Foundations for the Successful Establishment of a Multidisciplinary Orthoplastic Surgery Team.

Adolescence is a developmental period marked by profound neurobiological, cognitive, and behavioral changes (; ). Among the factors shaping this trajectory, sleep plays a central role (). Circadian timing, sleep duration, and sleep regularity are increasingly recognized as critical determinants of cognitive development, emotional regulation, and health outcomes during this vulnerable window (; ; ). Across development, normative changes in circadian biology include a progressive delay in the timing of the endogenous circadian system from late childhood through adolescence, accompanied by later sleep – wake preferences (“eveningness”), reduced sleep duration on school nights, and increased night-to-night variability in sleep timing (; ; ). These shifts are thought to reflect both biological changes in circadian phase and sleep homeostasis and increasing psychosocial demands, culminating in a “perfect storm” of sleep vulnerability during adolescence (, 20). A growing literature indicates that later chronotype (a tendency toward later sleep – wake timing, often referred to as eveningness) and greater sleep irregularity are associated with poorer executive functioning, heightened impulsivity, and increased risk-taking in youth. Social jetlag – the misalignment between endogenous circadian timing and externally imposed schedules, typically operationalized as the difference in midsleep timing between school/workdays and free days – has been repeatedly implicated in these associations. Adolescents are particularly susceptible to social jetlag due to the normative developmental delay in circadian timing that emerges after puberty and peaks in late adolescence or early adulthood, combined with early school start times during middle school and high school (; ; ). Evidence from the Adolescent Brain Cognitive Development (ABCD) Study () and the National Consortium on Alcohol and Neurodevelopment in Adolescence (NCANDA) study () and other large adolescent samples demonstrates that eveningness and social jetlag are linked to deficits in inhibitory control, and some studies report associations with steeper delay discounting and more impulsive decision-making (; ; ). Despite these advances, most prior investigations in adolescent populations have evaluated individual sleep features in relation to individual outcomes using regression-based approaches. Such designs may obscure broader patterns of covariation – that is, how constellations of sleep dimensions jointly relate to cognitive and behavioral regulation. This limitation is notable given growing recognition of sleep as a multidimensional construct, encompassing timing, regularity, duration, and subjective quality, rather than a single attribute (; ). In adult samples, multidimensional approaches – including machine-learning and multivariate methods – have demonstrated that combinations of sleep characteristics provide stronger and more informative associations with health outcomes than any single sleep dimension alone (). Comparable multivariate approaches remain less common in adolescent sleep research.