Sleep and Breathing

, Volume 13, Issue 4, pp 357–367 | Cite as

Sleep duration, wake/sleep symptoms, and academic performance in Hong Kong Secondary School Children

  • E. P. Ng
  • D. K. NgEmail author
  • C. H. Chan
Original Article



Sleep deprivation is common among teenagers. The aim of this study was to investigate the relationship between sleep duration, wake/sleep symptoms, and academic performance among Hong Kong students.

Materials and methods

The sleep habit questionnaires were distributed to all Year 11 students at an international school that catered to different ethnic groups in Hong Kong. Analysis of various parameters of academic performance and sleep habits and their relationships were undertaken.


Fifty-nine students were recruited. The average sleep duration in this group was 7.23 h. The overall prevalence of excessive daytime sleepiness (defined as an Epworth Sleepiness Scale score of >10) was 25.4%. Eleven subjects had excessive class sleepiness, defined as high likelihood to fall asleep during at least one school session. Mathematics performance was positively correlated with sleep duration. Excessive sleepiness on rising was identified as a significant risk factor for poor performance in English and Mathematics. Sleepiness during the third and fourth lessons was identified as a significant risk factor for poor performance in Mathematics only.


Sleep deprivation was common in the studied cohort and it was associated with a decrease in Mathematics performance. Excessive sleepiness on rising and sleepiness during third and fourth lessons were associated with poorer grades in Mathematics and English. Excessive daytime sleepiness was reported in 25% of students. Bruxism and snoring were associated with excessive daytime sleepiness.


Sleep Cognition Adolescents Sleep deprivation Snoring 


  1. 1.
    Yoo S, Hu P, Gujar N, Jolesz F, Walker MP (2007) A deficit in the ability to form new human memories without sleep. Nat Neurosci 10:385–392. doi: 10.1038/nn1851 CrossRefPubMedGoogle Scholar
  2. 2.
    Walker MP, Stickgold R (2004) Sleep-dependent learning and memory consolidation. Neuron 44:121–133. doi: 10.1016/j.neuron.2004.08.031 CrossRefPubMedGoogle Scholar
  3. 3.
    Curcio G, Ferrara M, Gennaro LD (2006) Sleep loss, learning capacity and academic performance. Sleep Med Rev 10:323–327. doi: 10.1016/j.smrv.2005.11.001 CrossRefPubMedGoogle Scholar
  4. 4.
    Stern WC (1971) Acquisition impairments following rapid eye movement sleep deprivation in rats. Physiol Behav 7:345–352. doi: 10.1016/0031-9384(71)90312-X CrossRefPubMedGoogle Scholar
  5. 5.
    Smith C (1985) Sleep states and learning: a review of the animal literature. Neurosci Biobehav Rev 9:157–168. doi: 10.1016/0149-7634(85)90042-9 CrossRefPubMedGoogle Scholar
  6. 6.
    Guan Z, Peng X, Fang J (2004) Sleep deprivation impairs spatial memory and decreases extracellular signal-regulated kinase phosphorylation in the hippocampus. Brain Res 1018:38–47. doi: 10.1016/j.brainres.2004.05.032 CrossRefPubMedGoogle Scholar
  7. 7.
    McGrath MJ, Cohen DB (1978) REM sleep facilitation of adaptive waking behaviour: a review of the literature. Psychol Bull 85:24–57. doi: 10.1037/0033-2909.85.1.24 CrossRefPubMedGoogle Scholar
  8. 8.
    Gruart-Masso A, Nadal-Alemany R, Coll-Andreu M et al (1995) Effects of pretraining paradoxical sleep deprivation upon two-way active avoidance. Behav Brain Res 72:181–183. doi: 10.1016/0166-4328(96)00082-4 CrossRefPubMedGoogle Scholar
  9. 9.
    Ng DK, Kwok KL, Cheung JM et al (2005) Prevalence of sleep problems in Hong Kong primary school children. Chest 128:1315–1323. doi: 10.1378/chest.128.3.1315 CrossRefPubMedGoogle Scholar
  10. 10.
    Klackenberg G (1982) Sleep bahaviour studied longitudinally. Data from 4–16 years on duration, night-awakening and bed-sharing. Acta Paediatr Scand 71:501–506. doi: 10.1111/j.1651-2227.1982.tb09459.x CrossRefPubMedGoogle Scholar
  11. 11.
    Iglowstein I, Jenni OG, Molinari L et al (2003) Sleep duration from infancy to adolescence: reference values and generational trends. Pediatrics 111:302–307. doi: 10.1542/peds.111.2.302 CrossRefPubMedGoogle Scholar
  12. 12.
    Liu X, Uchiyama M, Okawa M et al (2000) Prevalence and correlates of self-reported sleep problems among Chinese adolescents. Sleep 23:27–34PubMedGoogle Scholar
  13. 13.
    Pilcher JJ, Huffcut AL (1996) Effects of sleep deprivation on performance: meta-analysis. Sleep 19:318–326PubMedGoogle Scholar
  14. 14.
    Shin C, Kim J, Lee S et al (2003) Sleep habits, excessive daytime sleepiness and school performance in high school students. Psychiatry Clin Neurosci 57:451–453. doi: 10.1046/j.1440-1819.2003.01146.x CrossRefPubMedGoogle Scholar
  15. 15.
    Johns MW (1991) A new method for measuring daytime sleepiness: the Epworth sleepiness scale. Sleep 14:540–545PubMedGoogle Scholar
  16. 16.
    Leung SS, Cole TJ, Tse LY et al (1998) Body mass index reference curves for Chinese children. Ann Hum Biol 25:169–174. doi: 10.1080/03014469800005542 CrossRefPubMedGoogle Scholar
  17. 17.
    Steptoe A, Peacey V, Wardle J (2006) Sleep duration and health in young adults. Arch Intern Med 166:1689–1692. doi: 10.1001/archinte.166.16.1689 CrossRefPubMedGoogle Scholar
  18. 18.
    Arakawa M, Taira K, Tanaka H et al (2001) A survey of junior high school students' sleep habit and life style in Okinawa. Psychiatry Clin Neurosci 55:211–212. doi: 10.1046/j.1440-1819.2001.00829.x CrossRefPubMedGoogle Scholar
  19. 19.
    Gau SF, Soong WT (1995) Sleep problems of junior high school students in Taipei. Sleep 18:667–673PubMedGoogle Scholar
  20. 20.
    Lazaratou H, Dikeos DG, Anagnostopoulos DC et al (2005) Sleep problems in adolescence. A study of senior high school students in Greece. Eur Child Adolesc Psychiatry 14:237–243. doi: 10.1007/s00787-005-0460-0 CrossRefPubMedGoogle Scholar
  21. 21.
    Kahn A, Van de Merckt C, Rebuffat E et al (1989) Sleep problems in healthy preadolescents. Pediatrics 84:542–546PubMedGoogle Scholar
  22. 22.
    Wolfson AR, Carskadon MA (1998) Sleep schedules and daytime functioning in adolescents. Child Dev 69:875–887PubMedGoogle Scholar
  23. 23.
    Carskadon MA, Wolfson AR, Acebo C (1998) Adolescent sleep patterns, circadian timing, and sleepiness at a transition to early school days. Sleep 21:871–881PubMedGoogle Scholar
  24. 24.
    Epstein R, Chillag N, Lavie P (1998) Starting times of school: effects on daytime functioning of fifth-grade children in Israel. Sleep 21:250–256PubMedGoogle Scholar
  25. 25.
    Gottlieb DJ, Yao Q, Redline S, Ali T, Mahowald MW (2000) Does snoring predict sleepiness independently of apnea and hypopnea frequency? Am J Respir Crit Care Med 162:1512–1517PubMedGoogle Scholar
  26. 26.
    Henke KG (1998) Upper airway muscle activity and upper airway resistance in young adults during sleep. J Appl Physiol 84:486–491PubMedGoogle Scholar
  27. 27.
    Stoohs RA, Dement WC (1993) Snoring and sleep-related breathing abnormality during partial sleep deprivation. N Engl J Med 328:1279. doi: 10.1056/NEJM199304293281714 CrossRefPubMedGoogle Scholar
  28. 28.
    Tsuno N, Jaussent I, Dauvilliers Y et al (2007) Determinants of excessive daytime sleepiness in a French community-dwelling elderly population. J Sleep Res 16:364–371. doi: 10.1111/j.1365-2869.2007.00606.x CrossRefPubMedGoogle Scholar
  29. 29.
    Ohayon M, Li K, Guilleminault C (2001) Risk factors for sleep bruxism in the general population. Chest 119:53–61. doi: 10.1378/chest.119.1.53 CrossRefPubMedGoogle Scholar
  30. 30.
    Kato T (2004) Sleep bruxism and its relation to obstructive sleep apnea–hypopnea syndrome. Sleep Biol Rhythms 2:1–15. doi: 10.1111/j.1479-8425.2003.00077.x CrossRefGoogle Scholar
  31. 31.
    Carskadon MA, Dement WC (1987) Daytime sleepiness: quantification of a behavioral state. Neurosci Biobehav Rev 111:307–317. doi: 10.1016/S0149-7634(87)80016-7 CrossRefGoogle Scholar
  32. 32.
    Carskadon MA (1990) Patterns of sleep and sleepiness in adolescents. Paediatrician 17:5–12Google Scholar
  33. 33.
    Dahl RE (1996) The impact of inadequate sleep on children’s daytime cognitive function. Semin Pediatr Neurol 3:44–50. doi: 10.1016/S1071-9091(96)80028-3 CrossRefPubMedGoogle Scholar
  34. 34.
    Gray EK, Watson D (2002) General and specific traits of personality and their relation to sleep and academic performance. J Pers 70:177–206. doi: 10.1111/1467-6494.05002 CrossRefPubMedGoogle Scholar
  35. 35.
    Eliasson A, Eliasson A, King J, Gould B, Eliasson A (2002) Association of sleep and academic performance. Sleep Breath 6:45–48. doi: 10.1055/s-2002-23157 CrossRefPubMedGoogle Scholar
  36. 36.
    Wolfson AR, Carskadon MA (2003) Understanding adolescents’ sleep patterns and school performance: a critical appraisal. Sleep Med Rev 7:491–506. doi: 10.1016/S1087-0792(03)90003-7 CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag 2009

Authors and Affiliations

  1. 1.Australian International School Hong KongKowloon TongHong Kong
  2. 2.Department of PaediatricsKwong Wah HospitalYau Ma TeiHong Kong

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