Indoor Air Quality and Sleep Outcomes Among Schoolchildren: A Cross-Sectional Study in Yogyakarta and Sleman, Indonesia

Recent evidence has shown that air pollution may disrupt sleep quality in children through biological and environmental pathways. This cross-sectional study aimed to assess the association between PM2.5 exposure and sleep quality among 184 randomly selected primary school students aged 7 to 12 in Yogyakarta and Sleman, Indonesia, with consideration to environmental, behavioral, and social characteristics. PM₂.₅ levels were measured over seven consecutive days using portable monitors installed in each school. Sleep quality and individual characteristics were assessed using validated questionnaires. The results showed that poor sleep quality, defined as a Pediatric Sleep Questionnaire (PSQ) score > 5, was identified in 28.3% of participants (n = 52). Behavioral factors significantly associated with poor sleep included low sleep efficiency (< 65%), frequent nocturnal disturbances (≥ 2 times/week), prolonged sleep latency, daytime dysfunction, and poor subjective sleep quality (all p < 0.05). Higher maternal education and household income were identified as protective factors. In univariate analysis, higher PM₂.₅ exposure was strongly associated with poor sleep quality (χ² = 24.109; p < 0.001). After adjustment, the association between classroom PM2.5 exposure and sleep quality persisted in the expected direction but was not statistically significant (OR = 0.154; 95% CI 0.018–1.290; p = 0.085). In conclusion, PM2.5 exposure may contribute to poor sleep quality among children, together with behavioral and sociodemographic factors, highlighting the need for more comprehensive exposure assessments in future research. The inclusion of school air quality provides additional insight into factors associated with children’s sleep health.