Abstract
Recent reports have shown that the majority of school-aged children and adolescents experience insufficient sleep duration making sleep health a significant public health concern. School-based sleep interventions that have the ability to reach large numbers of children simultaneously may be a viable strategy to combat this epidemic. The goal of this topical review is to examine published school-based interventions to identify lessons learned and provide suggestions for future research. Our findings show that school-based sleep interventions to date have been designed as both universal interventions for all students as well as targeted interventions delivered only to those identified as having sleep problems. Unfortunately, most interventions resulted in minimal change in sleep, with only 3 interventions improving sleep by more than 30 min per night. Education-based strategies alone are typically insufficient to produce substantial behavior change. The strategy of screening the most at-risk students and then providing individual and specifically targeted intervention may be an efficient use of resources that schools could utilize. Further work is needed to examine the feasibility and efficacy of school-based interventions in achieving clinically significant improvements in sleep duration at a larger scale to curb the epidemic of insufficient sleep in school-aged children and adolescents.
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References
Bathory, E., & Tomopoulos, S. (2017). Sleep regulation, physiology and development, sleep duration and patterns, and sleep hygiene in infants, toddlers, and preschool-age children. Current Problems in Pediatric and Adolescent Health Care, 47(2), 29–42. https://doi.org/10.1016/j.cppeds.2016.12.001.
Bauducco, S. V., Flink, I. K., Boersma, K., & Linton, S. J. (2020). Preventing sleep deficit in adolescents: Long-term effects of a quasi-experimental school-based intervention study. Journal of Sleep Research, 29(1), e12940. https://doi.org/10.1111/jsr.12940.
Bell, J. F., & Zimmerman, F. J. (2010). Shortened nighttime sleep duration in early life and subsequent childhood obesity. Archives of Pediatrics & Adolescent Medicine, 164(9), 840–845. https://doi.org/10.1001/archpediatrics.2010.143.
Blake, M., Waloszek, J. M., Schwartz, O., Raniti, M., Simmons, J. G., Blake, L., Murray, G., Dahl, R. E., Bootzin, R., Dudgeon, P., Trinder, J., & Allen, N. B. (2016). The SENSE study: Post intervention effects of a randomized controlled trial of a cognitive-behavioral and mindfulness-based group sleep improvement intervention among at-risk adolescents. Journal of Consulting and Clinical Psychology, 84(12), 1039–1051. https://doi.org/10.1037/ccp0000142.
Blunden, S., Kira, G., Hull, M., & Maddison, R. (2012). Does sleep education change sleep parameters? Comparing sleep education trials for middle school students in Australia and New Zealand. The Open Sleep Journal, 5, 12–18. https://doi.org/10.2174/1874620901205010012.
Cain, N., Gradisar, M., & Moseley, L. (2011). A motivational school-based intervention for adolescent sleep problems. Sleep Medicine, 12(3), 246–251. https://doi.org/10.1016/j.sleep.2010.06.008.
Chiu, H. Y., Lee, H. C., Chen, P. Y., Lai, Y. F., & Tu, Y. K. (2018). Associations between sleep duration and suicidality in adolescents: A systematic review and dose-response meta-analysis. Sleep Medicine Reviews, 42, 119–126. https://doi.org/10.1016/j.smrv.2018.07.003.
Dunster, G. P., Crowley, S. J., Carskadon, M. A., & de la Iglesia, H. O. (2019). What time should middle and high school students start school? Journal of Biological Rhythms, 34(6), 576–578. https://doi.org/10.1177/0748730419892118.
Hedegaard, H., Curtin, S. C., & Warner, M. (2018). Suicide mortality in the United States, 1999-2017. NCHS Data Brief (330), 1-8.
Hiscock, H., Quach, J., Paton, K., Peat, R., Gold, L., Arnup, S., Sia, K.-L., Nicolaou, E., & Wake, M. (2019). Impact of a behavioral sleep intervention on new school entrants’ social emotional functioning and sleep: A translational randomized trial. Behavioral Sleep Medicine, 17(6), 698–712. https://doi.org/10.1080/15402002.2018.1469493.
Honaker, S. M., & Meltzer, L. J. (2016). Sleep in pediatric primary care: A review of the literature. Sleep Medicine Reviews, 25, 31–39. https://doi.org/10.1016/j.smrv.2015.01.004.
Illingworth, G., Sharman, R., Harvey, C.-J., Foster, R. G., & Espie, C. A. (2019). The Teensleep study: The effectiveness of a school-based sleep education programme at improving early adolescent sleep. Sleep Medicine: X, 100011. https://doi.org/10.1016/j.sleepx.2019.100011.
Kakumanu, S., & Lemanske Jr., R. F. (2019). Asthma in schools: How school-based partnerships improve pediatric asthma care. Immunology and Allergy Clinics of North America, 39(2), 271–281. https://doi.org/10.1016/j.iac.2018.12.011.
Keyes, K. M., Maslowsky, J., Hamilton, A., & Schulenberg, J. (2015). The great sleep recession: Changes in sleep duration among US adolescents, 1991-2012. Pediatrics, 135(3), 460–468. https://doi.org/10.1542/peds.2014-2707.
Kira, G., Maddison, R., Hull, M., Blunden, S., & Olds, T. (2014). Sleep education improves the sleep duration of adolescents: A randomized controlled pilot study. Journal of Clinical Sleep Medicine, 10(7), 787–792. https://doi.org/10.5664/jcsm.3874.
Koren, D., O'Sullivan, K. L., & Mokhlesi, B. (2015). Metabolic and glycemic sequelae of sleep disturbances in children and adults. Current Diabetes Reports, 15(1), 562. https://doi.org/10.1007/s11892-014-0562-5.
Lin, C. Y., Strong, C., Scott, A. J., Brostrom, A., Pakpour, A. H., & Webb, T. L. (2018). A cluster randomized controlled trial of a theory-based sleep hygiene intervention for adolescents. Sleep, 41(11). https://doi.org/10.1093/sleep/zsy170.
Marczyk Organek, K. D., Taylor, D. J., Petrie, T., Martin, S., Greenleaf, C., Dietch, J. R., & Ruiz, J. M. (2015). Adolescent sleep disparities: Sex and racial/ethnic differences. Sleep Health, 1(1), 36–39. https://doi.org/10.1016/j.sleh.2014.12.003.
Moore, M., Kirchner, H. L., Drotar, D., Johnson, N., Rosen, C., & Redline, S. (2011). Correlates of adolescent sleep time and variability in sleep time: The role of individual and health related characteristics. Sleep Medicine, 12(3), 239–245. https://doi.org/10.1016/j.sleep.2010.07.020.
Moseley, L., & Gradisar, M. (2009). Evaluation of a school-based intervention for adolescent sleep problems. Sleep, 32(3), 334–341. https://doi.org/10.1093/sleep/32.3.334.
O'Brien, L. M. (2009). The neurocognitive effects of sleep disruption in children and adolescents. Child and Adolescent Psychiatric Clinics of North America, 18(4), 813–823. https://doi.org/10.1016/j.chc.2009.04.008.
Owens, J. (2014). Insufficient sleep in adolescents and young adults: An update on causes and consequences. Pediatrics, 134(3), e921–e932. https://doi.org/10.1542/peds.2014-1696.
Owens, J., Wang, G., Lewin, D., Skora, E., & Baylor, A. (2017). Association between short sleep duration and risk behavior factors in middle school students. Sleep, 40(1). https://doi.org/10.1093/sleep/zsw004.
Paavonen, E. J., Huurre, T., Tilli, M., Kiviruusu, O., & Partonen, T. (2016). Brief behavioral sleep intervention for adolescents: An effectiveness study. Behavioral Sleep Medicine, 14(4), 351–366. https://doi.org/10.1080/15402002.2015.1007993.
Peña, M.-M., Rifas-Shiman, S. L., Gillman, M. W., Redline, S., & Taveras, E. M. (2016). Racial/ethnic and socio-contextual correlates of chronic sleep curtailment in childhood. Sleep, 39(9), 1653–1661. https://doi.org/10.5665/sleep.6086.
Quach, J., Gold, L., Arnup, S., Sia, K. L., Wake, M., & Hiscock, H. (2013). Sleep well--be well study: Improving school transition by improving child sleep: A translational randomised trial. BMJ Open, 3(10), e004009. https://doi.org/10.1136/bmjopen-2013-004009.
Rey, A. E., Guignard-Perret, A., Imler-Weber, F., Garcia-Larrea, L., & Mazza, S. (2020). Improving sleep, cognitive functioning and academic performance with sleep education at school in children. Learning and Instruction, 65. ARTN 101270. https://doi.org/10.1016/j.learninstruc.2019.101270.
Rigney, G., Blunden, S., Maher, C., Dollman, J., Parvazian, S., Matricciani, L., & Olds, T. (2015). Can a school-based sleep education programme improve sleep knowledge, hygiene and behaviours using a randomised controlled trial. Sleep Medicine, 16(6), 736–745. https://doi.org/10.1016/j.sleep.2015.02.534.
Ruan, H., Xun, P., Cai, W., He, K., & Tang, Q. (2015). Habitual sleep duration and risk of childhood obesity: Systematic review and dose-response meta-analysis of prospective cohort studies. Scientific Reports, 5, 16160. https://doi.org/10.1038/srep16160.
Street, N. W., McCormick, M. C., Austin, S. B., Slopen, N., Habre, R., & Molnar, B. E. (2018). Examining family and neighborhood level predictors of sleep duration in urban youth. Families, Systems & Health, 36(4), 439–450. https://doi.org/10.1037/fsh0000367.
van Rijn, E., Koh, S. Y. J., Ng, A. S. C., Vinogradova, K., Chee, N. I. Y. N., Lee, S. M., Lo, J. C., Gooley, J. J., & Chee, M. W. L. (2019). Evaluation of an interactive school-based sleep education program: A cluster-randomized controlled trial. Sleep Health, 6, 137–144. https://doi.org/10.1016/j.sleh.2019.10.006.
Walter, H., Sadeque-Iqbal, F., Ulysse, R., Castillo, D., Fitzpatrick, A., & Singleton, J. (2015). The effectiveness of school-based family asthma educational programs on the quality of life and number of asthma exacerbations of children aged five to 18 years diagnosed with asthma: A systematic review protocol. JBI Database of Systematic Reviews Implementation Reports, 13(10), 69-81. https://doi.org/10.11124/jbisrir-2015-2335.
Wheaton, A. G., Jones, S. E., Cooper, A. C., & Croft, J. B. (2018). Short sleep duration among middle school and high school students - United States, 2015. MMWR Morbidity and Mortality Weekly Report, 67(3), 85–90. https://doi.org/10.15585/mmwr.mm6703a1.
Wing, Y. K., Chan, N. Y., Man Yu, M. W., Lam, S. P., Zhang, J., Li, S. X., Kong, A. P., & Li, A. M. (2015). A school-based sleep education program for adolescents: A cluster randomized trial. Pediatrics, 135(3), e635–e643. https://doi.org/10.1542/peds.2014-2419.
Wolfson, A. R., Harkins, E., Johnson, M., & Marco, C. (2015). Effects of the young adolescent sleep smart program on sleep hygiene practices, sleep health efficacy, and behavioral well-being. Sleep Health, 1(3), 197–204. https://doi.org/10.1016/j.sleh.2015.07.002.
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Kaar, J.L., Bowen, A.E., Clark, E. et al. School-based interventions to improve sleep duration: Lessons learned and future directions. Curr Psychol 42, 8221–8231 (2023). https://doi.org/10.1007/s12144-021-02137-0
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DOI: https://doi.org/10.1007/s12144-021-02137-0