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Sleep and Student Performance at School
Howard Taras, William Potts-Datema
ABSTRACT: To review the state of research on the association between sleep among school-aged children and academic outcomes,
the authors reviewed published studies investigating sleep, school performance, and cognitive and achievement tests. Tables with
brief descriptions of each study’s research methods and outcomes are included. Research reveals a high prevalence among
school-aged children of suboptimal amounts of sleep and poor sleep quality. Research demonstrates that suboptimal sleep affects
how well students are able to learn and how it may adversely affect school performance. Recommendations for further research are
discussed. (J Sch Health. 2005;75(7):248-254)
H
ealth professionals frequently remind educators of
the correlation between healthy behaviors and educa-
tional o utcomes. However, evidence for this connection is
not always apparent or readily available. The increasing
emphasis on accountability for schools has amplified the
importance of demonstrating connections between stu-
dents’ health and their academic performance. An under-
standing of the impact of student health on educational
outcomes has major implications. Among them are rami-
fications for how schools address health concerns, such as
the focus of their school health programs.
The National Coordinating Committee on School
Health and Safety (NCCSHS), comprising representatives
of several federal departments and national nongovern-
mental organizations, encourages school districts to
respond to evolving challenges by developing coordinated
school health programs. To enhance awareness of existing
evidence linking health and school performance and to
identify gaps in knowledge, the NCCSHS is reviewing
the state of research in related areas. The project involves
a literature search of peer-reviewed, published research
reporting on the relationship between students’ health and
their performance in school. Compilations of research
articles that explore the association between academic
performance and health include various chronic conditions
(eg, asthma, diabetes), nutrition, and physical activity.
This article summarizes what is known on the association
of sleep with academic outcomes among school-aged
children.
BACKGROUND ON SLEEP
Most children need at least 9 hours of restful sleep
each night.
1
However, for many reasons, school-aged chil-
dren may receive less than the recommended number of
hours of sleep. These reasons include the working, eating,
and bedtime patterns of students and their families, early
school start times, and childhood sleep disorders such as
disrupted sleep from snoring or breathing pauses. A num-
ber of research artic les have reported on the prevalence of
suboptimal sleep in school-aged children and the associa-
tion of quality and quantity of sleep with school perfor-
mance and measures of cognitive ability.
SELECTION OF SLEEP ARTICLES
Only articles meeting the following criteria were
selected for review: (1) study subjects were school-aged
children (5-18 years); (2) the article was published in
the past 10 years (1994-2004) in a peer-reviewed journal;
and (3) the research included at least 1 of the following
outcomes—school attendance, academic achievement, a
measure of cognitive ability (such as general intelligence,
memory), and attention. The outcome of students’ level
of attention was acceptable only if measur ed objectively.
Studies were identified using MedLine and similar Inter-
net-based searches. If a full article could not be retri eved,
studies with detailed abstracts were included. Many stud-
ies cited in this review had major outcome measures other
than those pertinent to the objectives of this project.
These alternative outcomes may not be described at all or
are briefly mentioned.
LITERATURE REVIEW
Investigators are attempting to answ er several ques-
tions: How much sleep are students getting? Do inade-
quate amounts or quality of sleep affect educational
outcomes or cognitive performance? What is the effect of
sleep-disordered breathing on students? Is daytime sleepi-
ness associated with school performance?
Tables 1-3 contain lists of articles on sleep that met the
inclusion criteria. A brief description of the experimental
design and the outcome also is included for each. Table 1
lists general articles on sleep in school-aged children.
The largest number of articles studied sleep disorders
and sleep habits and patterns, particularly among adoles-
cents. Many studies on sleep disorders are on sleep-disor-
dered breathing. Most are relatively recent and include
control groups. Research findings appear to be relatively
consistent, although outcome measures differ. An excel-
lent review by Blunden et al
2
in 2001 of 13 articles dem-
onstrated that reduced attention, memory, intelligence, and
increased problematic behavior resulted from sleep-related
obstructive breathing. With the exception of 1 study in this
review, children in all studies improved in neurocognitive,
behavioral, and/or school performance after an adenoid-
tonsillectomy. Articles listed in Table 2 are those not re-
viewed by Blunden et al that investigate the same issues.
Like the conclusions of Blunden et al, the findings of these
studies raise concern because of the high prevalence of
Howard Taras, MD, Professor, (htaras@ucsd.edu), Division of Community
Pediatrics, University of California, San Diego, Gilman Drive #0927,
La Jolla, CA 92093-0927; and William Potts-Datema, MS, Director,
(wpottsda@hsph.harvard.edu), Partnerships for Children’s Health, Harvard
School of Public Health, 677 Huntington Ave, 7th Floor, Boston, MA 02115.
This article is 1 of 6 articles that are part of a project of the National Coor-
dinating Committee on School Health and Safety (NCCSHS). This NCCSHS
project was funded by the US Department of Health and Human Services,
Department of Education, and US Department of Agriculture. Opinions ex-
pressed in this article are not necessarily shared by these federal agencies
or other institutions that comprise NCCSHS membership.
248
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Journal of School Health
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September 2005, V ol. 75, No. 7
sleep-disordered breathing among elementary school student
populations. Most articles demonstrate an effect on neuro-
cognitive ability. Fewer demonstrate effects on academic
performance. It is encouraging that academic achievement
among children with disordered breathing improves after
corrective measures are taken, such as surgery or tonsillec-
tomy/adenoidectomy. If minor sleep disorders, such as snor-
ing, can be identified and managed prior to or during the
school-age years, significant improvement in educational
outcomes may ensue.
Table 3 lists published research that investigates sleep
patterns among children and adolescents. The research
findings raise several important issues for educators. The
onset of adolescence appears to be accompanied by
a decrease in sleep in a 24-hour period among many youth
at this stage of life. The academic consequences of these
changes in sleep habits are inconclusive. Data collection
in studies performed to date is based more on surveillance
of parents, teachers, or students—a methods that requires
some level of validation.
Some school districts have pushed back school start times
for adolescents, and the issue of school starting times is
widely debated among parents of adolescents and school ad-
ministrators. Unfortunately, published peer-reviewed studies
that investigate the benefits of such modifications are virtu-
ally absent in the literature. Experimental conditions of sleep
restriction and deprivation appear to impair neuropsycholog-
ical performance related to higher-level cognitive functions
and attention. But reversal of this through changed school
start times has yet to be proven.
An excellent article by Fallone et al
3
reviewed many of
the studies included in this collection and concluded that
varying definitions of ‘‘good’’ versus ‘‘poor’’ sleep limit the
ability to compare studies. A review of the literature was
performed by Wolfson and Carskadon
4
in 2003. These
reviewers noted that a majority of studies in this field rely
Table 1
General Articles on Sleep in School-Aged Children
Reference (Origin) Experimental Design Outcome
Eliasson A, Eliasson A, King J,
Gould B, Eliasson A. Association of
sleep and academic performance.
Sleep Breath. 2002;6(1):45-48.
(United States)
Teachers administered a 1-page
questionnaire to 1000 students in 9th
through 12th grades in a number of
schools in 1 community as well as to
200 7th graders. Self-reported Grade
Point Average (GPA) included in
questionnaire.
90% of students feel groggy at school
from sleepiness, 40% very groggy.
Average sleep time 6.7 hours/night
on weekdays (7.7 on weekends). No
correlation between sleep time and
academic performance in any grade.
Kahn A, Van de Merckt C, Rebuffat E,
et al. Sleep problems in healthy
preadolescents. Pediatrics.
1989;84(3):542-546.
(Belgium)
Parents of 972 3rd- to 5th-grade
children completed questionnaires
about their own and their children’s
sleeping habits and schooling.
Sleep difficulties lasting more than
6 months were present in 43%
of children. Among the 132 poor
sleepers, 21% failed 1 or more years
of school—a significantly higher
percentage than found among those
without sleep problems. 28%
expressed a desire for counseling.
Link SC, Ancoli-Israel S. Sleep and the
teenager. Sleep Res. 1995;24A:184.
(United States)
150 high school students (mean age
16 years) were given a questionnaire
that included sleep questions and
GPA.
High GPA correlated significantly with
waking up later on school days, early
rising on weekends, less time taken
to fall asleep, fewer night
awakenings, and fewer daytime naps
on school days.
Meijer AM, Habekothe HT, Van Den
Wittenboer GL. Time in bed, quality
of sleep and school functioning
of children. J Sleep Res.
2000;9(2):145-153.
(Netherlands)
449 students (9-14 years) responded to
classroom questionnaires, including
Bourdon-Vos pencil/paper test
measured attention, School
Perception Questionnaire of school
functioning, and a sleep
questionnaire. Study also controlled
for psychosomatic and neurotic
complaints that could influence the
association between sleep and
school functioning (using
a standardized questionnaire
measuring these characteristics).
15% report sleep problems, 43% have
difficulty getting up in the morning,
and 25% do not feel rested at school.
Regression analyses demonstrated
that although sleep characteristics do
not have an impact on concentration,
they do have a significant impact on
some aspects of school functioning,
in particular, children’s motivation to
achieve in school.
Journal of School Health
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September 2005, Vol. 75, No. 7
d
249
Table 2
Articles on Disordered Sleep (Continued on next page)
Reference (Origin) Experimental Design Outcome
Ali NJ, Pitson D, Stradling JR. Sleep disordered
breathing: effects of adeno-tonsillectomy on
behavior and psychological functioning. Eur J
Pediatr. 1996;155:56-62.
(United Kingdom)
33 children (6-12 years) who snored and were
on a waiting list for having their adenoids and
tonsils removed were visited at home and
monitored during sleep with a video and
oximetry (measure of air exchange and
oxygenation). Of these, 12 had evidence of
sleep disturbance secondary to airway
obstruction and 11 of those remaining on the
waiting list were matched by age and sex with
the 12. Another 10 control children were
studied as well. All children were studied for
intelligence (WISC-R), attention (continuous
performance test), and tests of impulsivity and
behavior were performed before surgery and
3-6 months after surgery.
Children with sleep-disordered breathing
improved in aggression, inattention,
hyperactivity, and vigilance after surgery, but
not on intelligence. The other 2 groups did not
change on pre- and posttests, or changed for
only hyperactive behavior and vigilance.
Andreou G, Karapetsas A, Agapitou P,
Gourgoulianis K. Verbal intelligence and sleep
disorders in children with ADHD. Percept Mot
Skills. 2003;96(3 Pt 2):1283-1288.
(Greece)
18 children (8-13 years) with ADHD were
matched with 18 age- and sex-matched
control children. Measures were ADHD
assessments, five verbal scales of the WISC-
III (intelligence scale), and polysomnographic
studies of sleep.
Poor quality of sleep was found on children with
ADHD (apnea, desaturated hemoglobin, and
awakenings associated with limb activity and
snoring). These children had low performance
(of up to 20 points) on the WISC-III verbal
scores.
Blunden S, Lushington K, Kennedy D, Martin J,
Dawson D. Behavior and neurocognitive
performance in children aged 5-10 years who
snore compared to controls. J Clin Exp
Neuropsych. 2000;22(5):554-568.
(Australia)
16 children referred to ENT/pulmonary clinic for
snoring evaluation (mean age 7.2). Matched
with 16 controls for age and sex. WISC (and
WPPSI-R for preschoolers), WRAML,
Auditory Continuous Performance Test and
Child Behavior Checklist measured
intelligence, memory and learning, attention
and behavior. Sleep measured using parents’
7-day sleep log, polysomnography, and
a sleep disturbance scale.
Compared to controls, children who snored
(but who did not necessarily have obstructive
sleep apnea) showed significantly impaired
attention, lower memory and intelligence
scores (although memory and intelligence
were within normal range). Mild sleep-
disordered breathing affected daytime
functioning.
Chervin RD, Clarke DF, Hoffman JL. School
performance, race, and other correlates of
sleep-disordered breathing in children. Sleep
Med. 2003;4:21-27.
(United States)
Students in 2nd and 5th grades in 1 school
district recruited by sending letters home.
Sleep-disordered breathing was measured
using a validated parent questionnaire. School
performance was measured using teachers’
ratings (5-point scale) and year-end Reading
and Math assessments.
146 parents completed the questionnaires on
their children. Sleep-disordered breathing was
associated with poor teacher rating. Sleep-
disordered breathing was not significantly
associated with Reading or Math assessment
scores.
250
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Journal of School Health
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September 2005, Vol. 75, No. 7
Table 2
Articles on Disordered Sleep (Continued from previous page)
Reference (Origin) Experimental Design Outcome
Gozal D. Sleep-disordered breathing and school
performance in children. Pediatrics.
1998:102(3);616-620.
(United States)
1st-grade children ranked in the lowest 10th
percentile of class were identified (297).
Parents completed a questionnaire on
obstructive sleep apnea; children received
overnight recordings of sleep and respiratory
function/gas exchange at night. Parents of
children with abnormal results were
encouraged to seek surgical correction.
Schools provided academic grades for
2 successive years.
Gas exchange difficulty, indicative of obstructive
sleep apnea, occurred frequently among 1st
graders with academic difficulty (18%). Those
with gas exchange problems who received
a tonsillectomy/adenoidectomy significantly
improved their grades (2.4-2.9) the following
year, whereas those electing not to get
recommended surgery had no significant
increase. No academic improvements
occurred in those without evidence
of obstructive sleep apnea.
Owens J, Spirito A, Marcotte A, McGuinn M,
Berkelhammer L. Neuropsychological and
behavioral correlates of obstructive sleep
apnea syndrome in children: a preliminary
study. Sleep Breath. 2000;4(2):67-77.
(United States)
18 children (age 7.3 years) with obstructive
sleep apnea were tested for a number of
neuropsychologic functions: general cognitive
functioning (McCarthy Scales); language
(Peabody Picture Vocabulary); executive
functioning, such as planning and
organization; and attention, memory (Memory
Scale of McCarthy Scale), and visual
perception and visual motor integration. Motor
and behavioral measures (parent ratings)
were also conducted. Eight children who
received an adenoid-tonsillectomy were
reevaluated.
Modest impairments in executive functioning,
attention, and motor skills were found. There
was little correlation between the severity of
the obstructive sleep apnea (as measured by
Apnea Hypopnea Index) and the level of
functioning. Tests did not significantly improve
after surgery, although some approached
statistical significance for improvement.
Roberts RE, Roberts CR, Chen LG. Functioning
of adolescents with symptoms of disturbed
sleep. J Youth Adolesc. 2001;30:1-18.
(United States)
Data from a large school-based survey of 5423
students (grades 6-8) were used to examine
the association between levels of functioning
and symptoms of insomnia (a period of at
least 2 weeks of having trouble falling asleep,
staying asleep, or awakening too early) and
‘‘hypersomnia’’ (at least 2 weeks of sleeping
too much).
Approximately 6%, 12%, and 3% of student
population reported hypersomnia only,
insomnia only, and both (respectively). Using
those without sleep problems as a reference
group and logistic regression analysis, the
authors found that reported absence due to
illness was significantly increased among
students who had insomnia and those with
both hypersomnia and insomnia.
ADHD, Attention Deficit/Hyperactivity Disorder; WISC-III, Wechsler Intelligence Scale for Children—Third Edition; WISC-R, Wechsler Intelligence Scale for Children—Revised;
WPPSI-R, Wechsler Preschool and Primary Scale—Revised; WRAML, Wide Range Assessment of Memory and Learning—Second Edition.
Journal of School Health
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September 2005, Vol. 75, No.7
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251
Table 3
Articles on Sleep Habits and Sleep Deprivation (Continued on next page)
Reference (Origin) Experimental Design Outcome
Allen RP. Social factors associated with the amount of
school week sleep lag for seniors in an early starting
suburban high school. Sleep Res. 1992;21:114.
(United States)
All students attending 12th grade in a human behavior
class in 1 ‘‘early starting’’ school (7:40 AM) were
surveyed anonymously for sleep patterns, partying
habits, grades, alcohol consumption, and other habits.
Those students who went to bed later on weekends
(ie, they did not ‘‘catch up’’ on sleep lost during the
week as a result of an early start) had poorer grades.
A usual weekend bedtime after 2:30 AM was reported
by 15% of students with A and B1 grades, and 35% of
those reporting average grades.
Drake C, Nickel C, Burduvali E, Roth T, Jefferson C,
Pietro B. The pediatric daytime sleepiness scale
(PDSS): sleep habits and school outcomes. Sleep.
2003;26(4):455-458.
(United States)
450 students (age 11-15) responded to a written survey of
sleep and school achievement and sleepiness.
Significant linear relationships found between sleep time
and daytime sleepiness. Significant linear relationships
found between daytime sleepiness and school
achievement. Sleepiness across grade levels indicated
that sleepiness increased significantly with grade level.
Epstein R, Chillag N, Lavie P. Starting times of school:
effects on daytime functioning of fifth-grade children in
Israel. Sleep. 1998;21(3):250-256.
(Israel)
5th-grade pupils (10-12 years old) from 28 classes in
18 schools throughout Israel were divided into ‘‘early
risers’’ (N ¼ 232), who started school at 7:10 AM (42%)
at least 2 times a week, and ‘‘regular risers’’ (N ¼ 340),
who always started school at 8:00 AM (58%). Children
completed self-administered questionnaires concerning
sleep habits during school days, weekends, and
holidays, daytime fatigue, sleepiness, and difficulties
concentrating and paying attention in school.
Mean sleep time of the ‘‘early risers’’ was significantly
shorter than that of the ‘‘regular risers.’’ Early risers
complained significantly more about daytime fatigue
and sleepiness, and about attention and concentration
difficulties in school. Their complaints were
independent of the reported hours of sleep.
Fallone G, Acebo C, Arnedt JT, Seifer R, Carskadon MA.
Effects of acute sleep restriction on behavior, sustained
attention, and response inhibition in children. Percept
Mot Skills. 2001;93:213-229.
(United States)
82 children (age 8-15) completed 5 nights of baseline
sleep and then randomly assigned to optimized (10
hours) or restricted (4 hours) sleep in an overnight lab.
Behavior, performance, and sleepiness were assessed
the following day. Students reported sleepiness and
were given several observation measures of
attentiveness.
Although sleep restriction was associated with increased
child reports of sleepiness and inattentive behaviors,
there was no significant impaired performance on tests
of response inhibition and of sustained attention.
Fredriksen K, Rhodes J, Reddy R, Way N. Sleepless in
Chicago: tracking the effects of adolescent sleep loss
during the middle school years. Child Dev.
2004;75(1):84-95.
(United States)
2259 students (age 10 through 14 over the course of the
study) were given a survey annually for 3 consecutive
years by their middle school teacher. Sleep, depressive
symptoms, self-esteem, and academic outcomes were
self-reported by the students. A statistical model was
used to determine whether fewer hours of sleep caused
poor grades, lower self-esteem, and depressive affect
or whether these caused poor sleep.
Girls initially reported more sleep than boys, yet reported
a sharper decline over the course of 3 years than boys.
Girls reported higher grades than boys initially and over
the 3 years. Students who initially reported higher
levels of sleep also tended to report higher grades. The
rate of change in hours of sleep over the 3 years was
not significantly associated with their grades. Grades
(and esteem and affect) were influenced by sleep, not
vice versa.
252
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Table 3
Articles on Sleep Habits and Sleep Deprivation (Continued from previous page)
Reference (Origin) Experimental Design Outcome
Giannotti F, Cortesi F, Sebastiani T, Ottaviano S.
Circadian preference, sleep and daytime behaviour in
adolescence. J Sleep Res. 2002;11(3):191-199.
(Italy)
Over 6600 adolescents (age 14-18) completed
a comprehensive questionnaire. The questionnaire
helped to categorize adolescents into morning types
and evening types.
Study confirmed an increasing tendency with age to be
less sleepy during evenings and more sleepy during
mornings (evening type). Evening types demonstrated
more sleepiness during day, reported poorer school
achievement, less attentiveness, and higher
consumption of caffeine beverages.
Randazzo AC, Muehlbach MJ, Schweitzer PK, Walsh JK.
Cognitive function following acute sleep restriction in
children ages 10-14. Sleep. 1998;21:861-868.
(United States)
16 children (10-14 years) were randomly assigned to
a control group (11 hours in bed) or an experimental
group (sleep deprived with maximum 5 hours in bed) on
a single night in a sleep laboratory. Sleep was
monitored using a polysomnograph test, sleep latency
was measured (time to fall asleep), and testing was
done the next day. Tests included the Digit Symbol
Substitution Test, Steer Clear test for visual vigilance,
WRAML (assessment of learning and memory),
Torrance Test of Creative Thinking, Children’s
Category Test (learning and problem solving),
Wisconsin Card Sorting Test, and California Verbal
Learning Test.
Cognitive tests with significant differences between the
control and sleep-deprived groups were always worse
for the sleep deprived, but limited to the following
cognitive functions: verbal creativity and the Wisconsin
Card Sorting Test. All other tested areas were similar
between control and sleep-restricted groups.
Sadeh A, Gruber R, Raviv A. The effects of sleep
restriction and extension on school-age children.
Child Dev. 2003;74:444-455.
(Israel)
The sleep of 77 children in 4th through 6th grades (9-12
years) was monitored nightly. Neurobehavioral function
tests were measured on the 2nd day of their normal
sleep schedule. On the 3rd through 5th nights, 40
children were asked to extend their sleep by 1 hour and
37 children were asked to restrict their sleep by 1 hour.
Tests were repeated on the 6th day. Tests included
finger tapping (motor speed), reaction time, continuous
performance test (visual attention and motor speed),
symbol-digit substitution (visual memory, scanning, and
speed), visual digit span test (working memory,
attention), serial digit learning (working memory,
learning strategies).
Children who extended their sleep significantly improved
their performance on the digit forward memory test and
reaction time with the continuous performance test.
Those children who decreased or maintained the same
number of sleep hours as they had at baseline showed
no change in neurobehavioral functioning. The authors
conclude that even modest extensions in sleep per
night could have benefits in neurobehavioral
functioning.
Shin C, Kim J, Lee S, Ahn Y, Joo S. Sleep habits,
excessive daytime sleepiness and school performance
in high school students. Psychiatry Clin Neurosci.
2003;57(4):451-453.
(South Korea)
Survey of 4781 11th-grade students from 10 randomly
selected schools. Excessive daily sleepiness based on
‘‘Epworth Sleepiness Scale.’’ Achievement was based
on the quartile students’ ranked in their final exams of
their first semester. There was an 80% response rate.
Mean total sleep time was 6.4 hours/day. Total sleep time
did not significantly correlate with excessive daily
sleepiness. Prevalence of excessive daily sleepiness
increased significantly with a decline in school
performance.
Journal of School Health
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253
on self-report. Self-reported shortened sleep time, erratic
sleep/wake schedules, late bed and rise times, and poor
sleep quality are negatively associated with academic
performance for adolescents from middle school through
college years. Future research designs must go beyond sub-
jective feelings of sleepiness to measure academic perfor-
mance. We need methodologies that include control groups
and randomization.
Despite the drawbacks in the literature on sleep depri-
vation among teenage populations, the preponderance of
literature that recognizes the detrimental effects of sleep
disorders is astounding and perhaps not fully appreciated
among many primary care providers, school health profes-
sionals, and educators. Professionals faced with school-
aged children with learning or attention disorders have
enough scientific justification to suspect that poor sleep
may be a contributing factor. These children and their
families should be asked about regularity and duration
of sleep, bedtime resistance, sleep onset delay, night-
wakings, sleep-disordered breathing, and increased day-
time sleepiness. j
References
1. National Heart, Lung, and Blood Institute. Star Sleeper. Available
at: http://www.nhlbi.nih.gov/health/public/sleep/starslp/parents/whysleep.
htm. Accessed March 8, 2004.
2. Blunden S, Lushington K, Kennedy D. Cognitive and behavioral
performance in children with sleep-related obstructive breathing disorders.
Sleep Med Rev. 2001;5(6):447-461.
3. Fallone G, Owens JA, Deane J. Sleepiness in children and adoles-
cents: clinical applications. Sleep Med Rev. 2002;6(4):287-306.
4. Wolfson AR, Carskadon MA. Understanding adolescents’ sleep
patterns and school performance: a critical appraisal. Sleep Med Rev.
2003;7(6):491-506.
Table 3
Articles on Sleep Habits and Sleep Deprivation (Continued from previous page)
Reference (Origin) Experimental Design Outcome
Wolfson AR, Carskadon MA. Sleep schedules and
daytime functioning in adolescents. Child Dev.
1998;69(4):875-887. (United States)
Sleep habits survey given to 3120 students (age 13-19
years) at 4 high schools. Cross-sectional study. Sleep
time and school performance were self-reported. A
depressive mood scale was also given.
Students of older ages report decreasing hours of sleep
(a decrease of 45 minutes/night from age 13 to 19) due
to later bedtimes. Students with grades averaging C, D,
and F obtained 25 minutes less sleep and went to bed
40 minutes later than students with A’s and B’s.
Weekend delays in bedtime were also associated with
poorer grades.
WRAML, Wide Range Assessment of Memory and Learning.
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