Prevalence of sleep disturbances in Chinese adolescents: A systematic review and meta-analysis

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.