Peer-reviewed article
Multidimensional sleep health and serious cognitive difficulty among US adolescents.
Knowlden AP ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This study examined how sleep patterns and concussion history relate to serious cognitive difficulty in US adolescents aged 12-17. Using national survey data, researchers found that short sleep duration, inconsistent bedtimes, lack of sports participation, and low physical activity were all associated with greater odds of serious cognitive difficulty. The effects were cumulative, meaning adolescents with multiple risk factors had substantially higher vulnerability to cognitive problems.
Key points
- Concussion history doubled the odds of serious cognitive difficulty (aOR = 2.07)
- Short sleep duration increased odds of cognitive difficulty by 27% (aOR = 1.27)
- Inconsistent bedtimes increased odds by 42% (aOR = 1.42)
- No sports participation more than doubled the odds (aOR = 2.05)
- Effects were cumulative across multiple risk factors
Limitations
The cross-sectional design cannot establish causation, only associations. The study relied on caregiver report of children's cognitive difficulties and sleep patterns, which may not fully capture clinical cognitive impairment.
Abstract
Purpose This study examined associations among concussion history, multidimensional sleep health, physical activity, and serious cognitive difficulty in a nationally representative sample of US adolescents. Methods Cross-sectional data from adolescents aged 12-17 years participating in the 2022-2024 National Survey of Children's Health were analyzed. Sequential multivariable models accounting for complex sampling examined associations among concussion history, short sleep duration, bedtime inconsistency, sports participation, physical activity, and serious cognitive difficulty. Sensitivity analyses evaluated alternative bedtime consistency operationalizations and interaction effects. Results In fully adjusted models, concussion history (aOR = 2.07, 95% CI = 1.72-2.48), short sleep duration (aOR = 1.27, 95% CI = 1.11-1.46), bedtime inconsistency (aOR = 1.42, 95% CI = 1.22-1.65), no sports participation (aOR = 2.05, 95% CI = 1.81-2.33), insufficient physical activity (aOR = 1.32, 95% CI = 1.09-1.58), greater ACE burden, and lower caregiver capacity (aOR = 2.04, 95% CI = 1.80-2.31) were associated with greater odds of serious cognitive difficulty. Exploratory analyses identified a statistically significant short sleep × bedtime inconsistency interaction (Wald F = 4.35, p = .037), whereas concussion-related interaction terms were not statistically significant. Adjusted predicted probabilities demonstrated substantial cumulative neurobehavioral vulnerability across multidimensional sleep health and concussion-risk profiles. Conclusion Insufficient sleep duration and bedtime inconsistency were independently associated with serious cognitive difficulty among US adolescents. Findings support consideration of both sleep duration and sleep regularity in adolescent neurobehavioral health promotion efforts. Current knowledge/study rationale Concussion history and insufficient sleep have independently been associated with poorer neurobehavioral functioning among adolescents. However, fewer nationally representative studies have examined multidimensional sleep health constructs, including bedtime consistency, in relation to serious cognitive difficulty. Study impact Short sleep duration and bedtime inconsistency were associated with greater odds of serious cognitive difficulty among US adolescents. Findings support multidimensional sleep health frameworks emphasizing the combined importance of sleep duration and bedtime consistency for adolescent cognitive functioning.