Scholars@Duke publication: Leveraging convenient wearable technology to assess adolescent sleep: physical and behavioral health correlates of single-channel sleep electroencephalogram in a community sample of youth.

Leveraging convenient wearable technology to assess adolescent sleep: physical and behavioral health correlates of single-channel sleep electroencephalogram in a community sample of youth.

Conferences

Flannery, JL; Engelhard, MM; Kansagra, S; Kollins, SH; Krystal, A; Lunsford-Avery, JR

Published in: J Clin Sleep Med

July 13, 2026

STUDY OBJECTIVES: Sleep disturbances during adolescence heighten risk for physical and behavioral health problems, yet sleep physiological markers critical to health outcomes are rarely assessed in pediatric care. Wearable single-channel electroencephalography (EEG) devices may offer scalable, ecologically valid methods for assessing sleep physiology in home settings. This study evaluated whether single-channel sleep-EEG metrics were associated with physical and behavioral health in adolescents. METHODS: Eighty-five community-derived adolescents (ages 11-17, 50% female) completed seven consecutive nights of at-home, single-channel sleep-EEG, physical health assessments (i.e., body mass index and blood pressure), and subjective sleep and behavioral health measures. Parents provided psychiatric diagnosis history. RESULTS: Odds of being overweight/obese decreased with greater REM duration (- 2.72% per minute) and higher REM percentage (- 100% per 1%). Odds of hypertension decreased with greater time spent in stage 3 (N3) (- 4.78% per minute). Multivariate analyses showed reduced N3 sleep was associated with parent-reported ADHD symptoms, whereas shorter total sleep time, lower sleep efficiency (SE), and longer sleep onset latency (SOL) were associated with higher adolescent-reported ADHD and conduct problems (p's < .05). Odds of an ADHD diagnosis increased with longer SOL (+ 1.92% per minute) and slower N3 decline (+ 89.4% per 0.01 units) but decreased with higher SE (- 7.78% per 1%). Odds of an internalizing disorder increased with higher SE (+ 12.4% per 1%) and greater wake after sleep onset (+ 3.18% per minute), but decreased with more REM sleep (- 9.62% per minute). CONCLUSIONS: Findings highlight the clinical value of wearable sleep-EEG for detecting sleep-related risk processes during adolescence. By capturing physiological features not accessible through self-report, at-home sleep-EEG may flag youth who could benefit from sleep-focused interventions, complementing routine care in identifying risk of future health problems. Integrating such tools into pediatric settings could support more precise, developmentally informed approaches to prevention and intervention. CURRENT STUDY/STUDY RATIONALE: Sleep disturbances are common during adolescence and increase risk for physical conditions such as obesity and hypertension, as well as behavioral health problems, yet sleep physiology is rarely adequately assessed in pediatric care. Wearable single-channel EEG offers an accessible way to capture sleep architecture and continuity that subjective reports cannot provide. This study shows that EEG-derived sleep features, including REM, N3 sleep, sleep efficiency, and sleep-onset latency, are associated with physical and behavioral health outcomes above and beyond adolescent and caregiver reports. STUDY IMPACT: These findings highlight the potential value of integrating wearable EEG into routine care to identify sleep-related vulnerabilities and support targeted prevention efforts.