Recommended Amount of Sleep for Pediatric Populations: A

785

Journal of Clinical Sleep Medicine, Vol. 12, No. 6, 2016

Sleep is essential for optimal health in children and adolescents. 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 modied RAND Appropriateness Method.

The recommendations are summarized here. A manuscript detailing the conference proceedings and the evidence supporting these recommendations will be

published in the Journal of Clinical Sleep Medicine.

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. Recommended amount of sleep for pediatric populations: a consensus statement of the American Academy of Sleep Medicine. J Clin Sleep Med

2016;12(6):785–786.

CONSENSUS RECOMMENDATIONS

• 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. Insufcient sleep also

increases the risk of accidents, injuries, hypertension,

obesity, diabetes, and depression. Insufcient sleep in

CONSENSUS STATEMENT

Recommended Amount of Sleep for Pediatric Populations:

A Consensus Statement of the American Academy of Sleep Medicine

Shalini Paruthi, MD

*; Lee J. Brooks, MD

2,3

; Carolyn D’Ambrosio, MD

; Wendy A. Hall, PhD, RN

; Suresh Kotagal, MD

; Robin M. Lloyd, MD

;

Beth A. Malow, MD, MS

; Kiran Maski, MD

; Cynthia Nichols, PhD

; Stuart F. Quan, MD

; Carol L. Rosen, MD

; Matthew M. Troester, DO

;

Merrill S. Wise, MD

Saint Louis University, St. Louis, MO;

Children’s Hospital of Philadelphia, Philadelphia, PA;

Liaison for the American Academy of Pediatrics, Elk Grove Village, IL;

Brigham and

Women’s Hospital, Boston, MA;

University of British Columbia School of Nursing, Vancouver, BC;

Mayo Clinic, Rochester, MN;

Vanderbilt University Medical Center, Nashville,

TN;

Boston Children’s Hospital, Boston, MA;

Munson Sleep Disorders Center, Traverse City, MI;

Harvard Medical School, Boston, MA;

Rainbow Babies and Children’s Hospital,

Cleveland, OH;

Barrow Neurological Institute at Phoenix Children’s Hospital, Phoenix, AZ;

Methodist Healthcare Sleep Disorders Center, Memphis, TN; *moderator of the

Consensus Conference Panel

pii: jc-00158-16 http://dx.doi.org/10.5664/jcsm.5866

teenagers is associated with increased risk of self-harm,

suicidal thoughts, and suicide attempts.

◦ Regularly sleeping more than the recommended hours

may be associated with adverse health outcomes such

as hypertension, diabetes, obesity, and mental health

problems.

◦ Parents who are concerned that their child is sleeping

too little or too much should consult their healthcare

provider for evaluation of a possible sleep disorder.

Recommendations for infants younger than 4 months are not

included due to the wide range of normal variation in duration

and patterns of sleep, and insufcient evidence for associa-

tions with health outcomes.

BACKGROUND AND METHODOLOGY

Healthy sleep requires adequate duration, appropriate timing,

good quality, regularity, and the absence of sleep disturbances

or disorders. Sleep duration is a frequently investigated sleep

measure in relation to health. A panel of 13 experts in sleep

medicine and research used a modied RAND Appropriate-

ness Method

to develop recommendations regarding the sleep

duration range that promotes optimal health in children aged

0–18 years. The expert panel reviewed published scientic evi-

dence addressing the relationship between sleep duration and

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Journal of Clinical Sleep Medicine, Vol. 12, No. 6, 2016

S Paruthi, LJ Brooks, C D’Ambrosio et al. Consensus Statement

health using a broad set of National Library of Medicine Medi-

cal Subject Headings (MeSH) terms and no date restrictions,

which resulted in a total of 864 scientic articles. The process

was further guided by the Oxford grading system.

The panel

focused on seven health categories with the best available evi-

dence in relation to sleep duration: general health, cardiovas-

cular health, metabolic health, mental health, immunologic

function, developmental health, and human performance.

Consistent with the RAND Appropriateness Method, mul-

tiple rounds of evidence review, discussion, and voting were

conducted to arrive at the nal recommendations. The pro-

cess to develop these recommendations was conducted over a

10-month period and concluded with a meeting held February

19–21, 2016 in Chicago, Illinois.

DISCUSSION AND FUTURE DIRECTIONS

Current evidence supports the general recommendations for

obtaining an adequate number of hours of sleep per 24 hours

on a regular basis to promote optimal health among children

aged 4 months to 18 years. Individual variability in sleep need

is inuenced by genetic, behavioral, medical, and environmen-

tal factors. A clearer understanding of the precise biological

mechanisms underlying sleep need requires further scientic

investigation. These recommendations create a foundation to

raise awareness and improve understanding of sleep effects on

health. The recommendations provide a basis for:

• Educating children, teenagers, families, school

professionals, healthcare providers/trainees, and the

general public on the importance of adequate sleep

duration for health.

• Encouraging parents and caregivers to help children

obtain adequate sleep duration.

• Initiating discussions of social, educational, and economic

benets of adequate sleep duration, thereby informing

public policy.

• Promoting research on the role of sleep duration in health

and well-being. Research that directly examines the

effects of sleep duration on health may lead to revisions of

these recommendations in the future.

These recommendations have been endorsed by the American

Academy of Pediatrics, the Sleep Research Society and the

American Association of Sleep Technologists.

REFERENCES

1. Fitch K, Bernstein S, Aguilar M et al. The Rand/UCLA appropriateness method

user’s manual. Santa Monica, CA: Rand, 2001.

2. OCEBM Levels of Evidence Working Group. The Oxford 2011 Levels of

Evidence. [cited March 9 2016]. Available from: http://www.cebm.net/wp-

content/uploads/2014/06/CEBM-Levels-of-Evidence-2.1.pdf.

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. Attendance by these individuals

does not constitute endorsement of this statement by their afliated institutions or

organizations. American Academy of Sleep Medicine Staff: John Noel; Jonathan L.

Heald, MA; and Sarah Hashmi, MBBS, MSc, MPH.

SUBMISSION & CORRESPONDENCE INFORMATION

Submitted for publication April, 2016

Accepted for publication April, 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 ofcial 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 conicts of interest.