedhigher

levelsofsleepalsotendedto

reporthighergrades.The

rate

ofchangein

hours

ofsleepoverthe3years

was

notsignificantlyassociatedwiththeirgrades.Grades

(andesteem

andaffect)were

influencedbysleep,not

viceversa.

252 d Journal ofSchool Health d September 2005, Vol. 75, No.7

Table

3ArticlesonSleepHabitsandSleepDeprivation

(Continuedfrom

previouspage)

Reference(O

rigin)

ExperimentalDesign

Outcome

GiannottiF

,CortesiF

,SebastianiT

,OttavianoS.

Circadianpreference,sleepanddaytimebehaviourin

adolescence.JSleepRes.2002;11(3):191-199.

(Italy)

Over6600adolescents

(age14-18)completed

acomprehensivequestionnaire.Thequestionnaire

helpedto

categorizeadolescents

into

morningtypes

andeveningtypes.

Studyconfirm

edanincreasingtendencywithageto

be

lesssleepyduringeveningsandmore

sleepyduring

mornings(eveningtype).Eveningtypesdemonstrated

more

sleepinessduringday,reportedpoorerschool

achievement,lessattentiveness,andhigher

consumptionofcaffeinebeverages.

RandazzoAC,MuehlbachMJ,SchweitzerPK,WalshJK.

Cognitivefunctionfollowingacute

sleeprestrictionin

childrenages10-14.Sleep.1998;21:861-868.

(UnitedStates)

16children(10-14years)were

randomlyassignedto

acontrolg

roup(11hours

inbed)oranexperimental

group(sleepdeprivedwithmaxim

um

5hours

inbed)on

asingle

nightin

asleeplaboratory.Sleepwas

monitoredusingapolysomnographtest,sleeplatency

wasmeasured(tim

eto

fallasleep),andtestingwas

donethenextday.Tests

includedtheDigitSymbol

SubstitutionTest,SteerCleartestforvisualvigilance,

WRAML(assessmentoflearningandmemory),

TorranceTestofCreativeThinking,Children’s

Category

Test(learningandproblem

solving),

Wisconsin

Card

SortingTest,andCalifornia

Verbal

LearningTest.

Cognitivetests

withsignificantdifferencesbetweenthe

controla

ndsleep-deprivedgroupswere

alwaysworse

forthesleepdeprived,butlim

itedto

thefollowing

cognitivefunctions:verbalcreativityandtheWisconsin

Card

SortingTest.Allothertestedareaswere

sim

ilar

betweencontrola

ndsleep-restrictedgroups.

SadehA,GruberR,RavivA.Theeffects

ofsleep

restrictionandextensiononschool-agechildren.

Child

Dev.2003;74:444-455.

(Israel)

Thesleepof77childrenin

4th

through6th

grades(9-12

years)wasmonitorednightly.Neurobehavioralfunction

tests

were

measuredonthe2nddayoftheirnorm

al

sleepschedule.Onthe3rd

through5th

nights,40

childrenwere

askedto

extendtheirsleepby1hourand

37childrenwere

askedto

restricttheirsleepby1hour.

Tests

were

repeatedonthe6th

day.Tests

included

fingertapping(m

otorspeed),reactiontime,continuous

perform

ancetest(visuala

ttentionandmotorspeed),

symbol-digitsubstitution(visualm

emory,scanning,and

speed),visuald

igitspantest(w

orkingmemory,

attention),seriald

igitlearning(w

orkingmemory,

learningstrategies).

Childrenwhoextendedtheirsleepsignificantlyim

proved

theirperform

anceonthedigitforw

ard

memory

testand

reactiontimewiththecontinuousperform

ancetest.

Thosechildrenwhodecreasedormaintainedthesame

numberofsleephours

astheyhadatbaselineshowed

nochangein

neurobehavioralfunctioning.Theauthors

concludethatevenmodestextensionsin

sleepper

nightcould

havebenefits

inneurobehavioral

functioning.

Shin

C,Kim

J,LeeS,AhnY,JooS.Sleephabits,

excessivedaytimesleepinessandschoolp

erform

ance

inhighschoolstudents.PsychiatryClin

Neurosci.

2003;57(4):451-453.

(South

Korea)

Surveyof478111th-gradestudents

from

10randomly

selectedschools.Excessivedaily

sleepinessbasedon

‘‘EpworthSleepinessScale.’’Achievementwasbased

onthequartile

students’rankedin

theirfinale

xamsof

theirfirstsemester.There

wasan80%

responserate.

Meantotalsleeptimewas6.4

hours/day.Totalsleeptime

did

notsignificantlycorrelate

withexcessivedaily

sleepiness.Prevalenceofexcessivedaily

sleepiness

increasedsignificantlywithadeclinein

school

perform

ance.

Journal of School Health d September 2005, Vol. 75, No.7 d 253

on self-report. Self-reported shortened sleep time, erraticsleep/wake schedules, late bed and rise times, and poorsleep quality are negatively associated with academicperformance for adolescents from middle school throughcollege years. Future research designs must go beyond sub-jective feelings of sleepiness to measure academic perfor-mance. We need methodologies that include control groupsand randomization.

Despite the drawbacks in the literature on sleep depri-vation among teenage populations, the preponderance ofliterature that recognizes the detrimental effects of sleepdisorders is astounding and perhaps not fully appreciatedamong many primary care providers, school health profes-sionals, and educators. Professionals faced with school-aged children with learning or attention disorders haveenough scientific justification to suspect that poor sleepmay be a contributing factor. These children and theirfamilies should be asked about regularity and durationof sleep, bedtime resistance, sleep onset delay, night-wakings, sleep-disordered breathing, and increased day-time sleepiness. j

References1. National Heart, Lung, and Blood Institute. Star Sleeper. Available

at: http://www.nhlbi.nih.gov/health/public/sleep/starslp/parents/whysleep.htm. Accessed March 8, 2004.

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3. Fallone G, Owens JA, Deane J. Sleepiness in children and adoles-cents: clinical applications. Sleep Med Rev. 2002;6(4):287-306.

4. Wolfson AR, Carskadon MA. Understanding adolescents’ sleeppatterns and school performance: a critical appraisal. Sleep Med Rev.2003;7(6):491-506.T

able

3ArticlesonSleepHabitsandSleepDeprivation

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previouspage)

Reference(O

rigin)

ExperimentalDesign

Outcome

WolfsonAR,CarskadonMA.Sleepschedulesand

daytimefunctioningin

adolescents.Child

Dev.

1998;69(4):875-887.(U

nitedStates)

Sleephabitssurveygivento

3120students

(age13-19

years)at4highschools.Cross-sectionalstudy.Sleep

timeandschoolp

erform

ancewere

self-reported.A

depressivemoodscale

wasalsogiven.

Students

ofolderagesreportdecreasinghours

ofsleep

(adecreaseof45minutes/nightfrom

age13to

19)due

tolaterbedtimes.Students

withgradesaveragingC,D,

andFobtained25minuteslesssleepandwentto

bed

40minuteslaterthanstudents

withA’sandB’s.

Weekenddelaysin

bedtimewere

alsoassociatedwith

poorergrades.

WRAML,WideRangeAssessmentofMemory

andLearning.

254 d Journal of School Health d September 2005, Vol. 75, No.7