Prevalence of Sleep Disturbances in Chinese Adolescents: A Systematic Review and Meta-analysis

Overview

Journal PLoS One

Specialties General Medicine
Science

Date 2021 Mar 4

PMID 33661914

Citations 30

Authors

Mengjiao Liang

Ling Guo

Jing Huo

Guoliang Zhou

Affiliations

Soon will be listed here.

Abstract

Objectives: To review cross-sectional studies on the prevalence of sleep disturbance in Chinese adolescents and use a meta-analysis to explore the factors that may explain the heterogeneity between estimates of the prevalence.

Methods: We followed the Preferred Reporting Items for Systematic Review and Meta-analysis and searched the PubMed, Embase, Cochrane Library, PsycINFO, Scopus, Web of Science, SinoMed, Chinese National Knowledge Infrastructure (CNKI), WanFang, and VIP Database for Chinese Technical Periodicals databases from their inception through June 30, 2020. Analysis of the abstract, full-text, and data were conducted independently with uniform standards. Sub-group analyses and meta-regression analyses were performed to explore the associations between prevalence and gender, sex ratio, mean age, area, studying stage, sample size, survey time, response rate, assessment tools, PSQI cut-off, and quality score of the study.

Results: A total of 63 studies (64 groups of outcomes) were included in our analysis, covering 430,422 adolescents across China, of which 104,802 adolescents had sleep disturbances. The overall pooled prevalence was 26% (95% CI: 24-27%). Adolescents in senior high school (28%, 95% CI: 24-31%, p<0.001) had a higher prevalence of sleep disturbances than those in junior high school (20%, 95% CI: 15-24%, p<0.001). Studies with effective sample size of more than 1,000 and less than 3,000 had the highest prevalence of 30% (95% CI: 24-35%, p<0.001). The prevalence of sleep disturbances was not affected by other factors.

Conclusion: This systematic review and meta-analysis revealed that sleep disturbances are common in Chinese adolescents, and effective psychological and behavior intervention may be needed to help adolescents solve their sleep problems.

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References

Li L, Wang Y, Wang S, Zhang L, Li L, Xu D . Prevalence of sleep disturbances in Chinese university students: a comprehensive meta-analysis. J Sleep Res. 2018; 27(3):e12648. DOI: 10.1111/jsr.12648. View

Lu L, Wang S, Rao W, Zhang Q, Ungvari G, Ng C . The Prevalence of Sleep Disturbances and Sleep Quality in Older Chinese Adults: A Comprehensive Meta-Analysis. Behav Sleep Med. 2018; 17(6):683-697. DOI: 10.1080/15402002.2018.1469492. View

Begg C, Mazumdar M . Operating characteristics of a rank correlation test for publication bias. Biometrics. 1994; 50(4):1088-101. View

Xiao D, Wang T, Huang Y, Wang W, Zhao M, Zhang W . Gender differences in the associations between types of childhood maltreatment and sleep disturbance among Chinese adolescents. J Affect Disord. 2020; 265:595-602. DOI: 10.1016/j.jad.2019.11.099. View

Cao X, Wang S, Zhong B, Zhang L, Ungvari G, Ng C . The prevalence of insomnia in the general population in China: A meta-analysis. PLoS One. 2017; 12(2):e0170772. PMC: 5325204. DOI: 10.1371/journal.pone.0170772. View

Cheung L, Wong W . The effects of insomnia and internet addiction on depression in Hong Kong Chinese adolescents: an exploratory cross-sectional analysis. J Sleep Res. 2010; 20(2):311-7. DOI: 10.1111/j.1365-2869.2010.00883.x. View

Ades A, Lu G, Higgins J . The interpretation of random-effects meta-analysis in decision models. Med Decis Making. 2005; 25(6):646-54. DOI: 10.1177/0272989X05282643. View

Chung K, Cheung M . Sleep-wake patterns and sleep disturbance among Hong Kong Chinese adolescents. Sleep. 2008; 31(2):185-94. PMC: 2225574. DOI: 10.1093/sleep/31.2.185. View

Higgins J, Thompson S, Deeks J, Altman D . Measuring inconsistency in meta-analyses. BMJ. 2003; 327(7414):557-60. PMC: 192859. DOI: 10.1136/bmj.327.7414.557. View

10.

Cheng S, Shih C, Lee I, Hou Y, Chen K, Chen K . A study on the sleep quality of incoming university students. Psychiatry Res. 2012; 197(3):270-4. DOI: 10.1016/j.psychres.2011.08.011. View

11.

Buysse D, Reynolds 3rd C, Monk T, BERMAN S, Kupfer D . The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research. Psychiatry Res. 1989; 28(2):193-213. DOI: 10.1016/0165-1781(89)90047-4. View

12.

Crowley S, Acebo C, Carskadon M . Sleep, circadian rhythms, and delayed phase in adolescence. Sleep Med. 2007; 8(6):602-12. DOI: 10.1016/j.sleep.2006.12.002. View

13.

Morin C, Belleville G, Belanger L, Ivers H . The Insomnia Severity Index: psychometric indicators to detect insomnia cases and evaluate treatment response. Sleep. 2011; 34(5):601-8. PMC: 3079939. DOI: 10.1093/sleep/34.5.601. View

14.

Chen D, Truong K, Tsai M . Prevalence of poor sleep quality and its relationship with body mass index among teenagers: evidence from Taiwan. J Sch Health. 2013; 83(8):582-8. DOI: 10.1111/josh.12068. View

15.

Zhang J, Chan N, Lam S, Li S, Liu Y, Chan J . Emergence of Sex Differences in Insomnia Symptoms in Adolescents: A Large-Scale School-Based Study. Sleep. 2016; 39(8):1563-70. PMC: 4945316. DOI: 10.5665/sleep.6022. View

16.

Tan Y, Chen Y, Lu Y, Li L . Exploring Associations between Problematic Internet Use, Depressive Symptoms and Sleep Disturbance among Southern Chinese Adolescents. Int J Environ Res Public Health. 2016; 13(3). PMC: 4808976. DOI: 10.3390/ijerph13030313. View

17.

Chen Y, Kawachi I, Subramanian S, Acevedo-Garcia D, Lee Y . Can social factors explain sex differences in insomnia? Findings from a national survey in Taiwan. J Epidemiol Community Health. 2005; 59(6):488-94. PMC: 1757060. DOI: 10.1136/jech.2004.020511. View

18.

Egger M, Davey Smith G, Schneider M, Minder C . Bias in meta-analysis detected by a simple, graphical test. BMJ. 1997; 315(7109):629-34. PMC: 2127453. DOI: 10.1136/bmj.315.7109.629. View

19.

Chahine R, Farah R, Chahoud M, Harb A, Tarabay R, Sauleau E . Assessing sleep quality of Lebanese high school students in relation to lifestyle: pilot study in Beirut. East Mediterr Health J. 2018; 24(8):722-728. DOI: 10.26719/2018.24.8.722. View

20.

Kao C, Huang C, Wang M, Tsai P . Insomnia: prevalence and its impact on excessive daytime sleepiness and psychological well-being in the adult Taiwanese population. Qual Life Res. 2008; 17(8):1073-80. DOI: 10.1007/s11136-008-9383-9. View