How Did COVID-19 Impact Adolescent Sleep Health?

New research presented at SLEEP 2021—the 35th annual meeting of the Associated Professional Sleep Societies, LLC—illustrates the bidirectional relationship between sleep and the COVID-19 pandemic among children, adolescents, and young adults. Abstracts were also published in an online supplement of the journal Sleep.

Not only has COVID-19 altered sleep health in this population, but poor sleep may be a predictor of COVID-19–related stress among adolescents.

In one study,¹ researchers used multidimensional (threat vs deprivation) assessments of child maltreatment (CM) to determine whether COVID-19–related stress intensified the established association between maltreatment (abuse vs neglect) and sleep problems among youth.

“The COVID-19 pandemic introduces new psychosocial stressors, which may be particularly harmful to youth already experiencing stress in the home environment,” the authors wrote.

Data were gleaned from 126 youth aged approximately 13 years between January 2019 and March 2020 (T1) and after the pandemic’s onset in May of 2020 (T2). COVID-19–related stress was assessed via 3 questions regarding negative changes, uncertainty about the future, and stress induced from disruptions. The Childhood Trauma Questionnaire and Pittsburgh Sleep Quality Index were used to measure CM and sleep-related problems, respectively.

Results showed:

• Threat-related abuse was significantly associated with increased sleep problems at T2 (β = .43; P <.01) but neglect was not (β =.03; P = .85)
• COVID-19–related stress significantly intensified the link between abuse and sleep problems (β = .14; P <.05) as well as between neglect and sleep problems (β = .43; P <.01) at T2
• Among youth who experienced higher levels of CM, increased COVID-19–related stress exacerbated sleep problems

“These results bolster extant research on the negative impact CM bears on youth sleep health and indicates that COVID-19 stress may exacerbate sleep problems,” the authors wrote, adding future prevention and intervention efforts should aim to reduce sleep problems among youth who suffer CM during the pandemic.

In an additional analysis,² researchers conducted a longitudinal study assessing if poor sleep served as a predictor of COVID-19–related stress, fear, and sadness in adolescents.

Adolescence already marks a transitional life stage accompanied by biopsychosocial changes and greater psychophysiological vulnerability, the authors explained, while global events like COVID-19 may increase vulnerability to anxiety or depression in this age group.

Although studies have shown the pandemic impacts sleep and mood, most investigations have focused on adults. To address this knowledge gap, the researchers analyzed self-reported data from 3099 individuals, aged 9 to 10 years at baseline. All participants were enrolled in the population-based, demographically diverse Adolescent Brain Cognitive Development study. Data were collected at 3 prepandemic annual visits and 3 monthly time points throughout the pandemic, at which children were aged 11 to 13 years.

Participants filled out questionnaires at each time point that contained questions on sleep, environment, and psychological well-being. Gradient Boosted Tree machine learning algorithms were trained using prepandemic sleep measures and demographic information.

“Pandemic-related perceived stress, fear, and sadness were accurately detected with our classifiers (area under the curve [AUC] = 0.83 for perceived stress, AUC = 0.73 for fear, AUC = 0.79 for sadness),” the researchers wrote. In addition, “across all models, shorter sleep duration, prolonged sleep onset latency, and longer time between waking and getting out of bed predicted greater distress.”

In all 3 models, several factors—including female sex, greater family conflict, fewer economic resources, and more screen time—all also contributed to prediction performance. Based on these results and considering the long-term effects of poor sleep heath, “it would be crucial to improve sleep health by targeted prevention, intervention, and increased awareness among adolescents,” the authors wrote.

A third analysis presented at the conference focused on the impact of race/ethnicity and community social vulnerability on COVID-19 stress and sleep disturbances in youth.³ Researchers used data from the Nationwide Education and Sleep in TEens During COVID (NESTED) study (N = 6578), an online survey that collected information on sociodemographic factors, COVID-19–related stress, depression, anxiety, instructional format (for school), and sleep disturbance.

Of the 4171 individuals included in the analysis, approximately 65% were White and 35.4% identified as racial/ethnic minority, mixed, or other. Responses showed sleep disturbance was prevalent among adolescents surveyed (89% above average), and around 64% reported more stress due to the pandemic.

Chi-squared analyses found race/ethnicity and social vulnerability index (SVI) had effects on sleep disturbance. However, “race/ethnicity (P = .44) and SVI (P = .45) did not independently predict sleep disturbance. Race/ethnicity-stratified analyses indicated that for Black and Hispanic adolescents, being in grades 11/ 12 and depression predicted sleep disturbance; and for Asian adolescents, SVI and anxiety predicted sleep disturbance.”

Overall, “compared to White (88.5%) adolescents, sleep disturbance was more common in Black (91.2%), Hispanic (90.5%), American Indian/Alaska native (95.1%), and Mixed (92.3%) and less common in Asian (83.9%) adolescents,” the researchers said.

Hierarchical binary logistic regression analyses also showed:

• Compared with prepandemic, adolescents reporting “little stress” (odds ratio [OR], 0.70; 95% CI, 0.49-0.99; P = .04) or “the “same amount of stress” (OR, 0.64; 95% CI, 0.47-0.89; P = .007) had lower odds of sleep disturbance
• Higher depression (OR, 1.06; 95% CI, 1.04-1.07; P <.001) and anxiety (OR, 1.05; 95% CI, 1.04-1.07; P <.001) symptoms increased odds of sleep disturbance, while male gender lowered odds of sleep disturbance (OR, 0.11; 95% CI, 0.015-0.86; P <.05)

References

1. Zhang L, Cui Z, Sasser J, and Oshri A. COVID-19 related stress intensify the impact of child maltreatment on sleep quality. Presented at: SLEEP 2021; June 10-13, 2021; Virtual. Abstract 222.

2. Kiss O, Alzueta E, Yuksel D, et al. Poor sleep as a predictor of COVID-19 related stress, fear and sadness in young adolescents: a longitudinal study. Presented at: SLEEP 2021; June 10-13, 2021; Virtual. Abstract 227.

3. Seixas A, Honaker S, Wolfson A, et al. COVID stress and sleep disturbance among a racially/ethnically diverse sample of adolescents: analysis from the NESTED study. Presented at: SLEEP 2021; June 10-13, 2021; Virtual. Abstract 232.