Better sleep, better life? How sleep quality influences children’s life satisfaction



To assess the association between children’s sleep quality and life satisfaction; and to evaluate the underlying mechanisms of this relationship.


Three pediatric cohorts in the National Institutes of Health (NIH) Environmental influences on Child Health (ECHO) Research Program administered Patient-Reported Outcome Measurement Information System (PROMIS®) parent-proxy measures to caregivers (n = 1111) who reported on their 5- to 9-year-old children’s (n = 1251) sleep quality, psychological stress, general health, and life satisfaction; extant sociodemographic data were harmonized across cohorts. Bootstrapped path modeling of individual patient data meta-analysis was used to determine whether and to what extent stress and general health mediate the relationship between children’s sleep quality and life satisfaction.


Nonparametric bootstrapped path analyses with 1000 replications suggested children’s sleep quality was associated with lower levels of stress and better general health, which, in turn, predicted higher levels of life satisfaction. Family environmental factors (i.e., income and maternal mental health) moderated these relationships.


Children who sleep well have happier lives than those with more disturbed sleep. Given the modifiable nature of children’s sleep quality, this study offers evidence to inform future interventional studies on specific mechanisms to improve children’s well-being.

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Fig. 1



Analysis of variance


Comparative fit index


Confidence interval


Environmental influences on Child Health Outcomes


Health-Related Quality of Life


Likelihood ratio test


National Institutes of Health


Patient-Reported Outcomes Measurement Information System


Root Mean Square Error of Approximation


Standard deviation


Standardized root mean squared residual


Tucker–Lewis Index


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The authors wish to thank our ECHO colleagues, the medical, nursing and program staff, as well as the children and families participating in the ECHO cohorts.


Research reported in this publication was supported by the Environmental influences on Child Health Outcomes (ECHO) program, Office of The Director, National Institutes of Health, under Award Numbers U2COD023375 (Coordinating Center), U24OD023319 with co-funding from the Office of Behavioral and Social Sciences Research (OBSSR; Person Reported Outcomes Core, Blackwell & Forrest), UG3/UH3OD023313 (LeBourgeois & Hartstein); UG3/UH3OD023279 (Elliott), UG3/UH3OD023389 (Ganiban), UG3OD023316 (Hunt), and UG3/UH3OD023253 (Camargo). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

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We also acknowledge the contributions of the following ECHO program collaborators: Duke Clinical Research Institute (Coordinating Center), Durham, NC: DKB, PBS, KLN, HB. Medical University of South Carolina, Charleston, SC: JEV, RW. National Institutes of Health (ECHO Program Office), Bethesda, MD: CB. Northwestern University (Person Reported Outcomes (PRO) Core), Evanston, IL: RG, DC. University of Oregon, Eugene, OR: LDL.

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Correspondence to Courtney K. Blackwell.

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Blackwell, C.K., Hartstein, L.E., Elliott, A.J. et al. Better sleep, better life? How sleep quality influences children’s life satisfaction. Qual Life Res 29, 2465–2474 (2020).

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  • ECHO
  • Life satisfaction
  • Positive health
  • Sleep quality
  • Well-being