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Children
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Insufficient Sleep Syndrome in Children and Adolescents
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Insufficient Sleep Syndrome in Children and Adolescents

A special issue of Children (ISSN 2227-9067). This special issue belongs to the section "Pediatric Pulmonary and Sleep Medicine".

Deadline for manuscript submissions: closed (20 November 2025) | Viewed by 18003

Special Issue Editor

Dr. Jun Kohyama

E-Mail Website
Guest Editor
Tokyo Bay Urayasu Ichikawa Medical Center, Urayasu 279-0001, Japan
Interests: sleep; children; adolescence; insufficient sleep syndrome
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Sleep is essential for humans and good sleep is positively associated with health. However, sleep is affected by bio-psycho-social factors, and thus variability in sleep duration among individuals is quite high. Although several recommendations for adequate sleep duration have been made, these recommendations have a wide range due to the marked interindividual variations for each optic sleep duration (OSD). Most people in modern society, especially adolescents, tend to sleep for a much shorter duration, which leads to the development of insufficient sleep syndrome due to the accumulation of sleep debt. A previous study showed that among patients aged 20 years or less who visited an outpatient sleep clinic, 31% were diagnosed with insufficient sleep syndrome. To reduce sleep debt, it is important to find the individual’s OSD; however, no simple method to determine OSD has yet been established. In the current Special Issue, manuscripts on adolescent sleep, insufficient sleep syndrome, and the optimal sleep duration of adolescents from variable standpoints such as obesity, cardiovascular diseases,  academic performance, and PVT  are welcome. Submissions on the educational view points to reduce insufficient sleep among adolescents are also expected.

Dr. Jun Kohyama
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 250 words) can be sent to the Editorial Office for assessment.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Children is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2400 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • insufficient sleep syndrome
  • adolescents
  • optimal sleep duration
  • body mass index
  • academic performance
  • educational program
  • suicide
  • bio-psycho-social model

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Published Papers (6 papers)

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Research

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18 pages, 4561 KB  
Article
Relationship Between Sleep Irregularity and School Non-Attendance Among Japanese Elementary and Junior High School Students
by Ikuko Hirata, Tomoko Nishimura, Yuko Osuka, Manabu Wakuta and Masako Taniike
Children 2026, 13(1), 80; https://doi.org/10.3390/children13010080 - 4 Jan 2026
Viewed by 817
Abstract
Background/Objectives: In Japan, the number of elementary and junior high school students who do not attend school is increasing. Sleep problems are considered a contributing factor. Methods: This study utilized self-administered questionnaires about the sleep patterns and backgrounds of 25,257 students [...] Read more.
Background/Objectives: In Japan, the number of elementary and junior high school students who do not attend school is increasing. Sleep problems are considered a contributing factor. Methods: This study utilized self-administered questionnaires about the sleep patterns and backgrounds of 25,257 students from the 3rd–10th grades across 91 elementary schools, 51 junior high schools, and 36 high schools in Japan. Latent class analysis was performed to assess sleep regularity. Logistic regression analysis was conducted to examine the relationship between sleep regularity and school attendance status, as well as the relationship with protective factors against non-attendance. Results: Overall, 19,005 students responded. The response rate was 75.2%. Sleep regularity was categorized into Class 1, Regular; Class 2, Somewhat Irregular; Class 3, Irregular; and Class 4, Schedule-Dependent. Class 1 decreased with grade, from 61.8% in the 3rd grade to 46.2% in the 10th grade. Class 3 comprised 10.0% of students not experiencing school non-attendance, 37.9% among students with persistent school non-attendance, and 17.9% among students who had resumed school attendance after school non-attendance in the previous year. Classes 2, 3, and 4 showed a negative relationship with protective factors against non-attendance such as good relationships with teachers and family, good communication, academic performance, proficiency in athletic activities, and the presence of a place to belong outside school. Conclusions: Sleep irregularity is related to school non-attendance and may serve as a barometer of students’ communication and academic difficulties. Additionally, we propose an early intervention for sleep problems to prevent the exacerbation of school non-attendance. Full article
(This article belongs to the Special Issue Insufficient Sleep Syndrome in Children and Adolescents)
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14 pages, 780 KB  
Article
Gut Microbiota Composition and Sleep in Preschoolers: The ELFE Birth Cohort Study
by Zeinab Houshialsadat, Cécile Zaros, Marie-José Butel, Marie-Aline Charles, Gaël Toubon and Sabine Plancoulaine
Children 2025, 12(9), 1240; https://doi.org/10.3390/children12091240 - 16 Sep 2025
Viewed by 1209
Abstract
Background/Objectives: Sleep is essential for children’s well-being, yet insufficient sleep duration and quality are common among preschoolers. The brain–gut microbiota axis, a bidirectional communication network connecting the brain, the gastrointestinal tract, and the microorganisms living there, known as the gut microbiota, influences sleep [...] Read more.
Background/Objectives: Sleep is essential for children’s well-being, yet insufficient sleep duration and quality are common among preschoolers. The brain–gut microbiota axis, a bidirectional communication network connecting the brain, the gastrointestinal tract, and the microorganisms living there, known as the gut microbiota, influences sleep regulation, but its role in children remains largely unexplored. Here, we examined the association between gut microbiota and sleep in preschoolers from Étude Longitudinale Française depuis l’Enfance (ELFE) birth cohort study. Methods: This study included 597 children (51.2% boys) with available stool samples and sleep data at 3.5 years. The gut microbiota data was analyzed using bacterial 16S rRNA sequencing. Data on day and night sleep durations and frequencies of sleep onset difficulties and night waking were collected through telephone questionnaires and grouped into ‘optimal’ and ‘suboptimal’ clusters using Latent Class Analysis. Statistical analyses involved multivariate logistic regressions or multivariate permutation analysis of variance, controlling for confounders. Results: In total, 25% of the included children were in the suboptimal sleep cluster. No significant associations were found between gut microbiota diversity and composition and sleep clusters at age 3.5 years. Similarly, no differences were found in the abundance of specific microbiota genera between the two sleep clusters. Conclusions: While emerging evidence suggests correlations between gut microbiota and sleep in preschool children, our results do not confirm such correlations. The data used in this study were obtained from a homogeneous, high socioeconomic population, which must be considered when interpreting the findings. Further research is needed to validate the results of this study. Full article
(This article belongs to the Special Issue Insufficient Sleep Syndrome in Children and Adolescents)
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12 pages, 1119 KB  
Article
Managing Complexity in Rett Syndrome with a Focus on Respiratory Involvement: A Tertiary Center Experience
by Adele Corcione, Luigi Antonio Del Giudice, Simona Basilicata, Mariantonia Maglio, Salvatore Aiello, Raffaele Cerchione, Anna Annunziata, Alessandro Amaddeo and Melissa Borrelli
Children 2025, 12(9), 1181; https://doi.org/10.3390/children12091181 - 4 Sep 2025
Viewed by 1225
Abstract
Background: Rett syndrome (RS) is a rare neurodevelopmental disorder primarily affecting females, characterized by severe neurological impairment and complex comorbidities, including epilepsy, scoliosis, and respiratory dysfunction. Respiratory complications, such as recurrent infections and sleep-disordered breathing (SDB), are increasingly recognized as significant contributors to [...] Read more.
Background: Rett syndrome (RS) is a rare neurodevelopmental disorder primarily affecting females, characterized by severe neurological impairment and complex comorbidities, including epilepsy, scoliosis, and respiratory dysfunction. Respiratory complications, such as recurrent infections and sleep-disordered breathing (SDB), are increasingly recognized as significant contributors to morbidity. This study aimed to evaluate the prevalence, severity, and management of major comorbidities—including epilepsy, scoliosis, respiratory infections, and SDB—in a pediatric cohort with genetically confirmed RS. Methods: We conducted a retrospective review of medical records from 23 female patients under 18 years of age with MECP2 mutations, referred to our tertiary care center from 2021 to 2025. Data on epilepsy, scoliosis, respiratory infections, and nutritional status were collected. The presence of SDB was assessed through overnight home polygraphy (oPG) and transcutaneous carbon dioxide monitoring in selected cases. Results: Epilepsy affected 65% of patients, all with good seizure control. Scoliosis was present in 52%, with two patients requiring spinal surgery. At least one episode of lower respiratory tract infection (LRTI) was presented in 39% of our girls. LRTIs positively correlated with the number of hospitalization and antibiotic treatment. Among patients undergoing oPG, 67% presented obstructive sleep apnea, with its severity positively correlating with the frequency of lower respiratory infections. Severe nocturnal hypercapnia was documented in three patients, leading to non-invasive or invasive ventilation. Conclusions: Our findings highlight the high prevalence of sleep-related respiratory disorders and their association with respiratory infections in children with RS. Systematic respiratory assessment, including sleep studies, and early implementation of airway clearance techniques and ventilatory support are crucial to improving clinical outcomes in this vulnerable population. Full article
(This article belongs to the Special Issue Insufficient Sleep Syndrome in Children and Adolescents)
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Review

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18 pages, 678 KB  
Review
Sleep Education Program with Self-Help Treatment—Sleep-Promoting Behaviors for Children and Adolescents in Japan
by Hideki Tanaka, Norihisa Tamura, Kaori Yamaoka and Taro Matsuki
Children 2026, 13(1), 92; https://doi.org/10.3390/children13010092 - 8 Jan 2026
Viewed by 902
Abstract
Late bedtimes and insufficient sleep duration among children and adolescents have been consistently associated with daytime sleepiness, irritability, and poorer academic performance. To mitigate these adverse consequences of insufficient sleep, it is essential to provide children, students, teachers, and parents with not only [...] Read more.
Late bedtimes and insufficient sleep duration among children and adolescents have been consistently associated with daytime sleepiness, irritability, and poorer academic performance. To mitigate these adverse consequences of insufficient sleep, it is essential to provide children, students, teachers, and parents with not only knowledge about sleep improvement but also practical tools that facilitate behavioral change. This review synthesizes existing evidence from studies that have addressed this issue by evaluating students’ individual sleep behaviors using checklists of sleep-promoting practices. Drawing on practical examples from school-based interventions, the review highlights the effectiveness of sleep education programs for children and adolescents. These programs aim to bridge the gap between sleep-related knowledge and actual behavioral change by targeting daily sleep habits. Typically, such programs consist of a single 50 min educational session focusing on the importance of sleep and strategies for improvement, followed by a two-week self-help period during which students actively practice and monitor specific target behaviors. Overall, the findings indicate that sleep education programs incorporating self-help components not only enhance sleep-related knowledge but also promote healthier sleep behaviors and improve sleep patterns. Moreover, these programs effectively reduce daytime sleepiness and irritability among children and adolescents, thereby contributing to a healthier and more adaptive school life. Full article
(This article belongs to the Special Issue Insufficient Sleep Syndrome in Children and Adolescents)
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14 pages, 984 KB  
Review
Insufficient Sleep Syndrome in Childhood
by Teruhisa Miike
Children 2025, 12(1), 19; https://doi.org/10.3390/children12010019 - 26 Dec 2024
Cited by 1 | Viewed by 5867
Abstract
Sleep disorders in children have a negative impact on mental and physical development, and a lack of sleep is one of the most important problems in infancy. At the age when naps are commonly accepted, the judgment of whether the amount of sleep [...] Read more.
Sleep disorders in children have a negative impact on mental and physical development, and a lack of sleep is one of the most important problems in infancy. At the age when naps are commonly accepted, the judgment of whether the amount of sleep is adequate has been based on the total amount of sleep per day. In other words, the idea is that even if the amount of sleep at night is insufficient, it is not considered insufficient if it is compensated for by taking a long nap or sleeping late on weekend mornings. However, these lifestyle habits disrupt the circadian rhythm and cause social jet lag, which is not appropriate for healthy mental and physical development. Therefore, in this review, I present the average required nighCime basic sleep duration (NBSD) of 10 h for Japanese and 11 h for Caucasian children as a judgment standard. (1) If the child sleeps less than 8 h at night, and (2) if the child sleeps less than 9 h at night or 30 to 60 min less than the required NBSD, immediate treatment is recommended. I also discuss briefly how to address sleep insufficiency in childhood. Full article
(This article belongs to the Special Issue Insufficient Sleep Syndrome in Children and Adolescents)
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15 pages, 594 KB  
Review
Re-Evaluating Recommended Optimal Sleep Duration: A Perspective on Sleep Literacy
by Jun Kohyama
Children 2024, 11(9), 1098; https://doi.org/10.3390/children11091098 - 7 Sep 2024
Cited by 5 | Viewed by 6856
Abstract
A significant number of adolescents experience sleepiness, primarily due to sleep deprivation. The detrimental effects of inadequate sleep on both physical and mental health are well documented, particularly during adolescence—a critical developmental stage that has far-reaching implications for later life outcomes. The International [...] Read more.
A significant number of adolescents experience sleepiness, primarily due to sleep deprivation. The detrimental effects of inadequate sleep on both physical and mental health are well documented, particularly during adolescence—a critical developmental stage that has far-reaching implications for later life outcomes. The International Classification of Diseases 11th Revision recently introduced the disorder termed ‘insufficient sleep syndrome,’ characterized by a persistent reduction in sleep quantity. However, diagnosing this condition based solely on sleep duration is challenging due to significant individual variation in what constitutes optimal sleep. Despite this, managing sleep debt remains difficult without a clear understanding of individual optimal sleep needs. This review aims to reassess recommended sleep durations, with a focus on enhancing sleep literacy. Beginning with an exploration of insufficient sleep syndrome, this review delves into research on optimal sleep duration and examines foundational studies on sleep debt’s impact on the developing brain. Finally, it addresses the challenges inherent in sleep education programs from the perspective of sleep literacy. By doing so, this review seeks to contribute to a deeper understanding of the chronic sleep debt issues faced by adolescents, particularly those affected by insufficient sleep syndrome. Full article
(This article belongs to the Special Issue Insufficient Sleep Syndrome in Children and Adolescents)
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