Sleep is essential for a person's health and well-being, yet millions of American teens don't get enough sleep and many suffer from lack of sleep. It is widely known that insufficient sleep can impair reaction time, vigilance, learning and alertness; so students with short nights and irregular sleep patterns perform poorly in school and in other aspects of their lives and have a tendency for a depressed mood. But poor sleep habits can have an even more profound effect on a teen's health-it can lead to high blood pressure, which can cause stroke, kidney disease and other illnesses.

A team of researchers at Case Western Reserve University in Cleveland, Ohio studied the sleeping habits of 238 adolescents aged 13 to16; 14 percent of whom either had high blood pressure or reading at the borderline, called pre-hypertension. The participants filled out sleep diaries and also wore wrist-watch-like monitors that measured their sleep efficiency. On average, the teens got only 7.71 hours of sleep a night, when they need nine hours at that age. A large portion of them (26 percent) had poor sleep efficiency, either trouble falling asleep or waking up too early. Another 11 percent slept less than 6? hours per night. The teens that slept fewer than 6? hours per night were found to have more than twice the risk of high blood pressure and those with troubled sleep had more than triple the risk. The problem was worst among poor and minority teens, which researchers say is a concern because those groups already have an elevated risk of cardiovascular problems. "Our study underscores the high rate of poor quality and inadequate sleep in adolescence coupled with the risk of developing high blood pressure and other health problems," said Dr. Susan Redline, the pediatrician who led the study. "We also found that a low sleep efficiency may be more consistently associated with pre-hypertension than a shorter sleep period."

While previous studies have associated poor sleep and diminished amounts of sleep with hypertension, obesity and hormone intolerance in adults, this is the first to make the connection between sleep patterns and high blood pressure in adolescents. "These associations may have a large public health impact," Dr. Redline said. "Although the overall frequency of sleep insufficiency in children is unknown, our study's prevalence of 26 percent may be underestimated due to the exclusion of children with known sleep disorders and other illnesses."

Dr. Stephen R. Daniels, pediatrician-in-chief at the Children's Hospital in Denver and a spokesman for the American Heart Association, said that though the study is preliminary, "it does point to the direction that the next studies need to go to understand what less sleep and less efficient sleep mean in terms of blood pressure." He said if the findings are confirmed, they could eventually influence school system schedules. Many schools currently start early in the morning for teens and later for younger students. "But the changes in the diurnal patterns for adolescents make it harder for them to get up in the morning and to get to sleep at night. If we reorganize the day-night schedule for adolescents, that could make life easier for them and their parents," he noted.

However, Dr. Redline attributes part of the problem to computers, televisions, stereos and cell phones that occupy the teen bedroom. "There are teens who text message or listen to music all night, compounded by early school hours," she said. Her recommendation for achieving better sleep for teens is to have regular sleep and wake times, keep bedrooms quieter and avoid substances that may disturb sleep, such as caffeine. She also suggests that pediatricians "monitor quality and quantity of sleep as part of a child's overall health strategy."

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