Factors of sleep pattern in school-aged children: a cross-cultural investigation

To investigate whether school start times (SSTs) and parent-related factors relate to sleep patterns, on weekdays and weekends, of school-aged children in Singapore (SG), China (CN), and the United States (US).

An online cross-sectional survey was completed by parents of 251 SG, 251 CN, and 151 US children. Children's bedtimes, wake times, and sleep durations were reported separately for typical weekdays and weekends. SSTs, sleep hygiene, sleep priority, and parent sleep patterns were assessed.

Across all countries, compared to weekends, children on weekdays went to bed 26-63 min earlier, woke up 59-124 min earlier, and obtained 27.60-61.80 min less sleep (ps < 0.001). In all 3 countries, on weekdays, later SSTs were associated with later children's wake time and longer sleep duration, and earlier maternal bedtime was associated with earlier children's bedtime (ps < 0.05), while on weekends, better sleep hygiene and earlier maternal bedtimes were associated with earlier children's bedtime, and later maternal wake time was associated with later children's wake time (ps < 0.03). Higher sleep priority was related to longer sleep duration on weekdays in the US (p = .03) but on weekends in SG (p = .001).

Consistently across cultures, later SSTs lengthened weekday sleep in school-age children, and better sleep hygiene had a more prominent relationship with earlier bedtimes on weekends. The relationship of sleep priority with children's sleep patterns could be culture-specific. Delaying SSTs, reinforcing family-centered sleep hygiene practices and integrating culture-specific sleep education in future sleep interventions on school-age children may improve their sleep duration and timing.