Sex And Pubertal Effects On Daytime Sleepiness In School-aged Children And Adolescents

Abstract

Background: Excessive daytime sleepiness (EDS) was found to be prevalent among school-aged children and adolescents. We aimed to examine the prevalence of EDS among Hong Kong Chinese students across pubertal stages. In addition, the effects of EDS on mental and behavioral problems were also examined. Methods: A total of 10086 students (boys, 48.1%) aged from 6-18 years (mean: 12.3 ± 3.2 years) were recruited. Socio-demographics, sleep duration, chronotypes, behavioral and emotional problems, and Tanner pubertal stages were measured. EDS was defined as total score of the Pediatric Daytime Sleepiness Scale > 18. Results: The prevalence of EDS was 29.2% and increased from 19.8% at Tanner stage 1 to 47.2% at Tanner stage 5 with an emergence of girl preponderance at Tanner stage 3. Girls were more likely to having EDS than boys upon the effect of short weekday sleep duration (interaction p < 0.001). Participants at pre-puberty were more affected by eveningness (interaction p < 0.001). The association of EDS with SDQ total difficulties and emotional symptoms were stronger in adolescents at post-puberty than in adolescents at pre-puberty (interaction p < 0.01). However, the associations of EDS with SDQ prosocial behavior was stronger in adolescents at pre-puberty than in adolescents at late puberty (interaction p < 0.01). Conclusions: EDS is prevalent with a progressive increase across pubertal development among children and adolescents. Sex and puberty effects indicate that timely intervention at adolescence period is needed to mitigate the highly prevalent EDS and its negative impact of behaviour and emotion.