The Association Between School Connectedness and Sleep Health in Children and Adolescents: A Systematic Review.

Schools are key settings for sleep health promotion and interventions. Yet their value as rich social-emotional environments that shape student health and wellbeing has largely been neglected by sleep research. School connectedness reflects students' engagement with learning and sense of belonging with peers, teachers, and the school environment. Although school connectedness is associated with physical and mental health in children and adolescents, whether it is associated with sleep is unclear. To address this gap, we systematically reviewed the evidence for cross-sectional and prospective associations between school connectedness and sleep. We searched Medline, PubMed, PsycINFO, and ERIC databases for observational and intervention studies published from 1950 to 17^th July 2024 that examined relationships between school connectedness and sleep health or sleep problems/disorders in four- to 24-year-olds. We identified ten eligible studies (seven cross-sectional and three longitudinal) for narrative synthesis. Studies were primarily from China and Taiwan (n = 6) and conducted in secondary schools (n = 8). Participants were 14.5 years old, on average. Most of the cross-sectional studies found a positive relationship between school connectedness and sleep health. All longitudinal studies reported at least one significant relationship between school connectedness and sleep health, however two of these studies also reported non-significant relationships. We did not identify any intervention studies. Most studies were rated as 'fair' quality representing a moderate risk of bias. The findings of this review suggest that school connectedness is linked to some aspects of sleep health and insomnia in secondary-school aged adolescents. Longitudinal studies are needed to explore prospective relationships in addition to studies conducted in primary and tertiary education settings.