A Cluster Randomised Trial of a School‐Based Universal Intervention Program for Middle School Students' Sleep and Related Outcomes

Most middle school students have entered or started entering adolescence, which involves rapid and significant neurodevelopmental changes associated with their sleep. International literature indicates that myriad school- and health-related outcomes are influenced by adolescents' sleep. As a multidisciplinary team, the authors designed a theory-informed universal intervention program (Sleep to Enhance Educational Performance in Schools; SLEEPS) that leveraged the social-cognitive influences of peers, caregivers and teachers on adolescents' sleep hygiene. This cluster randomised trial was designed to explore the effectiveness of SLEEPS on middle school students' sleep and related outcomes. Eight middle schools in the US (n _teacher = 8, n _student = 104) were randomly assigned to the treatment (SLEEPS; n _teacher = 4, n _student = 61) or control condition (standard curriculum not focusing on sleep; n _teacher = 4, n _student = 43). Multilevel-ANCOVAs were conducted to examine the effects of SLEEPS on the theoretical mechanisms of sleep-behaviour change (sleep-related belief, attitudes, self-efficacy, subjective social norms and intentions), sleep (sleep behaviours and quality) and related outcomes (internalising symptoms, academic motivation and engagement; See Section 2.3). The authors also explored whether the effects of SLEEPS varied across subgroups based on adolescents' demographics or baseline status. Outcomes were assessed at baseline and 8-week post-test (2 weeks after completing SLEEPS). Compared to the control group, adolescents receiving SLEEPS showed significantly larger improvement in their sleep-related belief and self-efficacy, daytime sleepiness and internalising symptoms. Also, students with less baseline belief about sleep hygiene improved more from SLEEPS than peers with more baseline belief. Trial Registration: This trial was retrospectively registered at OSF Preregistration on 2/1/2025 [osf.io/9skf5].