Sleep behavioural outcomes of school-based interventions for promoting sleep health in children and adolescents aged 5 to 18 years: A systematic review

C. Gaskin, C. Venegas Hargous, Lena D Stephens, Gunchmaa Nyam, Victoria Brown, Natalie Lander, Serene Yoong, B. Morrissey, Steven Allender, Claudia Strugnell
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Abstract

Insufficient sleep is common among children and adolescents and can contribute to poor health. School-based interventions potentially could improve sleep behaviour due to their broad reach, but their effectiveness is unclear. This systematic review focused on the effects of school-based interventions on sleep behaviour among children and adolescents aged 5 to 18 years. Five electronic databases were searched for randomised controlled trials of sleep health interventions initiated or conducted in school settings and in which behavioural sleep outcomes were measured. Cochrane risk of bias tools were used to assess study quality. From the 5,303 database records and two papers from other sources, 21 studies (22 papers) met the inclusion criteria for this review. These studies involved 10,867 children and adolescents at baseline from 13 countries. Most studies (n=15) were conducted in secondary schools. Sleep education was the most common intervention, either alone (n=13 studies) or combined with other initiatives (stress management training, n=2; bright light therapy, n=1; health education, n=1). Interventions were typically brief in terms of both the intervention period (median=4 weeks) and exposure (median=200 minutes). Behavioural outcomes included actigraphy-measured and self-reported sleep patterns, and sleep hygiene. All outcomes had high risk of bias or some concerns with bias. Sleep education interventions were typically ineffective. Later school start times promoted longer sleep duration over 1 week (1 study, high risk of bias). Current evidence does not provide school-based solutions for improving sleep health, perhaps highlighting a need for complex, multi-component interventions (e.g., whole-of-school approaches) to be trialled.
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促进 5 至 18 岁儿童和青少年睡眠健康的校本干预措施的睡眠行为结果:系统回顾
睡眠不足在儿童和青少年中很常见,会导致健康状况不佳。校本干预由于覆盖面广,有可能改善睡眠行为,但其效果尚不明确。本系统性综述主要研究校本干预措施对 5 至 18 岁儿童和青少年睡眠行为的影响。 我们在五个电子数据库中搜索了在学校环境中发起或开展的睡眠健康干预措施的随机对照试验,并对这些试验中的睡眠行为结果进行了测量。科克伦偏倚风险工具用于评估研究质量。 在 5303 条数据库记录和两篇其他来源的论文中,有 21 项研究(22 篇论文)符合本综述的纳入标准。这些研究涉及 13 个国家的 10867 名基线儿童和青少年。大多数研究(n=15)在中学进行。睡眠教育是最常见的干预措施,要么单独进行(13 项研究),要么与其他措施相结合(压力管理培训,2 项;强光疗法,1 项;健康教育,1 项)。就干预期(中位数=4 周)和暴露时间(中位数=200 分钟)而言,干预通常都很短暂。行为结果包括行动记录仪测量和自我报告的睡眠模式以及睡眠卫生。所有结果都存在高偏倚风险或一些偏倚问题。睡眠教育干预通常没有效果。推迟开学时间能延长一周的睡眠时间(1 项研究,偏倚风险高)。 目前的证据并不能提供基于学校的改善睡眠健康的解决方案,这或许凸显了对复杂的、多成分干预措施(如全校方法)进行试验的必要性。
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