School Closures Amid Pandemic Linked With Increased Sleep Duration, QOL in Teens

Lockdown procedures implemented during the first wave of the COVID-19 pandemic in Switzerland were associated with longer sleep duration and improved health-related quality of life (HRQOL) in high school students, according to study findings published today in JAMA Network Open.

As schools worldwide were forced to shut down in early 2020 amid the threat of COVID-19, children and adolescents experienced drastic changes in daily life that contributed to greater prevalence of mental health problems, including depression, anxiety, and reduced HRQOL.

However, the researchers of the present study highlighted a potentially conflicting finding that has also appeared consistently: Adolescents slept significantly longer during school closures than before them.

“Sleep plays a crucial role in mental and physical health, and thus, a positive association of increased sleep with adolescent well-being and health could be expected,” they noted. “The sleep gains observed during school closures can be interpreted similarly: Because students in homeschooling do not need to commute to school, school closures create a naturalistic delay in school start times.”

With previous research not having explored whether longer sleep duration during school closures was associated with adolescent health benefits, the researchers investigated the potential link via cross-sectional online surveys answered by students of 21 public high schools in Zurich, Switzerland.

In the study, participants who provided their sex, age, and school were split and compared based on whether they completed the survey under regular, pre-pandemic conditions (May-July 2017; control group) or during lockdown school closures (May-June 2020; lockdown group).

Assessments included sleep-wake patterns, HRQOL (KIDSCREEN-10 questionnaire), substance use (caffeine, alcohol, and nicotine), and depressive symptoms (lockdown sample only; assessed using the withdrawn/depressed scale from the Youth Self Report).

“We also investigated the differential associations of sleep and depressive symptoms with adolescents’ health,” the authors added. “We aimed to render a more comprehensive picture about the outcomes of pandemic high school closures by considering the closures’ associations with both psychological distress and later school start times.”

Of the 8972 students included, 5308 (median age, 16 years; interquartile range [IQR], 15-17 years; 65.1% female) and 3664 (median age, 16 years; IQR, 15-17 years; 66.3% female) were placed in the control group and lockdown group, respectively.

Among the lockdown cohort, significantly longer sleep duration of 75 more minutes was reported on scheduled days (semipartial R² statistic [R² _β*], 0.238; 95% CI, 0.222-0.254; P < .001), as well as improved HRQOL (R² _β*, 0.007; 95% CI, 0.004-0.012; P < .001) and less consumption of caffeine (R² _β*, 0.010; 95% CI, 0.006-0.015; P < .001) and alcohol (R² _β*, 0.014; 95% CI, 0.008-0.022; P < .001) vs the control group.

Notably, longer sleep duration was associated with better HRQOL (R² _β*, 0.027; 95% CI, 0.020-0.034; P < .001) and less caffeine consumption (R² _β*, 0.013; 95% CI, 0.009-0.019; P < .001).

Further multilevel regression models in the lockdown sample revealed an inverse association between depressive symptoms and HRQOL (R² _β*, 0.285; 95% CI, 0.260-.0311; P < .001) and a positive association with caffeine consumption (R² _β*, 0.003; 95% CI, 0.000-0.008; P = .01).

“These findings should be considered when evaluating and implementing school closures,” concluded the study authors. “Furthermore, the findings provide support for delaying school start times for adolescents.”

Reference

Albrecht JN, Werner H, Rieger N, et al. Association between homeschooling and adolescent sleep duration and health during COVID-19 pandemic high school closures. JAMA Netw Open. Published online January 5, 2022. doi:10.1001/jamanetworkopen.2021.42100