Mild sleep deprivation, such as sleeping 39 minutes less per night for 1-week, is associated with reduced health-related quality of life (HRQOL) in children, according to study findings published in JAMA Network Open.
Poor sleep quality is known to impact physical and psychological health outcomes; however, no experimental studies have evaluated the role of sleep in HRQOL in the pediatric setting.
Researchers from University of Otago in New Zealand sourced data for this analysis from the Daily Rest, Eating, and Activity Monitoring (DREAM) study, which was a randomized, crossover trial of 100 children living in New Zealand between 2018 and 2020. In the trial, the children underwent a week long intervention of sleep restriction, a week of no intervention, and a week of sleep extension, by means of changing the child’s bedtime by 1-hour. In this analysis, changes to HRQOL were assessed using the 27-item KIDSCREEN questionnaire.
Study participants were mean age 10.3 (SD, 1.4); 52% were girls; 57% were a healthy weight; and 78% were New Zealand European.
At baseline, the children got an average of 8 hours 59 minutes (SD, 45 minutes) of sleep. They had a 95.8% sleep efficacy, woke 0.71 (SD, 0.61) times per night, and all measures of the Children’s Sleep Hygiene Scale were good, ranging from 4.5 (bedtime routine subscale) to 5.6 (environmental subscale).
According to the accelerometer data, children slept 39 (95% CI, 32-46) fewer minutes during sleep restriction.
Both children (mean difference [MD], 0.4; 95% CI, 0.3-0.6) and parents (MD, 0.8; 95% CI, 0.6-0.9) reported the child was impaired during days in the sleep restriction intervention.
Stratified by sleep extension and restriction time periods, KIDSCREEN-27 total scores were significantly lower with sleep restriction (standardized mean difference [SMD], -0.21; 95% CI, -0.34 to -0.08) as were physical well-being (SMD, -0.28; 95% CI, -0.49 to -0.08), and school environment (SMD, -0.26; 95% CI, -0.42 to -0.09) subscores.
In the per-protocol analysis, the children slept 71 (95% CI, 64-78) fewer minutes during sleep restriction. The HRQOL outcomes of physical well-being (SMD, -0.29; 95% CI, -0.57 to -0.01), school environment (SMD, -0.27; 95% CI, -0.48 to -0.06), social and peer support (SMD, -0.25; 95% CI, -0.43 to -0.06) subscores, and the total score (SMD, -0.25; 95% CI, -0.43 to -0.06) were significantly affected compared with sleep extension.
Study limitations included the limited participant diversity and study interruption due to the COVID-19 pandemic.
Overall, the researchers found that the children with mild sleep deprivation reported significantly worse physical and overall well-being and an impaired ability to cope well at school.
“These findings highlight that ensuring children receive sufficient good-quality sleep is an important child health issue,” they concluded.
Taylor RW, Haszard JJ, Jackson R, et al. Effect of sleep changes on health-related quality of life in healthy children: a secondary analysis of the DREAM crossover trial. JAMA Netw Open. Published online March 15, 2023. doi:10.1001/jamanetworkopen.2023.3005