Sleep Hygiene in Adolescents and Factors Influencing Sleep Pattern: A Cross-sectional Study from Southern India

Abstract

Introduction: Adolescence is an important period of growth and development. Sleep patterns undergo changes as the child transitions from adolescence to adulthood. A proper sleep hygiene for adolescents is important for their proper health, academic performance and prevention of adult-onset diseases. Aim: To assess sleep pattern and factors influencing sleep among adolescent school-going children. Materials and Methods: This cross-sectional questionnairebased study was conducted at Saveetha Medical College Hospital, Chennai, Tamil Nadu, India (tertiary care centre), from June 2021 to December 2021. School children aged 12-19 years, studying in class 8-12 were included in the study. Adolescent Sleep Hygiene Scale (ASHS) questionnaire, was used to collect information about the sleep practices. In addition, socio-economic class, start to school time, after school activities, sharing of bed room and access to personal devices like mobile phone were also noted. Sleep was assessed with regards to different parameters like physiological factors, cognitive and emotional factor, sleep environment factor, sleep stability factor, daytime sleep factor, bedtime routine factors. In addition, disturbance of sleep based on sharing of bed with others; use of social media, school routine preventing adequate sleep and presence or absence of outdoor activities was also assessed. The primary data was tabulated using Microsoft excel sheet. Analysis of the independent variables with dependant variables was done using a three-way Analysis of Variance (ANOVA) was done using Sigma Plot 13 (Systat Software, USA). Results: A total of 826 students were enrolled in the study. Majority of the study population was females (n=500). Mean age was 15.1±1.6 years. The mean sleep score was 118.7±14.3, out of a possible 150. Sleep stability and bedtime routine factors were the areas the children had lesser scores of 12.6 and 4.2 respectively, compared to other domains. Majority of the children (76.8%, 635) did not have a bedroom of their own and shared it with their parents, siblings or grandparents. Total 602 children did not have television inside their bedroom, likewise, access to computer was also limited (129,15.6%). Socio-economic status was found to be significantly impacting behavioural arousal factors (p-value=0.006), sleep environmental factors (p-value=0.009), sleep stability factors (p-value=0.001) and bedtime routine factors (p-value=0.004) as assessed using ASHS questionnaire. Conclusion: The overall sleep quality was good in the study population. In the Indian setting, the socio-economic class and the type of family play an important role in the sleep hygiene practices of an adolescent. School based and family-based interventions will do a lot of good to adolescent sleep hygiene thereby increasing their overall health, productivity and academic performance.