Sleep timing and health indicators in children and adolescents: A systematic review

Abstract

Introduction: To continue to inform sleep health guidelines and the development of evidence-based healthy sleep interventions for children and adolescents, it is important to better understand the associations between sleep timing (bedtime, wake-up time, midpoint of sleep) and various health indicators. The objective of this systematic review was to examine the associations between sleep timing and 9 health indicators in appar¬ently healthy children and adolescents 5 to 18 years old. Methods: Studies published in the 10 years preceding January 2021 were identified from searches in four electronic databases. This systematic review followed the guidelines pre¬scribed in PRISMA 2020, the methodological quality and risk of bias were scored, and the summary of results used a best-evidence approach for accurate and reliable reporting. Results: Forty-six observational studies from 21 countries with 208 992 unique partici¬pants were included. Sleep timing was assessed objectively using actigraphy in 24 stud¬ies and subjectively in 22 studies. The lack of studies in some of the health outcomes and heterogeneity in others necessitated using a narrative synthesis rather than a meta¬analysis. Findings suggest that later sleep timing is associated with poorer emotional regulation, lower cognitive function/academic achievement, shorter sleep duration/poorer sleep quality, poorer eating behaviours, lower physical activity levels and more sedentary behaviours, but few studies demonstrated associations between sleep timing and adiposity, quality of life/well-being, accidents/injuries, and biomarkers of cardio-metabolic risk. The quality of evidence was rated as “very low” across health outcomes using GRADE. Conclusion: The available evidence, which relies on cross-sectional findings, suggests that earlier sleep timing is beneficial for the health of school-aged children and adoles¬cents. Longitudinal studies and randomized controlled trials are needed to better advance this field of research. (PROSPERO registration no.: CRD42020173585).