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Sleep timing and health indicators in children and adolescents: a systematic review
Caroline Dutil1,2, Irina Podinic1,3, Christin M Sadler2
1Healthy Active Living and Obesity Research Group, Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada.
Insights
Earlier sleep timing is linked to better health in children and adolescents. This review highlights the need for more research to confirm these sleep timing benefits.
Area of Science:
- Pediatric Health
- Sleep Science
Background:
- Understanding sleep timing's impact on child and adolescent health is crucial for developing effective sleep interventions.
- This systematic review examined associations between sleep timing and nine health indicators in children and adolescents aged 5–18.
Approach:
- Conducted a systematic review of studies published in the 10 years preceding January 2021, adhering to PRISMA 2020 guidelines.
- Included 46 observational studies from 21 countries with over 200,000 participants, assessing sleep timing via actigraphy or self-report.
- Utilized a narrative synthesis due to study heterogeneity and a lack of data for certain health outcomes.
Key Points:
- Later sleep timing correlated with poorer emotional regulation, cognitive function, academic achievement, sleep quality, eating behaviors, and increased sedentary behavior.
- Associations between sleep timing and adiposity, quality of life, injuries, and cardiometabolic risk biomarkers were less consistently demonstrated.
- The overall quality of evidence was rated as "very low" using GRADE criteria.
Conclusions:
- Current evidence suggests earlier sleep timing is beneficial for school-aged children and adolescents' health.
- Further longitudinal studies and randomized controlled trials are essential to strengthen the evidence base and advance research in this area.
Introduction:
To continue to inform sleep health guidelines and the development of evidence-based healthy sleep interventions for children and adolescents, it is important to better understand the associations between sleep timing (bedtime, wake-up time, midpoint of sleep) and various health indicators. The objective of this systematic review was to examine the associations between sleep timing and 9 health indicators in apparently healthy children and adolescents 5 to 18 years old.
Methods:
Studies published in the 10 years preceding January 2021 were identified from searches in four electronic databases. This systematic review followed the guidelines prescribed in PRISMA 2020, the methodological quality and risk of bias were scored, and the summary of results used a best-evidence approach for accurate and reliable reporting.
Results:
Forty-six observational studies from 21 countries with 208 992 unique participants were included. Sleep timing was assessed objectively using actigraphy in 24 studies and subjectively in 22 studies. The lack of studies in some of the health outcomes and heterogeneity in others necessitated using a narrative synthesis rather than a metaanalysis. Findings suggest that later sleep timing is associated with poorer emotional regulation, lower cognitive function/academic achievement, shorter sleep duration/ poorer sleep quality, poorer eating behaviours, lower physical activity levels and more sedentary behaviours, but few studies demonstrated associations between sleep timing and adiposity, quality of life/well-being, accidents/injuries, and biomarkers of cardiometabolic risk. The quality of evidence was rated as "very low" across health outcomes using GRADE.
Conclusion:
The available evidence, which relies on cross-sectional findings, suggests that earlier sleep timing is beneficial for the health of school-aged children and adolescents. Longitudinal studies and randomized controlled trials are needed to better advance this field of research. (PROSPERO registration no.: CRD42020173585).
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