MIND, BRAIN, AND EDUCATION
SleepWake Cycle, Daytime
Sleepiness, and Attention
Components in Children
Attending Preschool
in the Morning and Afternoon
Shifts
Aline S. Belsio1 , Fernanda F. Kolodiuk1 , Fernando M. Louzada2 , Pablo Valdez3 , and
Carolina V. M. Azevedo1
ABSTRACT Children tend to sleep and wake up early and
to exhibit daytime sleep episodes. To evaluate the impact of
school start times on sleepiness and attention in preschool
children, this study compared the temporal patterns of
sleep, daytime sleepiness, and the components of attention
between children aged 46 years that study in the morning
(n = 66) and the afternoon (n = 144) shifts. The former get
up 1 hr and 30 min earlier on weekdays and show lower e-
ciency on the sustained attention task than those who study
in the afternoon. Thus, the morning shift was associated with
a reduction in nighttime sleep, which might have a nega-
tive eect on childrens performance in the morning, causing
higher levels of daytime sleepiness and a decline in sustained
attention. Because only one parameter of one component of
attention was negatively aected, further studies are needed
to conrm this eect on cognition.
1 Laboratrio de Cronobiologia, Programa de Ps-Graduao em Psi-
cobiologia, Departmento de Fisiologia, Universidade Federal do Rio
Grande do Norte
2 Departmento de Fisiologia, Universidade Federal do Paran
3 Laboratrio de Psicosiologia, Departmento de Psicologia, Universi-
dad Autnoma de Nuevo Len
Address correspondence to Carolina V.M. Azevedo, Caixa Postal 1511,
CEP 59078-970, Natal, RN, Brazil; e-mail: carolina@cb.ufrn.br
2016 International Mind, Brain, and Education Society and Wiley Periodicals, Inc.
The sleepwake cycle plays an important role in the cog-
nitive processes of learning, such as attention (Gillberg
& Akerstedt, 1998; Thomas et al., 2000; Valdez, Reilly, &
Waterhouse, 2008) and memory consolidation (Drosopou-
los, Schulze, Fischer, & Born, 2007; Wilhelm, Diekelmann, &
Born, 2008), in addition to contributing to restoring phys-
iological and biochemical processes (Benington & Heller,
1995; Ramm & Smith, 1990) and maintaining energy bal-
ance (Spiegel, Tasali, Penev, & Van Cauter, 2004; Taheri,
Lin, Austin, Young, & Mignot, 2004; Taveras, Rifas-Shiman,
Oken, Gunderson, & Gillman, 2008).
Sleep has an essential function in cognitive and motor
development, especially in children, who are still maturing.
A number of changes inherent to this age group occur in
the sleepwake cycle as a result of the maturation process
of the nervous system. Children tend to go to bed and
wake up early; that is, they have a tendency to morningness
(Jenni & Carskadon, 2005). Total sleep duration declines
progressively with age, along with an increase in nighttime
sleep and a decrease in daytime sleep episodes (naps), which
are frequent in young children (Acebo et al., 2005; Jenni &
Carskadon, 2005; Louzada, Orsoni, Mello, Benedito-Silva,
& Menna-Barreto, 1996; Menna-Barreto, Isola, Louzada,
Benedito-Silva, & Mello, 1996).
The sleepwake cycle is inuenced by a series of peculiari-
ties in the childs social environment, such as behavior before
1
 Sleep, Sleepiness, and Attention in Children
(drinking milk, going to the bathroom, listening to stories,
and use of favorite object) and during sleep (co-sleeping
or bed-sharing). These sleep patterns change when chil-
dren start school and the school start times modulate the
sleepwake cycle, which may lead to daytime sleepiness and
compromise academic performance (Beltramini & Hertzig,
1983; Li et al., 2008; Reimo, Souza, Medeiros, & Almiro,
1998; Reimo et al., 1999; Silva et al., 2005).
Despite exhibiting a tendency to morningness, children
between 3 and 10 years of age who study in the morning and
wake up and go to bed earlier sleep less during the week than
on the weekend (Adam, Snell, & Pendry, 2007; Belsio, 2010;
El-Sheikh, Buckhalt, Mize, & Acebo, 2006; Louzada et al.,
1996; Mello, Isola, Louzada, & Menna-Barreto, 1996; Silva
et al., 2005). Moreover, children aged between 7 and 10 years
who study in the morning show greater frequency of naps, in
addition to sleeping approximately 1 hr more than children
who study in the afternoon (Silva et al., 2005). Thus, children
who study in the morning experience acute sleep deprivation
on weekdays that is generally compensated for on weekends.
An increase of around 2629 min in time spent in bed during
the weekend was observed in children aged between 4 and
6 (Belsio, 2010) and 8 and 10 years (Anacleto, 2011). This
slight dierence between school days and weekends is likely
caused by a natural predisposition to go to sleep and wake
up early, characteristic of this age group, and the inuence
of parents in determining the sleepwake schedule of their
children (Iglowstein, Jenni, Molinari, & Largo, 2003; Meijer,
Habekoth, & Van Den Wittenboer, 2000).
The shorter nighttime sleep and irregular sleep times
related to the morning shift would not be expected in chil-
dren, who naturally wake up earlier. However, in addition to
causing changes in sleep patterns, school start time may lead
to high levels of daytime sleepiness (Silva et al., 2005) and low
attention levels (Valdez et al., 2008), which may negatively
interfere with the childs learning process.
Among the cognitive processes aected by sleep depriva-
tion we highlight the attention, which is the ability to select
and respond specically to a stimulus in the environment for
a certain period of time. This cognitive process can be stud-
ied using neuropsychological models (Cohen & ODonnell,
1993; Mirsky, Anthony, Duncan, Ahearn, & Kellam, 1991;
Posner & Rafal, 1987; Valdez et al., 2005), which makes it
possible to analyze the brain areas involved, as well as ver-
ify the presence of circadian rhythms in the dierent atten-
tion components and the impact of sleep deprivation in this
process.
The model used in the present study was proposed by
Valdez et al. (2005) and is based on the Posner and Rafal
(1987) model, with some changes, namely in dening atten-
tion components and assessing each component of the atten-
tion process. In the model proposed by Valdez et al. (2005),
attention is divided into four components denominated
2
tonic alertness, phasic alertness, selective attention, and sus-
tained attention. Tonic alertness is the ability to respond to
changes in the environment; phasic alertness is the ability to
respond to environmental changes preceded by a warning
signal; selective attention is the ability to process a sensory
event and ignore other events; and sustained attention is the
ability to respond to the environment for a certain interval
of time.
Attention may be modulated by time of day (Valdez,
Ramrez, Garca, Talamantes, & Cortez, 2010) and sleep
deprivation (Rodrguez, 2011), which leads to a decline in
attention levels and may compromise school learning. With
the changes in current lifestyles, children go to sleep late on
weekdays and wake up early to go to school. This results
in partial deprivation and irregular sleeping hours and, in
turn, daytime sleepiness, primarily in children who study in
the morning. However, the relationship between the com-
ponents of attention, sleep pattern, and daytime sleepiness
in children aged between 4 and 6 years remains unknown,
as is the eect of school start times on these parameters. The
present study aimed to compare sleep habits, daytime sleepi-
ness, and the components of attention in preschool children
as a function of school shift (morning and afternoon).
METHODS
The study was approved by the Onofre Lopes University
Hospital Research Ethics Committee (CEP/HUOL protocol
no. 554/11). The sample consisted of 210 children of both
sexes from the morning (n = 66) and afternoon (n = 144)
shifts, aged between 4 and 6 years, from the city of Natal,
Brazil (Latitude: 5 47 42 S and longitude: 35 12 34
W). Seven private schools took part in the research. At all
schools, morning classes start at 7 a.m. and nish at 11 a.m.,
while afternoon classes are between 1 p.m. and 5 p.m.
The following inclusion criteria were adopted: preschool
children (1) of both sexes aged between 4 and 6 years, (2)
enrolled in private schools in Natal, who study in the morn-
ing or afternoon shift, and (3) whose parents or guardians
gave their informed consent.
The exclusion criteria were (1) sleep disturbance or any
health problem, such as allergies, sinusitis, hypertension or
neurological disorders, and (2) incomplete questionnaires.
Sleep habits were characterized using the sleep habits
questionnaire applied by Wey (2002), to which were added
questions regarding bedtime rituals (Owens, Spirito, &
McGuinn, 2000) and information about parents schooling
level.
Economic level was characterized using a questionnaire
adapted from the model proposed by the Brazilian Economic
Classication Criterion (CCEB) of the National Association
of Research Companies (Associao Nacional de Empresas
 Aline S. Belsio et al.
de Pesquisa, 2008). This classication straties the popula-
tion into eight economic classes (A1, A2, B1, B2, C1, C2, D,
and E), based on responses related to possession of goods
and the head of the familys schooling level. Classication in
points makes it possible to infer mean family income.
An adapted version of the sleep diary (Wey, 2002) was
used to characterize sleep pattern for 9 consecutive days
(from Friday night to Monday morning). The following out-
comes were obtained from the sleep diary: (1) sleep at night
(bedtimes, wake up times, and time in bed), (2) daytime naps
(frequency of children who doze during the week and week-
end, duration, and times of start and end); (3) the activity
before bedtime (options: watching TV, playing, homework,
or other); (4) parent regulation of bedtime (options: the par-
ents regulated the bedtime, or the child goes to bed sponta-
neously); (5) the way of waking up (options: spontaneously,
by an alarm clock, or called by someone); and (6) the rea-
son for wake up time (options: school starting time, physical
activities or sports, travel, promenade, or other). Parents or
guardians completed the questionnaires on sleep habits, eco-
nomic classication, and the sleep diary with information on
the childrens sleep habits.
In order to assess the sleepiness levels, an adapted version
(Belsio, 2014) of the Pictorial Sleepiness Scale Based on Car-
toon Faces of Maldonado (Maldonado, Bentley, & Mitchell,
2004) was applied during 6 days, from Monday to Friday
and the next Monday, consecutively. The data collected on
the rst Monday were excluded from analysis to reduce the
eects of a new person in the school environment. Dur-
ing questionnaire application children were asked how they
were feeling at that moment, that is, whether they felt sleepy
or not. Next, the children indicated the face on the scale that
best represented how they were feeling at the time. The scale
was applied between 8 a.m. and 9 a.m. and 2 p.m. and 3 p.m.
to children of the morning and afternoon shifts, respectively.
A continuous performance task (CPT) was used to assess
the components of attention in the children. The CPT
uses frequent stimuli to track the childs attention, but
also requires responses to infrequent and specic stimuli
that occur at random intervals (Riccio, Reynolds, Lowe, &
Moore, 2002). A CPT, a simple task that continuously mon-
itors behavior, is sensitive to sleep deprivation and circa-
dian rhythms (Gill, Haerich, Westcott, Godenick, & Tucker,
2006; Mullaney, Kripke, Fleck, & Johnson, 1983; Valdez et al.,
2005). It has been demonstrated that this task measures each
component of attention and the indices of sustained atten-
tion (Smith, Valentino, & Arruda, 2002; Valdez et al., 2005,
2010).
The CPT used in the present study was an adapted ver-
sion for preschool children (Belsio, 2014) of that applied
on university students by Valdez et al. (2005). In this task,
three images familiar to children (a green heart, a red circle,
and a blue star) were used. Each image was displayed on a
computer screen for 200 ms. There were a total of 100 stim-
uli: 70 green hearts, 20 red circles, and 10 blue stars (each
blue star was preceded by an arrow). The images were dis-
played randomly. Responses were recorded on a keyboard.
The child had to press key 1 when a green heart appeared,
key 2 when a red circle appeared, and key 3 when a blue
star appeared. Each key was covered with an image sticker
related to the requested response: key 1 with a green heart,
key 2 with a red circle, and key 3 with a blue star. A 100-ms
feedback sound (beep) was presented after each correct
response.
According to the attention model proposed by Pos-
ner and Rafal (1987) and Valdez et al. (2005), responses
to the green heart (a frequent stimulus) indicated tonic
alertness, the red circle (a dierent, infrequent, specic
stimulus) indicated selective attention, the blue star (a stim-
ulus preceded by an arrow that acted as a warning signal)
indicated phasic alertness, while changes in performance
during the task indicated sustained attention. Task duration
was 5 min.
Training sessions were held on Monday and Tuesday,
during which the task was explained to the children as a
game in which they would have to press certain keys corre-
sponding to the gures displayed on the screen. Data from
this training were excluded from the analysis. The task was
applied on three weekdays (Wednesday, Friday, and Mon-
day) between 8 a.m. and 9 a.m. to children of the morning
shift and between 2 p.m. and 3 p.m. to their afternoon coun-
terparts. The children responded to the Maldonado daytime
sleepiness scale before the task was applied.
DATA ANALYSIS
Sleep habits (co-sleeping, room sharing, and bedtime ritu-
als) and economic classication of children in the morning
and afternoon shifts were compared using the chi-square
test (2 ).
The sleep parameters obtained from the sleep diary (the
bed and wake up times, time spent in bed at night, and total
time spent in bed every 24 hr, the latter obtained from the
sum of the time spent in bed at night and the duration of
nap) were compared between shifts by analysis of variance
(ANOVA) for repeated measures and Bonferronis posttest.
Daytime sleepiness, irregularity of bed and wake up times
(calculated from the standard deviation in bed and wake
up times, respectively), and the parameters related to naps
(start time, end time, and duration) were compared between
shifts using the MannWhitney test. Comparative analysis
of nap-related parameters between week and weekend days
was conducted using the Wilcoxon test.
In relation to attention task data, the MannWhitney
test was applied to compare the percentage and reaction
3
 Sleep, Sleepiness, and Attention in Children

time for correct responses in each attention component Economic Classication

(tonic alertness, selective attention, phasic alertness, and
sustained attentionconcentration); sequences of hits and
errors during the attention task (obtained by a sequence
of hits and errors over the course of the test; e.g., 1 hit, 2
hits, 3 hits, until achieving 100 hits, which refers to the total
number of stimuli in the task), and omissions (no response
to the stimulus) between children who study in the morning
and afternoon.
Furthermore, the time on task stability, which is an index
of sustained attention, was obtained from a linear regres-
sion of the percentage of correct responses and reaction
time in all attention components throughout the task (tonic
alertness, selective attention, and phasic alertness). Nega-
tive values represent a decrease in correct answers/reaction
time over the task. On the other hand, positive values
represent an increase in these parameters across the task.
The MannWhitney test was used to compare the indices
between the shifts. A signicance level of 5% was set in all
tests applied.
RESULTS
Most of the morning shift children belonged to classes A2
(24%) and B1 (44%), whereas those from the afternoon
shift were in B1 (22%) and B2 (40%) (X 2 = 37.32,
p < .0001).
Childrens Activity Before Bedtime
A higher percentage of children who studied in the morning
watch TV on Monday (51%; 2 = 30.74; p < .0001), Tuesday
(51%; 2 = 13.72; p = .0174), and Friday (72%; 2 = 37.13;
p < .0001), whereas a greater percentage of those who
studied in the afternoon watch TV on Wednesday (60%;
2 = 11.73; p = .0386), Thursday (51%; 2 = 27.47; p < .0001),
and Saturday (50%; 2 = 31.40; p < .0001).
Parent Regulation of Childrens Bedtime
A greater percentage of morning shift students have their
bedtime regulated by their parents on Tuesday (52%;
2 = 8.48; p = .0035), Wednesday (50%; 2 = 17.36; p < .0001),
Thursday (50%; 2 = 1107; p = .0008), and Saturday (49%;
X 2 = 10.55; p = .0011), whereas this occurred only on Friday
(43%; 2 = 6.55; p = .0104) for children who study in the
afternoon.

Co-Sleeping, Room Sharing and Bedtime Ritual Reason for Wake Up Time
There was no dierence in the frequency of co-sleeping, A higher percentage of parents of children who study
room sharing, or bedtime rituals between children who in the morning report school as the reason for wake up
study in the morning and afternoon (2 , p > .05) (Table 1). time on weekdays (Monday: 97%; 2 = 401.20; Tuesday:

Table 1
Frequency of Co-Sleeping, Room-Sharing, and Bedtime Rituals During the Week in Children Who Study in the Morning and Afternoon
Shifts (2 test, p > .05).

Morning Afternoon
Frequently Sometimes Rarely Frequently Sometimes Rarely
Behaviors % % % % % % 2 p
Co-sleeping and room-sharing
Co-sleeping with brother/sister 5.0 4.0 91.0 7.0 7.0 86.0 2.06 .3561
Co-sleeping with parents/guardians 41.0 27.0 33.0 41.0 27.0 32.0 0.40 .9799
Room-sharing with brother/sister 20.0 3.0 76.0 20.0 5.0 75.0 0.52 .7694
Room-sharing with parents/guardians 29.0 10.0 59.0 26.0 12.0 61.0 0.67 .7126
Sleeping alone 31.0 17.0 53.0 30.0 16.0 54.0 0.09 .9520
Bedtime rituals
Drinking milk 44.0 22.0 33.0 40.0 24.0 35.0 .73 .6914
Listening to stories 17.0 51.0 32.0 18.0 50.0 32.0 0.09 .9531
Going to the bathroom 64.0 27.0 9.0 58.0 32.0 10.0 1.26 .5319
Requires the parents in the room 57.0 25.0 18.0 61.0 23.0 17.0 0.55 .7577
Sleeping with the lights on 25.0 14.0 62.0 23.0 19.0 59.0 1.48 .4752
Using a special object 40.0 15.0 45.0 32.0 18.0 50.0 3.38 .1836
Others 29.0 19.0 50.0 38.0 15.0 46.0 3.73 .1543

Note: Frequently = behavior occurs 5 or more times during the week; Sometimes = behavior occurs 24 times during the week; rarely = behavior occurs once or
never during the week.

4
 Aline S. Belsio et al.
Fig. 1. Mean and standard deviation of bedtime, wake up time, and time in bed at night, and total time in bed (night and daytime nap)
during the week in children of morning and afternoon shifts (ANOVA, *p < .05).
92%; 2 = 600.61; Wednesday: 94%; 2 = 947.41; Thurs-
day: 86%; 2 = 342.08; Friday: 80%; 2 = 358.96; p < .0001)
compared to those who study in the afternoon (Monday:
18%; 2 = 401.20; Tuesday: 12%; 2 = 600.61; Wednesday:
8%; 2 = 947.41; Thursday: 17%; 2 = 342.08; Friday: 14%;
2 = 358.96; p < .0001).
Way of Waking Up
A greater number of children who study in the morn-
ing are woken up by someone on weekdays (Monday:
76%; 2 = 180.28; Tuesday: 76%; 2 = 128.92; Wednesday:
68%; 2 = 140.76; Thursday: 76%; 2 = 123.17; Friday: 63%;
2 = 193.39, p < .0001), whereas more children who study
in the afternoon wake up spontaneously on these days
(Monday: 78%; 2 = 180.28; Tuesday: 73%; 2 = 128.92;
Wednesday: 79%; 2 = 140.76; Thursday (72%; 2 = 123.17;
Friday: 82%; 2 = 193.39, p < .0001).
Temporal Sleep Patterns
Bedtimes did not dier between shifts (F (6.462) = 0.97,
p = .4438). Nevertheless, children in the morning shift usu-
ally went to bed 40 min earlier than those who studied in
the afternoon. Children who studied in the morning went
to bed earlier on Monday and Wednesday than on Saturday,
whereas those who studied in the afternoon went to bed
earlier on Monday, Tuesday, and Thursday than on Saturday
(F (6.462) = 8.47; Bonferroni, p < .0001) (Figure 1).
Children from the morning shift woke up about 1 hr
and 30 min earlier from Monday to Friday compared to
those who studied in the afternoon, with no dierence on
weekends (F (6.450) = 7.06; Bonferroni, p < .0001). Children in
the morning shift woke up earlier during the week than on
Saturday and Sunday (F (6.450) = 11.34; Bonferroni, p < .0001),
whereas those in the afternoon shift showed no dierence
between weekdays and weekends (F (6.450) = 11.34; Bonfer-
roni, p < .0001) (Figure 1).
Morning shift students spent 1 hr less in bed on Monday
and Sunday nights than their afternoon shift counterparts
(ANOVA F (6.456) = 7.01; Bonferroni, p < .0001). Time spent
in bed for children who studied in the morning was shorter
on Tuesday, Thursday, and Sunday than on Saturday. On
the other hand, children who studied in the afternoon spent
more time in bed from Monday to Friday than on Saturday
(ANOVA F (6.456) = 1.10; Bonferroni, p < .0001) (Figure 1).
There was no dierence in the irregularity of bed-
times (MannWhitney, p = .9588) and wake up times
(MannWhitney, p = .4067) between the shifts (Table 2).
Children who studied in the morning napped more fre-
quently on weekdays and weekends (2 , p < .0001) and
naps were longer on weekdays (MannWhitney, p = .008)
(Table 2). It is important to underscore that the children
5
 Sleep, Sleepiness, and Attention in Children

Table 2
Irregularity in Bedtime and Wake Up Times, Frequency of Children
Who Nap, Times of Start, End, and Duration of Naps in Children
of the Morning and Afternoon Shifts (2 , MannWhitney, p < .05).

Morning Afternoon
Characteristics (n = 44) (n = 39) p
Nap
Weekdays frequency 68% 26% <.0001
of children
Start 13:40 01:18 13:38 03:05 .3121
End 15:48 01:30 15:04 03:29 .4238
Duration 02:08 00:54 01:25 00:50 .0001
Weekend frequency 44% 31% .0080
of children
Start 14:26 00:59 14:36 01:37 .4062
End 16:19 01:12 16:16 01:50 .5022 Fig. 2. Mean and standard deviation of daytime sleepiness level
Duration 01:52 00:46 01:44 00:51 .4356
during the week in children of morning and afternoon shifts. The
Irregularity
Bedtime 00:43 00:22 00:43 00:20 .9588 daytime sleepiness was measured by an adapted version of the
Wake up time 00:50 00:55 00:42 00:24 .4067 Pictorial Sleepiness Scale Based on Cartoon Faces of Maldonado
et al. (2004) (MannWhitney, p < .05).

napped at home. In children who studied in the morning,

time increased less in this group (MannWhitney, p = .05)
the naps occurred after they returned from school; while
(Figure 4). Nevertheless, there was no dierence between
those in the afternoon shift napped, for example, when they
shifts in relation to omissions (Figure 5) and the sequence
missed school to go to the dentist or to accompany their
of hits and errors across the test (MannWhitney, p > .1777)
parents to solve personal problems.
(Figure 6).

Time Spent in Bed

There was no dierence between shifts (F (6.480) = 4.05, DISCUSSION
p = .3828) or weekdays (F (6.480) = 1.62, p = .1388) for
time spent in bed every 24 hr (nighttime sleep and naps) This is a pioneering investigation on comparing the habits
(Figure 1). and temporal patterns of sleep, daytime sleepiness, and the
components of attention in preschool children enrolled in
the morning and afternoon shifts. Sleep habits did not dier
Daytime Sleepiness
between shifts, but there were dierences in temporal sleep
The level of daytime sleepiness in children who study in the
patterns, daytime sleepiness, and some components of atten-
morning was higher on Monday (MannWhitney, p = .05)
tion between children who studied in these shifts.
and Friday (MannWhitney, p = .004) compared to those
It was observed that most of the children co-slept and
who studied in the afternoon (Figure 2).
engaged in bedtime rituals regardless of the shift in which
they studied. Thus, school start time did not change these
Components of Attention behaviors, probably because they are part of family dynam-
Children in the morning shift exhibited a higher percentage ics that increase childparent interactions (Beltramini &
of correct answers for phasic alertness than those from the Hertzig, 1983; Buckley, Rigda, Mundy, & McMillen, 2002;
afternoon shift (MannWhitney, p = .05) (Figure 3). How- Silva et al., 2005).
ever, over the course of the test children who studied in the With respect to temporal sleep patterns according to
morning had fewer correct answers and a lower increase in school start time, it was observed that during the week chil-
reaction time than those who studied in the afternoon. This dren who studied in the morning woke up 1 hr and 30 min
can be visualized in the time on task stability in Figure 4. earlier than those who studied in the afternoon. Thus, they
The negative values observed represent a decrease in correct spent 1 hr less in bed at night and tended to be sleepier on
answers throughout the task. On the other hand, the positive Monday and Friday than their afternoon shift counterparts.
values represent an increase in reaction time during the task. Furthermore, a higher frequency of children from the morn-
The decrease in the percentage of correct answers across the ing shift napped with longer episodes than those who studied
task was higher in morning shift children. However, reaction in the afternoon.

6
 Aline S. Belsio et al.

Fig. 3. Mean and standard error of the percentages and reaction time of correct answers for the components of attention during the
continuous performance task in children who study in the morning and the afternoon shifts (MannWhitney, p = .05).

Fig. 4. Mean and standard error of indices of time on task stability Fig. 5. Mean and standard error of omissions during the attention
in relation to the percentage and reaction time of correct answers task for children who study in the morning and the afternoon
during the performance task in children who study in the morning (MannWhitney, p > .05).
and afternoon shifts (MannWhitney, p < .05).

and the stronger inuence of parents in determining their

In more sleep deprived teenagers, this corresponds to a
dierence of nearly 2 hr of sleep between school days and
weekends (Carskadon, 2002; Carskadon, Acebo, & Jenni,
2004; Sousa, Arajo, & Azevedo, 2007). The dierence
between children and teenagers may be due to the natural
predisposition of children to go to bed and wake up earlier,
sleepwake times (Iglowstein et al., 2003; Meijer et al., 2000)
This dierence in temporal sleep patterns between week-
days and weekend in children who studied in the morn-
ing may be due to acute sleep deprivation associated with
a shorter time in bed at night in consequence to the school
starting time in the morning, which may contribute to a

7
 Sleep, Sleepiness, and Attention in Children
Fig. 6. Average and standard error of the sequence of hits and
error runs during the continuous performance task in children
who study in the morning and the afternoon shifts. No signicant
diferences were found between the groups in hits or error runs.
(MannWhitney, p > .05).
higher level of daytime sleepiness. It is important to under-
score that most of the children who studied in the morning
were woken up by their parents during the week and most
who studied in the afternoon woke up spontaneously, reaf-
rming the signs of acute sleep deprivation in the former
group. Thus, the increase in sleepiness on Monday may be
a consequence of the shorter time in bed from Sunday to
Monday, whereas on Friday it may result from accumulated
tiredness during the week. This sleepiness pattern may lead
to the long nap episodes observed in the children enrolled in
the morning shift.
With regard to naps and the shorter time spent in bed,
it was observed that after adding time spent in bed at night
and the daytime nap, the total sleep time of morning shift
students was similar to that of afternoon students. This
shows that children who studied in the morning slept less at
night than those from the afternoon shift, but they seemed
to compensate this deprivation by taking daily naps. These
results corroborate those observed by Silva et al. (2005), who
reported that 7- to 10-year-old children who studied in the
morning took more naps than those who studied in the
afternoon. These sleeping patterns demonstrate acute sleep
deprivation during the week that is compensated by taking
daily naps. Thus, school start time inuenced the childrens
sleeping patterns, given that they spent less time in bed and
woke up earlier to go to school in the morning.
In addition, morning shift students had fewer correct
answers, even though they exhibited a shorter increase in
reaction time during the CPT compared to their after-
noon shift counterparts. Nevertheless, in this investigation
no intershift dierences were observed in omissions, the
sequence of hits and errors during the test, or the number
of correct answers and reaction time for tonic alertness and
8
selective attention, although an increase in the percentage of
correct answers for phasic alertness was observed in children
enrolled in the morning shift.
The decrease in one of the sustained attention indices
(percentage of correct answers across the task) in children
from the morning shift may have been caused by acute sleep
deprivation associated to the shorter time they spent in bed
at night due to the school start time. In the school context,
this negative eect might compromise learning.
However, both groups of children showed an increase
in reaction time across the task, but this increase was
less marked in children who studied in the morning. This
increase across the task was expected in cognitive assess-
ment tests due to the fatigue eect. The lower increase
in morning shift students may be due to a motivational
eect (Valdez et al., 2008), as a consequence of a higher
activity level associated with methodological dierences
in school tasks. Motivation and the higher activity level
might have stimulating eects on cognitive development
(Wojtczak-Jaroszowa & Jarosz, 1987).
The absence of intershift dierences in some attention
parameters may result from the level of daily sleep depri-
vation observed in children (about 1 hr), which might not
have been sucient to interfere in attention levels. Further-
more, the time the tasks were applied could have inu-
enced the responses obtained. Children from each shift
answered the tasks at dierent circadian moments (morn-
ing or afternoon). Additionally, those who studied in the
morning should have exhibited a higher homeostatic pres-
sure level since they had less nighttime sleep, but afternoon
shift students displayed a higher number of previous waking
hours. These factors may lead to more rapid fatigue in both
groups and might have inuenced the results obtained for
attention.
In other studies, it was observed that university students
had increased attention levels during the day and a decline
between 4 a.m. and 6 a.m. (Valdez et al., 2005, 2010). The
continuous application task presented in this study was
applied between 8 a.m. and 9 a.m. to the morning group and
2 p.m. and 3 p.m. to the afternoon group. Based on the study
with university students, it was expected that both shifts
would exhibit high attention levels, while sleep-deprived
children would not perform well on the task. However, chil-
dren are characterized by an advanced circadian phase in
relation to college students. Thus, circadian variation in
attention should be assessed considering the ontogenetic dif-
ferences that could cause dierent results in each age group.
The reduction in sustained attention eciency observed
in this study is similar to the levels identied in previous
research with children starting at 7 years of age that sought
to identify cognitive development. Shorter sleep duration
and poorer sleep quality have been associated with low per-
formance (Paavonen et al., 2009; Sadeh, Gruber, & Raviv,
 Aline S. Belsio et al.
2002; Touchette et al., 2007). However, these studies mea-
sured performance using scores on tests or tasks that only
assessed sustained attention.
This study had a number of limitations: (1) sleepwake
cycle analysis using questionnaires completed by parents
may have contained inaccuracies regarding their childs
habits (according to Lam, Mahone, Mason, and Scharf
[2011], because parents tend to overestimate the sleep time
of children, actigraphy is one of the best ways to evaluate
sleep patterns); (2) the dierent task application times could
have inuenced intershift results; (3) some participants
abandoned the study at dierent stages, contributing to a
decrease in the number of participants; and (4) the absence
of chronotype evaluation due to the lack of an instrument
validated for Portuguese that could have been applied to the
children. Finally, an actigraphic assessment of sleeping pat-
terns, using sleepiness variables, such as sleepwake times to
classify the chronotypes of children younger than 8 years old,
is suggested for future studies. The attention components in
this age group should be analyzed more often throughout
the day to verify whether the ndings of the present investi-
gation really had an inuence on daily sleep compensation,
and motivation or were due to a circadian eect.
It is suggested that school start time inuences tem-
poral sleep patterns and daytime sleepiness in preschool
children. Changes in sleeping patterns due to the morn-
ing start time have been assessed in teenagers (Andrade,
1997; Carskadon, 2002; Carskadon et al., 2004; Sousa et al.,
2007) and preteenagers aged 1012 years (Epstein, Chillag,
& Lavie, 1998), but we observed that school start time also
inuences younger children, despite their natural tendency
to morningness. In addition to the negative impact on sleep
patterns, there were signs of negative eects on sustained
attention, which may compromise learning. Since only one
parameter of one component of attention was negatively
aected, further studies evaluating the attention compo-
nents in this age group at dierent times of the day are
needed to conrm this eect on cognition. Nevertheless, the
results obtained reinforce the importance of broadening the
discussion regarding changing school start times, which is
focused on teenagers, to other age groups, such as preschool
children. To that end, it is essential to take into account the
biological characteristics of each age group.
AcknowledgmentsWe thank Dr. John Arajo, Dr. Luiz
Menna-Barreto, and Dra. Katie Almondes for suggestions
throughout this study. We also thank the students Diana
Jurez, Ana-hi Flores, Mariana Reyna, Gabriela Iracheta,
Susana Hernandez, Galileu Borges, Maria Luiza Oliveira,
Sabinne Galina, Jackleyde Silva, Icemria Felipe, and Kar-
lyne dos Anjos for their help in data collection and analysis;
Dra. Candelria Ramrez and Dra. Aida Garca for analysis
support; and CAPES, Programa de Ps-Graduao em
Psicobiologia and the Universidade Federal do Rio Grande
do Norte for nancial support.
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