Citation

Davidson-Urbain W, Servot S, Godbout R, Montplaisir JY, Touchette E. Encephale (1974) 2022; ePub(ePub): ePub.

Vernacular Title

La somnolence chez les adolescents: étiologie et conséquences multiples

Copyright

(Copyright © 2022, Masson Editeur)

DOI

10.1016/j.encep.2022.05.004

PMID

35970642

Abstract

Over the past century a dramatic decline in sleep duration among adolescents, such as more than one hour of sleep loss per night, has been reported. A debt in sleep duration could lead to sleep deprivation, a major risk factor associated with daytime sleepiness. Sleepiness refers to the inability to maintain an adequate level of alertness during the day which may result in more or less being able to control falling asleep at inappropriate times. This literature review updates on sleepiness regarding its characteristics, etiology and consequences on adolescents. Studies revealed that from 25 % to 78 % of adolescents had reported sleepiness. Its manifestations may include heavy lids, yawns, difficulties to concentrate and emotional irritability. In addition, while it is recommended that adolescents under 18 years-old should sleep from eight to ten hours a night, only 63 % of them actually do so. The etiology of sleep deprivation and sleepiness in this population can be explained by various biological and societal factors. First, the sleep-wake cycle of adolescents shows a biological shift from the beginning of pubertal maturation, described as a perfect storm. It refers to a social jetlag by going to sleep and waking up later and accumulating a sleep debt during weekdays which they try to reimburse during weekends. This phenomenon can be explained by physiological changes such as a slower accumulation of sleep pressure. In addition to this perfect storm, environmental and societal factors contribute to the social jetlag and reduce sleep duration in adolescents. Screen exposure before bedtime can delay sleep and wake onset, which is a risk factor for sleeping debt. Substance use such as caffeine, cigarettes or electronic vaporizer, ADHD or freely available medication, alcohol, cannabis use or drug consumption could further disrupt sleep-wake cycle by stimulating, depressing or otherwise disrupting the central nervous system. Early, before 8:30 am, class start times have been associated with chronic sleep deprivation, higher level of sleepiness and delayed melatonin peak secretion. Adolescents working or doing extracurricular occupations for more than 20hours a week are more at risk for reduced sleep duration and sleepiness. Parental supervision about sleep during the weekdays were associated with more appropriate bedtime. Adolescents from low socio-demographic characteristics and from minority ethnic groups have reported displaying a shorter sleep duration. Finally, sleep disorders of a physiological origin such as narcolepsy, sleep apnea or restless legs syndrome, may explain the sleep deprivation and sleepiness. Sleep deprivation and sleepiness in adolescents have consequences on their health. Cognitive functioning, such as problem solving, attention or memory, as well as school performance, can be compromised by sleep deprivation and sleepiness. At the psychological level, adolescents reporting sleepiness are more prone to display mental health problems: associations were found between sleepiness and subjective perception of depression, anxiety, somatic complaints as well as with antisocial behaviors. Finally, 68 % of 16 year-old adolescents reported they drove a car, and the reported sleepiness could lead to road accidents due to reduced attentional functioning, reaction time and decision-making abilities. In the United-States, from 7 % to 16.5 % of deadly accidents were related to driving while drowsy. Highlighting etiology and problems associated with sleep deprivation and sleepiness in adolescents could guide researchers and clinicians towards the development of possible interventions. Public health measures and knowledge transfer programs regarding modifiable psychosocial and societal factors associated with sleep-wake bioregulation could increase awareness in parents as well as in political and societal decision makers.

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La durée de sommeil des adolescents a connu un déclin important pendant le dernier siècle, il n'est donc pas surprenant que nombre d'entre eux éprouvent de la somnolence diurne. Cette recension de la littérature actualise les connaissances disponibles sur ce sujet d'importance. L'étiologie du manque de sommeil et de la somnolence chez les adolescents peut s'expliquer par différents facteurs tant biologiques, psychologiques que sociétaux. Le cycle veille-sommeil des adolescents connaît un décalage d'origine biologique dès le début de la maturation pubertaire, mais il est également affecté par l'exposition aux écrans, l'utilisation de substances psychoactives, l'heure de début des cours, leurs occupations extrascolaires, les réglementations parentales et certaines caractéristiques sociodémographiques. En outre, des troubles du sommeil d'origine physiologique peuvent être en cause, tels que la narcolepsie, l'apnée du sommeil ou le syndrome des jambes sans repos. Le manque de sommeil et la somnolence chez les adolescents ont des conséquences sur leur fonctionnement cognitif ainsi que sur leur régulation émotionnelle et attentionnelle, avec d'importantes conséquences sur la réussite académique. La mise en lumière des problématiques associées à la somnolence chez les adolescents peut servir de guide aux chercheurs et cliniciens vers le développement de pistes d'intervention. Enfin, des mesures de santé publique et de programmes de transfert de connaissances quant aux facteurs psychosociaux et sociétaux modifiables associés à la biorégulation veille-sommeil pourront être mieux considérés auprès des parents ainsi qu'aux niveaux politique et sociétal.

Language: fr

Keywords

Adolescents; Consequences; Conséquences; Durée de sommeil; Étiologie; Etiology; Sleep duration; Sleepiness; Somnolence