The Association Between Sleep And Executive Function In Adolescents

Part ? Analysis of sleep status and related factors among adolescents in ShanghaiOBJECTIVE: To investigate sleep status and related factors among adolescents in Shanghai.METHODS: Multi-stage stratified cluster random sampling method was used to select students and parents from 12 junior schools and 12 high schools in 6 administrative districts in Shanghai from November 2017 to January 2018.Sleep was evaluated from 3 dimensions: sleep duration,sleep quality and chronotype.Sleep duration was mainly analyzed by weekday sleep duration,weekend sleep duration,average sleep duration and weekend catch-up sleep duration.Sleep quality was assessed by Insomnia Severity Index(ISI),Pediatric Daytime Sleepiness Scale(PDSS)and Sleep Disturbance Scale for Children(SDSC).Chronotype was assessed by reduced version of Morningness-Eveningness Questionnaire(r MEQ).Among sleep-related factors,negative emotions were assessed by 21-Item Depression Anxiety and Stress Scale(DASS-21)and physical activity level was assessed by International Physical Activity Questionnaire(IPAQ).All data were collected in electronic form.RESULTS: Total of 2336 adolescents were enrolled in our study.After excluding adolescents with physical and mental illnesses diagnosed by doctors,1986 cases(85.0%)were available for final analysis.The mean age was(14.71±2.01)years and 1019(51.3%)were male.Weekday sleep duration was(7.83±1.15)h,weekend sleep duration was(9.77±1.42)h,average sleep duration was(8.38±1.01)h,and weekend catch-up sleep duration was(1.94±1.56)h.The incidence of sleep insufficiency(average sleep duration<8h)was 34.3%.The incidence of insomnia symptom was 37.0%,sleepiness symptom was 46.6% and sleep disturbance symptom was 3.2%.Chronotype was intermediate types(60.1%)in the majority,followed by morning types(32.0%)and evening types(7.9%).Senior school students had shorter average sleep duration,higher incidence of sleep insufficiency,insomnia and sleepiness symptoms and later chronotype compared with junior school students(p<0.001).With every additional year of age,the risk ratio of sleep insufficiency increased by 71%(95% CI: 1.60~1.83),insomnia symptom increased by 19%(95% CI: 1.12~1.26),sleepiness symptom increased by 27%(95% CI: 1.20~1.34)and evening types increased by 50%(95% CI: 1.33~1.68).Stress(OR=1.51,95% CI: 1.09~2.10)increased the risk ratio of sleep insufficiency.Risk factors for insomnia symptom included stress(OR=2.21,95% CI: 1.62~2.99),anxiety(OR=3.00,95% CI: 2.29~3.92),depression(OR=2.58,95% CI: 1.93~3.46),and the risks were higher in junior school students.Risk factors for sleepiness symptom included female(OR=1.47,95% CI: 1.19~1.83),stress(OR=2.04,95% CI: 1.50~2.79),anxiety(OR=1.81,95% CI: 1.41~2.31)and depression(OR=1.94,95% CI: 1.44~2.60).Anxiety(OR=3.36,95% CI: 1.51~7.47)increased the risk ratio of sleep disturbance symptom in junior school students.Risk factors for evening types included anxiety(OR=2.60,95% CI: 1.50~4.52)and depression(OR=3.03,95% CI: 1.74~5.26).CONCLUSIONS: Sleep insufficiency,insomnia and sleepiness symptoms were common among adolescents in Shanghai.With increase of age,incidence of sleep insufficiency,insomnia symptom,sleepiness symptom and evening types increased significantly.In addition,negative emotion was also an important factor related to sleep.Therefore,it is necessary to pay close attention to sleep problem of adolescents,especially problems that are increasingly prominent with age,and intervention of negative emotions of adolescents is needed to improve sleep quality.Part ? The association between sleep and executive function in adolescentsOBJECTIVE: To investigate executive function status among adolescents in Shanghai and explore the association between sleep characteristics and executive function.METHODS: Multi-stage stratified cluster random sampling method was used to select students and parents from 12 junior schools and 12 high schools in 6 administrative districts in Shanghai from November 2017 to January 2018.International standardized questionnaire Behavior Rating Inventory of Executive Function(BRIEF)was used to assess executive function of students by parents.Meanwhile,students' sleep duration,sleep quality and chronotype parameters were collected.Sleep quality was assessed by Insomnia Severity Index(ISI),Pediatric Daytime Sleepiness Scale(PDSS)and Sleep Disturbance Scale for Children(SDSC).Chronotype was assessed by reduced version of Morningness-Eveningness Questionnaire(r MEQ).Negative emotions were assessed by 21-Item Depression Anxiety and Stress Scale(DASS-21)and physical activity level was assessed by International Physical Activity Questionnaire(IPAQ).All data were collected in electronic form.RESULTS: Total of 2336 adolescents were enrolled in our study.After excluding adolescents with physical and mental illnesses diagnosed by doctors,1986 cases(85.0%)were available for final analysis.The mean age was(14.71±2.01)years and 1019(51.3%)were male.The average Global Executive Composite(GEC)was(49.83±9.45),and the suspicious rate of executive function(GEC>65)was 5.94%.GEC of boys was significantly higher than girls(t=6.71,p<0.001).There was a significant difference of GEC among adolescents with different levels of family income(F=5.24,p=0.005),and adolescents with a family income less than 50,000/year had significantly lower GEC than those with income of 50,000~150,000/year(p=0.005).Adolescents with stress,anxiety and depression had significantly higher GEC than those without(p<0.001).Adolescents with symptoms of sleep insufficiency,insomnia,sleepiness and sleep disturbance had significantly higher GEC than those without(p<0.001).The later the chronotype,the higher GEC(F=11.74,p<0.001).Pearson correlation analysis showed that adolescents' sleep duration was negatively correlated with GEC in all dimensions(except inhibition);ISI,PDSS and SDSC scores were positively correlated with GEC in all dimensions;r MEQ score was negatively correlated with GEC in all dimensions.Multiple linear regression results showed that after adjustment for confounding factors,sleep disturbance was significantly positively correlated with GEC(?=0.40,t=17.89,p<0.001),while sleep duration or chronotype were not correlated with GEC.Also,gender(?=-0.15,t=-6.77,p<0.001)and depression(?=0.11,t=3.06,p=0.002)were significantly correlated with GEC.Logistic regression analysis showed that sleep disturbance significantly increased the risk ratio of suspicious executive function in senior school students(OR=4.02,95% CI: 1.81~8.93);sleep insufficiency significantly increased the risk ratio of suspicious executive function in junior school boys(OR=1.64,95% CI: 1.00~2.66),mainly in emotional control(OR=2.20,95% CI: 1.02~2.69).CONCLUSIONS: Girls' executive function performance was significantly better than boys' in Shanghai,and adolescents with depression performed significantly worse than those without.Sleep disturbance was strongly associated with executive function in adolescents,which increased the risk of suspicious executive function especially in senior school students.Sleep insufficiency was associated with an increased risk of suspicious executive function in junior school boys,particularly in emotional control.Therefore,sleep is an important factor affecting executive function,suggesting improving sleep quality may be an important measure to improve adolescents' executive function.