gms | German Medical Science

Background: The pandemic and measures against it impacted upon the health and behavior of children. Sleep is a crucial aspect of health, and the pandemic has affected different attributes of sleep quality differently. We analyzed sleep quality of children and parents before, during, and after the pandemic in the Ulm SPATZ Health Study.

Methods: SPATZ is a birth cohort study with baseline recruitment of n=1006 children shortly after delivery in 2010-2011 at the university hospital of Ulm. Children and parents have been followed up annually; consequently, pre-pandemic, trans-pandemic and post-pandemic data are available. Sleep quality was assessed with the Children's Sleep Habits Questionnaire (CSHQ) among boys and girls and with the Pittsburgh Sleep Quality Index (PSQI) for work-days and free-days separately among parents. For this analysis, we looked at the period from April 2017 to May 2023 (child age 5-10 years), with the period between 15 March 2020 and 3 April 2022 being defined as 'during the pandemic'. Descriptive values of sleep quality were analyzed longitudinally. Correlations between concurrent parent and child sleep quality and between concurrent parental mental health and parent and child sleep quality were examined. We used multivariable mixed models to estimate the association of two distinct time periods (during vs before/after the pandemic) with sleep quality among boys, girls, mothers, and fathers, separately.

Results: We analyzed n=558 children (n=278 boys, n=280 girls), n=465 mothers, and n=318 fathers with available follow-up data on sleep quality. The analysis samples showed a slightly higher proportion of mothers with German nationality and higher educational attainment compared to the baseline sample.

Descriptive results showed better sleep quality (CSHQ) in girls than boys at all time points, except in the early phase of the pandemic. Mothers showed slightly worse sleep quality (PSQI) compared to fathers. Sleep quality of 6-year-old boys slightly correlated with maternal sleep quality (weekdays: r=0.19 (p=0.01), free-days: 0.22 (0.005)), whereas girls’ correlation was 0.14 (0.06) and 0.10 (0.19). A stronger correlation was found between mothers' mental health and children's sleep quality among boys aged 5, 6 and 9 years (0.33 (<0.001), 0.28 (<0.001), 0.25 (0.01), and among 5 year-old girls (0.25 (<0.001)). Mental health was also strongly correlated with sleep quality in parents.

In the mixed models we found better sleep quality among boys during the pandemic compared to before and after the pandemic (difference in means: -1.52; 95% confidence interval (CI): -2.85, -0.19). Also, daytime sleepiness decreased among boys (-1.24; 95% CI -1.84, -0.63) and girls (-1.52; 95% CI -2.85, -0.19). Among mothers, sleeping duration increased on free-days (+0.26 h; 95% CI 0.06, 0.46), among fathers on work-days (+0.18 h; 95% CI 0.01, 0.35), while the fathers’ sleep efficiency also increased (+4.81; 95% CI 2.15, 7.46). Overall sleep quality (PSQI) among parents did not substantially change.

Conclusion: This analysis showed that sleep quality of families did not decrease during the pandemic compared to before and after. Though, sleeping duration among parents increased, daytime sleepiness among children decreased, and sleep quality among boys increased.

The authors declare that they have no competing interests.

The authors declare that a positive ethics committee vote has been obtained.