Is sleep hygiene the most neglected hygiene among adolescents? A school based comparative cross-sectional study from Kerala, India

Background: Sleep hygiene is an important determinant of sleep, encompassing simple behavioural and environmental factors intended to promote healthy sleep

Objectives: To assess and compare various aspects of sleep hygiene among adolescent schoolchildren in different types of schools in an urban area of Kerala, India and assess the factors associated with sleep hygiene practices.

Method: A school based cross-sectional study was conducted among 657 adolescents in the Pathanamthitta District, Kerala, India. All adolescents in high school and higher secondary classes were included using stratified random sampling based on the type of school (government, government-aided or private).  Study tool was a self-administered questionnaire which included sociodemographic data and Adolescent Sleep Hygiene Scale (ASHS) to collect information on sleep hygiene practices.

Results:In this study, 657 students were enrolled from government, government-aided and private schools. Mean age of participants was 15.09 ± 1.33 years. Mean ASHS score was 4.49 ± 0.52. Only 16.4% had good sleep hygiene. Sleep hygiene in the sleep stability (differences in sleep duration between

weekdays and weekends) and bedtime routine domains were found to be poor. Nearly 85% usedelectronic devices one hour before sleep. Higher age (r= -0.242, p<0.0001), class (χ²=20.39, p<0.0001), maternal education (r= -0.242, P <0.0001), family income (F=4.18, p=0.016), private school (χ²=21.69, p<0.0001)) and chronic illness (χ² =7.244, p <0.0001) were associated with poor sleep hygiene. Good sleep hygiene practices were associated with good academic performance.

Conclusions: In this study only 16.4% of adolescent schoolchildren in an urban area of Kerala, India had good sleep hygiene. Sleep stability and bedtime routine domains were poor compared to other domains. Type of school, age, family income, maternal education and chronic illness were associated with sleep hygiene. Primary prevention approach aimed at promoting good sleep hygiene practices among adolescents should be encouraged.

Sri Lanka Journal of Child Health, 2022; 51(3): 344-350