Inequities in sleep duration and quality among adolescents in Canada

Several recent global events may have impacted adolescent sleep and exacerbated pre-existing disparities by social positions (i.e., social roles, identity or sociodemographic factors, and/or group memberships that are associated with power and oppression due to the structures and processes in a given society at given time). Current understanding of sleep among adolescents is critical to inform interventions for a more equitable future, given the short and long-term consequences of inadequate sleep on health and well-being. This study aimed to provide contemporary evidence on sleep disparities by key social positions among adolescents in Canada.

Cross-sectional analyses were conducted using self-reported data collected during 2020-2021 (the first full school year after the COVID-19 pandemic onset) from 52,138 students (mean [SD] age = 14.9 [1.5]) attending 133 Canadian secondary schools. Multiple regression models were used to test whether sleep quality (how well students slept during past week), duration (weekday, weekend, weighted daily average), and guideline adherence (8-10 h/day) differed by sex and gender, race and ethnicity, and socioeconomic status (SES).

Females reported a mean [95% CI] difference of -1.7 [-3.7, 0.4] min/day less sleep on weekdays than males, but 7.1 [4.5, 9.6] min/day more sleep on weekends, resulting in no difference in average daily sleep between males and females. Females were less likely to report good quality sleep compared to males (AOR = 0.57 [0.54, 0.60]). SES followed a generally monotonic trend where higher scores were associated with more sleep on weekdays (Δ_{highest: lowest} = -28.6 [-39.5, -17.6]) and weekends (Δ_{highest: lowest} = -17.5 [-3.8, -31.2]) and greater likelihood of higher sleep quality (AOR_{highest: lowest} = 3.04 [2.35, 3.92]). Relative to White adolescents, weekday and average daily sleep duration were lower among all other racial identities; mean differences ranged from ∼ 5-15 min/day, with Black students reporting the least sleep.

Differences in sleep duration and quality were most profound among adolescents from the lowest and highest SES. Racial disparities were more evident on weekdays. Compensatory weekend sleep appears more pronounced in females than males. Addressing sleep inequities is critical, as a robust predictor of multiple health outcomes.