Worry-related sleep problems in Brazilian adolescents: Findings from the National School Health Survey (PeNSE)

Objective To estimate the prevalence of worry-related sleep problems among Brazilian adolescents and to identify associated sociodemographic, lifestyle, and health-related factors. Methods This cross-sectional study used data from the 2015 National School Health Survey (PeNSE), which included 9th-grade students from public and private schools across Brazil. Self-reported worry-related sleep problems were analyzed alongside sociodemographic, lifestyle, and health variables. Prevalence estimates with 95% confidence intervals (95%CI) were calculated, and prevalence ratios (PR) were obtained using Poisson regression with robust variance, accounting for the complex survey design. Results The overall prevalence of sleep problems was 36.2% (95%CI: 35.5–36.8), ranging from 32.1% in Tocantins to 40.6% in Acre. In multivariate analyses, higher prevalence was observed among girls (PR = 1.60; 95%CI: 1.55–1.65), adolescents aged ≥ 16 years (PR = 1.23; 95%CI: 1.16–1.30), indigenous (PR = 1.10; 95%CI: 1.03–1.18), and black adolescents (PR = 1.05; 95%CI: 1.00–1.10). Higher maternal education was protective (PR = 0.92; 95%CI: 0.87–0.96). Unhealthy dietary patterns were associated with sleep problems, including frequent consumption of soft drinks (PR = 1.08; 95%CI: 1.04–1.11), fried snacks (PR = 1.04; 95%CI: 1.01–1.08), and fast food ≥ 3 days/week (PR = 1.08; 95%CI: 1.03–1.12). Protective factors included eating beans ≥ 5 days/week (PR = 0.91; 95%CI: 0.89–0.94), having breakfast regularly (PR = 0.94; 95%CI: 0.91–0.97), and eating lunch or dinner with parents ≥ 5 days/week (PR = 0.85; 95%CI: 0.83–0.88). Substance use showed significative associations: alcohol experimentation (PR = 1.16; 95%CI: 1.12–1.21), current alcohol use (PR = 1.18; 95%CI: 1.14–1.21), cigarette experimentation (PR = 1.10; 95%CI: 1.05–1.15), and illicit drug experimentation (PR = 1.06; 95%CI: 1.01–1.12). Poor self-rated health (PR = 1.19; 95%CI: 1.16–1.23) and body image dissatisfaction (dissatisfied: PR = 1.23; 95%CI: 1.18–1.29; very dissatisfied: PR = 1.42; 95%CI: 1.35–1.50) were also associated. Conclusion Worry-related sleep problems affect more than one-third of Brazilian adolescents and are linked to sociodemographic inequalities, unhealthy dietary patterns, family dynamics, substance use, and indicators of health and well-being. These findings underscore the need for integrated public health strategies to promote healthy sleep, including psychosocial support, healthier food environments, substance use prevention, and stronger family engagement.