Child health inequalities in sleep duration

Abstract Background Sleep is a key predictor of mental health and inequalities exist in sleep duration during childhood and adolescence. Children from deprived backgrounds or with additional needs report less sleep. School Health Needs Assessments offer valuable data to help identify children at the intersection of deprivation and additional needs and enables targeted public health interventions. Methods The study analysed routinely collected survey data on sleep duration (≥8, 6-8, or ≤ 6 hours) from health needs assessments conducted in UK primary and secondary schools between 2018 and 2024. A mixed-effects regression modelled sleep duration as a function of school year, Special Educational Needs (SEN), and Free School Meal (FSM) eligibility. The model adjusted for survey year, school size, school-level proportions of SEN and FSM pupils, and school-level deprivation. School was included as a random intercept, and the Satterthwaite estimated degrees of freedom. Standardised residuals (z-scores) were generated to compare school-level differences in sleep duration. Results The sample included 71,978 pupils with valid sleep data: 42,423 aged 10-11 years (Year 6) and 29,555 aged 14-15 years (Year 9). The group with SEN and FSM had the shortest sleep durations in Year 6 (M = 1.679, 95% CI [1.648, 1.710]). The largest reduction in duration was between Year 6 and Year 9 in those without SEN or FSM (+0.459, 95% CI [0.431, 0.487]). In Year 9, sleep durations remained significantly longer than the group with both SEN and FSM (Δ = 0.135, 95% CI [0.080, 0.190]). The school-level random effect was significant (σ² = 0.065), indicating meaningful school-level variance in sleep duration. Conclusions Health inequalities exist in sleep duration that is most notable in younger primary-aged children with additional educational needs and this disadvantage continues into adolescence. School-level differences existed beyond deprivation indicating potential structural inequalities in sleep outcomes. Key messages • Children from deprived backgrounds with additional needs show the shortest sleep, with inequalities most evident in primary school. • School-level differences exist beyond deprivation and indicate standardised scores could be used to identify and evaluate best practice and support earlier intervention.