COVID-19 Pandemic Associated With Sleep Disturbances in Children, Adolescents

Mohit Sharma, MBBS, MD

A recently published study investigated the effect of the COVID-19 pandemic on sleep patterns in children and adolescents, with sleep duration recommendations not being met by almost half of the children studied, when compared to sleep habits prior to the pandemic. 

The primary end point was the prevalence of sleep disturbances resulting from the pandemic and quarantine measures, with secondary end points consisting of effects on sleep quality, duration, and the severity of insomnia in both healthy children and those with neurobehavioral disorders.

Investigators, led by Mohit Sharma, MBBS, MD, department of psychiatry, Institute of Human Behaviour and Allied Sciences, in Delhi, India; and Shivali Aggarwal, MD, department of psychiatry, All Indian Institute of Medical Sciences, in New Delhi, India, deemed resultant sleep problems in children “alarming,” with the pooled prevalence of children experiencing sleep disturbances at 54% (95% CI, 50-57; P <.01) and the pooled prevalence not getting the recommended amount of sleep at 49% (95% CI, 39-58, P <.01). 

Preschool children, who were evaluated in 5 studies, were found to have a lower prevalence of sleep disturbances during the pandemic, which had a risk ratio of 0.87 (95% CI, 0.58-1.30; P <.01) and was not statistically significant. 

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“Preschool children had a trend towards relatively fewer sleep disturbances in comparison with pre-pandemic times. Besides, the proportion of children with worsening sleep quality during the pandemic was nearly 3 times the proportion of those with improvement,” Sharma, Aggarwal, et al wrote.1 “Sleep duration recommendations were not met in nearly half of healthy children during the pandemic. However, these findings need to be seen in light of limited literature on the topic, few included studies done in heterogenous populations, and dubious quality of inferences drawn from these studies which were predominantly online surveys.”

Investigators included a total of 16 studies, following a review of 371 articles. Healthy children were evaluated in 14 studies, while those with behavioral disorders such as autism spectrum disorder (ASD) and attention deficit hyperactivity disorder (ADHD) were evaluated in 2 studies. Children with both ASD and ADHD have a higher burden of sleep problems, when compared to healthy children, further reporting an increase with the onset of the pandemic.

Limited data and studies on the pandemic were noted as an area of concern for investigators, as well as the fact that surveys were mostly conducted online. Further research will be necessitated to ascertain preventative recommendations for sleep management during similar times of crisis.

“The index study is the first systematic review capturing sleep in children during the COVID-19 pandemic,” Sharma, Aggarwal, et al wrote.1 “However, very few studies were eligible for inclusion and most of the included studies were not high quality and assessed sleep based on parental reporting who were themselves under psychological stress due to the pandemic.”

These data coincide with a recent initiative from the American Academy of Sleep Medicine (AASM), which announced the second annual Student Sleep Health Week, held from September 12-18, 2021. Transitioning from virtual learning environments associated with the COVID-19 pandemic to more “normal,” in-person settings has placed even more emphasis on the importance of sleep health in school-aged children. 

In conversation with NeurologyLive about Student Sleep Health Week, Raman Malhotra, MD, president, AASM, and associate professor of neurology, Washington University in St. Louis, explained that in this shift to a virtual world, “one thing that we did notice is that the consistent routine that in-person learning provided—needing to be at school at a certain time, getting home, and being on schedule was lost. A lot of the learning may have been done asynchronously, meaning they can learn whenever they want, they can wake up when they want, [which] in some respects, sounded appealing because they would be able to get enough sleep. But, in reality, it really altered children's schedules. So, children and adults both need a set pattern—a set bedtime and wake time, and what we noticed during the pandemic is that consistency was lost.”

The AASM recommends 9 to 12 hours of sleep for children aged 6 to 12 years and 8 to 10 hours for children aged 13 to 18 years, with a lack of sleep associated with decreased academic and extracurricular performance, mood, motivation, and a slowing of cognitive processes.

REFERENCE

1. Sharma M, Aggarwal S, Madaan P, Saini L, Bhutani M. Impact of COVID-19 pandemic on sleep in children and adolescents: a systematic review and meta-analysis. Sleep Med. 2021;84:259-267. doi:10.1016/j.sleep.2021.06.002
2. American Academy of Sleep Medicine organizes second annual Student Sleep Health Week. News release. American Academy of Sleep Medicine. September 7, 2021. Accessed September 14, 2021. https://aasm.org/american-academy-of-sleep-medicine-organizes-second-annual-student-sleep-health-week/