We read with interest the study by Zhang et al., which establishes cognitive emotion regulation as a mediator between transition readiness and quality of life in adolescents with inflammatory bowel disease (IBD) (Zhang et al. 2025). The authors rightly identify sleep quality as a significant correlate. However, measuring sleep quality alone is insufficient; it acts as a final common pathway for multiple upstream factors. A crucial, modifiable, and system-level driver of poor sleep in adolescents is social jetlag, the misalignment between biological sleep timing and socially imposed schedules, primarily dictated by school start times. This factor was not considered, but could transform the interpretation and clinical utility of their findings. Social jetlag is highly prevalent in adolescents and is exacerbated by early school schedules. It correlates with worse emotional regulation, higher depressive symptoms, and lower academic achievement in healthy teens (Illingworth et al. 2025). For adolescents with a chronic condition like IBD, the consequences may be magnified. Disrupted circadian rhythms can intensify gastrointestinal symptom perception, inflammatory markers, and medication non-adherence (Chakradeo et al. 2018). Therefore, the reported correlation between poor sleep and lower quality of life (Zhang et al. 2025) might be fundamentally linked to a fixed environmental factor: school start time Without measuring this, we cannot discern if poor sleep results from intrinsic factors, disease activity, or an immutable external schedule. This distinction is vital for intervention. Recommending cognitive strategies to a patient whose sleep is destroyed by a 7:30 a.m. school bell may be futile without also addressing the schedule conflict. We propose three immediate, low-burden steps to address this. First, the authors could re-analyze their existing data to examine the correlation between the “school performance” subscale of the PedsQL and sleep quality scores. A strong negative correlation might indirectly suggest schedule-related fatigue. Second, in any future data collection, adding two brief questions would be transformative: “What time does your school day typically begin?” and “On a school night, what time do you usually try to fall asleep?” Calculating the difference between weekday and weekend sleep midpoints would quantify social jetlag. Third, they could pilot a micro-intervention: collaborating with one school to provide brief sleep hygiene education that specifically addresses managing IBD symptoms within early school constraints, measuring changes in self-reported sleep quality and cognitive emotion regulation. Incorporating the social jetlag lens moves the research from identifying a problem to understanding a root cause. It shifts implications from solely patient-focused behavioral interventions to include advocacy for healthier school policies, a powerful nursing role. Examining how fixed school schedules interact with a variable disease like IBD could explain significant variance in daily coping and transition success (Bishop et al. 2014; Chaudhry et al. 2020). We encourage the authors to explore this accessible yet overlooked dimension. It would strengthen their model's real-world relevance and offer concrete levers for improving adolescent IBD care within the systems where they live and learn. Yuyu Peng and Xuefeng Liu drafted the manuscript; Yuedong Liu provided critical revisions. This study was supported by The Third Affiliated Hospital of Liaoning University of Traditional Chinese Medicine. The authors declare no conflicts of interest. Data sharing not applicable to this article as no datasets were generated or analyzed during the current study.
Peng et al. (Tue,) studied this question.