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Members of the American Academy of Sleep Medicine developed consensus recommendations for the amount of sleep needed to promote optimal health
in children and adolescents using a modied RAND Appropriateness Method. After review of 864 published articles, the following sleep durations are
recommended: Infants 4 months to 12 months should sleep 12 to 16 hours per 24 hours (including naps) on a regular basis to promote optimal health.
Children 1 to 2 years of age should sleep 11 to 14 hours per 24 hours (including naps) on a regular basis to promote optimal health. Children 3 to 5 years
of age should sleep 10 to 13 hours per 24 hours (including naps) on a regular basis to promote optimal health. Children 6 to 12 years of age should sleep
9 to 12 hours per 24 hours on a regular basis to promote optimal health. Teenagers 13 to 18 years of age should sleep 8 to 10 hours per 24 hours on a
regular basis to promote optimal health. Sleeping the number of recommended hours on a regular basis is associated with better health outcomes including:
improved attention, behavior, learning, memory, emotional regulation, quality of life, and mental and physical health. Regularly sleeping fewer than the
number of recommended hours is associated with attention, behavior, and learning problems. Insufcient sleep also increases the risk of accidents, injuries,
hypertension, obesity, diabetes, and depression. Insufcient sleep in teenagers is associated with increased risk of self-harm, suicidal thoughts, and
suicide attempts.
Commentary: A commentary on this article apears in this issue on page 1439.
Keywords: pediatric, sleep duration, consensus
Citation: Paruthi S, Brooks LJ, D’Ambrosio C, Hall WA, Kotagal S, Lloyd RM, Malow BA, Maski K, Nichols C, Quan SF, Rosen CL, Troester MM, Wise MS.
Consensus statement of the American Academy of Sleep Medicine on the recommended amount of sleep for healthy children: methodology and discussion.
J Clin Sleep Med 2016;12(11):1549–1561.
1.0 INTRODUCTION
Healthy sleep requires adequate duration, appropriate timing,
good quality, regularity, and the absence of disturbances and
disorders. Sleep duration is a frequently investigated sleep
measure in relation to health outcomes. Many studies have
shown that adequate sleep duration is associated with better
attention, behavior, cognitive functioning, emotional regula-
tion, and physical health among children.
1–3
A panel of 13 experts in sleep medicine and research used a
modied RAND Appropriateness Method
4
to develop recom-
mendations regarding the sleep duration range that promotes
optimal health in children aged 0–18 years. The Consensus
Recommendations
5
were previously published, and this report
expands on the methodology, results of the literature search,
key ndings from published research, overview of discus-
sion by the panel members during the in-person meeting, and
limitations of the process to answer the critical question: How
much sleep is needed for optimal health in children?
SPECIAL ARTICLES
Consensus Statement of the American Academy of Sleep Medicine
on the Recommended Amount of Sleep for Healthy Children:
Methodology and Discussion
Shalini Paruthi, MD, Moderator
1
; Lee J. Brooks, MD
2,3
; Carolyn D’Ambrosio, MD
4
; Wendy A. Hall, PhD, RN
5
; Suresh Kotagal, MD
6
; Robin M. Lloyd, MD
6
;
Beth A. Malow, MD, MS
7
; Kiran Maski, MD
8
; Cynthia Nichols, PhD
9
; Stuart F. Quan, MD
10
; Carol L. Rosen, MD
11
; Matthew M. Troester, DO
12
;
Merrill S. Wise, MD
13
1
Saint Louis University, St. Louis, MO;
2
Children’s Hospital of Philadelphia, Philadelphia, PA;
3
Liaison for the American Academy of Pediatrics;
4
Brigham & Women’s Hospital,
Boston, MA;
5
University of British Columbia School of Nursing, Vancouver, BC;
6
Mayo Clinic, Rochester, MN;
7
Vanderbilt University Medical Center, Nashville, TN;
8
Boston
Children’s Hospital, Boston, MA;
9
Munson Sleep Disorders Center, Traverse City, MI;
10
Harvard Medical School, Boston, MA;
11
Rainbow Babies & Children’s Hospital, Cleveland,
OH;
12
Barrow Neurologic Institute at Phoenix Children’s Hospital, Phoenix, AZ;
13
Methodist Healthcare Sleep Disorders Center, Memphis, TN
pii: jc-00365-16 http://dx.doi.org/10.5664/jcsm.6288
2.0 METHODS
The American Academy of Sleep Medicine (AASM) Sleep
Duration Consensus Conference used a modied RAND Ap-
propriateness Method (RAM)
4
to establish consensus for the
amount of sleep needed to promote optimal health in children
and teenagers.
2.1 Expert Panel Selection
In accordance with the recommendations of the RAM, the Sleep
Duration Consensus Conference panel comprised 13 voting
members, including a moderator. All panel members are experts
in sleep medicine and/or sleep science. The panel members were
recommended by the Board of Directors of the AASM.
Panel members were sent a formal letter of invitation from
the AASM and were required to complete Conict of Interest
disclosures before being ofcially accepted. To avoid further
conicts, panel members were not permitted to participate in
similar consensus activities by other organizations.
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2.2 Modified RAND Appropriateness Method
The RAND Appropriateness Method uses a detailed search
of the relevant scientic literature, followed by two rounds
of anonymous voting to determine consensus on the appro-
priateness of a recommendation. The rst round of voting is
completed without panel interaction to prevent panel members
from inuencing each other’s votes. The second round of vot-
ing occurs after a panel discussion of the available evidence
and Round 1 voting results.
In a modication to RA M, the Consensus Conference included
a third round of voting, which considered all available evidence
and the previous voting results, to establish a single recommen-
dation for the amount of sleep needed to promote optimal health
for each age group in children. The third round also involved a
discussion of the merits of recommending an optimal sleep dura-
tion range versus a simple threshold value. The nal Consensus
Recommendations resulted from the third round of voting.
The charge to the Consensus Conference panel was to de-
termine a sleep duration recommendation for healthy children.
Panel members voted on the appropriateness of one-hour in-
crements ranging from < 6 to ≥ 18 hours of sleep. One-hour
increments were selected because these were the most com-
monly reported units in epidemiologic and experimental stud-
ies. Substantial heterogeneity was present in the sleep duration
assessment instruments. The consensus recommendations
focused on overnight and daytime nap durations when appro-
priate as napping is considered biologically normal under the
age of 7 years. The nal recommendations were based on the
one-hour values that were determined by the panel to be “ap-
propriate” to promote optimal health in children.
2.3 Detailed Literature Search and Review
The AASM Board of Directors charged the panel with devel-
oping a recommendation for sleep duration in healthy children.
This charge coincides with the goals of the National Healthy
Sleep Awareness Project (NHSAP) and with the Sleep Health
Objective of Healthy People 2020 to “increase the proportion
of students in grades 9 to 12 who get sufcient sleep.”
6
The scope of the recommendation was limited to children
aged 0–18 years. After a preliminary review of the litera-
ture, prior Centers for Disease Control and Prevention (CDC),
AASM, and National Sleep Foundation (NSF) recommenda-
tions, as well as commonly frequented websites, the following
age groups were created: < 12 months, 12 months to < 3 years,
3 years to < 6 years, 6 years to < 13 years, and 13–18 years.
There was substantial overlap of age groups within the litera-
ture, and this was discussed during the in-person conference.
A preliminary search of the literature and specic National
Library of Medicine Medical Subject Headings (MeSH) terms
identied several health outcomes that were most commonly
examined in relation to sleep duration in children. Based on
this evidence, the panel decided to focus on the relationships
between sleep duration and the following 10 health categories:
cardiovascular health, developmental health, human perfor-
mance, general health, immunology, longevity, mental health,
metabolic health, pain, and cancer.
After establishing the health categories, a detailed literature
search was performed in PubMed on October 1, 2015. The
search terms used for the literature search are detailed in the
supplemental material. The search was restricted to studies in
human children ages 0–18 years, published in English, with no
publication date limit. Case reports, editorials, commentaries,
letters and news articles were excluded from the search results.
The initial search produced 1,040 publications. The search re-
sults were reviewed based on title and excluded a priori for
the following reasons: focus on sleep quality or fatigue instead
of sleep duration, assessing sleep duration in specic disor-
ders or sleep disorders, experiments on total sleep deprivation,
children sleeping outside normal day/night sleep schedules, as-
sessments of sleep deprivation as a treatment (insomnia or de-
pression), and focusing on medication effects on sleep duration.
Application of these restrictions resulted in 864 publications.
The panel reviewed the abstracts of these remaining publi-
cations using the criteria described above. Citation pearl grow-
ing was used to capture additional important publications that
were not identied by the search. Accepted publications were
graded for quality using the Oxford criteria.
7
All accepted pub-
lications were reviewed in detail and the data listed in Table 1
were extracted.
Based on the data extraction, accepted studies were subdi-
vided into the categories listed in Table 2.
The extraction sheet and full text of all accepted publica-
tions were made available to the panel members for review.
Each panel member was assigned to a particular health domain
and asked to identify the most informative studies based on
study design and evidence quality. After review of the litera-
ture, the domains of pain and cancer did not contain sufcient
data to guide sleep duration recommendations and therefore
were excluded prior to Round 1 Voting. After lengthy discus-
sion at the conference, the domain of longevity was excluded
prior to Round 2 Voting. A second PubMed literature search
Table 1—Data extracted from studies for evidence tables.
1 Study design
2 Oxford grade
3 Number of study participants
4 % of female participants
5 Method by which sleep duration was obtained
6 Age range of child participants
7 Major outcomes and conclusions
Table 2—Health domains.
1 Cardiovascular health
2 Developmental health
3 Human performance
4 General health
5 Immunology
6 Longevity
7 Mental health
8 Metabolic health
9 Cancer
10 Pain
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was performed during the conference on February 19, 2016 to
collect more recent relevant studies.
2.4 Round 1 Voting
Prior to the conference, panel members reviewed the accepted
publications and extraction sheets. Based on their review of
this material and their clinical and research expertise, mem-
bers voted to indicate their agreement with the following state-
ment, “Based on the available evidence, [x] hours of sleep is
associated with optimal health within the [x] category in the
[x] age group.” “Hours of sleep” was categorized as: < 6 hours,
6 to < 7 hours, 7 to < 8 hours, 8 to < 9 hours, 9 to < 10 hours,
10 to < 11 hours, 11 to < 12 hours, 12 to < 13 hours, 13 to < 14
hours, 14 to < 15 hours, 15 to < 16 hours, 16 to < 17 hours,
17 to < 18 hours, ≥ 18 hours. The panel members voted us-
ing a 9-point Likert scale, where 1 meant “strongly disagree,”
9 meant “strongly agree,” and 5 meant “neither disagree nor
agree.” Panel median values were placed into three broader
categories, with the following interpretations: 1–3 indicated
disagreement with the statement, 4–6 indicated uncertainty,
and 7–9 indicated agreement with the statement.
Panel members were instructed not to discuss the evidence
or their votes with each other to ensure independence. Panel
members’ votes were collected by email and compiled to
determine the median and distribution of votes. Individual
results tables were created and distributed to the members
at the consensus conference, displaying the distribution of
votes (anonymously), the member’s vote, and the median vote
(Figure 1).
2.5 Conference Proceedings and Round 2 Voting
Prior to the conference, panel members were selected to be-
come domain experts for each domain. At the conference,
members reviewed the results of Round 1 voting for a domain,
and then the domain experts presented a review of the best
available evidence for that domain. Panel members then dis-
cussed the results of Round 1 voting, the accepted publica-
tions for the domain and any other relevant evidence. After
discussion, panel members completed Round 2 voting for the
age groups within the domain, following the same procedures
from Round 1 voting. The conference proceeded in this man-
ner for each domain.
2.6 Round 3 Voting and Development of
Recommendations
Panel members reviewed and discussed Round 2 voting results
for all domains and the entire body of accepted publications
in preparation of voting on recommendation statements. After
Figure 1—Round 1 voting results.
Round 1 voting was based on voting across all age groups under the following eight domains: cardiovascular health, developmental health, human
performance, general health, immunology, longevity, mental health and metabolic health.
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S Paruthi, LJ Brooks, C D’Ambrosio et al. Special Article
discussions concluded, panel members completed Round 3
voting for a single recommendation of appropriate sleep dura-
tion range for each age group, following the same procedure as
for Round 1 and Round 2 voting, but with the following state-
ment: “Based on the available evidence, [x] hours of sleep is
associated with optimal health in [x] age group.”
Based on the results of Round 1 and Round 2 voting, the
conference discussions, and with the agreement of all the panel
members, the infant (0 to 12 months) category was reduced to 4
to 12 months. This decision was based on the lack of evidence
in this 0–4 month old age group. Thus, no recommendations
were made for children under 4 months of age for any of the
categories.
Upon completion of Round 3 voting, the panel members
reviewed the voting results and developed the recommenda-
tions. The age groups and hour ranges were simplied to those
presented in the consensus statements for the purposes of
simplifying recommendations and ensuring clarity.
The nal recommendations were submitted to the AASM,
Sleep Research Society (SRS), American Academy of Pediat-
rics (AAP), and American Association of Sleep Technologists
(AAST) Boards of Directors for their endorsements.
3.0 SUMMARY OF LITERATURE
The following sections summarize the key evidence consid-
ered by the panel in developing the recommendations while
acknowledging that a complete evaluation of the evidence is
beyond the scope of this consensus process.
For each domain, the panel reviewed studies with children
from all over the world, addressing sleep duration and health
outcomes across the prespecied age ranges. Within each do-
main, there were topics without information for some of the age
groups, and often studies spanned several of our prespecied
age groups. Studies that assessed the relationship between
sleep duration and the search term of interest were the most
informative. Many studies reported more than one outcome.
However, emphasis was placed on longitudinal or cross-sec-
tional cohort studies that reported sleep duration in unselected
general populations as well as smaller studies of unconstrained
sleep in healthy children. Some studies only provided correla-
tion or regression coefcients and thus were minimally infor-
mative. Others reported the association between general health
and sleep duration, but only at a limited number of thresholds.
In most studies, sleep duration was assessed by parent or child
self-report. Polysomnographic data and actigraphy were con-
sidered when appropriate such as in studies of unconstrained
sleep in the laboratory or at home. Systematic comparisons be-
tween studies were challenging and in most cases not possible.
The following domains and information were reviewed.
3.1 General Health
In the general health domain, the number of children in each
study ranged from less than 25 to over 74,000.
Within the 4-months to < 12 months age range, there were
few studies. However, two large prospective birth cohorts
indicated that over a 24-hour period, healthy infants slept
slightly > 13 to slightly > 14 hours.
8,9
Furthermore, infants
sleeping for lesser amounts of time had a greater likelihood of
quality of life issues later in childhood.
9
For children in the 1 to < 3 years and 3 to < 6 years age
ranges, there were only a small number of studies to review.
One cohort study reported sleep durations between 11 and
12 hours in normal children.
8
Limited data also suggested
that sleeping less than 10 hours was associated with a greater
risk of accidental injury
10
and reduced quality of life several
years later.
11
More studies were available that addressed general health
outcomes in older children including those with polysomno-
graphic data during unconstrained sleep.
12,13
In the 6 to < 13
years age group, the panel observed that this was a period of
rapid physical and mental development with more sleep appro-
priate for children at the lower end and less sleep for those at
the higher end of the age range. Most informative was a large
meta-analysis of children from 20 countries that indicated
children between 9 and 12 years of age slept approximately 10
hours per night.
14
In addition, data were available suggesting
children sleeping 10 hours or more per night reported better
health.
15
In the 13–18 year age range, increased rates of injury
were noted for those sleeping less than 7 or 8 hours
16,17
and
better health was reported for those sleeping 9 hours or more.
15
A meta-analysis found that in teenagers, sleep declined con-
tinuously from between 9 and 10 hours at age 13 to between
slightly less than 8 to slightly greater than 9 hours at age 18
years of age.
15
Extended sleep duration was noted on weekends
compared with weekdays.
In summary, limited information indicates that there is a
continuous decline in the amount of sleep required for nor-
mal general health. Lesser amounts are associated with poorer
overall health and reduced quality of life later in childhood.
However, there is little information regarding any impact of
excessive sleep on overall health.
3.2 Cardiovascular Health
Many of the studies in the cardiovascular domain examined
the relationship between sleep duration and hypertension. Oth-
ers looked at body mass index, waist circumference, serum lip-
ids, C-reactive protein (CRP), and hemoglobin A1C (HbA1C).
Most studies were cross-sectional, observational, retrospec-
tive or cohort design; none were randomized controlled stud-
ies. The number of participants varied from as few as 20 to
just over 5,500. No studies in this domain included children
younger than 5 years of age. Most studies focused on adoles-
cents and teenagers.
The majority of studies suggested a shorter sleep duration
was associated with either an increased risk of hypertension or
actual hypertension. However, the denition of “short/shorter”
sleep was different between the studies. For children > 5
years, studies suggested a shorter sleep duration (< 10 hours,
18
some < 9 hours,
19
some < 8 hours,
20,21
and one < 5 hours
22
) was
associated with either an increased risk of hypertension or ac-
tual hypertension. One study showed an increased odds ratio
of hypertension in girls who slept > 9.5 hours.
23
Another study
suggested that < 10 hours of sleep was associated with hypoten-
sion (systolic blood pressure < 100 mm Hg) in preschoolers.
18
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S Paruthi, LJ Brooks, C D’Ambrosio et al. Special Article
Conversely, there were also data to suggest no adverse effect of
sleep characteristics on cardiovascular health.
24–26
In summary, evidence indicates that shorter sleep duration
of < 5 hours is associated with increased risk of hypertension.
However, there is some suggestion that in girls regularly sleep-
ing more than 9.5 hours, hypertension risk is increased.
3.3 Metabolic Health
Many studies in the metabolic domain specically targeted the
relationship between sleep duration and overweight/obesity.
Other metabolic parameters studied included: waist circum-
ference, insulin resistance (HOMA-IR), bone mineral content,
triglycerides, C-reactive protein, HbA1c, leptin, and ghrelin.
Most were cross-sectional studies of community-based popu-
lations. The number of participants in studies ranged from 62
to 81,390.
Most studies demonstrated a negative association between
sleep duration and overweight/obesity. Shorter sleep dura-
tions were also associated with increased risk for developing
overweight/obesity. Two meta-analyses found sleep duration
inversely correlates with obesity in children 0–18 years.
27,28
For each hour increase in sleep, the risk of overweight/obesity
decreased. Children under age 10 years show a more linear
dose-response relationship of sleep duration and weight status.
Additionally, there is evidence of a stronger inverse relation-
ship for sleep duration and weight status in boys compared
with girls.
28
A longitudinal study of 915 children aged 6 months to 3
years, showed infant sleep duration of less than 12 hours per
day was associated with higher body mass index (BMI) z
scores and increased odds of overweight during subsequent
preschool years.
29
Similarly, in a cohort study of 1,930 children
ages 0–13 years, in younger children, ages 0–4 years, sleep du-
ration of less than 11 hours was subsequently associated with
increased risk of being overweight/obese. However for chil-
dren ages 5–13 years, sleep duration was not associated with
subsequent weight status.
30
Other cohort studies report similar
ndings.
31
A large cross-sectional study of 3,875 infants and
3,844 children (up to age 7 years) showed that sleep duration
did not predict obesity; however, obese children ages 6 to 7
years were found to sleep approximately 30 minutes less than
non-obese children.
32
In a cross-sectional study of 1,229 chil-
dren ages 5 to 11 years, children who slept less than 10 hours
per weeknight were 5 times more likely to be overweight than
those who slept at least 12 hours on weeknights.
33
In another
large cross-sectional study of 8,274 children ages 6 to 7 years
old, children with sleep duration shorter than 10 hours had an
increased odds ratio to develop obesity.
34
In a cross-sectional
study of 6,576 children, ages 7–11 years, children who slept < 9
hours per night had a higher risk for overweight, obesity, and
abdominal obesity compared to children who slept 10–11
hours.
35
In a study of 319 children ages 10–17 years, total sleep
time was negatively correlated with overweight/obese status.
36
Similar ndings were observed in a larger cross-sectional study
of 6,324 children ages 7–15 years. Boys who slept < 10 hours
per night had increased odds of overweight compared to chil-
dren sleeping > 10 hours.
37
In 3,311 children 12.5 to 17.5 years,
shorter sleep duration < 8 hours was associated with increased
BMI, body fat, and waist and hip circumferences.
38
A cohort
study of 1,303 children aged 5–29 months showed that chil-
dren sleeping < 10 hours per night consumed approximately
50 more kcal per day than children sleeping 11–12 hours,
39
sug-
gesting that changes in appetite may be a possible mechanism
for a relationship between short sleep and weight status. Of
note, one study of children ages 6–17 years reported no inde-
pendent association between insufcient sleep and childhood
obesity; however, no sleep duration information was provided
by parents.
40
In terms of other metabolic parameters, in a cohort of
652 children, chronic short sleep duration was associated
with higher waist circumference, higher insulin levels, and
greater HOMA-IR attributed to adiposity.
41
Higher HOMA
Indices were also observed in high school-aged children who
slept < 6.48 hours.
42
In children ages 4–7 years, there was in-
creased bone mineral content in children who slept longer than
8 hours.
43
A sample of 62 obese 8- to 17-year-old children studied
with polysomnography (PSG) showed a U-shape curve for
metabolic parameters such as HbA1c and insulin suggesting
an ideal range of 7.5–8.5 hours of sleep for this group of chil-
dren.
44
A U-shape curve was also observed in a study of 387
children ages 13–17 years, where HOMA-IR was 20% higher
when sleep duration was < 5 hours or > 10.5 hours.
45
Furthermore, higher C-reactive protein was observed in
13–17 year old children with < 9 hours sleep duration.
46
In summary, short sleep duration is associated with an in-
creased risk for overweight/obesity, particularly in younger
children < 10 years, and in boys. There is also evidence that
short or long sleep duration is associated with disruption of
other metabolic parameters including appetite and glucose/in-
sulin metabolism.
3.4 Mental Health
The variables of interest in the mental health domain related
to mood (e.g., depression, anxiety, suicidality, emotional regu-
lation, irritability and self-esteem); risk-taking behaviors (e.g.,
drug use); problematic behaviors (e.g., deance and tantrums);
and attention-decit/hyperactivity disorder (ADHD) symp-
toms (e.g., hyperactivity, impulsivity, and inattentiveness).
Studies included approximately 100 to 30,000 participants.
Limited data were available for children in the 4 months to
less than 12 months age range. One study looked at the longitu-
dinal sleep trajectories of approximately 3,000 children begin-
ning at age 0–1 year with follow-up at age 6–7 years.
9
Those
children who were persistent short sleepers and poor sleepers
had more difculties with emotional, social and physical func-
tioning at age 6–7 years when compared to “typical sleepers”
who slept approximately 14.5 hours of sleep at age 0–1 year
and 10.75 hours of sleep at age 6–7 years. Similarly, there were
few studies on sleep duration and emotional/mental health
within the 12 month to < 3 year old and 3 to < 6 year old age
categories. One study collected almost 33,000 parental sur-
veys regarding child sleep duration and the emotional and be-
havioral regulation of these children at 18 months and 5 years
of age.
47
Children who had short sleep duration of ≤ 10 hours
at 18 months were at signicantly greater risk of concurrent
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S Paruthi, LJ Brooks, C D’Ambrosio et al. Special Article
and subsequent incident emotional and behavioral problems
compared to a reference group of children receiving at least 13
hours of sleep at 18 months.
47
Studies reviewed for children ages 6–13 years of age fo-
cused on associations between total sleep duration and affect,
emotional regulation, irritability, relationships with peers/
family, and perceived health. Experimental studies of sleep re-
striction or sleep extension showed that participants sleeping
more than 9 hours (mean 9.8 hours) had better emotional labil-
ity scores and less restless/impulsive behaviors per teacher re-
ports compared to those sleeping an average of 8.4 hours.
48
In
a similar study, children with a mean of 9.3 hours of sleep had
signicantly higher positive affect scores and parent-reported
emotional regulation compared to children sleeping a mean of
8.1 hours.
49
In contrast, no group differences were detected in
negative affective scores and child-reported emotional regula-
tion ratings. In cross-sectional studies, data were more mixed.
For instance, impulsivity scores were signicantly higher
among children ages 7–8 years sleeping < 7.7 hours compared
to those sleeping > 7.7 hours, but no group differences were
found in total ADHD global scores.
50
Likewise, there were no
relationships between children sleeping less than 10 hours and
their affective scores or reported peer/family relationships, but
those sleeping ≥ 10 hours reported better overall health.
15
In contrast, the literature review showed a clearer relation-
ship between sleep duration and mental health among adoles-
cents, 13–18 years of age. Adolescents sleeping ≥ 9 hours of
sleep had signicantly better life satisfaction scores, fewer
general health complaints, and better quality relationships
with family compared to those sleeping less.
15
Of greatest con-
cern in the adolescent population are associations between
short sleep duration and suicidal thoughts/behaviors and sub-
stance abuse. In one cross-sectional survey of 27,939 adoles-
cents, participants who slept 7–8 hours reported less feelings
of hopelessness, less tobacco use, less alcohol use, less illicit
drug use, fewer suicidal thoughts, and fewer suicidal attempts
compared to participants who reported sleeping 6–7 hours per
night.
51
Of note, this study showed a negative correlation be-
tween more sleep and less concerning behaviors, but after 9
hours of sleep, an increase in these behaviors was noted. This
nding suggests a U-shape curve to sleep among adolescents
in which too little or too much sleep is associated with mental
health problems and substance abuse. To this point, another
study showed that teens sleeping ≤ 5 hours and ≥ 10 hours had
more suicidal attempts than those sleeping 8 hours per night.
52
In summary, there are limited data for infants 4 months to 1
year, but based on the literature, 14.5 hours of sleep seems ap-
propriate. Available longitudinal data on sleep duration for tod-
dlers suggests that at least 13 hours of sleep are benecial for
future mental health outcomes. In school-aged children, there
are conicting data, but children sleeping at least 10 hours re-
port less health complaints and children with < 8 hours of sleep
have increased reports of ADHD behaviors. Experimental data
suggest at least 9 hours of sleep is necessary for adequate be-
havioral functioning. In teens, data suggests that 8–9 hours of
sleep seems optimal for mental health and < 8 hours is associ-
ated with increased inappropriate behavior, including suicidal
attempts, and substance abuse. In this population, more than
10 hours of sleep was also associated with an increase in sui-
cidality, although causality cannot be ascertained.
3.5 Immunologic Health
The panel reviewed only 13 studies with respect to loosely
dened immunological health and sleep duration. All stud-
ies were cross-sectional, observational, or cohort design, and
none were randomized controlled studies. The number of par-
ticipants varied from as few as 54 to just under 1,500. The ma-
jority of study participants were older children, adolescents,
and teenagers. Sleep duration was measured via a mix of self-
report, parent report, actigraphy, or in some cases, the method
of measurement was not even reported.
One study suggested that sleep duration of 8–8.9 hours was
associated with a healthier immune prole (cortisol, immune
cell counts, and cytokines).
53
Another study noted an inverse
relationship between CRP and sleep duration with higher
CRPs noted in those sleeping less than 8 hours.
46
Other studies
showed no relationship between sleep variables and inamma-
tion (brinogen, IL-6, and CRP).
54
No studies suggested too
much sleep was harmful.
In summary, based on very limited and less than ideal qual-
ity evidence, it would seem that sleep durations less than 8
hours are associated with worse overall immunological health,
and that optimal sleep is between 8–9 hours for older children
and adolescents.
3.6 Human Performance
The human performance domain included a wide range of out-
comes including: neuropsychological testing (e.g., emotional
responses, cognitive performance, academic achievement);
school grades; rating scales for attention, behavior or execu-
tive functioning; ratings scales for behavioral persistence (sus-
tained attention), well-being, health behaviors and complaints;
suicide or accident risk; subjective reports of daytime sleepi-
ness; and measured electroencephalography (EEG) arous-
als. Most studies were cohort or cross-sectional studies of
community-based populations; prospective, longitudinal co-
hort data were rare. Some studies utilized a case-control study
design. Other studies used an experimental design to compare
the effects of sleep deprivation or sleep extension to the control
condition. The number of participants ranged from less than
100 in most of the case-control or experimental studies to over
3,000 in some of the cohort studies.
In a small experimental sample of 10 children aged 30–36
months, loss of a daytime nap resulting in total 24-h sleep du-
ration of less than 11 hours was associated with more nega-
tive emotional responses.
55
In preschoolers, sleep durations
of less than 8 hours in the previous 24 hours were associated
with a more than 2-fold increased risk of accidental falls.
56
In
a large prospective longitudinal cohort study of 1,492 children
aged 6 years, it was found that children with sleep durations
less than 10 hours as toddlers and preschoolers had higher
parent-reported hyperactivity indices and lower cognitive per-
formance.
57
In 812 school-aged children, sleeping less than 9
hours per night was associated with worse teacher-reported ac-
ademic achievement, but did not impact domains of attention,
motivation, or relationships.
58
In 74 children ages 6–12 years,
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S Paruthi, LJ Brooks, C D’Ambrosio et al. Special Article
one week of sleep restriction to 6.5 hours resulted in increases
in teacher-reported academic difculties and attentional prob-
lems compared with “optimized” sleep (at least 9 hours).
59
In
33 children ages 7–11 years with a mean baseline sleep dura-
tion of 9 hours 20 minutes, sleep extension of approximately
30 minutes was associated with improved alertness; whereas
modest sleep restriction (approximately 1 hour) had opposite
effects.
48
Among 77 children ages 9–12 years with a baseline
sleep duration of 8.1 hours, cognitive performance testing im-
proved with a 1-hour extension, but worsened with a 1-hour re-
striction.
60
In 32 children ages 8–12 years with a baseline sleep
duration of 8.8 hours, 4 days of sleep restriction to 8 hours
compared to 4 days of sleep extension to 9.3 hours, resulted in
impairment of memory and attention.
49
Several studies reported on both school-age and teen par-
ticipants. Self-reported sleep durations of less than 10 hours
for children and less than 9 hours for adolescents were asso-
ciated with increased somatic health complaints (higher odds
ratios) when compared to their full sleep conditions.
15
Among
3,011 children 6 to 16 years, short sleep duration (less than
the median hours for each of 4 age groups dened by school
grade levels) was associated with self-reported daytime tired-
ness in school.
61
In a large sample of 1,691 participants ages
10–19 years, sleep duration that was one hour less than “op-
timum” self-reported sleep (which varied by age) predicted
lower academic achievement scores, with a larger effect on
the older group.
62
This study also suggested a U-shape effect
where much longer sleep durations were associated with worse
performance.
62
In a small sample of 16 adolescents, 5 nights of
experimental sleep restriction to 6.5 hours resulted in inatten-
tion, diminished learning and lowered arousal in a simulated
classroom when compared to a “healthy” sleep condition of 8
hours.
63
Lower parent-ratings of executive function and par-
ticipant performance were associated with self-reported sleepi-
ness in an urban cohort of 236 teens, but not with sleep duration
measured by actigraphy.
64
Among a large cohort of 2,716 teens,
sleeping less than 8 hours per night was related to more self-
reported tiredness, inferior behavioral persistence (sustained
attention), less positive attitude toward life, and lower school
grades, as compared to sleeping longer durations.
65
Daytime
tiredness and behavioral persistence mediated the relationship
between short sleep duration and positive attitude toward life
and school grades. Except for self-reported tiredness, there
were no differences between sleeping 8–9 hours and sleeping
more than 9 hours. Students who started school 20 minutes
later received reliably more sleep and reported less tiredness.
65
In a large cohort of 1,564 teens, sleeping less than 8 hours was
associated with lower cognitive performance for boys, but not
girls.
66
Finally, in a large cohort of 1,362 teens, sleeping less
than 8 hours, compared to more than 9 hours, per night was
associated with greater risk of suicide, while sleeping 8 to 9
hours was not.
67
In summary, among various outcomes that comprise human
performance, there are sufcient and compelling data to sup-
port recommendations for sleep durations of at least 11 hours
for toddlers, 10 hours for preschoolers, 9 hours for school-
aged children, and 8 hours for teenagers to support optimal
performance.
3.7 Developmental Health
Many studies in the developmental health domain targeted
the associations between sleep duration and neurobehavioral
and neurocognitive measures. There was signicant overlap in
studies reviewed for this domain, most often with the mental
health and human performance domains. Sample sizes ranged
from 10 participants (randomized cross-over design) to 35,956
(meta-analysis). There were often methodological issues about
assumptions of directionality of relationships and variation
in reference categories used for “normal sleep duration.” The
covariates differed widely by study and there was signicant
heterogeneity in outcomes. Results also differed by gender and
ethnicity. The panel members noted that besides being associ-
ated with child development, short sleep duration has the po-
tential to affect parent-child interactions, which increases the
complexity of health interactions.
Short sleep duration has a negative association with cog-
nitive performance in a number of age groups based on
longitudinal (< 10 hours,
57
< 9 hours,
58
< 11 hours
68
) and cross-
sectional (< 9 hours
15,69
), (< 8 hours
70
), (< 11 hours
71
) studies;
however, some studies have reported a U-shape relationship
with too much sleep time associated with poorer cognitive
performance.
68
For children aged 11–13 months, the proportion of total
daily sleep occurring at night has been positively correlated
with the development of communication and problem solv-
ing skills.
72
Young children’s poorer language function was
positively associated with shorter sleep hours during the
night.
73
For preschoolers (4 years) and school-aged children
(10 years), short sleep duration (< 11 hours) was negatively
associated with receptive vocabulary.
74
Poor emotional regu-
lation and reactivity have been associated with short sleep
duration (30–36 month-olds,
55
18-month-olds
47
for < 13 hours,
and 2.5–6 year-olds for < 10 hours
57
), but one study reported
a U-shape relationship.
75
Shorter sleep duration has been as-
sociated with poorer morning and daytime mood in infants.
76
As mentioned above in the mental health domain, short sleep
duration at 18 months (< 13 hours) predicted more emotion-
ally reactive and aggressive behavior at 5 years.
47
Persistent
short sleep duration (from 0 to 7 years) has been associated
with higher levels of child irritability and poorer emotional
functioning.
9
Additionally, naps may be important. Missing one nap by
preschoolers produced more negative emotional responses
55
and nap provision improved toddlers’ performances on a gen-
eralization task
77
and grammatical language patterns 24 hours
later
78
compared with non-nap groups.
In one study, sleeping less than 8 hours per night was associ-
ated with poorer cognitive performance on reasoning abilities
for adolescent boys but not adolescent girls.
66
Another study
showed that adolescents had positive associations between
sleeping less than 8 hours and poorer school grades.
65
The
single meta-analysis of 35,956 children aged 5 to 12 years did
not specify sleep duration, but reported that longer sleep du-
ration was associated with better cognitive performance (e.g.,
implicit memory, intelligence, and school performance) and
fewer behavioral problems.
79
Shorter sleep duration has been
linked to school-aged children’s and adolescents’ attention
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S Paruthi, LJ Brooks, C D’Ambrosio et al. Special Article
problems,
49,59,63,80
restless/impulsive behavior
48
(< 9 hours) and
deterioration in vigilance
60
(30-minute sleep restriction).
The cited range for normal sleep duration is wide, ranging
from 14.5 hours during infancy
9
to 9–10 hours at school entry
and pre-adolescent children
9,81,82
to about 8.5 hours in late ado-
lescence.
83
Studies do not consistently exclude forms of sleep
problems. For example, in younger children, the proportion of
sleep at night, sleep efciency and difculty settling demon-
strate the complexity of explicating relationships between sleep
duration and developmental well-being.
72,73
A large, cross-sec-
tional study of 4–9-year-olds did not demonstrate consistent
relationships between sleep duration thresholds and learning,
based on parent-completed 24-hour time-use diaries.
84
Only at
ages 6 to 7 years did they report a positive relationship be-
tween at least 10 hours of sleep per night and mathematical
thinking, language, and literacy based on cutoff points on di-
agnostic categories from teacher report. The ndings were dif-
cult to interpret because plots showed most children averaged
between 10 to 12 hours of sleep per night. Thus the variance
in sleep duration appeared quite limited and the dichotomizing
of measures into problem/no problem reduced the information
available for testing.
In summary, there appears to be consistent relationships be-
tween inadequate sleep duration and development of children’s
cognition, language, memory, executive function, emotional
regulation, and reactivity.
3.8 Longevity
This area focused on sleep patterns in pediatric age groups
and how those patterns affect longevity. Seventy-four studies
were identied in the initial review. Thirty-seven of the stud-
ies associated sleep duration with accidents, suicidal ideation,
insomnia, stress, depression, or anxiety. The other 37 studies
associated sleep duration with cardiovascular, metabolic, pul-
monary, allergy/atopy, and obesity-related conditions. None
of the articles either evaluated or demonstrated any direct re-
lationship between sleep duration and longevity in the pedi-
atric population. Although some of the associations, such as
increased risk of suicidal ideation or adverse cardiovascular
risk factors could impact longevity, those outcomes were not
specically addressed in any of the studies. Therefore, no rec-
ommendation was made for optimal sleep duration at any age
as related to longevity.
4.0 STRENGTHS AND WEAKNESSES OF THE
LITERATURE
The panel recommendations were based on literature charac-
terized by several strengths. Taken together, studies on sleep
duration include data on hundreds of thousands of children
and teenagers, studied across several continents, aggregated
over several decades. The studies include cross-sectional and
longitudinal epidemiologic designs, randomized controlled tri-
als, meta-analyses, and a range of other designs. Studies in the
mental health category appear to have the strongest evidence.
A number of important limitations in both epidemiologic
and lab-based studies are also evident. First, most of the
studies reviewed were cross-sectional, thus ndings were cor-
relational, precluding statements of causation. Second, sleep
duration was ascertained for a limited time frame around the
assessment, with multiple ages grouped together despite ob-
vious differences in development. For example, some studies
included participants aged 8–18 years, and it is unknown how
the results would have differed had the participants’ data been
grouped as pre-adolescent vs adolescent with a different age
cut-off. Some studies may have had insufcient adjustment
for confounders. Additionally, without prospective, long-term
studies, pediatric sleep duration data on outcomes such as lon-
gevity are lacking.
Furthermore, the methods of sleep assessment present limi-
tations. Most studies described sleep duration obtained from
parental report, or child report when age-appropriate. This
may be less accurate than averages from daily report on sleep
diaries. Parent- or self-reported duration may over- or under-
estimate sleep duration measured objectively by actigraphy or
polysomnography. Additionally, studies varied in how sleep
duration was reported, i.e., per 24 hours or overnight sleep. Du-
ration reporting was discussed extensively by panel members
to determine the best means to evaluate the available literature
and provide appropriate sleep duration recommendations in the
predened age groups of children. Survey questions often had
good face validity, but most were not formally validated with
psychometric analyses. Multiple surveys also gathered health
outcomes such as height, weight, and lists of medical problems,
by parental or child report; relying on these reports may be a
source of measurement error. Also, measures of sleep duration
often do not capture information about the regularity of sleep
patterns, the timing of sleep, or the quality of sleep, all of which
could directly affect sleep duration and health outcomes.
Experimental designs have important limitations as well.
Most studies included short periods of sleep duration manip-
ulation, almost always < 2 weeks. The acute effects of sleep
deprivation may not approximate real-world effects of chronic
sleep deprivation. Few studies examined sleep duration in the
range between 8 and 12 hours. This likely reects the aim of
experimental studies, which often try to maximize differences
in outcomes by contrasting extreme sleep duration groups. The
absence of experimental groups in these sleep duration ranges
creates some uncertainty in recommendations due to lack of
data. Many studies also lack generalizability because of small
sample sizes that may not represent the population in terms
of age, sex, race, ethnicity, socioeconomic status, or health
history. Many studies investigated groups of children across
multiple ages at different developmental stages, but reported a
single result. PSG measurements of sleep duration may not be
an accurate measure of typical sleep duration given the differ-
ent sleep environment (lab) and weak correlations with paren-
tal or child self-reported duration.
5.0 VOTING SUMMARY
Voting results from all 3 rounds are presented in Figures 1–3.
Napping was discussed for age appropriate groups, and re-
ected in the nal recommendations for children through age
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S Paruthi, LJ Brooks, C D’Ambrosio et al. Special Article
5 years explicitly, with the understanding that some healthy
children up to age 7 years may habitually nap. The panel dis-
cussed several reasons for why short or long sleep durations
may be inappropriate for each age group after incorporating
ndings from the literature and criteria for sleep disorders. All
values are per 24 hours.
For infants, there was consensus that < 12 hours of sleep
per 24 hours was inappropriate to support optimal health.
There was also consensus that a range of 12 to 16 hours was
appropriate to support optimal infant health. Consensus could
not be reached on 16 to 18 hours due to uncertainty given the
lack of data in this sleep duration range. However, there was
consensus that ≥ 18 hours of sleep was inappropriate. There
was also consensus that no recommendations could be made
in infants < 4 months of age, due to the paucity of published
outcomes in infants this young.
For children aged 1 to < 3 years, there was consensus that
sleep duration of < 10 hours was inappropriate. There was con-
sensus that 11 to 14 hours per 24 hours was appropriate. Un-
certainty was observed in the 10–11 hour range and 14 to 16
hour range, with panel consensus that sleep times longer than
16 hours in this age group were inappropriate.
For children aged 3 to < 6 years, there was consensus
that sleep duration of < 10 hours or more than 14 hours was
inappropriate. There was consensus that 10–13 hours of sleep
was appropriate. Uncertainty existed in the 13 to 14 hour dura-
tion range. The panel discussed that the sleep needs of a 3-year
old preschooler may be vastly different than the sleep needs of
a 6-year old rst-grader.
For children aged 6 years to < 13 years, there was consen-
sus that sleep duration of 9 to 12 hours was appropriate and
that > 13 hours was inappropriate. There was uncertainty if
12–13 hours of sleep duration was appropriate.
For teenagers aged 13 to 18 years of age, there was consen-
sus that < 8 hours or > 10 hours of sleep on a regular basis was
inappropriate. There was consensus that 8 to 10 hours was ap-
propriate for optimal health.
The panel discussed the merits of recommending sleep du-
rations for multiple age groups vs collapsing all age groups
to recommend 1 single sleep duration threshold. Implicit to a
range recommendation is the conclusion that sleep duration
above a certain amount of sleep is detrimental to health. The
literature supported a clear cut-off in optimal sleep duration in
the teenager group, as there were unambiguously better health
outcomes within the recommended range, and clear negative
outcomes and an increased likelihood of sleep disorders when
nightly sleep durations were < 8 hours or > 10 hours. Within
other age groups, due to the wide age ranges in studies and lack
Figure 2—Round 2 voting results.
Round 2 voting was based on voting across all age groups under the following seven domains: cardiovascular health, developmental health, human
performance, general health, immunology, mental health and metabolic health.
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S Paruthi, LJ Brooks, C D’Ambrosio et al. Special Article
of published literature, there was often uncertainty on the outer
ends of the agreed upon appropriate sleep duration ranges. The
panel also discussed consideration of nap duration for age ap-
propriate children. With these considerations in mind, the
panel voted to recommend ranges for each age group. No age
groups were collapsed and no age groups were further sepa-
rated during the in-person meeting because voting in Round 1
had already taken place.
6.0 DISCUSSION
Sleep is a necessity for health. Meeting the need for sleep dura-
tion, timing, regularity, and quality requires volitional behav-
iors by parents and children, which are partially dictated by
genetic and physiologic factors. However, a large proportion
of inter-individual variability in sleep is likely explained by
psychological, behavioral, social, cultural, and environmental
factors. Sleep disorders also contribute to this variability.
For reasons stated above, the panel focused solely on the
dimension of sleep duration, while recognizing the importance
of other factors such as timing, regularity, and quality. The rec-
ommendations provide sleep durations that promote optimal
pediatric health, but do not address other sleep factors. The
panel excluded studies that focused on sleep factors other than
sleep duration and studies that focused on total sleep depri-
vation (no sleep for 24 hours). Total sleep deprivation is not
sustainable and thus not reective of habitual sleep, which was
the focus of the panel. In general, the total sleep time is high
in infants and toddlers, with gradual reduction over time as
one approaches pre-adolescence and adolescence. This change
parallels the ontogeny of cerebral metabolism that was studied
in 100 healthy children using positron emission tomography.
85
The reduction in total sleep time over the rst decade is felt to
be related to an initial overproduction, and subsequent pruning
away of unnecessary synapses.
85
All panel members agreed that too little sleep for each age
group was unhealthy. The panel discussed thoroughly the ap-
propriateness of longer sleep durations for each age group. The
panel discussed the higher likelihood of sleep disorders often
being associated with longer sleep times, which was then in-
congruent with sleep duration for optimal health. Another con-
sideration was the lack of studies in children on sleep extension.
There were a few U-shape curves that showed that both, too
little and too much sleep were associated with poorer outcomes.
The panel strongly encourages future experimental studies to
examine the effects of sleep extension on health outcomes.
The panel recommendations reect typical or habitual sleep
duration, i.e., the ideal average sleep duration. However, the
panel discussed that sleep duration in the real world is a dy-
namic process. Many children, particularly those who have ex-
perienced a delay in their circadian rhythms in puberty, have
variable sleep schedules depending on school start times, work,
and extracurricular activities that may curtail sleep on week-
days and extend sleep on weekends. More studies are needed
to better characterize effects of this “social jet lag.”
Figure 3—Round 3 voting results.
Round 3 voting is based on voting summary across all age groups.
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S Paruthi, LJ Brooks, C D’Ambrosio et al. Special Article
The panel discussed heterogeneity of sleep duration
measurement at length: subjective report vs (more) objective
actigraphy, parental report vs child self-report, time in bed vs
time asleep, and inclusion vs exclusion of naps. Several stud-
ies have shown that self-report may differ substantially from
objective measurement.
Polysomnography and actigraphy were utilized in some
studies as objective measurements of sleep duration, and the
panel discussed the strengths and limitations of these studies.
Actigraphy may over-estimate sleep duration relative to self-
report in poor sleepers. PSG directly records sleep, however,
other factors such as “rst night effect” or logistics such as
set wake up times to end PSG recordings may be in place and
thus not accurately reect a typical night of sleep. Home sleep
apnea testing is not currently recommended in children, and
also does not provide accurate reection of sleep time. As
technology improves and the use of activity trackers becomes
more widespread in the pediatric population, more data will be
available to better measure sleep duration and compare time
and effects within large participant samples.
7.0 FUTURE DIRECTIONS
The recommendations of the panel are intended to be a rst
step towards promoting adequate sleep duration for all chil-
dren. The panel reviewed existing literature to achieve con-
sensus, and realized that serious gaps in knowledge exist in
the pediatric population. As more high-quality literature be-
comes available, the recommendations may change in the fu-
ture. Based on this process, specic areas for future research
consideration are presented:
1. Implement improved sleep duration measures and
study designs, including intervention studies. As
child development changes signicantly from year
to year, it is imperative to study narrower age groups,
with validated studies and intervention designs to
better delineate sleep deprivation effects on important
outcomes such as mental health, physical health, and
cognitive functioning. Small preliminary studies
have begun to explore the effects of sleep extension
on health and functioning in children. More studies
are recommended (i.e., between 8 and 10 hours in
adolescents) to systematically vary sleep opportunity
in discrete steps between the upper and lower amounts
using objective measurements of sleep physiology
and cognitive performance. These studies should also
examine longer time periods (e.g., 30 days), including
weekdays and weekend days, to develop more precise
dose-response curves for sleep and recovery effects
within the ranges most often reported by children and
parents. Studies that mimic typical sleep-wake cycles
and lifestyles in each age group are needed.
2. Investigate downstream mechanisms linking habitual
sleep duration to health and functioning. Intervention
studies are needed to help clarify whether modifying
sleep duration improves health outcomes in children.
Such studies will help to explain whether sleep
duration has a causal role in health and functioning vs
operating as a marker of other processes.
3. Delineate the upstream physiologic, behavioral, social,
and environmental factors that may play a role in sleep
duration and health outcomes. Studies are needed to
identify how genetics relate to individual sleep need
and the response and resilience to sleep loss. Studies
are also needed that explore the roles of race, ethnicity,
socioeconomic factors, neighborhoods, school start
times, and other factors that contribute to sleep
duration.
4. Identify biomarkers of sleep need or sleep deprivation.
Inexpensive, reliable, and feasible biomarkers could
advance the goals of clinical care, public health, and
public policy. In the future, biomarkers may allow
clinicians to provide more accurate sleep schedule
recommendations to children, parents, and policy
makers to facilitate policy decisions (e.g., school start
times and teen driving). Biomarkers may greatly assist
research assessment of the long term consequences of
sleep deprivation.
CONCLUSIONS
The 13-member panel used a modied RAND Appropriate-
ness Method to generate consensus recommendations for the
amount of sleep to promote optimal health in children. Mul-
tiple rounds of evidence review, discussion and voting were
conducted to arrive at the nal recommendations. Additional
research on the role of sleep duration at different stages in a
child’s growth and development will help increase the aware-
ness of the importance of sleep and lead to improved health
and well-being for children and families.
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ACKNOWLEDGMENTS
The AASM acknowledges the following individuals for their participation and
contributions: Non-Participating Observers: Michael Twery, PhD, National Health,
Lung, Blood Institute, NIH, Bethesda, MD; and Joel Porquez, RST, RPSGT, CCSH,
American Association of Sleep Technologists. American Academy of Sleep Medicine
Staff: John Noel; Jonathan L. Heald, MA; and Sarah Hashmi, MBBS, MSc, MPH.
SUBMISSION & CORRESPONDENCE INFORMATION
Submitted for publication September, 2016
Accepted for publication September, 2016
Address correspondence to: Shalini Paruthi, MD, St. Luke’s Hospital, 232 S. Woods
Mill Road, St. Louis, MO 63017; Email: research@aasmnet.org
DISCLOSURE STATEMENT
Funding for this project was provided by the American Academy of Sleep Medicine,
and supported by the cooperative agreement number 1U50DP004930-03 from
the Centers for Disease Control and Prevention (CDC). Its contents are solely the
responsibility of the authors and do not necessarily represent the ofcial views of the
CDC. Dr. Maski has consulted for Medscape Inc. and has received research support
from Jazz Pharmaceuticals. Dr. Rosen has consulted as a medical advisor for Jazz
Pharmaceuticals. The other Consensus Conference Panel members have indicated
no nancial conicts of interest.
LITERATURE SEARCH TERMS
Category Search Term
Sleep Duration
Napping [All fields]
Sleep debt [All fields]
Short sleep [All fields]
Long sleep [All fields]
Sleep deprivation [All fields]
Insufficient sleep
syndrome
[All fields]
Excessive sleep [All fields]
Sleep curtailment [All fields]
Sleep length [All fields]
Sleep need [All fields]
Sleep duration [All fields]
Sleep deficiency [All fields]
Cancer
Neoplasms [MeSH terms]
Cardiovascular
Health
Cardiovascular
diseases
[MeSH terms]
Heart valves [MeSH terms]
Heart valve
diseases
[MeSH terms]
Blood pressure [MeSH terms]
Developmental
Health
Child Development
Disorders, Pervasive
[MeSH terms]
Academic
performance
[All fields]
Behavior [MeSH terms]
Psychology,
educational
[MeSH terms]
Personality [MeSH terms]
Learning [MeSH terms]
Attention [MeSH terms]
School start time [All fields]
Neuropsychological
tests
[MeSH terms]
Neuropsycholo* [All fields]
Neurocognitive [All fields]
Neurobehavioral [All fields]
Emotional regulation [All fields]
Language [MeSH terms]
Socialization [MeSH terms]
Category Search Term
Human
Performance
Function [All fields]
Activities of daily
living
[MeSH terms]
Alertness [All fields]
Cognition [MeSH terms]
Patient safety [All fields]
Patient harms [All fields]
Accidents [MeSH terms]
Accident proneness [MeSH terms]
Fatigue [MeSH terms]
Vigilance [All fields]
Psychomotor
performance
[MeSH terms]
Reaction [All fields]
Comprehension [MeSH terms]
Confusion [MeSH terms]
Impairment [All fields]
Sleepiness
NOT sleep disorders
[All fields]
Sleep satisfaction [All fields]
Achievement [MeSH terms]
Athletic performance [MeSH terms]
Automobile driving [MeSH terms]
Category Search Term
General Health
Epidemiology [MeSH terms]
Prevention medicine [MeSH terms]
Emergencies [All fields]
Endemic diseases [All fields]
Environmental
medicine
[All fields]
Environmental
microbiology
[MeSH terms]
Disease
transmission,
infectious
[MeSH terms]
Environmental
pollution
[MeSH terms]
Public health
practice
[MeSH terms]
Wellness [All fields]
Well-being [All fields]
Quality of life [MeSH terms]
Wounds and Injuries [MeSH terms]
Immunological
Health
Inflammation [MeSH terms]
Autoimmune
disease
[MeSH terms]
Cytokines [MeSH terms]
Leukocytes [MeSH terms]
Phagocytes [MeSH terms]
Immunoproteins [MeSH terms]
Vaccination [MeSH terms]
Asthma [MeSH terms]
Common cold [MeSH terms]
Infection [MeSH terms]
Longevity
Death [MeSH terms]
Survival [MeSH terms]
Vital statistics [MeSH terms]
Suicide [MeSH terms]
Category Search Term
Mental Health
Mental Health [MeSH terms]
Depression [MeSH terms]
Psychiatry [MeSH terms]
Anxiety disorders [MeSH terms]
Mood disorders [MeSH terms]
Schizophrenia and
disorders with
psychotic features
[MeSH terms]
Substance-related
disorders
[MeSH terms]
Mental Disorders
Diagnosed in
Childhood
[MeSH terms]
Attention Deficit and
Disruptive Behavior
Disorders
[MeSH terms]
Eating disorders [MeSH terms]
Emotions [MeSH terms]
Metabolic Health
Metabolism [MeSH terms]
Body weight [MeSH terms]
Metabolic disease [MeSH terms]
Insulin [MeSH terms]
Orexins [MeSH terms]
Ghrelin [MeSH terms]
Adipokines [MeSH terms]
Waist-hip ratio [MeSH terms]
Thyroid gland [MeSH terms]
Pediatric obesity [MeSH terms]
Pain
Pain [MeSH terms]
Nociception [MeSH terms]
Rheumatic diseases [MeSH terms]
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