Abstract
Introduction: Good sleep quality is critical for good sleep health, but how sleep quality is defined remains uncertain; most defining it based solely on subjective or objective measures, and more recently, a combination of the two. PSG-derived sleep efficiency and WASO are linked to subjective sleep quality in healthy adults, but whether this is the same in adolescents (an age group notorious for not getting enough sleep), remains unknown.
Aims: To investigate which objective measures of sleep correlate with next-day ratings of sleep quality (primary outcome), sleep sufficiency, morning and daytime sleepiness, mood and concentration.
Methods: Seventy-one 16-17 y-olds (50% female) without anxiety/depression symptoms, completed a week of actigraphy and daily ratings of the subjective elements described above (469 days analysed). Statistical analyses used generalised estimating equation models.
Results: In unadjusted models, sleep quality showed significant within- and between-subject relationships with variables of sleep timing, amount, efficiency and variability. However after adjustment, total sleep time (TST) was the only metric that remained significant; for every 1 h less TST/night, teens were 1.56 (95%CI: 1.29, 1.88) times more likely to rate their sleep quality as poor rather than good. TST also correlated with daily mood ratings, and awakenings with morning sleepiness. No other significant relationships were found.
Discussion: The key sleep metric contributing to perceptions of sleep quality in adolescents was in fact one related to sleep quantity. Surprisingly, none of the sleep quality metrics used in sleep quality guidelines, linked to subjective ratings of sleep quality in this age group.