Date of Award


Degree Type


Degree Name

Doctor of Philosophy (PhD)




Sleep is a critical component of healthy development during adolescence, and when disrupted, has been linked to difficulties with physical status, psychological health, family functioning, neuropsychological symptoms, and academic performance. The overarching goal of this project was to examine sleep-wake disturbances in association with bio-neuropsychosocial functioning in a vulnerable pediatric population of adolescents with spina bifida (SB). Specifically, this study aimed to 1) examine sleep-wake patterns in adolescents with SB using a multimodal sleep assessment, 2) identify daily temporal associations between sleep and pain as well as sleep and mood, and 3) identify the relationship between sleep-wake disturbances and bio-neuropsychosocial functioning in adolescents with SB. Sleep-wake patterns in adolescents ages 12 to 18 with SB (N = 37) were compared to a matched comparison group of typically developing (TD) peers (N = 37). A subjective and objective sleep assessment was conducted; ambulatory actigraphy recordings was completed over 10 days, and adolescents completed several sleep questionnaires (e.g., sleep quality, pre-sleep arousal) and a daily diary. In addition, adolescents and parents completed questionnaires to assess physical (pain, BMI), psychological (internalizing symptoms, health-related quality of life), family (conflict, cohesion), neuropsychological (attention, executive function), and academic functioning (school competence, grades).

Study findings revealed that adolescents with SB experienced higher rates of sleep-wake disturbances compared to their typically developing peers. Results of actigraphy and questionnaire report data found that adolescents were particularly at-risk for reduced sleep quantity (i.e., lower total sleep time) and poor sleep quality (i.e., difficulties with bedtime settling and staying asleep). Adolescents with SB also experienced higher levels of daytime fatigue compared to their peers. Sleep-wake disturbances were associated with every domain of adolescent functioning within the bio-neuropsychosocial model. In particular, there were consistent data to support the connection between nighttime sleep disturbances and psychological maladjustment (i.e., internalizing, quality of life). To a lesser extent, nighttime sleep disturbances were linked to worse physical health (pain, BMI) and family functioning (family conflict). Furthermore, daytime sleepiness and/or fatigue, but not nighttime sleep disturbances, predicted worse neuropsychological and academic functioning, including inattention/hyperactivity, executive dysfunction, and lower school grades. Ongoing evaluation and treatment of sleep disturbances will be critical to optimize health and functioning in this vulnerable pediatric population.