1. Effects of AlcoholEffects of Alcohol
on U.S. Adolescent Sleep Patterns:on U.S. Adolescent Sleep Patterns:
A Systematic ReviewA Systematic Review
Nancy Carballo, MSIVNancy Carballo, MSIV
Shahrzad Bazargan-Hejazi, PhDShahrzad Bazargan-Hejazi, PhD
Charles R. Drew University of Medicine & ScienceCharles R. Drew University of Medicine & Science
David Geffen School of Medicine at UCLADavid Geffen School of Medicine at UCLA
CDU/UCLA Medical Education ProgramCDU/UCLA Medical Education Program
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2. BackgroundBackground
Inadequate sleep duration and quality is known toInadequate sleep duration and quality is known to
affect trends in alcohol useaffect trends in alcohol use
On the other hand, the effects of alcohol use on sleepOn the other hand, the effects of alcohol use on sleep
is not well-knownis not well-known
Implications of alcohol-related sleep disturbanceImplications of alcohol-related sleep disturbance
patterns among minority adolescents are needed inpatterns among minority adolescents are needed in
primary care settingsprimary care settings
Reason: increasing trend of multiple substance useReason: increasing trend of multiple substance use
among adolescentsamong adolescents
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3. BackgroundBackground
Hasler BP, Soehner AM, Clark DB (2014). “Sleep and circadian contributions toHasler BP, Soehner AM, Clark DB (2014). “Sleep and circadian contributions to
adolescent alcohol use disorder.”adolescent alcohol use disorder.” AlcoholAlcohol pii: S0741-8329(14)20114-5.pii: S0741-8329(14)20114-5.
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4. ObjectivesObjectives
DetermineDetermine how alcohol use/misusehow alcohol use/misuse impactsimpacts
adolescent sleep patterns and sleep qualityadolescent sleep patterns and sleep quality
Identify theIdentify the role of primary carerole of primary care in reducing thein reducing the
impact of alcohol use/misuse and sleep disruptionsimpact of alcohol use/misuse and sleep disruptions
among adolescentsamong adolescents
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5. MethodsMethods
Study design: systematic reviewStudy design: systematic review
5 database sources (2009 – 2015)5 database sources (2009 – 2015)
CinahlCinahl
Embase/ElsevierEmbase/Elsevier
Google ScholarGoogle Scholar
PubMedPubMed
PsycINFOPsycINFO
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6. MethodsMethods
Study eligibility criteria:Study eligibility criteria:
English published articlesEnglish published articles
Peer reviewed journalsPeer reviewed journals
Alcohol effects on sleep patternsAlcohol effects on sleep patterns
U.S. adolescent 13 – 19 yoU.S. adolescent 13 – 19 yo
All ethnicitiesAll ethnicities
Normal health statusNormal health status
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7. MethodsMethods
Search strategy with a staged approachSearch strategy with a staged approach
Initial searchInitial search
Full searchFull search
Search of reference listsSearch of reference lists
Hand search using the following terms:Hand search using the following terms:
 ““sleep AND alcohol AND adolescent” ORsleep AND alcohol AND adolescent” OR
 ““sleep AND alcohol AND adolescence”sleep AND alcohol AND adolescence”
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8. Data AnalysisData Analysis
Identified studies during the database search wereIdentified studies during the database search were
assessed for relevancy by reviewing the following:assessed for relevancy by reviewing the following:
TitleTitle
AbstractAbstract
Descriptor/MeSH termsDescriptor/MeSH terms
PRISMA flow diagramPRISMA flow diagram
Obtained full manuscripts for potentially all relevantObtained full manuscripts for potentially all relevant
studiesstudies
Table summary report for all studies meeting theTable summary report for all studies meeting the
inclusion criteriainclusion criteria
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9. ResultsResults
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10. ResultsResults
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11. ResultsResults
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12. ResultsResults
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13. ConclusionsConclusions
Objective 1: Determine how alcohol use/misuse impacts adolescentObjective 1: Determine how alcohol use/misuse impacts adolescent
sleep patterns and sleep qualitysleep patterns and sleep quality
Adolescents use alcohol as a sleep aidAdolescents use alcohol as a sleep aid
Yet, adolescents report insufficient sleepYet, adolescents report insufficient sleep
Alcohol exacerbates circadian misalignmentsAlcohol exacerbates circadian misalignments
 Impairs ability to shift to changing schedulesImpairs ability to shift to changing schedules
 Compounds sleep-related health-risk behaviorsCompounds sleep-related health-risk behaviors
Alcohol use/misuse leads to inadequate sleep, and therefore:Alcohol use/misuse leads to inadequate sleep, and therefore:
Lower school performanceLower school performance
Higher incidences of MVAsHigher incidences of MVAs
EEGsEEGs
Heavy drinking linked to longer REM time and shorter latencyHeavy drinking linked to longer REM time and shorter latency
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14. ConclusionsConclusions
Objective 2: Identify the role of primary care in reducing theObjective 2: Identify the role of primary care in reducing the
impact of alcohol use/misuse and sleep disruptions amongimpact of alcohol use/misuse and sleep disruptions among
adolescentsadolescents
Understand the adolescent patient from different angles:Understand the adolescent patient from different angles:
Alcohol use/misuse; seeing someone cut, stabbed, or shot; worry;Alcohol use/misuse; seeing someone cut, stabbed, or shot; worry;
and internalized anger are all associated with low-incomeand internalized anger are all associated with low-income
adolescentsadolescents
Ask the adolescent patient the right supplementary questions:Ask the adolescent patient the right supplementary questions:
Heavy drinking, living conditions, and other SES factors that areHeavy drinking, living conditions, and other SES factors that are
associated with a shorter sleep duration (<6 h/day)associated with a shorter sleep duration (<6 h/day)
Brief interventions can reduce quantity and frequency of alcoholBrief interventions can reduce quantity and frequency of alcohol
use/misuse:use/misuse:
Effects seem to be greatest among adolescents who already drinkEffects seem to be greatest among adolescents who already drink
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15. LimitationsLimitations
Inherent limitations of each individual study designInherent limitations of each individual study design
Randomized controlled trials can be difficult to acquire:Randomized controlled trials can be difficult to acquire:
Unethical to provide alcohol to adolescentsUnethical to provide alcohol to adolescents
Adolescents may not admit to substance useAdolescents may not admit to substance use
Some studies consider U.S. adolescents alongside:Some studies consider U.S. adolescents alongside:
18 – 25 yo: young adults vs. late adolescents18 – 25 yo: young adults vs. late adolescents
Non-U.S. adolescentsNon-U.S. adolescents
Ethnicities are lumped along “other” or don’t “exist”Ethnicities are lumped along “other” or don’t “exist”
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16. Recommendations:Recommendations:
Future DirectionsFuture Directions
ProvidersProviders will have a study to cite when talking withwill have a study to cite when talking with
adolescents and parents in underserved communitiesadolescents and parents in underserved communities
about preventive healthcareabout preventive healthcare
More studies that address outcomes of alcohol‐More studies that address outcomes of alcohol‐
related sleep disturbances, stratified by race andrelated sleep disturbances, stratified by race and
gender, to identify at‐risk groupsgender, to identify at‐risk groups
More studies that address circadian misalignmentsMore studies that address circadian misalignments
caused by alcohol use, which disrupt reward systemscaused by alcohol use, which disrupt reward systems
Bridge gaps in underrepresented populationsBridge gaps in underrepresented populations
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17. AcknowledgmentsAcknowledgments
I would like to thank my research mentor Dr. Bazargan‐I would like to thank my research mentor Dr. Bazargan‐
Hejazi for her expertise and coaching while performingHejazi for her expertise and coaching while performing
this systematic review. I would also like to thank thethis systematic review. I would also like to thank the
Urban Underserved College at Charles R. Drew UniversityUrban Underserved College at Charles R. Drew University
of Medicine and Science as well as the David Geffenof Medicine and Science as well as the David Geffen
School of Medicine at UCLA for their facilitation andSchool of Medicine at UCLA for their facilitation and
supervision of this systematic review.supervision of this systematic review.
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18. Thank you!Thank you!
Q & AQ & A
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