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January 27, 2022
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Teens benefited from extra sleep during COVID-19 lockdown

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Adolescents who were homeschooled during a COVID-19 lockdown slept longer on school days and drank less alcohol and caffeine than before the pandemic, according to a cross-sectional online survey of nearly 9,000 students in Switzerland.

Researchers found that longer sleep durations were associated with better health-related quality of life among the participants. However, these gains were offset by an increase in depressive symptoms during the COVID-19 lockdown period.

An infographic with a quote that reads "We should continue to push for later school start times to improve sleep quality and quality of life for school-aged children and teenagers." The source of the quote is Cora Collette Breuner, MD, MPH.

“Although negative associations of COVID-19 pandemic high school closures with adolescents’ health have been demonstrated repeatedly, some research has reported a beneficial association of these closures with adolescents’ sleep,” Joëlle N. Albrecht, MSc, of the Child Development Center at the University Children’s Hospital Zurich in Switzerland, and colleagues wrote in JAMA Network Open. “The present study was, to our knowledge, the first to combine both perspectives.”

The researchers analyzed survey responses from 5,308 students (65.1% girls) that were collected in 2017 as well as survey responses from 3,664 students (66.3% girls) that were collected during a partial COVID-19 lockdown in 2020. The median age of both cohorts was 16 years. Since depression symptoms were not assessed in the pre-pandemic group, the researchers conducted a subsample analysis to ascertain if there was a link between sleep duration and health-related characteristics.

Albrecht and colleagues reported that students who were surveyed during the lockdown slept a median of 75 minutes longer than students who were surveyed before the pandemic (semipartial R2 statistic [R2*] = 0.238; 95% CI, 0.222-0.254) and experienced better health-related quality of life (R2* = 0.007; 95% CI, 0.004-0.012), drank less caffeine (R2* = 0.01; 95% CI, 0.006-0.015) and drank less alcohol (R2* = 0.014; 95% CI, 0.008-0.022). Further analyses revealed significant associations between longer sleep times and better health-related quality of life (R2* =0.027; 95% CI, 0.02-0.034) and lower caffeine consumption (R2* =0.013; 95% CI, 0.009-0.019).

In the lockdown cohort, the prevalence of depressive symptoms was 4.5 times higher than “the expected level of 2%,” with 9.1% of students having clinically relevant levels of depressive symptoms, the researchers wrote. An inverse association was found between depressive symptoms and health-related quality of life (R2* = 0.285; 95% CI, 0.26-.0311) and a positive link was found with caffeine consumption (R2* = 0.003; 95% CI, 0-0.008).

The researchers said that the most important limitation to their study was its pseudo-longitudinal approach.

“The two samples consisted of students from mostly the same schools, and it is likely that some students participated in both samples,” they wrote. “However, because the surveys were answered anonymously, quantification or even paired analysis was not possible. Therefore, the data only allowed investigation of associations between measures, not the investigation of associations among changes or causality.”

According to the researchers, other study limitations included differences between the two cohorts, the passage of 3 years (and the potential increase in digital media use) between surveys and the lack of information on survey participants’ specific school start and stop times during the partial lockdown.

Even so, “the findings suggest that school closures allowed students to better align their sleep schedules with adolescents’ late sleep phase,” Albrecht and colleagues wrote. “Of most importance, to our knowledge, this study provides the first scientific evidence for the beneficial sleep-related associations of school closures with adolescents’ health ... [and] provides further support for delaying [school start times] in countries with early [school start times].”