Sleep-wake timing is central to adolescent sleep health: longitudinal cohort network analyses supporting adding circadian metrics to multidimensional sleep health
Abstract
Objectives: The RU-SATED sleep health model encompasses RegUlarity, Satisfaction, Alertness during wake, Timing, Efficiency and Duration of sleep, but lacks explicit representation of circadian processes. We applied network analysis to data from adolescents to (1) examine relationships and relative centrality of each sleep health dimension; and (2) explore the effects of adding circadian variables to this sleep health model.
Methods:: We assessed 175 adolescents (98 female, 12.8±0.4 years) six-monthly over two years. At each timepoint, participants completed two-weeks of at-home sleep monitoring using daily diaries and wrist actigraphy, and an online survey assessing diurnal preference. At baseline and annual timepoints, circadian timing was assessed via salivary dim light melatonin onset (DLMO). Network analysis quantified relationships among sleep regularity index, sleep satisfaction, daytime alertness, sleep-wake times, sleep efficiency/continuity, and total sleep time at each timepoint. Centrality analyses identified the node (variable) most strongly connected with the rest of the nodes for each network. Additional analyses added diurnal preference or DLMO as a node.
Results:: The most central (i.e., strongly connected) nodes were sleep onset time, wake time and total sleep time, with sleep onset time and wake time becoming the most central at participants ages 14-15 years. Both diurnal preference and DLMO related to sleep onset and wake timing across timepoints. Diurnal…
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