Objective  To analyze the epidemiological characteristics of insufficient sleep and influencing factors in middle and high school students in Zhejiang province, and provide evidence for the development of prevention and treatment strategy and the evaluation of intervention measures.

  Methods  Through a multi-stage stratified cluster sampling design, a total of 28 043 students in 376 middle and high schools in 30 counties in Zhejiang were recruited for an anonymous self-administered questionnaire survey between April and June, 2022. The factors associated with the prevalence of insufficient sleep in the students were identified by using multivariate logistic regression model for complex sampling design.

  Results   In 26 594 students included in the final analysis, there were 13 711 boys and 12 883 girls. The mean age of the students was (15.75±1.73) years. According to diagnostic criteria recommended by the American Academy of Sleep Medicine, the overall prevalence rate of insufficient sleep in the students was 44.56% (95%CI: 42.45%–46.66%), and it was higher in girls (49.70%, 95%CI: 47.33%–52.06%) than in boys (39.92%, 95%CI: 37.76%–42.08%）(χ²=129.361, P<0.001), and it was higher in students living in urban area (47.84%, 95%CI: 44.21%–51.47%) than in those living in rural area (42.76%, 95%CI: 39.78%–45.73%) (χ²=3.843, P=0.049). The prevalence rate of insufficient sleep in junior high school students, senior high school students, and vocational high school students were 39.97% (95%CI: 36.90%–43.05%), 64.90% (95%CI: 61.79%–68.00%) and 31.27% (95% CI: 29.04%–33.51%), respectively, the differences were significant (χ²=265.62, P<0.001). Multivariate logistic regression analysis indicated that age, sex, living area, type of school, paternal and maternal education attainments, family economic status, academic performance, physical activity, fruit intake, eating breakfast, self-reported health status and feeling of loneliness and sadness were significantly associated with the prevalence insufficient sleep in the students.

  Conclusion  Insufficient sleep was common in middle students in Zhejiang. It is necessary to suggest students to take appropriate diet and increase physical exercise, and strengthen mental health intervention in students.