Sleep patterns in children and adolescents

First created | 10/10/2011

Last edited   | 05/11/2012

Written by Maurice M. Ohayon, MD, DSc, PhD

References to cite: 1) Ohayon MM. Sleep patterns in children and adolescents. SleepEval.com Website. Oct 2011. 2) Ohayon MM, Carskadon MA, Guilleminault C, Vitiello MV. Meta-analysis of quantitative sleep parameters from childhood to old age in healthy individuals: developing normative sleep values across the human lifespan. Sleep. 2004 Nov 1;27(7):1255-73. Free PMC

Four age-related changes have been consistently demonstrated in polysomnographic (PSG) studies of sleep architecture:

- total sleep time (7-29),

- sleep efficiency (7,9-14,17-23,25-29,30-36), and

- slow wave sleep (7,8,10, 12-18, 21-28, 31,33, 35,37-39) all decrease, while

- wake after sleep onset (12-14,16,17,19,21,23,28,29, 32,33,36,37,40) increases with age.

 

Why such discrepancies between the studies?

Several factors may be responsible for the difficulties identifying age trends in sleep architecture of apparently healthy subjects. For example: small sample sizes; inconsistency in controlling factors that may influence sleep, such as mental or physical illness; insufficient screening for sleep disorders.

 

 

Methods

 

Targeted studies

• Non-clinical studies

• Participants aged 5 to 18 years

• measures of sleep characteristics by “all night” polysomography (PSG)

• or measures of sleep-wake patterns obtained by questionnaires.

• data presented numerically

• published between 1960 and 2003 in peer-reviewed journals.

 

Variables analyzed

• Sleep latency (SL)

• Sleep efficiency (SE)

• Total sleep time (TST)

• Stage 1,

•  stage 2,

• slow wave sleep (SWS),

• REM

• REM latency

• Minutes awake after sleep onset (WASO)

• Bedtime & rising time

 

Questionnaires

- Number of studies: 21

- Number of subjects: 24,617

- Age range: 5-18 years

- Data examined:

• Bedtime,

• rising time and

• sleep duration for weekdays and weekends.

- Europe versus USA

 

 

 

Bedtime

 

Weekday:  age; interaction.  Weekend:  age; country; interaction.

 

 

 

Rising Time

 

Weekday:  age; country; interaction.  Weekend:  age; country.

 

 

Nighttime Sleep Duration

 

 

Weekday:  age; country; interaction.  Weekend:  age; country; interaction.

 

 

Polysomnography or Actigraphy

 

- Number of studies = 18

- Number of subjects = 1,186 ¨Age range: 5-18 years

- Variables examined: TST, SL, SE, WASO, REM, S1, S2, SWS

 

Significant changes

• TST

• Percentage stage 2

• Percentage SWS

• Percentage REM

 

Total sleep time

Percentage of Stage 2

Percentage SWS

Percentage REM

Discussion

 

Questionnaires

Age effects for weekdays and weekends

• Bedtime,

• rise time,

• total sleep time

 

Country effects

• Weekday rise time & TST,

• weekend bedtime, rise time,

• TST

 

Interaction effects

• Weekday bedtime,

• rise time,

• TST

•  weekend bedtime & TST

 

European studies focused more on younger samples than did US studies.

Patterns across age were reasonably consistent.

 

Interactions likely reflect socio-cultural differences.

 

PSG

Significant age-related changes in:

- TST,

- Stage 2 Sleep,

- SWS,

- REM

Extremely large variability.

Methodology may contribute to differences.

 

Careful controls and protocols are needed.

 

 

Conclusion

 

Normative data can provide a framework for understanding changes with age across time.

 

Societal and cohort differences may emerge as well-controlled studies emerge.

 

 

 

 

More Information

 

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