| Literature DB >> 34273194 |
Julia E Stone1, Andrew J K Phillips1, Evangelos Chachos1, Anthony J Hand1, Sinh Lu1, Mary A Carskadon2, Elizabeth B Klerman3,4,5, Steven W Lockley4,5, Joshua F Wiley1, Bei Bei1, Shantha M W Rajaratnam1,4,5.
Abstract
During the COVID-19 pandemic, schools around the world rapidly transitioned from in-person to remote learning, providing an opportunity to examine the impact of in-person vs remote learning on sleep, circadian timing, and mood. We assessed sleep-wake timing using wrist actigraphy and sleep diaries over 1-2 weeks during in-person learning (n = 28) and remote learning (n = 58, where n = 27 were repeat assessments) in adolescents (age M ± SD = 12.79 ± 0.42 years). Circadian timing was measured under a single condition in each individual using salivary melatonin (Dim Light Melatonin Onset; DLMO). Online surveys assessed mood (PROMIS Pediatric Anxiety and Depressive Symptoms) and sleepiness (Epworth Sleepiness Scale - Child and Adolescent) in each condition. During remote (vs in-person) learning: (i) on school days, students went to sleep 26 minutes later and woke 49 minutes later, resulting in 22 minutes longer sleep duration (all P < .0001); (ii) DLMO time did not differ significantly between conditions, although participants woke at a later circadian phase (43 minutes, P = .03) during remote learning; and (iii) participants reported significantly lower sleepiness (P = .048) and lower anxiety symptoms (P = .006). Depressive symptoms did not differ between conditions. Changes in mood symptoms were not mediated by sleep. Although remote learning continued to have fixed school start times, removing morning commutes likely enabled adolescents to sleep longer, wake later, and to wake at a later circadian phase. These results indicate that remote learning, or later school start times, may extend sleep and improve some subjective symptoms in adolescents.Entities:
Keywords: COVID-19; adolescence; circadian rhythms; melatonin; remote learning; school start times; sleep
Mesh:
Substances:
Year: 2021 PMID: 34273194 PMCID: PMC8420593 DOI: 10.1111/jpi.12757
Source DB: PubMed Journal: J Pineal Res ISSN: 0742-3098 Impact factor: 12.081
FIGURE 1Protocol and data collection timing. Data were collected as part of an existing longitudinal cohort trial in Australia, with repeated assessments in 6‐month waves. Group 1 was monitored during in‐person school and during remote learning. Group 2 commenced data collection during in‐person school in March 2020, with their second week of at‐home monitoring and circadian phase assessment conducted during vacation. Group 3 was monitored during remote learning only. Due to the design of the longitudinal study, circadian phase (salivary dim light melatonin onset; DLMO) was measured in the first wave of data collection for each Group. DLMO was measured for Group 1 during in‐person learning, for Group 2 during vacation, and Group 3 during remote learning. Abbreviations: DLMO, dim light melatonin onset; ESS‐CHAD, Epworth Sleepiness Scale Child and Adolescent version. Note: * one participant in Group 2 was monitored during in‐person and remote learning, but not during vacation. Another participant withdrew from the study prior to the remote learning assessment. ** one participant in Group 3 did not complete the DLMO assessment
Participant characteristics by school mode
| In‐person learning | Remote learning | Vacation | |||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| n | Mean | SD | Min | Max | n | Mean | SD | Min | Max | n | Mean | SD | Min | Max | |
| Sex (F, M) | 18, 10 | 33, 25 | 9, 6 | ||||||||||||
| Age (years) | 28 | 12.9 | 0.5 | 12.0 | 13.7 | 58 | 12.8 | 0.4 | 12.0 | 13.7 | 15 | 12.6 | 0.4 | 12.0 | 13.1 |
| Sleep onset time (hh:mm) | 28 | 22:16 | 0:40 | 20:53 | 23:44 | 58 | 22:44 | 1:03 | 21:15 | 2:05 | 15 | 23:01 | 1:18 | 20:49 | 1:05 |
| Wake time (hh:mm) | 28 | 7:12 | 0:34 | 6:00 | 8:18 | 58 | 7:55 | 0:41 | 6:19 | 9:43 | 15 | 8:20 | 1:02 | 6:37 | 10:31 |
| Sleep duration (hh:mm) | 28 | 8:55 | 0:35 | 7:36 | 10:01 | 58 | 9:10 | 0:45 | 7:29 | 11:14 | 15 | 9:18 | 0:59 | 7:26 | 10:55 |
| DLMO (hh:mm) | 12 | 20:24 | 1:03 | 19:07 | 22:21 | 30 | 20:30 | 0:52 | 18:45 | 22:40 | 15 | 20:43 | 1:21 | 18:09 | 22:45 |
| Sleep onset phase angle (hh:mm) | 12 | −1:44 | 1:19 | −3:04 | 0:32 | 30 | −2:03 | 0:49 | −3:33 | −0:04 | 15 | −2:18 | 1:20 | −5:03 | −0:04 |
| Wake time phase angle (hh:mm) | 12 | 10:19 | 1:12 | 8:14 | 11:51 | 30 | 11:03 | 0:50 | 9:14 | 13:00 | 15 | 11:37 | 1:19 | 9:32 | 13:43 |
| Depressive symptoms (PROMIS) | 28 | 51.4 | 8.2 | 35.2 | 66.0 | 56 | 52.9 | 7.6 | 31.8 | 67.5 | — | — | — | — | — |
| Anxiety (PROMIS) | 26 | 49.5 | 6.3 | 35.7 | 62.9 | 55 | 46.1 | 8.8 | 31.9 | 76.6 | — | — | — | — | — |
| Daytime sleepiness (ESS‐CHAD) | 28 | 5.1 | 3.0 | 0.0 | 12.0 | 56 | 4.1 | 3.2 | 0.0 | 13.0 | — | — | — | — | — |
| Perceived stress (PSS) | 27 | 15.1 | 5.9 | 3.0 | 28.0 | 55 | 15.3 | 5.9 | 5.0 | 29.0 | — | — | — | — | — |
n = 27 participants had repeated assessments during in‐person and remote learning. n = 15 participants had repeated assessments during in‐person, remote learning, and during vacation. Sleep onset, wake time, and sleep duration represent the average sleep timing across the two‐week monitoring phase, measured via actigraphy. Phase angle is calculated for school days only.
Abbreviations: DLMO, dim light melatonin onset; ESS‐CHAD, Epworth Sleepiness Scale – Child and Adolescent version; PROMIS, Patient Reported Outcomes Measurement Information System; PSS, Perceived Stress Scale; SD, standard deviation.
FIGURE 2Differences in sleep duration and timing during in‐person and remote learning. Box plots for sleep duration (A), sleep onset time (B), and wake time (C) are shown for school days and free days during in‐person (IP; n = 28) and remote (R; n = 58) learning, and during school vacation (n = 15), with Tukey‐style whiskers. Linear mixed models were used to compare conditions, with participant as a random factor. Horizontal blue lines indicate significant group differences: dashed lines indicate P < .05, solid lines indicate P < .001. Group mean is indicated by a plus symbol. See also Table S2
Sleep outcomes assessed each day on school days and free days during in‐person, remote learning, and vacation (fixed effects), with participant (n = 59) as random effect. Data for other conditions are presented as relative to the mean during in‐person school days (“Reference”)
| β | Lower CI | Upper CI |
| |
|---|---|---|---|---|
| Sleep onset time (hh:mm) | ||||
| Reference: In‐person school day | 22:08 | 21:51 | 22:24 | |
| In‐person free day | 0:35 | 0:23 | 0:46 |
|
| Remote school day | 0:26 | 0:17 | 0:34 |
|
| Remote free day | 0:59 | 0:49 | 1:08 |
|
| Vacation | 0:57 | 0:40 | 1:13 |
|
| Wake time (hh:mm) | ||||
| Reference: In‐person school day | 6:50 | 6:39 | 7:02 | |
| In‐person free day | 1:05 | 0:54 | 1:16 |
|
| Remote school day | 0:49 | 0:41 | 0:57 |
|
| Remote free day | 1:40 | 1:31 | 1:50 |
|
| Vacation | 1:20 | 1:04 | 1:36 |
|
| Sleep duration (hh:mm) | ||||
| Reference: In‐person school day | 8:42 | 8:29 | 8:55 | |
| In‐person free day | 0:30 | 0:16 | 0:43 | . |
| Remote school day | 0:22 | 0:12 | 0:32 |
|
| Remote free day | 0:41 | 0:29 | 0:52 |
|
| Vacation | 0:23 | 0:04 | 0:43 | .18 |
Table shows unstandardized coefficients (β) in h:mm time, lower and upper 95% confidence intervals in h:mm time, and P‐values, with significant values in bold. Comparisons are made to the in‐person school day mean. Multiple post hoc comparisons were run to examine differences between each fixed effect (see also Table S2). Daily sleep timing was measured using wrist actigraphy. 1196 sleep entries were included in the model, with 5 fixed effects coefficients, and participant as a random effect. P‐values indicate whether the metric is significantly different from zero.
FIGURE 3Timing of circadian phase (DLMO, h) and sleep. Top panel: Timing of DLMO (A); and timing of sleep (circles) and wake (squares) on school days relative to DLMO time (phase angle, 0 = DLMO time) (B) during in‐person learning (n = 12), remote learning (n = 30), and vacation (n = 15). Open circles represent individual participants, and triangles represent the group mean. * indicates P < .05. See also Figure S1. Lower panels: Relationships between circadian phase (DLMO, h) and sleep‐wake timing during school days (C and E) and free days (D and F). The in‐person learning group (n = 12) is represented as closed circles, and the remote learning group (n = 30) in open triangles. Straight solid lines indicate a significant linear relationship, whereas dashed lines indicate a nonsignificant linear relationship
FIGURE 4Changes between in‐person and remote learning in (A) anxiety symptoms, (B) depressive symptoms, and (C) daytime sleepiness. Box plots with Tukey‐style whiskers are shown for each group. Group mean is indicated by a plus symbol. Individual datapoints are shown as circles for each group, with a line connecting participants who had repeated measurements. Blue lines indicate significant group differences, where * signifies P < .05