School-Based Intervention for Sleep Education Shown to Benefit Adolescents

School-based interventions for health issues pertinent to adolescents have been linked with beneficial outcomes, and a study published this week in the Journal of Sleep Research showed potential long-term benefits of a school-based sleep education program.

In adolescence, sleep is a vital component for balancing the biological and psychological changes occurring during this developmental period. In a previous study, insufficient sleep among adolescents was linked with impaired physical and mental health, which was shown to impact school performance and overall childhood flourishing. As the authors of the current study note, sleep competes with increasing school demands and the pervasive use of information and communication technology, highlighting a need for proactive factors such as parent-set bedtimes and good sleep practices to offset this risk.

These proactive factors have been shown to decline as adolescents grow older, with a heightened lack of intervention in low-income, underserved communities. The benefit of school-based intervention programs, especially in impoverished areas, shows potential in providing proper education to students on the importance of sleep, but the authors note that school-based interventions to improve sleep have shown limited success. The study authors indicated that this may be due to the lack of long-term follow-ups on sleep health and the fact that the content of the programs in not targeting central factors, such as daytime stress and technology use.

Researchers aimed to evaluate the efficacy of a school-based program by measuring the long-term impact of a curriculum that included time-management training. The intervention consisted of 5 sessions, lasting 50 to 60 minutes, conducted once per week for 6 to 7 weeks among 3622 adolescents (mean age 13.7, 48% girls) divided into 3 groups according to baseline sleep duration: insufficient (fewer than 7 hours of sleep), borderline (7 to 8 hours of sleep), and adequate (more than 8 hours of sleep). The study placed 286 adolescents in the intervention group and 3336 adolescents in natural control group. Data were collected before intervention and at a 1-year follow-up; the primary outcome was sleep duration, and secondary outcomes included perceived stress, sleep hygiene (behavioral and emotional subscales), and technology use at bedtime.

The school-based sleep education program implemented by researchers showed a significant increase in sleep knowledge in the intervention group based on pre- to post-test results and maintained knowledge at follow-up (mean difference, 0.007 [0.18]; CI, −0.427 to 0.441; P = 1.0). The intervention group were additionally found to be 1.7 times less likely to report borderline sleep duration and 2.4 times less likely to report insufficient sleep duration as compared to the control group.

There were, however, no changes in emotional sleep hygiene (bedtime worry) and perceived stress, and to the researchers’ surprise, an increase in technology use and worsening of behavioral sleep hygiene was observed in the intervention group. For program feedback from participants, the benefit was found most in those with insufficient sleep, as 25% reported using more than 2 of the strategies they had learned, compared with 15.7% and 12.2% of adequate and borderline sleepers.

Lead study author Serena Bauducco, PhD, post-doctoral researcher at Örebro University, stressed the importance of the study findings in tackling issues facing adolescents today. “These results are promising and mean that we might be able to prevent the development of sleep problems in youths,” said Bauducco.

The use of school-based intervention programs have been found to improve student knowledge of potential risks related to behaviors and attributed conditions. Asthma education has been shown to be on the decline, which has led to the increase of preventable emergency department visits among adolescents. Students with asthma in rural and medically underserved communities were shown to benefit from a school-based telehealth program, highlighting the potential benefit of implementing these programs in schools.

“More work needs to be done, however: We need to replicate these results and to understand what works. Therefore, we encourage future sleep intervention studies to investigate long-term outcomes—after 1 year or even longer–and to look for mechanisms of change,” said Bauducco.

Reference

Bauducco SV, Flink IK, Boersma K, et al. Preventing sleep deficit in adolescents: long-term effects of a quasi-experimental school-based intervention study. [published online November 5, 2019]. J Sleep Res. doi: 10.1111/jsr.12940.