Background

Although the American Academy of Sleep Medicine suggests at least 9 h of sleep per day for 6–12-year-olds, children in recent generations often report sleeping less than this amount. Because early adolescence is a crucial period for neurocognitive development, we aimed to investigate how insufficient sleep affects children's mental health, cognition, brain function, and brain structure over 2 years.

Methods

In this propensity score matched, longitudinal, observational cohort study, we obtained data from a population-based sample of 9–10-year-olds from 21 US study sites in the ongoing Adolescent Brain Cognitive Development (ABCD) study. Participants were categorised as having sufficient sleep or insufficient sleep on the basis of a cutoff of 9 h sleep per day. Using propensity score matching, we matched these two groups of participants on 11 key covariates, including sex, socioeconomic status, and puberty status. Participants were excluded from our analysis if they did not pass a baseline resting-state functional MRI quality check or had missing data for the covariates involved in propensity score matching. Outcome measures retrieved from the ABCD study were behavioural problems, mental health, cognition, and structural and resting-state functional brain measures, assessed at baseline and at 2-year follow-up. We examined group differences on these outcomes over those 2 years among all eligible participants. We then did mediation analyses of the neural correlates of behavioural changes induced by insufficient sleep.

Findings

Between Sept 1, 2016, and Oct 15, 2018, 11 878 individuals had baseline data collected for the ABCD study, of whom 8323 were eligible and included in this study (4142 participants in the sufficient sleep group and 4181 in the insufficient sleep group). Follow-up data were collected from July 30, 2018, to Jan 15, 2020. We identified 3021 matched sufficient sleep–insufficient sleep pairs at baseline and 749 matched pairs at 2-year follow-up, and observed similar differences between the groups in behaviour and neural measures at both timepoints; the effect sizes of between-group differences in behavioural measures at these two timepoints were significantly correlated with each other (r=0·85, 95% CI 0·73–0·92; p<0·0001). A similar pattern was observed in resting-state functional connectivity (r=0·54, 0·45–0·61; p<0·0001) and in structural measures (eg, in grey matter volume r=0·61, 0·51–0·69; p<0·0001). We found that cortico–basal ganglia functional connections mediate the effects of insufficient sleep on depression, thought problems, and crystallised intelligence, and that structural properties of the anterior temporal lobe mediate the effect of insufficient sleep on crystallised intelligence.

Interpretation

These results provide population-level evidence for the long-lasting effect of insufficient sleep on neurocognitive development in early adolescence. These findings highlight the value of early sleep intervention to improve early adolescents' long-term developmental outcomes.

Funding

National Institutes of Health.

中文翻译：

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睡眠持续时间对美国青少年早期神经认知发展的影响：倾向评分匹配的纵向观察性研究

背景

尽管美国睡眠医学会建议 6 至 12 岁的儿童每天至少需要 9 小时的睡眠，但近几代儿童的睡眠时间往往少于这个时间。由于青春期早期是神经认知发展的关键时期，我们旨在研究睡眠不足如何影响儿童在两年内的心理健康、认知、大脑功能和大脑结构。

方法

在这项倾向评分匹配、纵向、观察性队列研究中，我们从正在进行的青少年大脑认知发展 (ABCD) 研究中来自美国 21 个研究中心的 9-10 岁儿童样本中获得了数据。根据每天 9 小时睡眠的界限，参与者被分为睡眠充足或睡眠不足。使用倾向评分匹配，我们将这两组参与者在 11 个关键协变量上进行匹配，包括性别、社会经济地位和青春期状况。如果参与者未通过基线静息态功能 MRI 质量检查或缺少参与倾向评分匹配的协变量数据，则他们将被排除在我们的分析之外。ABCD 研究检索到的结果指标包括行为问题、心理健康、认知以及结构性和静息状态下的大脑功能指标，并在基线和 2 年随访时进行评估。我们检查了所有符合条件的参与者在这两年中这些结果的组间差异。然后，我们对睡眠不足引起的行为变化的神经相关性进行了中介分析。

发现

2016年9月1日至2018年10月15日期间，共有11878人收集了ABCD研究的基线数据，其中8323人符合资格并纳入本研究（睡眠充足组4142名参与者，睡眠不足组4181名参与者） 。随访数据收集时间为 2018 年 7 月 30 日至 2020 年 1 月 15 日。我们在基线时确定了 3021 个匹配的充足睡眠-睡眠不足对，在 2 年随访时确定了 749 个匹配对，并在两个时间点的行为和神经测量；这两个时间点行为测量的组间差异的效应大小彼此显着相关（r = 0·85，95% CI 0·73–0·92；p<0·0001）。在静息态功能连接（ r =0·54, 0·45–0·61；p<0·0001）和结构测量（例如，灰质体积r =0·61, 0）中观察到类似的模式·51–0·69；p<0·0001)。我们发现皮质-基底神经节功能连接介导睡眠不足对抑郁、思维问题和结晶智力的影响，而前颞叶的结构特性介导睡眠不足对结晶智力的影响。

解释

这些结果为睡眠不足对青春期早期神经认知发展的长期影响提供了人群水平的证据。这些发现强调了早期睡眠干预对于改善青少年早期长期发展结果的价值。

资金

美国国立卫生研究院。