This literature review conflates experimental, self-reported, and case-control studies to analyze the cognitive and mental health effects of inadequate sleep. In children and adolescents, sleep is essential to rest, growth, and health (Jithesh et al.), so it’s essential for youths to receive adequate night sleep of 9-12 hours. However, in a study by the Sleep Foundation in 2006, 45% of adolescents reported getting less than 8 hours of sleep.
This image compares the activation of the amygdala in the presence and absence of sleep. Insufficient sleep triggers the firing of the amygdala as shown in the image to the right. Fear, anger, and other strong emotions are processed by the amygdala. With an increased amygdala activation, the propensity to exhibit anger and irritability are increased.
(Goldstein, Walker, 2014)
In a cross-sectional study, 19 children with Obstructive Sleep Apnea (a condition in which the muscles at the back of the throat relax to the point of insufficient breathing) and 12 healthy controls from the ages 6-16 were tested to determine how sleep apnea affects neuropsychological dysfunction.
NAA or N-acetyl Aspartate is a marker of neuroplasticity and neuron stability. Decreased NAA can be a sign of neuronal dysfunction and injury. Additionally, in a study with Patel et al., there have been moderate correlations (0.40) between NAA levels and cognition.
The participants went through polysomnography and neuropsychology assessments with proton magnetic resonance spectroscopic imaging performed. Neuropsychology test scores and neuronal metabolite ratios were analyzed across Control and OSA participants. In the participants with OSA, there were lower IQ scores and executive functioning scores: verbal working memory and verbal fluency. The graph from the study compares the NAA/ Choline ratios which show the ratio disparity between OSA and Control participants. OSA participants have a lower NAA ratio which can be a sign of neuronal damage and moderately impaired cognition.
This experimental and self-report study examined how bedtime and sleep affect Australian Adolescents in terms of cognition and mental health. 385 adolescents between the ages of 13 and 18 logged a 7-day sleep diary and took several tests after, such as the Pediatric Daytime Sleepiness Scale, Flinders Fatigue Scale, and the Centre for Epidemiological Studies Depression Scale.
The chart shows that most Australian adolescents were getting approximately 8 hours of sleep per night, which is below the recommended 9-12 hours.
However, this chart shows that only about 20.8% or 80 people got a sufficient amount of sleep while about 79.2% or 305 people got less than adequate sleep.
This chart shows the negative correlation between bedtime and total sleep time (TST), the strong correlations between depression and anxiety, fatigue and depressed mood, and sleepiness and fatigue. Bedtime affects total sleep time and fatigue. Fatigue affects depressed mood, and depression affects anxiety, which shows a correlation between poor sleep to daily mood. In a study by Boksem et al., fatigue decreases reaction time and increases the number of false alarms and missed targets during activities. Fatigue also decreased adaptation time and increased the brain's retention of unnecessary information. This irrelevant retention prevents the brain from creating important memories, thus inhibiting memorization and cognition.
PDSS: 49.1% elevated levels of daytime sleepiness
FFS: 53% elevated levels of fatigue
CES-D:
Females: 30.4% increase in depression
Males: 41.3% increase in depression
12 participants in Stanford Summer Sleep Camp ranging from 11 to 14 years agreed to participate in a 6-day study with 1 adaptation day, 2 baseline days, one sleep deprivation day, and 2 recovery days. There were performance tests at 10 am, 2 pm, and 8 pm, while deprivation days had an extra test at 2 am and 6 am. The tests were 4 systematic tests given at every battery: 30 min Wilkinson Addition (adding 5 2-digit numbers), Williams Word Memory (recalling 25 4-letter words), Listening attention, and serial alternation. In addition, EEG, EOG, and switch output were monitored in the participants. The table shows that sleep deprivation days (SD) had a lower score in Wilkinson Addition (79% compared to an average of 87.9%), fewer words recalled in Williams Word Memory (8.4 compared to an average of 12.2), higher missed levels in Listening attention (11.8 compared to an average of 8.2) and a significantly larger disparity in serial alternation (74.6 seconds compared to an average of 4.8 seconds. Sleep deprivation in these participants resulted in reduced attentivity and increased error in cognitive activities.
Conclusion:
These studies have shown that there is a high prevalence of insufficient sleep in adolescents and children. As the current youths are transitioning into adulthood, sleep patterns can become a societal detriment in terms of transportation and occupational safety. Mental health issues are rising and approximately ⅓ of males and females had increased anxiety and depressed mood that was correlated to inadequate sleep. In the future, more education on the importance of sleep can be helpful, as well as a shift in the pop-culture 'grind' mindset that thrives on minimal sleep. Changes in school systems to accommodate adequate sleep are a long-term change that has been proven beneficial. In Dexter et al. study, 2 nearby schools with similar demographics had different start times, 7:50 and 8:35 am respectively. Students at the school that started at 7:50 am reported significantly less sleep and increased daytime sleepiness. In a study by Danner and Phillips, the start time of schools were changed from 7:30 am to 8:30 am and motor crashes were compared to nearby counties. The results showed a significant decrease in weekend sleep times and an increase in weekday sleep time. In addition, teen crashes in the county decreased and there were lower crashes in the studied county compared to nearby counties. Understanding the detriments of inadequate sleep is beneficial to improving the steady decline of inadequate sleep in children and adolescents.
Sources:
Becker, Stephen P., et al. “Intraindividual Variability of Sleep/Wake Patterns in Relation to Child and Adolescent Functioning: A Systematic Review.” Sleep Medicine Reviews, vol. 34, Aug. 2017, pp. 94–121, 10.1016/j.smrv.2016.07.004.
Birrer, Bramley, et al. “Research at UCLA Links Sleep Apnea to Loss of Memory | UCLA Health.” Www.uclahealth.org, 11 June 2008, www.uclahealth.org/news/research-at-ucla-links-sleep-apnea-to-loss-of-memory. Accessed 7 July 2022.
Boksem, Maarten A. S., and Mattie Tops. “Mental Fatigue: Costs and Benefits.” Brain Research Reviews, vol. 59, no. 1, 1 Nov. 2008, pp. 125–139, www.sciencedirect.com/science/article/abs/pii/S0165017308000714, 10.1016/j.brainresrev.2008.07.001.
Danner, Fred, and Barbara Phillips. “Adolescent Sleep, School Start Times, and Teen Motor Vehicle Crashes.” Journal of Clinical Sleep Medicine, vol. 04, no. 06, 15 Dec. 2008, pp. 533–535, 10.5664/jcsm.27345. Accessed 31 Jan. 2020.
Dexter, Donn, et al. “Sleep, Sleepiness and School Start Times: A Preliminary Study.” WMJ: Official Publication of the State Medical Society of Wisconsin, vol. 102, no. 1, 2003, pp. 44–46, pubmed.ncbi.nlm.nih.gov/12679971/. Accessed 27 Oct. 2021.
Halbower, Ann C, et al. “Childhood Obstructive Sleep Apnea Associates with Neuropsychological Deficits and Neuronal Brain Injury.” PLoS Medicine, vol. 3, no. 8, 22 Aug. 2006, p. e301, 10.1371/journal.pmed.0030301. Accessed 2 June 2021.
Mary, A. Carskadon, et al. “Sleep Loss in Young Adolescents.” Sleep, vol. 4, no. 3, Sept. 1981, pp. 299–312, 10.1093/sleep/4.3.299. Accessed 28 Oct. 2019.
Patel, Tulpesh, et al. “Moderate Relationships between NAA and Cognitive Ability in Healthy Adults: Implications for Cognitive Spectroscopy.” Frontiers in Human Neuroscience, vol. 8, 2014, 10.3389/fnhum.2014.00039.
Reese, Phillip. “More Adolescents Seek Medical Care for Mental Health Issues.” Kaiser Health News, 12 Nov. 2019, khn.org/news/more-adolescents-seek-medical-care-for-mental-health-issues/. Accessed 7 July 2022.
Short, Michelle A., et al. “The Sleep Patterns and Well-Being of Australian Adolescents.” Journal of Adolescence, vol. 36, no. 1, 1 Feb. 2013, pp. 103–110, 10.1016/j.adolescence.2012.09.008.
Suni, Eric, and Alex Dimitriu. “Sleep for Teenagers.” Sleep Foundation, Sleep Foundation, 5 Aug. 2020, www.sleepfoundation.org/teens-and-sleep.
“28 Collection of Brain Clipart Easy High Quality Free - Simple Brain Clip Art, HD Png Download - Kindpng.” KindPNG.com, www.kindpng.com/imgv/Jhxhwm_28-collection-of-brain-clipart-easy-high-quality/. Accessed 7 July 2022.
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