Preprint Article Version 1 Preserved in Portico This version is not peer-reviewed

The Effects of COVID-19 Lockdown on the Sleep Quality of Children

Version 1 : Received: 6 March 2023 / Approved: 10 March 2023 / Online: 10 March 2023 (13:36:42 CET)

A peer-reviewed article of this Preprint also exists.

Lopez-Iracheta, R.; Moreno-Galarraga, L.; Moreno-Villares, J.M.; Bueso-Asfura, O.E.; Martinez-Gonzalez, M.A.; Martin-Calvo, N. The Effects of COVID-19 Lockdown on the Sleep Quality of Children. Children 2023, 10, 944. Lopez-Iracheta, R.; Moreno-Galarraga, L.; Moreno-Villares, J.M.; Bueso-Asfura, O.E.; Martinez-Gonzalez, M.A.; Martin-Calvo, N. The Effects of COVID-19 Lockdown on the Sleep Quality of Children. Children 2023, 10, 944.


Abstract: Introduction: Covid-19 lockdown has caused important changes in children's routines, especially in terms of nutrition, physical activity, screen time, social activity, and school time. Regarding these changes, recent studies show that Covid-19 lockdown was associated with higher levels of anxiety and depression in children. The objective of this study was to assess changes in sleep quality in Spanish children during lockdown decreed by the Spanish government between March and June 2020. Methodology: We compared the BEAR score of 478 participants in the SENDO project at the periods before, during and after lockdown. We used hierarchical models with two levels of clustering to account for the intra-cluster correlation between siblings. Interaction of time with and a set of a priori selected variables was assessed by introducing the interaction term into the model and calculating the likelihood ratio test. Results: Mean scores in the BEAR questionnaire referred to the periods before, during, and after lockdown were 0.52 (sd 1.25), 1.43 (sd 1.99) and 1.07 (sd 1.55), respectively, showing a worsening of sleep quality as a result of confinement. Parental level of education was found to be an effect modifier (p for interaction=0.004). Children whose parents had higher education (university graduates or higher) showed a smaller worsening than those without. Conclusion: We found that the mean score in the BEAR questionnaire significantly worsened during lockdown and significantly improved after it. However, it did not reach the initial level. The mean score in the BEAR questionnaire referred to the period after lockdown was significantly higher than before.


Covid-19 lockdown; sleep quality; parental education; SENDO project


Medicine and Pharmacology, Pediatrics, Perinatology and Child Health

Comments (1)

Comment 1
Received: 23 March 2023
Commenter: (Click to see Publons profile: )
The commenter has declared there is no conflict of interests.
Comment: Thank you for this important splendid research in a contemporary issue

My observations in sequential order are:
1] Title & Abstract: Claim to study Spanish children, but the population of study turned out to be a cohort of age-specific group. Authors may wish to define the cohort with a name (e.g. ‘pre-schoolers’ , ‘younger children’.. etc) and express this explicitly in the title.
Additionally the project SENDO which was the primary source of data, was originally implemented in the Spanish region of Navarra and does not seem to be a country-wide project in Spain. This was not mentioned in any part of the manuscript.
The Conclusion in ‘Abstract’ only presented results of BEAR score without the interpretation of this in terms of study objectives. Authors may wish to extend a few lines to mention the association of the lock-down with the sleep quality of these children
2] Sentence in Introduction: ”The most important long-term consequences …psychological impact” ”Many of the most important…”
3] Paragraph: “Adolescence is a critical period in which… on the Internet” To stay balanced and keep relevance, this paragraph should be reduced/or removed, then replaced with more data about children (the target population of this study) see Kolcakoglu et al 2021 ( ); El Refay et al.2021 ( ); Urbina-Garcia 2020 (
4] Sentence in Introduction: ”Spain was one of the most affected … in Europe” Authors may wish to present some statistical/epidemiologic data to show the burden regionally and in Spain. Then, to mention how universal public health measures were embraced until reaching Lockdowns.
5] Sentence in Introduction: ”one of the most affected country” most affected countries
6] last sentence in Introduction: ”… during the COVID19.” ”during the COVID19 pandemic”
7] Statement in Methods: ” inclusion criteria are: 1) age between 4 and 5 years” (ERROR? … did you mean 7 years?) if no error, then for the purpose of this research, authors should give this narrow cohort a definition and reflect this in the title of the manuscript. An explanation of this difference from the original cohort of the SENDO project should be presented.
8] Statement in Methods: ” The only exclusion criterion is lack of access to an internet- connected device.. This may be related to low income of the household and also the lower educational status of the parents. It may be necessary to be mentioned in limitations.
9] Conclusion
should point out also the non-significance of socio-demographic differences especially the age.
10] Figures (the graphs):
a) Suggestion: for better readability, remove the sentence “Figure 1. Description of score of quality of sleep”. Then assign a separate number to each of the Figures (1.e Figure 1., Figure 2., etc); then amend the above in-text sentence” Figure 1 shows the responses to each question..etc” to “Figures 1 to 4 show the responses to each question..etc”
b) Suggestion: position the captions of Figures below their images, not above.
c) Adjust the increment on the y-axis to heighten the bars enough to be recognizable. If necessary you may change the graph format to the horizontal bar type.
d) Using shades of black/grey alone may present some difficulty in distinguishing the bars of the graphs. It may be helpful to add different patterns inside the bars.

Thank you
Yasir E. A. Elsanousi, MBBCh, DTM&H, MeHM, EMDM
Infectious Disease Specialist, Disaster Medicine Consultant
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