Assessment of sleep quality in school children of 6-12 years in COVID-19 pandemic

Palak Y. Desai, Pradeep Borkar


Background: Sleep disorders in children are one of the common disorders and their frequency has increased during the COVID-19 pandemic. The study aims to assess the quality of sleep and study the parameters of sleep in school children aged 6-12 years in pandemic with the help of children’s sleep habit questionnaire (CSHQ).

Methods: A survey-based study was conducted from December 2020 to March 2021 using the data obtained from CSHQ. The study involved 498 school children, among which 244 were male participants and 254 were female participants. It involved students from schools of Rahata and Mumbai, Maharashtra.

Results: The results of the study were withdrawn. Bedtime Resistance had mean value of 11.79±4.56, sleep onset delay had mean of 1.56±0.71. Average of sleep duration was 4.56±2.09. Sleep anxiety had mean of 7.48±3.1, night wakings had mean of 4.27±1.91. Mean of parasomnias was 10.1±4.46. Average of sleep disordered breathing was 4.09±1.86, for daytime sleepiness mean was 13.04±5.44 with significance of p˂0.0001.

Conclusions: The study concluded that sleep time became lesser and bedtime became later in present scenario of COVID-19. The subscale items of CSHQ scale have increased values indicating towards altered sleep pattern. The total scoring of CSHQ for age group 6-9 years on average is higher than age group 10-12 years except “sleep onset delay” and “sleep duration”. Also, the total scores of female participants are higher as compared to male participants.


Sleep pattern, Sleep problems, Bedtime, School children, CSHQ, Sleep in COVID-19

Full Text:



Wolfgang Babisch, Oliviero Bruni, J.A. Horne etal. WHO technical meeting on sleep and health Bonn Germany. 2004. Available at: Accessed on 15 January 2021.

Sembulingam K, Sembulingam P. Physiology of sleep. Essentials of Medical Physiology. 6th Edition. Jaypee Brothers Medical Publishers. 2012.

Vyazovskiy VV. Sleep, recovery, and metaregulation: explaining the benefits of sleep. Nature Sci Sleep. 2015;7:171.

McCarley RW. Neurobiology of REM and NREM sleep. Sleep Med. 2007;8(4):302-30.

Hirshkowitz M, Whiton K, Albert SM, Alessi C, Bruni O, Don Carlos L etal. National Sleep Foundation’s sleep time duration recommendations: methodology and results summary. Sleep health. 2015;1(1):40-3.

Axelsson EL, Williams SE, Horst JS. The Effect of Sleep on Children's Word Retention and Generalization. Front Psychol. 2016;7:1192.

Mindell JA, Williamson AA. Benefits of a bedtime routine in young children: Sleep, development, and beyond. Sleep Med Rev. 2018;40:93-108.

Bharti B, Malhi P, Kashyap S. Patterns and Problems of Sleep in School Going Children. Indian Pediatr. 2006;43.

Dutta K, Mukherjee R, Sen D, Sahu S. Effect of COVID-19 lockdown on sleep behavior and screen exposure time: an observational study among Indian school children. Biological Rhythm Res. 2020.

Stores G, Wiggs L. Sleep disturbance in children and adolescents with disorders of development: its significance and management. Cambridge University Press. 2001.

Moturi S, Avis K. Assessment and treatment of common pediatric sleep disorders. Psychiatry (Edgmont). 2010;7(6):24.

Al-Balushi B, Essa MM. The impact of COVID-19 on children− parent’s perspective. Int J Nutr Pharmacol Neurol Dis. 2020;10(3):164.

Liu Z, Tang H, Jin Q, Wang G, Yang Z, Chen H, et al. Sleep of pre-schoolers during the coronavirus disease 2019 (COVID‐19) outbreak. J Sleep Res. 2021;30(1):13142.

Cellini N, Di Giorgio E, Mioni G, Di Riso D. Sleep and Psychological Difficulties in Italian School-Age Children During COVID-19 Lockdown. J Pediatr Psychol. 2021;46(2):153-67.

Owens JA, Spirito A, McGuinn M. The Children's Sleep Habits Questionnaire (CSHQ): psychometric properties of a survey instrument for school-aged children. Sleep-New York-. 2000;23(8):1043-52.

Bruni O, Reto FL, Miano S, Ottaviano S. Daytime behavioral correlates of awakenings and bedtime resistance in preschool children. Suppl Clin Neurophysiol. 2000;53:358-61.

Freeman KA. Treating bedtime resistance with the bedtime pass: A systematic replication and component analysis with 3‐year‐olds. J Appl Behav Analysis. 2006;39(4):423-8.

Nathanson AI, Beyens I. The relation between use of mobile electronic devices and bedtime resistance, sleep duration, and daytime sleepiness among pre-schoolers. Behav Sleep Med. 2018;16(2):202-19.

Narendhran R, Bharti B, Malhi P. Children Sleep Habits Questionnaire (CSHQ): psychometric validation in Indian school children. Indian J Sleep Med. 2008;3(3):102-6.

Iwadare Y, Kamei Y, Oiji A, Doi Y, Usami M, Kodaira M etal. Study of the sleep patterns, sleep habits, and sleep problems in Japanese elementary school children using the CSHQ-J. Kitasato Med J. 2013;43:31-7.

Cheung CH, Bedford R, De Urabain IR, Karmiloff-Smith A, Smith TJ. Daily touchscreen use in infants and toddlers is associated with reduced sleep and delayed sleep onset. Sci Rep. 2017;7(1):1-7.

Tse CY, Lee HP, Chan KS, Edgar VB, Wilkinson-Smith A, Lai WH. Examining the impact of physical activity on sleep quality and executive functions in children with autism spectrum disorder: A randomized controlled trial. Autism. 2019;23(7):1699-710.

Bathory E, Tomopoulos S. Sleep regulation, physiology and development, sleep duration and patterns, and sleep hygiene in infants, toddlers, and preschool-age children. Curr Prob Pediatr Adolesc Health Care. 2017;47(2):29-42.

Palmer CA, Clementi MA, Meers JM, Alfano CA. Co-sleeping among school-aged anxious and non-anxious children: associations with sleep variability and timing. J Abnorm Child Psychol. 2018;46(6):1321-32.

Reynaud E, Forhan A, Heude B, Charles MA, Plancoulaine S, Annesi-Maesano I, et al. Night-waking and behavior in preschoolers: a developmental trajectory approach. Sleep Med. 2018;43:90-5.

Bollu PC, Goyal MK, Thakkar MM, Sahota P. Sleep medicine: Parasomnias. Missouri Med. 2018;115(2):169.

Aathira R, Gulati S, Tripathi M, Shukla G, Chakrabarty B, Sapra S, et al. Prevalence of sleep abnormalities in Indian children with autism spectrum disorder: a cross-sectional study. Pediatr Neurol. 2017;74:62-7.

Gipson K, Lu M, Kinane TB. Sleep-disordered breathing in children. Pediatr Rev. 2019;40(1):3.

Owens JA, Babcock D, Weiss M. Evaluation and Treatment of Children and Adolescents with Excessive Daytime Sleepiness. Clin Pediatr. 2020;59(4-5):340-51.