Beyond counting sheep: social and behavioral determinants of adolescent sleep quality in the Czech Republic

Adolescence is a critical period of neurodevelopment, during which adequate sleep is essential for cognitive, emotional, and physical health. Despite extensive research on sleep duration, there is limited data on the social, behavioral, and psychosocial determinants of sleep quality among Czech adolescents. This study aims to investigate these factors and their associations with adolescent sleep quality.

Using a sample of 4,508 adolescents aged 13-15 years from the 2021/22 HBSC survey, sleep quality was assessed using the Short Adolescent Sleep Wake Scale (ASWS). Sociodemographic variables, social environment, stressors, health and health behaviors were assessed. Multivariate linear regression models were employed to identify significant links with sleep quality.

In multivariate analyses, clinically meaningful associations (≥ 0.2 SD in absolute value) were observed for sex and sleep duration, with girls showing lower overall sleep quality (non-standardized b = -2.1, 95% CI [-2.6, -1.6]) and adolescents reporting longer sleep showing higher overall sleep quality (β = 1.8, 95% CI [1.6, 2.1]). Smaller but consistent associations (≥ 0.1 SD in absolute value) were observed for age (non-standardized b = 1.5, 95% CI [1.0, 2.0]), overall health (β = 1.3, 95% CI [1.1, 1.6]), academic pressure (β = -1.7, 95% CI [-1.9, -1.5]), and perceived family support (β = 1.3, 95% CI [1.0, 1.6]). No meaningful associations were observed between overall sleep quality and either friend support or physical activity.

These results highlight the multifaceted nature of adolescent sleep quality and emphasize the associations with psychosocial and behavioral factors. Although no single factor showed a large clinical effect, their cumulative influence may be meaningful. Interventions targeting multiple modest-risk factors simultaneously - such as reducing academic pressure, increasing family support, and limiting screen time - could improve adolescent sleep quality at the population level.