Sleep in adolescents of different socioeconomic status: a systematic review

Original studies found in the MEDLINE/PubMed and SciELO databases without language and period restrictions that analyzed associations between sleep variables and socioeconomic indicators. The initial search resulted in 99 articles. After reading the titles and abstracts and following inclusion and exclusion criteria, 12 articles with outcomes that included associations between sleep variables (disorders, duration, quality) and socioeconomic status (ethnicity, family income, and social status) were analyzed.

Data synthesis:

The studies associating sleep with socioeconomic variables are recent, published mainly after the year 2000. Half of the selected studies were performed with young Americans, and only one with Brazilian adolescents. Regarding ethnic differences, the studies do not have uniform conclusions. The main associations found were between sleep variables and family income or parental educational level, showing a trend among poor, low social status adolescents to manifest low duration, poor quality of sleeping patterns.

Conclusions:

The study found an association between socioeconomic indicators and quality of sleep in adolescents. Low socioeconomic status reflects a worse subjective perception of sleep quality, shorter duration, and greater daytime sleepiness. Considering the influence of sleep on physical and cognitive development and on the learning capacity of young individuals, the literature on the subject is scarce. There is a need for further research on sleep in different realities of the Brazilian population.

Sleep; Adolescent; Social class

Authors	Sample/nationality	Sleep variables	Socioeconomic variables	Results	D&B score
Roberts et al. (2000)¹⁵15 Roberts RE, Roberts CR, Chen IG. Ethnocultural differences in sleep complaints among adolescents. J Nerv Ment Dis. 2000;188:222-9.	5423 individuals from the USA aged 10–17 years	Insomnia and hypersomnia	Ethnicity and perception of socioeconomic status	Adolescents from different ethnic backgrounds showed differences related to insomnia and hypersomnia. Insomnia was more frequent in groups of African and Hispanic descent. Adolescents of Chinese descent were less likely to have sleep problems.	13
Roberts et al. (2004)¹⁶16 Roberts RE, Lee ES, Hernandez M, Solari AC. Symptoms of insomnia among adolescents in the lower Rio Grande valley of Texas. Sleep. 2004;27:751-60.	5118 individuals from the USA aged 13–18 years	Insomnia, sleep duration, quality of sleep and restful sleep	Ethnicity and family life style	The study showed significant differences between ethnic groups regarding insomnia and sleep quality. Insomnia was more prevalent among poor adolescents. The associations between insomnia and ethnicity were not significant after adjusting for confounders. The adolescents classified as “poor” were 4.5 times more likely to report insomnia.	12
Roberts et al. (2006)¹⁷17 Roberts RE, Roberts CR, Chan W. Ethnic differences in symptoms of insomnia among adolescents. Sleep. 2006;29:359-65.	4.175 individuals from the USA aged 11 to 17 years and adult caregivers	Problems falling asleep, nighttime awakenings, insomnia and unrestful sleep	Ethnicity, family income and level of schooling of caregivers	Young individuals with low family income were more likely to develop sleep disorders. Individuals of European descent were more likely to have trouble sleeping, have sleeping problems (such waking up during the night) and difficulty falling asleep than those of African descent. Young individuals of Hispanic descent had a lower prevalence of sleep problems than the ones of European descent.	11
Smaldon et al. (2007)¹⁸18 Smaldone A, Honig JC, Byrne MW. Sleepless in America: inadequate sleep and relationships to health and well-being of our nation's children. Pediatrics. 2007;119:S29-37.	68,418 individuals from the USA aged 6 to 17 years	Quality of sleep	Ethnicity, parental level of schooling, income and skin color	Non-Hispanic white adolescents, with higher levels of family education, were approximately 30% more likely to have inadequate sleep patterns. However, it was verified that adolescents with lower family income were 50% less likely to have inadequate sleep patterns, having as reference the adolescents with higher family income.	14
Dollman et al. (2007)⁶6 Dollman I, Ridley K, Olds T, Lowe E. Trends in the duration of school-day sleep among 10- to 15-year-old South Australians between 1985 and 2004. Acta Paediatr. 2007;96:1011-4.	900 individuals from Australia aged 10–15 years (390 in 1985 and 510 in 2004)	Duration of sleep, bedtime and wake up time	Australian socioeconomic index	When comparing the two evaluations, there was a significant reduction in sleep duration in young individuals with lower socioeconomic status (44 min) than in those with higher socioeconomic status.	9
Bernardo et al. (2009)⁴4 Bernardo MP, Pereira EF, Louzada FM, D’Almeida V. Sleep duration in adolescents of different socioeconomic status. J Bras Psiquiatr. 2009;58:231-7.	863 individuals from Brazil aged 10–19 years	Sleep duration and sleep disorders	Social classes	Sleep duration showed decreasing trend with increasing socioeconomic status.	13

Authors	Sample/nationality	Sleep variables	Socioeconomic variables	Results	D&B score
Siomos et al. (2010)⁷7 Siomos KE, Avagianou P-A, Floros GD, Skenteris N, Mouzas OD, Theodorou K, et al. Psychosocial correlates of insomnia in an adolescent population. Child Psychiatry Hum Dev. 2010;41:262-73.	2195 individuals from Greece aged 13–18 years	Sleep latency, nighttime awakenings, sleep duration, welfare and daytime sleepiness	Parental schooling and family financial status	Young individuals who perceive higher family financial status were less likely to suffer from insomnia. There was no significant association between parental level of schooling and insomnia complaints.	9
Moore et al. (2011)¹⁹19 Moore M, Kirchner HL, Drotar D, Johnson N, Rosen C, Redline S. Correlates of adolescent sleep time and variability in sleep time: the role of individual and health related characteristics. Sleep Med. 2011;12:239-45.	247 individuals from the USA aged 13–16 years	Sleep duration	Ethnicity, income, parental level of schooling and neighborhood characteristics	Ethnicity was associated with sleep duration, indicating that adolescents belonging to majority ethnic groups had 19.91 min more sleep than the minority ones. Similarly, adolescents living in less problematic neighborhoods slept on average more than the others. The correlations showed that sleep duration was positively and significantly correlated with parental income.	15
Marco et al. (2011)²⁰20 Marco CA, Wolfson AR, Sparling M, Azuaje A. Family socioeconomic status and sleep patterns of young adolescents. Behav Sleep Med. 2011;10:70-80.	155 individuals from the USA with a mean age of 12.6 (0.6) years	Sleep duration and sleep pattern consistency	Income, parental level of schooling and family environment and neighborhood	Young individuals of low socioeconomic status had lower sleep duration and a later bedtime. Additionally, young individuals with poorer social and environmental indicators had less consistent and more irregular sleep pattern.	11
Bøe et al. (2012)²¹21 Bøe T, Hysing M, Stormark KM, Lundervold AJ, Sivertsen B. Sleep problems as a mediator of the association between parental education levels, perceived family economy and poor mental health in children. J Psychosom Res. 2012;73:430-6.	5781 individuals from Norway aged 11–13 years	Difficulty initiating or maintaining sleep and sleep duration	Parental level of schooling and perception of family economic status	Poor socioeconomic status was associated with difficulties for the young individual to initiate and/or maintain sleep, while low sleep duration was associated only to the perceived family socioeconomic status as poor. Higher level of maternal education was associated with longer duration of adolescent sleep.	13
Fernando et al. (2013)²²22 Fernando AT, Samaranayake CB, Blank CJ, Roberts G, Arroll B. Sleep disorders among high school students in New Zealand. J Prim Health Care. 2013;5:276-82.	1388 individuals from New Zealand aged 14–23 years	Sleep disorders, duration of sleep problems and drug use related to sleep	Ethnicity and economic profile of schools	No differences were observed regarding the assessed sleep disorders considering the economic profile of schools. Additionally, sleep disorders were similar between the ethnic groups investigated.	11
Jarrin et al. (2013)²³23 Jarrin DC, McGrath JJ, Quon EC. Objective and subjective socioeconomic gradients exist for sleep in children and adolescents. Health Psychol. 2014;33:301-5.	239 individuals from Canada aged 8–17 years	Sleep quality, disorders and duration, daytime sleepiness	Family income, parental education and social status	Adolescents with low social indicators had a poor sleep pattern. Nevertheless, the objective socioeconomic measures had greater explanatory power in childhood, whereas the subjective indicator was more relevant in adolescents.	13

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[1] * Corresponding author. E-mail:ericofelden@gmail.com (E.P.G. Felden).