Multidimensional sleep health and serious cognitive difficulty among US adolescents.

PURPOSE: This study examined associations among concussion history, multidimensional sleep health, physical activity, and serious cognitive difficulty in a nationally representative sample of US adolescents. METHODS: Cross-sectional data from adolescents aged 12-17 years participating in the 2022-2024 National Survey of Children's Health were analyzed. Sequential multivariable models accounting for complex sampling examined associations among concussion history, short sleep duration, bedtime inconsistency, sports participation, physical activity, and serious cognitive difficulty. Sensitivity analyses evaluated alternative bedtime consistency operationalizations and interaction effects. RESULTS: In fully adjusted models, concussion history (aOR = 2.07, 95% CI = 1.72-2.48), short sleep duration (aOR = 1.27, 95% CI = 1.11-1.46), bedtime inconsistency (aOR = 1.42, 95% CI = 1.22-1.65), no sports participation (aOR = 2.05, 95% CI = 1.81-2.33), insufficient physical activity (aOR = 1.32, 95% CI = 1.09-1.58), greater ACE burden, and lower caregiver capacity (aOR = 2.04, 95% CI = 1.80-2.31) were associated with greater odds of serious cognitive difficulty. Exploratory analyses identified a statistically significant short sleep × bedtime inconsistency interaction (Wald F = 4.35, p = .037), whereas concussion-related interaction terms were not statistically significant. Adjusted predicted probabilities demonstrated substantial cumulative neurobehavioral vulnerability across multidimensional sleep health and concussion-risk profiles. CONCLUSION: Insufficient sleep duration and bedtime inconsistency were independently associated with serious cognitive difficulty among US adolescents. Findings support consideration of both sleep duration and sleep regularity in adolescent neurobehavioral health promotion efforts. CURRENT KNOWLEDGE/STUDY RATIONALE: Concussion history and insufficient sleep have independently been associated with poorer neurobehavioral functioning among adolescents. However, fewer nationally representative studies have examined multidimensional sleep health constructs, including bedtime consistency, in relation to serious cognitive difficulty. STUDY IMPACT: Short sleep duration and bedtime inconsistency were associated with greater odds of serious cognitive difficulty among US adolescents. Findings support multidimensional sleep health frameworks emphasizing the combined importance of sleep duration and bedtime consistency for adolescent cognitive functioning.