Effectiveness of school-based sleep promotion programs for adolescents: a systematic review with meta-analysis

The objective of this review is to assess the effectiveness of school-based sleep promotion programs for adolescents on sleep knowledge, sleep hygiene, sleep quality, sleep behavior, sleep efficiency, health-related quality of life, and depressive or anxiety symptoms.

Adolescence is a critical period for physical and mental development, during which, quality sleep is essential. However, many adolescents experience sleep deprivation due to factors such as excessive electronic device use, academic and peer pressures, stress, and anxiety. School-based sleep promotion programs have been proposed to address these issues, but their effectiveness remains unclear.

This review included studies published in English, Spanish, and Portuguese that assessed the effectiveness of school-based sleep promotion programs for adolescents aged 10 to 19 years on sleep knowledge, sleep hygiene, sleep quality, sleep efficiency, sleep behavior, health-related quality of life, and depressive or anxiety symptoms. Both randomized controlled trials and quasi-experimental studies, with or without a comparator, were eligible.

A comprehensive search strategy was used to identify relevant published and unpublished studies. Studies meeting the eligibility criteria were retrieved and their methodological quality was assessed by 2 independent reviewers using the JBI critical appraisal checklists for randomized controlled trials and quasi-experimental studies. Quantitative data were extracted using the standardized data extraction tool. Studies were pooled for statistical meta-analysis. Effect sizes were expressed as final post-intervention standardized mean differences, and their 95% CI were calculated. Heterogeneity was assessed statistically using the standard χ2 and I2 tests. Statistical analyses were performed using random-effects models and fixed-effect models. Where statistical pooling was not possible, the findings were presented in narrative format.

A total of 34 studies met the inclusion criteria, with a total of 22,679 adolescents. Meta-analysis of randomized controlled trials showed statistically significant differences for sleep knowledge (SMD=0.99, 95% CI=0.48 to 1.50, P<0.001), sleep hygiene (SMD=-0.20, 95% CI=-0.31 to -0.09, P=0.0003), and depressive symptoms (SMD=-0.70, 95% CI=-1.12 to -0.29, P<0.001). No statistically significant differences were found for sleep quality (SMD=0.06, 95% CI=-0.16 to 0.27, P=0.62), sleep efficiency (SMD=0.12, 95% CI=-0.02 to 0.26, P=0.09), sleep behavior-total sleep time/sleep duration (SMD=0.69, 95% CI=-0.27 to 1.65, P=0.16), and sleep behavior-sleep onset latency (SMD=-0.88, 95% CI=-1.77 to 0.01, P=0.05). Large effect sizes were observed for sleep knowledge and sleep onset latency; moderate-to-large effects for depressive symptoms and total sleep time; and small effects for sleep hygiene, sleep efficiency, and sleep quality. The funnel plot for sleep knowledge did not suggest publication bias, and Egger's test was not statistically significant.

These findings suggest that school-based sleep promotion programs can be effective in improving adolescents' sleep knowledge and sleep hygiene, and reduce depressive symptoms. However, the high variability in intervention designs and methodological quality highlights the need for further high-quality studies to identify the most effective components of these programs and clarify their long-term impacts.

PROSPERO CRD42023374838.

A Portuguese-language translation of the abstract of this review is available: https://links.lww.com/SRX/A197.