title: A multi-step pathway connecting short sleep duration to daytime somnolence, reduced attention, and poor academic performance: an exploratory cross-sectional study in teenagers.
abstract: BACKGROUND
  A multi-step causality pathway connecting short sleep duration to daytime somnolence and sleepiness leading to reduced attention and poor academic performance as the final result can be envisaged. However this hypothesis has never been explored.
  
  
  OBJECTIVE
  To explore consecutive correlations between sleep duration, daytime somnolence, attention levels, and academic performance in a sample of school-aged teenagers.
  
  
  METHODS
  We carried out a survey assessing sleep duration and daytime somnolence using the Pediatric Daytime Sleepiness Scale (PDSS). Sleep duration variables included week-days' total sleep time, usual bedtimes, and absolute weekday to-weekend sleep time difference. Attention was assessed by d2 test and by the coding subtest from the WISC-IV scale. Academic performance was obtained from literature and math grades. Structural equation modeling was used to assess the independent relationships between these variables, while controlling for confounding effects of other variables, in one single model. Standardized regression weights (SWR) for relationships between these variables are reported.
  
  
  RESULTS
  Study sample included 1,194 teenagers (mean age: 15 years; range: 13-17 y). Sleep duration was inversely associated with daytime somnolence (SWR = -0.36, p < 0.01) while sleepiness was negatively associated with attention (SWR = -0.13, p < 0.01). Attention scores correlated positively with academic results (SWR = 0.18, p < 0.01). Daytime somnolence correlated negatively with academic achievements (SWR = -0.16, p < 0.01). The model offered an acceptable fit according to usual measures (RMSEA = 0.0548, CFI = 0.874, NFI = 0.838). A Sobel test confirmed that short sleep duration influenced attention through daytime somnolence (p < 0.02), which in turn influenced academic achievements through reduced attention (p < 0.002).
  
  
  CONCLUSIONS
  Poor academic achievements correlated with reduced attention, which in turn was related to daytime somnolence. Somnolence correlated with short sleep duration.
authors.affiliation: Departamento de Docencia e Investigación, Facultad de Ciencias Médicas, Universidad Católica Argentina, Buenos Aires, Argentina. splloret@fleni.org.ar
authors.forename: Santiago
authors.initials: S
authors.lastname: Perez-Lloret
authors.forename: Alejandro J
authors.initials: AJ
authors.lastname: Videla
authors.forename: Alba
authors.initials: A
authors.lastname: Richaudeau
authors.forename: Daniel
authors.initials: D
authors.lastname: Vigo
authors.forename: Malco
authors.initials: M
authors.lastname: Rossi
authors.forename: Daniel P
authors.initials: DP
authors.lastname: Cardinali
authors.forename: Daniel
authors.initials: D
authors.lastname: Perez-Chada
mesh_terms: D000124:Achievement; D000293:Adolescent; D000294:Adolescent Behavior / Q000502:physiology; D001118:Argentina / Q000453:epidemiology; D001288:Attention / Q000502:physiology*; D015984:Causality; D003430:Cross-Sectional Studies; D006970:Disorders of Excessive Somnolence / Q000453:epidemiology*; D004521:Educational Measurement / Q000379:methods / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008297:Male; D012892:Sleep Deprivation / Q000453:epidemiology*; D011795:Surveys and Questionnaires; D013997:Time Factors
keywords: Sleep deprivation; academic performance; attention; daytime somnolence; structural equation modeling