Brief CommunicationEffect of sleep extension on sluggish cognitive tempo symptoms and driving behavior in adolescents with chronic short sleep
Introduction
It is recommended that adolescents obtain eight to ten hours of sleep each night [1], although it is widely recognized that sleep in many adolescents regularly falls short of this recommendation [2], [3], [4]. Moreover, shortened sleep duration in adolescence has been linked to a range of adverse outcomes [5]; one particularly concerning negative outcome associated with adolescent sleep deprivation is diminished driving ability [6]. Automobile crashes are a leading cause of adolescent deaths, and driving crashes occur often in short-sleeping adolescents [7], [8]. This may be partially due to inattention resulting from sleep deprivation. In one study, adolescents whose attention worsened following experimental sleep restriction also showed less consistency in lateral vehicle control during driving simulation [9].
Sluggish cognitive tempo (SCT), characterized by symptoms such as daydreaming, slowed behavior/thinking, and confusion, may also play a role in the effect of sleep on driving. The study of SCT and its relation to attention-deficit/hyperactivity disorder (ADHD) has spanned over three decades, and it is established that SCT is associated with, but independent from, ADHD [10]. A recent meta-analysis on SCT concluded that there is “strong support for the internal validity of SCT” [10]. Although SCT correlates with sleep pathology and daytime sleepiness, it is distinct from both [10], [11]. Studies examining whether SCT is associated with impairment beyond inattention are greatly required [10]. Because driving demands SCT-relevant skills beyond basic attention, SCT may reflect a second mechanism by which insufficient sleep might affect adolescent driving.
This exploratory study examined the unique relationship between SCT and driving problems in a sample of adolescents who chronically sleep five to seven hours on school nights. We examined whether experimental sleep extension (EXT) reduced SCT and whether reduction in SCT was linked to improved driving. We hypothesized that EXT would mitigate SCT with an associated improvement in driving behaviors.
Section snippets
Method
The local IRB approved all study procedures. Adolescent informed assent and parental informed consent were obtained. Participants were healthy adolescents aged 16–18 years with a valid driving license who regularly obtained five to seven hours of sleep on school nights (Supplemental Table). Exclusion criteria included report of psychiatric or neurologic history, self-report or actigraphic evidence of <5 or >7 h of typical sleep (TYP) on school nights, medication use that affects sleep or
Results
Of the 41 teens initially recruited, three were excluded prior to randomization due to ineligibility (eg, obesity). The randomized 38 adolescents (63.2% female; Mage = 16.82 years, SD = 0.80; Mlicensed = 1.32 months, SD = 0.64) averaged 6.34 (SD = 0.68) h of weeknight sleep at baseline according to actigraphy. Eleven did not complete the five-week protocol because of lack of interest or schedule conflicts; one was excluded from participation for being nonadherent to wearing the actigraphy, and
Discussion
This is the first study to examine the effect of EXT on SCT in a sample of chronically short-sleeping adolescents. SCT symptoms, at least as experienced by the adolescents themselves, appear to be modified by extending sleep. This suggests that prior correlational links between SCT and sleep [10] may reflect true cause–effect relationships. Although SCT symptoms are distinct from sleepiness [10], [17], lengthening sleep time may alleviate SCT symptoms. SCT symptoms changed only in self-report.
Acknowledgements
We would like to thank Catharine Whitacre, Shealan McAlister, Perry Catlin, and Patrick Nalepka for their assistance in executing this project. Funding was provided by a grant from the State of Ohio Emergency Medical Services (Project 134987). Dr. Garner received grants from T32HT1002 National Research Service Award while the study was in progress. Dr. Becker received grant from K23MH108603 the National Institute of Mental Health. The content is solely the responsibility of the authors and does
References (19)
- et al.
National Sleep Foundation's updated sleep duration recommendations: final report
Sleep Health
(2015) - et al.
Recent worldwide sleep patterns and problems during adolescence: a review and meta-analysis of age, region, and sleep
Sleep Med
(2011) - et al.
Developmental trends in sleep duration in adolescence and young adulthood: evidence from a national United States sample
J Adolesc Health
(2014) - et al.
Impact of experimentally manipulated sleep on adolescent simulated driving
Sleep Med
(2015) - et al.
Sluggish cognitive tempo in children referred to a pediatric sleep disorders center: examining possible overlap with sleep problems and associations with impairment
J Psychiatric Res
(2016) - et al.
Sleep patterns and insomnia among adolescents: a population-based study
J Sleep Res
(2013) - et al.
Advancing a biopsychosocial and contextual model of sleep in adolescence: a review and introduction to the special issue
J Youth Adolesc
(2015) - et al.
Sleep-deprived young drivers and the risk for crash: the DRIVE prospective cohort study
JAMA Pediatr
(2013) Early estimate of motor vehicle traffic fatalities in 2010
(2011)
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2022, Neuroscience and Biobehavioral ReviewsCitation Excerpt :Unfortunately, over 50% of adolescents fall short of this recommendation due to a combination of developmental changes, such as a shift in circadian rhythm and a slower build-up of homeostatic sleep pressure such that adolescents across cultures tend to initiate sleep later in the night (Gradisar et al., 2011; Karan et al., 2021; Owens et al., 2014), and ecological changes, such as earlier school start times, the need to “make up” sleep on weekends, and increased homework (Meltzer et al., 2021). Shorter sleep duration has a number of cognitive consequences in typically developing adolescents such as impaired attention, increased daydreaming/mind-wandering, daytime sleepiness (Becker et al., 2019) and an increase in driving errors (Garner et al., 2017). Changes in sleep duration can also affect socioemotional functioning.
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2021, Sleep Medicine ReviewsCitation Excerpt :The most commonly reported BCT was “shaping knowledge (n = 30) [26–28,30,31,34–39,41,43,45–50,52,54–57,59,61–64,67]. Other commonly used techniques were goals and planning (n = 23) [26,28,29,32–34,36,39–42,48,51,52,54,55,57,59,62–64,66,67] and feedback/monitoring (n = 14) [28,32,35,46,49,50,53–55,57,62,63,66,67]. Use of social support was rare (n = 4) [39,43,45,66] as were natural consequences [39], comparison [39], reward [67] and antecedents [39].