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

Steven W H Chau; Samara Hussain; Sandra S M Chan; Oscar W H Wong; Jihui Zhang; Hongliang Feng; Kelly Y C Lai; Suk Ling; Suzanne H W So; Kelvin K F Tsoi; Yun Kwok Wing; Se Fong Hung; Patrick W L Leung

doi:10.5664/jcsm.10422

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

J Clin Sleep Med. 2023 Apr 1;19(4):749-757. doi: 10.5664/jcsm.10422.

Authors

Affiliations

¹ Li Chiu Kong Family Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR.
² Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR.
³ Department of Psychology, Faculty of Social Science, The Chinese University of Hong Kong, Hong Kong SAR.
⁴ JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR.

Abstract

Study objectives: The lifestyles change of children and adolescents during the COVID-19 pandemic due to antipandemic measures can affect their sleep health. Existing studies have used convenient samples and focused on the initial months of the pandemic, leaving a knowledge gap on changes in young people's sleep patterns under the "new normal" under COVID-19.

Methods: 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. Sleep parameters were collected using the structured diagnostic interview for sleep patterns and disorders. We investigated the pandemic's effects on sleep parameters by comparing data of participants recruited pre-COVID and those recruited during COVID using multivariate regression, adjusting for age, sex, household income, seasonality, and presence of mental disorders, and the moderators and mediators of the effects.

Results: Between September 1, 2019 and June 2, 2021, 791 primary and 442 secondary school students were recruited and analyzed. Primary school and secondary school participants assessed before COVID had a longer sleep latency on school days (95% confidence interval [CI] = 1.0-5.2 minutes, adjusted P-value = .010; and 95% CI= 3.9-13.0 minutes, adjusted P-value = .004, respectively) and nonschool days (95% CI = 1.7-7.2 minutes, adjusted P-value = .005; 95% CI = 3.4-13.7 minutes, adjusted P-value = .014, respectively). Low household income was a moderator for later bedtime (adjusted P-value = .032) and later sleep onset (adjusted P-value = .043) during nonschool days among secondary school students.

Conclusions: Changes associated with COVID have a widespread and enduring effect on the sleep health of school-aged students in Hong Kong. Household income plays a role in adolescent sleep health resilience, and the impact of antiepidemic measures on the health gaps of the youth should be considered.

Citation: Chau SWH, Hussain S, Chan SSM, et al. A comparison of sleep-wake patterns among school-age children and adolescents in Hong Kong before and during the COVID-19 pandemic. J Clin Sleep Med. 2023;19(4):749-757.

Keywords: adolescents; children; epidemiology; pandemic; sleep health.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adolescent
COVID-19*
Child
Cross-Sectional Studies
Hong Kong / epidemiology
Humans
Pandemics*
Sleep