Modifying the Impact of Eveningness Chronotype (“Night-Owls”) in Youth: A Randomized Controlled Trial

Abstract

Objective: To determine whether an intervention to reduce eveningness chronotype improves sleep, circadian, and health (emotional, cognitive, behavioral, social, physical) outcomes. Method: Youth aged 10 to 18 years with an evening chronotype and who were “at risk” in 1 of 5 health domains were randomized to: (a) Transdiagnostic Sleep and Circadian Intervention for Youth (TranS-C; n = 89) or (b) Psychoeducation (PE; n = 87) at a university-based clinic. Treatments were 6 individual, weekly 50-minute sessions during the school year. TranS-C addresses sleep and circadian problems experienced by youth by integrating evidence-based treatments derived from basic research. PE provides education on the interrelationship between sleep, stress, diet, and health. Results: Relative to PE, TranS-C was not associated with greater pre–post change for total sleep time (TST) or bed time (BT) on weeknights but was associated with greater reduction in evening circadian preference (pre-post increase of 3.89 points, 95% CI = 2.94–4.85, for TranS-C, and 2.01 points, 95% CI = 1.05–2.97 for PE, p = 0.006), earlier endogenous circadian phase, less weeknight–weekend discrepancy in TST and wakeup time, less daytime sleepiness, and better self-reported sleep via youth and parent report. In terms of functioning in the five health domains, relative to PE, TranS-C was not associated with greater pre–post change on the primary outcome. However, there were significant interactions favoring TranS-C on the Parent-Reported Composite Risk Scores for cognitive health. Conclusion: For at-risk youth, the evidence supports the use of TranS-C over PE for improving sleep and circadian functioning, and improving health on selected outcomes. Clinical trial registration information: Triple Vulnerability? Circadian Tendency, Sleep Deprivation and Adolescence. (https://clinicaltrials.gov; .

Intraindividual variability of sleep/wake patterns in adolescents with and without attention‐deficit/hyperactivity disorder

“…Intriguingly, a recent cognitive‐behavioral intervention conducted with adolescents with an evening chronotype not only improved adolescent‐ and parent‐reported sleep, but also resulted in a decrease in evening circadian preference, an earlier endogenous circadian phase (i.e. dim light melatonin onset), and less weeknight–weekend discrepancy in total sleep time and wake time (Harvey et al., ). No studies have tested behavioral sleep interventions in adolescents with ADHD; testing cognitive‐behavioral and other interventions for improving sleep and daytime outcomes is an important area for investigation (Becker, ).…”

A transdiagnostic sleep and circadian intervention for adolescents: six‐month follow‐up of a randomized controlled trial

“…The second aim was to examine the effects of TranS‐C (vs. PE) on risks in five health domains at 6‐month follow‐up, and whether they were maintained from posttreatment to 6‐month follow‐up. We also conducted exploratory analysis for specific measures comprising the composite risk scores to understand the TranS‐C effects further and be consistent with the previous report on the pre‐post effects (Harvey et al, ). We hypothesized that TranS‐C would demonstrate greater improvements than PE in both sleep and circadian outcomes and risks across health domains at 6‐month follow‐up and that TranS‐C treatment effects would be maintained from posttreatment to 6‐month follow‐up.…”

“…Parents or guardians of all participants provided informed consent and participants provided informed assent. A detailed study procedure was reported elsewhere (Harvey et al, ). Participant flow was illustrated in Figure .…”

“…Secondary outcomes are weeknight‐weekend discrepancy in TST, BT, and wakeup time, sleepiness, PSQI, CBCL Sleep Composite, and parent‐report risk composites in the five health domains. These outcomes were pre‐registered on clinicaltrials.gov and tested in the previous report on the pre‐post effects (Harvey et al, ).…”

“…From pretreatment to posttreatment, relative to Psychoeducation (PE), TranS‐C was associated with shifting away from eveningness, an earlier endogenous circadian phase, a less weeknight‐weekend discrepancy in total sleep time and wakeup time, less daytime sleepiness, and better self‐ and parent‐reported sleep. TranS‐C did not directly affect primary and secondary outcomes in health‐related domains relative to PE, except for parent‐reported risk in the cognitive domain (Harvey et al, ). However, a mediation analysis suggested indirect effects of TranS‐C (vs. PE) on reducing risk in multiple mental and physical health domains via improving sleep and circadian problems from pretreatment to posttreatment (Dong, Gumport, Martinez, & Harvey, ).…”