A comparison of sleep-wake patterns among school-age children and adolescents in Hong Kong before and during the COVID-19 pandemic

  1. Steven WH Chau
  2. Samara Hussain
  3. Sandra SM Chan
  4. Oscar WH Wong
  5. Jihui Zhang
  6. Hongliang Feng
  7. Kelly YC Lai
  8. Suk Ling Ma
  9. Suzanne HW So
  10. Kelvin KF Tsoi
  11. Yun Kwok Wing
  12. Se Fong Hung
  13. Patrick WL Leung
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Abstract

Background

Lifestyle of children and adolescents have changed extensively during the COVID-19 pandemic due to school suspension and social distancing measures, which can affect their sleep health. Existing studies in the area used convenient samples and focused on the initial months of the pandemic.

Method

As part of a territory-wide epidemiological study in Hong Kong, this cross-sectional study recruited primary and secondary school students by stratified random sampling. We investigated the pandemic’s effects on sleep parameters using multivariate regression, adjusting for age, sex, household income, seasonality and presence of mental disorders, and the effects’ moderators and mediators.

Findings

Between September 1, 2019 and June 2, 2021, 791 primary and 442 school students were recruited and analysed. After correcting for multiple testing, being assessed during COVID predicted a longer sleep latency in primary and secondary school students in school days (95% CI = 1.0–5.2 minutes, adjusted p-value = 0.010; and 95% CI= 3.9–13.0 minutes, adjusted p-value =0.004, respectively) and non-school days (95% CI = 1.7–7.2 minutes, adjusted p-value = 0.005; 95% CI = 3.4–13.7 minutes, adjusted p-value = 0.014, respectively). Low household income was a moderator for later bedtime (adjusted p-value = 0.032) and later sleep onset (adjusted p-value = 0.043) during non-school days among secondary school students. Sex and digital leisure time were not moderator and mediator of the pandemic’s effect on sleep parameters, respectively.

Interpretation

Changes associated with the COVID-19 pandemic have a widespread and enduring effect on sleep health of school-aged students in Hong Kong. Household income play a role in adolescents’ sleep health’s resilience against these changes, and anti-epidemic measures effects on the health gap of the youth should be considered.

Funding

Government of the Hong Kong Special Administrative Region, Food and Health Bureau, Health and Medical Research Fund (Ref. No.: MHS-P1(Part 1)-CUHK).

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