Excessive daytime sleepiness among children and adolescents: prevalence, correlates, and pubertal effects

Nov 2, 2018Sleep medicine

How common excessive daytime sleepiness is in children and teens, what it relates to, and how puberty affects it

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Circadian Biology on OpenScience ↗PubMed ↗DOI ↗

Abstract

The overall prevalence of excessive daytime sleepiness (EDS) among Hong Kong children and adolescents is 29.2%.

EDS prevalence increased from 19.8% at pre-puberty to 47.2% at post-puberty.
A female predominance in EDS emerged at mid-puberty (Tanner stage 3).
Short weekday sleep duration, eveningness chronotype, insomnia, and sleep-disordered breathing were significantly associated with EDS.
Females reported shorter weekday sleep and more eveningness chronotype compared to males.
Morningness chronotype may protect pre and mid-pubertal children from EDS.
EDS was linked to daytime napping, consumption of alcohol and energy drinks, and adverse emotional and behavioral difficulties.

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OBJECTIVES: To examine the prevalence and correlates of excessive daytime sleepiness (EDS) among Hong Kong children and adolescents. We investigated the potential roles of sex and puberty in modulating the occurrence of EDS.

METHODS: A total of 10,086 students (male, 48.1%) aged 6-18 (mean ± SD: 12.3 ± 3.2) years old participated in this cross-sectional survey. EDS was defined by a total score >18 on the Pediatric Daytime Sleepiness Scale. Sociodemographic characteristics, time in bed, chronotypes, sleep problems, emotional and behavioral difficulties, mental health, and pubertal stages were assessed.

RESULTS: The overall prevalence of EDS was 29.2%, and increased from 19.8% at Tanner stage 1 (pre-puberty) to 47.2% at Tanner stage 5 (post-puberty). Female predominance emerged at Tanner stage 3 (mid-puberty). EDS was significantly associated with short weekday time in bed, both long and short weekend time in bed, eveningness chronotype, insomnia symptoms, and sleep-disordered breathing symptoms. Females were more likely to have short weekday time in bed and eveningness chronotype than males. Children and young adolescents at pre and mid-puberty were protected against EDS by morningness chronotype. EDS was independently associated with daytime napping, alcohol and energy beverage consumption, emotional and behavioral difficulties, as well as poor mental health even after adjusting for potential confounding factors.

CONCLUSIONS: EDS is prevalent among children and adolescents with the emergence of female preponderance at mid-puberty and independent association with pervasive adverse emotional and behavioral problems. The mechanisms underlying the modulation effects of sex and puberty on EDS merit further investigation.

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Excessive daytime sleepiness among children and adolescents: prevalence, correlates, and pubertal effects

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