The Neurocognitive Effects of Sleep Disruption in Children and Adolescents

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Sleep problems in children and adolescents are common, and sleep disruption is associated with a wide range of behavioral, cognitive, and mood impairments, including hyperactivity, reduced school grades, and depression. Insufficient or fragmented sleep may induce sleepiness, which is associated with problematic behavior, impaired learning, and/or negative mood. Furthermore, treatment of sleep disruption, by improving sleep hygiene or treating specific sleep disorders, is often associated with improvements in daytime performance, suggesting a common mechanism for the behavioral manifestations. This article reviews the daytime manifestations of sleep disruption.

Section snippets

Cultural

What constitutes normal sleep? Few large-scale epidemiological studies have been conducted to define normal sleep parameters in childhood, and in those studies that have attempted to investigate normal sleep, methodologies differ widely. Childhood and adolescence is a time of rapid growth and maturation; therefore, what is considered normal sleep is a dynamic and complex process. Normal sleep may be defined culturally in terms of what fits with societal or parental expectations, irrespective of

Poor sleep hygiene/insufficient sleep

We are a 24-hour society. Many young children and adolescents do not obtain enough sleep for a variety of reasons, including family schedules, chaotic living arrangements, television/computer/cell phone use in the bedroom after designated bedtimes, and after-school activities. There are often not enough hours in the day to accomplish what is wanted, and all too often it is sleep that is compromised. Data from the Zurich Longitudinal Studies,4 which followed Swiss children from infancy to

Delayed sleep phase syndrome

Circadian rhythms develop throughout life and are entwined with the light-dark cycle. Optimal sleep occurs when the internal circadian cycle is aligned with the external sleep-wake schedule, and when this alignment becomes destabilized, circadian rhythm sleep disorders can occur. One of the most relevant circadian disorders in childhood and adolescence is delayed sleep phase disorder, where the sleep period is delayed in relation to the required or desired sleep-wake times. As children develop

Sleep-disordered breathing

The cognitive and behavioral manifestations of sleep disruption are probably most well studied in children with sleep-disordered breathing (SDB). SDB describes a spectrum of sleep-related breathing problems ranging from snoring to obstructive sleep apnea and is most common in young school-aged children. Although there has been a considerable research effort in this area in the past few decades, the first reports of learning and behavioral problems in children with SDB were published in the late

Restless legs syndrome/periodic limb movements

Hyperactivity is most commonly associated with SDB. Nonetheless, restless legs syndrome (RLS) and periodic limb movements (PLM) during sleep in children are also strongly associated with hyperactivity.51, 52 Children and adolescents with PLMs have a high frequency of ADHD,53, 54 and conversely children with ADHD are more likely to have PLMs during sleep.55 One possibility is that RLS and PLMs may fragment sleep and lead to daytime sleepiness and symptoms similar to ADHD. Strong independent

Narcolepsy

Narcolepsy is rare in preschoolers and uncommon in young children. Affected school-aged children have been reported to have impaired concentration, poor school performance, executive dysfunction, and emotional instability. There are reports of children with narcolepsy being described as lazy and more likely to have negative peer interactions, which can feed the cycle of negative behavior and schooling problems. Depressive symptoms, as well as inattention and ADHD-like behaviors, have been

Treatment of sleep problems

Although it is beyond the scope of this article to discuss treatment options, it is noteworthy to mention that treatment of sleep disruptions, whether caused by insufficient sleep, poor sleep hygiene, SDB, RLS, or circadian problems, can improve daytime functioning. For example, the most well-studied disorder in terms of its impact on neurobehavioral function is SDB. Multiple studies have shown that treatment of childhood SDB by adenotonsillectomy improves both behavior and cognition.29, 30, 46

Is there a common thread?

The behavioral problems observed in multiple sleep disorders described in the preceding sections are remarkably similar: hyperactivity, inattention, conduct problems, depression, and cognitive/schooling problems. The vast majority of sleep disorders previously described, including SDB, result in fragmented sleep and daytime sleepiness. Thus, it is possible that the common feature of daytime sleepiness could play a role in the daytime morbidities. Children who are sleepy, whether as a result of

Summary

Sleep disruption in childhood and adolescence is common and associated with multiple behavioral and cognitive impairments. It is important to note that many of the sleep problems discussed here may not occur in isolation. Similarly, there are bidirectional relationships with some sleep problems and psychiatric disorders, and it can sometimes be challenging to disentangle these often complex relationships. Childhood sleep problems are a significant source of stress for the whole family, as

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