Adequate sleep among adolescents is positively associated with health status and health-related behaviors

A scoping review of the effect of chronic stretch training on sleep quality in people with sleep disorders

PURPOSE

The widespread and health-detrimental sleep disorders have resulted in stretching exercises being investigated as a non-drug solution for enhanced sleep quality. However, a comprehensive understanding of the impact of stretching exercises on individuals with sleep disorders is lacking.

METHODS

This scoping review systematically maps the existing literature and identifies research gaps on the impact of stretching exercises on sleep quality in individuals with sleep disorders.

RESULTS

Sixteen eligible studies were included, where the weighted mean changes indicate a positive trend in sleep quality improvement, ranging from trivial to very large magnitudes. However, concerning the individual study results only 5 out of 16 studies reported significant improvements. Notable enhancements include a small 1.22% overall sleep quality improvement, a large 6.51% reduction in insomnia severity, a large 8.88% increase in sleep efficiency, a moderate 4.36% decrease in sleep onset latency, a large 8.27% decrease in wake after sleep onset, and a very large 14.70% improvement in total sleep time. Trivial changes are noted in sleep duration (0.58%), sleep disturbance reduction (0.07%), and daytime dysfunction reduction (0.19%). Likely mechanisms for the improvement of sleep include autonomic nervous system modulation, muscle tension relief, cortisol regulation, enhanced blood circulation, and psychological benefits such as stress reduction and mood enhancement.

CONCLUSION

There is little evidence that stretching exercises positively impact sleep quality in individuals with sleep disorders. Additionally, further research is vital for designing optimal protocols, understanding of the long-term effects, and clarification of the mechanisms.

Personal and social resources in the context of adolescent sleep

OBJECTIVE

The existing literature has focused little on the health-promoting role of resources for sleep. Mainly risk factors have been highlighted regarding mental health in general. Moreover, for the vulnerable age group of adolescents, resources and their relation to sleep have hardly been explored. Therefore, this study aims to investigate the predictive role of personal/social resources for the likelihood of having chronic sleep problems in adolescents.

METHODS AND MEASURES

A sample of n = 131 adolescents (M = 14.31 years, SD = 1.84) completed the Sleep Disturbance Scale for Children and the Questionnaire to Assess Resources for Children and Adolescents at two measurement points about 8 months apart.

RESULTS

Binomial logistic regressions controlling for age and sex revealed that higher levels of personal and social resources were associated with a lower likelihood of having chronic sleep problems. Especially optimism and school integration were associated with not experiencing chronic sleep problems.

CONCLUSION

For the first time, this study highlighted multiple resources and their health-promoting role in adolescent sleep. Both personal and social resources seem to be relevant for preventing adolescents from chronic sleep problems. Prevention and intervention programs for sleep disorders in teenagers should especially promote optimism and school integration.

Body mass index is associated with health-related quality of life and disease characteristics in young adults with juvenile idiopathic arthritis

BACKGROUND

There is a growing interest concerning the relationship between obesity and several medical conditions and inflammation. Nevertheless, there is a lack of studies regarding body mass index (BMI) among patients with juvenile idiopathic arthritis (JIA). Our aim was to investigate the impact of BMI on health-related quality of life (HRQoL) measured with a 36-Item Short Form Survey (SF-36), disease activity, and disability in young adults with JIA.

METHODS

This study is a part of the population-based Nordic JIA cohort study. All newly diagnosed patients with JIA were recruited consecutively between 1997-2000 in specific regions in the Nordic countries. Patients in this sub-study were enrolled from 434 patients who attended their 18-year follow-up visit. Patients were classified according to the World Health Organization (WHO) into four groups based on their BMI. HRQoL, disease characteristics, disability, fatigue, sleep quality, physical activity, pain, comorbidities, and social status were assessed.

RESULTS

Three hundred fifty-five patients from the original study cohort were enrolled in this study and 72% of them were female. Mean age was 23.9 (± SD 4.4) years. A significant relationship was found between the JIA categories and BMI groups (p = 0.014). A significant relationship was also found between BMI and disease activity scores (DAS28) (p = 0.028), disability (p < 0.001), pain (p = 0.013), fatigue (p = 0.035), and sleep quality (p = 0.044). Moreover, a significant relationship between BMI and HRQoL regarding bodily pain (p = 0.010) and general health (p = 0.048) was revealed when adjusted for sex, age, and JIA subtype.

CONCLUSION

We discovered that BMI was significantly related to HRQoL, disease activity, and disability. BMI deserves more attention considering the treatment options and outcome of JIA in young adults.

Sleep hygiene a neglected paediatric identity - A cross-sectional study

Background

Sleep is the physiological need of any human being; its role in paediatric mental and physical development is irreplaceable. However, in recent days, the rising trend of childhood obesity makes it essential to assess the sleep hygiene of the children to know if there is any adjacent association.

Objectives

1. To estimate the prevalence of poor sleep quality using Sleep Hygiene Index Scoring. 2. To determine the association of sleep quality with academic performance and body mass index among the school children.

Materials and Methods

The present cross-sectional study was conducted among 322 children aged between 7 and 12 years attending paediatric OPD of a private tertiary care hospital, Puducherry. Using Sleep Hygeine Index scoring with the cut off 16, prevalence of poor sleep quality was assessed and its association with BMI and academic performance was determined. Frequency, proportion, and Chi-square test were used for analysis; P value < 0.05 was considered statistically significant.

Results

The mean age of the participants was 8.8 ± 2 years, and most of them were boys. Around 53% of the children had poor quality of sleep, and there was a positive association between poor sleep quality with obesity (P value: 0.0003) and unfavourable academic performance (P value: 0.00001).

Conclusion

Sleep hygiene importance should be taught to the parents and periodical assessment helps in predicting the neglected reason for obesity and poor academic performance, which could be managed easily with small lifestyle changes.

Age-related differences in food-specific inhibitory control: Electrophysiological and behavioral evidence in healthy aging

The number of older adults in the United States is estimated to nearly double from 52 million to 95 million by 2060. Approximately 80-85% of older adults are diagnosed with a chronic health condition. Many of these chronic health conditions are influenced by diet and physical activity, suggesting improved diet and eating behaviors could improve health-related outcomes. One factor that might improve dietary habits in older adults is food-related inhibitory control. We tested whether food-related inhibitory control, as measured via behavioral data (response time, accuracy) and scalp-recorded event-related potentials (ERP; N2 and P3 components), differed between younger and older adults over age 55. Fifty-nine older adults (31 females [52.5%], M_age = 64, SD_age = 7.5) and 114 younger adults (82 females [71.9%], M_age = 20.8) completed two go/no-go tasks, one inhibiting to high-calorie stimuli and one inhibiting to low-calorie stimuli, while electroencephalogram (EEG) data were recorded. Older adults had slower overall response times than younger adults, but this was not specific to either food task. There was not a significant difference in accuracy between younger and older adults, but both groups' accuracy and response times were significantly better during the high-calorie task than the low-calorie task. For both the N2 and P3 ERP components, younger adults had larger no-go ERP amplitudes than older adults, but this effect was not food-specific, reflecting overall generalized lower inhibitory control processing in older adults. P3 amplitude for the younger adults demonstrated a specific food-related effect (greater P3 amplitude for high-calorie no-go than low-calorie no-go) that was not present for older adults. Findings support previous research demonstrating age-related differences in inhibitory control though those differences may not be specific to inhibiting towards food.

Later school start time is associated with longer school day sleep duration and less social jetlag among Norwegian high school students: Results from a large-scale, cross-sectional study

The present study explored the associations between school start time and sleep habits among older adolescents, and whether these associations depended on circadian preference. The sample comprised 4010 high school students aged 16-17 years who completed a web-based survey on habitual school start time, sleep, and health. The survey included the Munich ChronoType Questionnaire, and the short version of the Horne-Östberg Morningness-Eveningness Questionnaire. Students were categorised according to habitual school start time (before 08:00 hours, 08:00 hours, 08:15 hours, 08:30 hours or after 08:30 hours) and circadian preference (morning, intermediate or evening). Data were analysed using two-way analyses of variance (school start time × circadian preference) and linear regression analyses. Results showed an overall effect of school start time on school day sleep duration (main effect, p < 0.001), with the latest school starters having the longest, and the earliest school starters having the shortest sleep duration (7:03 hr versus 6:16 hr; Tukey HSD p < 0.001). Similarly, later school starters generally reported shorter social jetlag and later school day wake-up times than earlier starting students (both main effect p < 0.001). Circadian preference did not modify these associations (interaction effects p > 0.05). In the crude regression analysis, 15 min later school start was associated with 7.2 min more sleep (p < 0.001). School start time remained a significant predictor of school day sleep duration when adjusted for sex, parental educational level and circadian preference (p < 0.001). Results suggest that school start time is a significant predictor of school day sleep duration among adolescents.

Bidirectional Daily Associations Between Accelerometer-Measured Sleep and Physical Activity in Brazilian High School Students

PURPOSE

This study analyzed day-to-day estimates of bidirectional associations between sleep parameters and intensity-specific physical activity and assessed whether the timing of physical activity influences these relationships.

METHODS

The sample was comprised of 651 high school students (51.2% female, 16.33 [1.0] y old) from southern Brazil. Physical activity and sleep were measured using accelerometers. Multilevel models were applied to test associations of nocturnal total sleep time, onset, and efficiency with moderate to vigorous and light (LPA) physical activity.

RESULTS

Higher engagement in moderate to vigorous physical activity and LPA was associated with increased total sleep time, and this effect was greater when physical activity was performed in the morning. Morning and evening LPA were associated with increased sleep efficiency and reduced total sleep time, respectively. Practice of LPA in the morning leads to early sleep onset, whereas evening LPA was associated with later onset. Higher total sleep time and later sleep onset were associated with lower moderate to vigorous physical activity and LPA on the following day. However, higher sleep efficiency was associated with increased LPA.

CONCLUSION

The relationship between sleep parameters and physical activity is bidirectional and dependent on physical activity intensity and timing.

Effects of sodium bicarbonate bath on the quality of sleep: An assessor-blinded, randomized, controlled, pilot clinical trial

BACKGROUND

Sleep is fundamental to a healthy life, and sleep disorders are an important health issue in healthcare. Whole-body warm water bathing is a non-pharmacological, safe (non-invasive), and widely used method for comforting. Here, we explored the feasibility and preliminary effectiveness of sodium bicarbonate bath (SBB) on sleep quality.

METHODS

Healthy adults without sleep disturbances were randomly assigned to shower baths (SHB), tap-water baths (TWB, placebo tablets), or SBB. All participants took a bath (shower, tap-water, or SBB) once a day for 10 min, after dinner, for 7 days. Sleepscan-derived sleep parameters, including total sleep time (TST), symptom questionnaires, and salivary α-amylase concentration were evaluated as outcome measures.

RESULTS

Forty participants were enrolled (14, 13, and 13 in SHB, TWB, and SBB groups, respectively) and 38 participants completed the trial (13, 12, and 13, respectively). The recruitment, adherence, and completion rates were 90.9% (40/44), 95.0% (38/40), and 95.0% (38/40), respectively. The SBB group showed a significant increase (12.35 [mean]±10.07 [standard deviation] min) in the mean TST at 1-week post-intervention (p = 0.0041) than the SHB (-1.81 ± 14.58 min; p = 0.0231) and TWB (4.54 ± 10.97 min; p = 0.0377) groups. The TST scores at 1-week post-intervention, sleep onset latency, wake after sleep onset, and sleep efficiency were significantly different between the groups. Sleep satisfaction by questionnaire was significantly improved with intervention in the SBB group than that in the SHB and TWB groups. Salivary α-amylase levels significantly improved in the SBB and TWB groups than in the SHB group, with the change being greater in the SBB group.

CONCLUSIONS

SBB for 7 days had positive effects that improved sleep quality of adults. Further studies are needed to examine the efficacy and safety of SBB for prolonged usage in people diagnosed with insomnia, using objective sleep measurements, and to investigate potential sleep-enhancing mechanisms of action.

Associations Between Sleep and Metabolic Outcomes in Preadolescent Children

Context

Growing evidence suggests an important role for sleep for the metabolic health of children.

Objective

We aimed to determine how sleep is related to insulin sensitivity, insulin secretion, beta-cell function, and adiposity (BMI z-scores, body fat %, waist to height ratio) using objectively measured sleep and oral glucose tolerance test (OGTT)-derived measures.

Methods

Sixty-two children aged 7-11 years, born at Kaiser Permanente Southern California, wore wrist accelerometers for 7 days to objectively measure sleep, completed an OGTT, and had anthropometric measures (height [cm], weight [kg], waist [cm], body fat [%]) collected. Using linear regression, associations between Matsuda insulin sensitivity index (ISI), insulinogenic index (IGI), disposition index (DI), BMI z-score, waist to height ratio, and body fat % with sleep parameters [total sleep time (TST; min), sleep efficiency (SE; %), time in bed (TIB; min), wake after sleep onset (WASO; min), and sleep latency (SL; min)] were assessed. Body fat % was tested as a mediator of the relationship between TST and ISI.

Results

Longer TST was associated with better insulin sensitivity (P = 0.02), but not after adjusting for body fat %. Sleep parameters were not associated with IGI or DI. Longer TST was associated with lower % body fat (P = 0.01) and lower waist-to-height-ratios (P = 0.05). Body fat % explained 62% (P = 0.01) of the relationship between TST and ISI. Longer TIB was associated with lower adiposity measures (P < 0.05). There were no associations between SE, WASO, or SL and metabolic outcomes.

Conclusion

Objectively measured sleep duration was associated with lower adiposity, and the relationship between sleep duration and ISI appeared partly through adiposity levels in preadolescent children. Longer sleep duration may be important for metabolic health.

Association between Breakfast Meal Categories and Timing of Physical Activity of Japanese Workers

Background: Breakfast is the most important meal of the day and has been associated with longevity. Regular breakfast consumers often have a healthy lifestyle, including a healthy diet and regular physical activity. Methods: We examined the association between breakfast type, chronotype (morningness-eveningness), and physical activity in 3395 Japanese workers using a cross-sectional web survey. Results: Participants who ate Japanese breakfasts showed an early chronotype, while those who ate breakfast cereal exhibited a later chronotype. Physical activity was positively associated with adopting a Japanese breakfast style. Japanese breakfast eaters performed physical activities from 6:00–9:00 compared with other breakfast eaters. Conclusion: Our findings suggest that eating a Japanese breakfast is associated with an earlier chronotype (morningness) and higher physical activity.

How Does Social Comparison Influence Chinese Adolescents' Flourishing through Short Videos?

Flourishing indicates one's emotional status and functioning level and is essential for adolescents' further development. Adolescents' social media use has been rising, with various potential effects on their development. Therefore, in this study, we shifted the emphasis from a traditional deficit-based approach to a strength-based approach by exploring how social comparison and social media usage influence Chinese adolescents' flourishing. Altogether, 786 Chinese adolescents aged 12-19 years completed a self-report questionnaire. The results indicate that (1) both social media social comparison of ability (SCA) and social media social comparison of opinion (SCO) have no significant effect on Chinese adolescents' flourishing; (2) integration into social routine has a positive indirect effect on the relationship between social media social comparison and flourishing; and (3) social integration and emotional connection negatively affect the relationship between social media social comparison and flourishing. These findings highlight the interaction between social media social comparison and social media usage. Furthermore, the results of this study clarify that the potentially harmful effect of social media usage on adolescents' flourishing is not determined by the frequency or time spent on using social media, but how much adolescents are connected to or invested in social media.

Does Prior Night's Sleep Impact Next Day's Executive Functioning? It Depends on an Individual's Average Sleep Quality

Executive functioning (EF) is a series of fundamental goal-directed cognitive abilities that enable effective learning. Differences in daily sleep quality may covary with fluctuations in EF among youth. Most studies linking sleep to EF rely on between-person differences and average effects for the sample. This study employed an intensive longitudinal design and examined the within-person relations between self-reported prior night's sleep quality and next day's EF. Students from Grades 4 to 12 (M age= 14.60, SD = 2.53) completed three behavioral EF tasks repeatedly across approximately one semester. The final analytic sample included 2898 observations embedded in 73 participants. Although, on average, sleep did not significantly covary with EF, there was heterogeneity in within-person sleep-EF relations. Moreover, individuals' average sleep quality moderated within-person effects. For individuals with low mean sleep quality, a better-than-usual sleep quality was linked to better EF performance. However, for individuals with high mean sleep quality, better-than-usual sleep quality was linked to worse EF performance. Understanding person-specific relations between sleep and EF can help educators optimize EF and learning on a daily basis and produce positive academic outcomes across longer time periods.

The Association of Sleep Duration with Breakfast Patterns and Snack Behaviors among Chinese Children Aged 6 to 17 Years: Chinese National Nutrition and Health Surveillance 2010–2012

A significant increase in the prevalence of short sleep among children has been observed. Short sleep may be associated with unhealthy breakfast and snacking behaviors. The purpose of the current study was to explore the associations of short sleep with breakfast and snacking behaviors among children. Data were obtained from the 2010–2012 China National Nutrition and Health Surveillance (CNNHS). A total of 5254 children aged 6 to 17 years were included. Sleep duration was classified into three categories: moderate sleep, slightly short sleep, and severely short sleep. Breakfast behaviors included skipping breakfast, food diversity, intake of energy and macronutrients, and their proportion of daily total intake. Snack behaviors included snack consumption rate/frequency, types, intake of energy and macronutrients, and proportion of daily total intake. Multiple linear regression and multivariate logistic regression were used for analysis, with models adjusted for the potential effects of gender, age, region, and family income level. The bootstrapping method was used to calculate the 95% confidence intervals of the model statistics. Results showed that slightly short sleep (OR = 1.15, 95%CI: 1.00, 1.33)) and severely short sleep (OR = 1.36, 95%CI: 1.04, 1.77) was related to higher rates of skipping breakfast compared to moderate sleep. Severely short sleep was associated with higher energy (β = 28.44, 95%CI: 31.97, 44.70), carbohydrate (β = 6.62, 95%CI: 8.29, 8.84) and protein (β = 1.17, 95%CI: 1.44, 1.70) intake at breakfast and breakfast accounted for a higher proportion of total daily energy (β = 1.39, 95%CI: 1.48, 2.52), protein (β = 2.26, 95%CI: 3.16, 5.84) and carbohydrate (β = 0.83, 95%CI: 0.07, 3.41). Severely short sleep was associated with higher energy (β = 27.4, 95%CI: 18.64, 69.41), protein (β = 0.8, 95%CI: 0.48, 2.40), and fat (β = 1.40, 95%CI: 1.21, 3.16) intake at snacks and snacks accounted for a higher proportion of total daily protein intake (β = 1.23, 95%CI: 0.71, 3.58) and fat intake (β = 2.74, 95%CI: 3.13, 6.09). Slightly short sleep was associated with higher energy (β = 7.28, 95%CI: 0.15, 28.13) and carbohydrate (β = 1.67, 95%CI: 0.86, 5.73) intake at snacks and snacks accounted for a higher proportion of total daily carbohydrate intake. Children with severely short sleep were more likely to choose sugar-sweetened beverages (SSBs) as snacks (16.5%) and intake them more frequently, at a daily consumption of 204.7 g and 26.7 g per night. Overall, short sleep was associated with unhealthy breakfast patterns and snack behaviors among children. Children with short sleep had higher intake of energy and macronutrients at breakfast and snacks compared with those with moderate sleep. Promoting adequate sleep among children may have a positive effect on developing healthy eating behaviors.

Neural mechanisms that promote food consumption following sleep loss and social stress: An fMRI study in adolescent girls with overweight/obesity

STUDY OBJECTIVES

Insufficient sleep and social stress are associated with weight gain and obesity development in adolescent girls. Functional magnetic resonance imaging (fMRI) research suggests that altered engagement of emotion-related neural networks may explain overeating when under stress. The purpose of this study is to explore the effects of acute sleep restriction on female adolescents' neural responding during social evaluative stress and their subsequent eating behavior.

METHODS

Forty-two adolescent females (ages 15-18 years) with overweight or obesity completed a social stress induction task in which they were told they would be rated by peers based on their photograph and profile. Participants were randomly assigned to one night of sleep deprivation or 9 hours of sleep the night before undergoing fMRI while receiving positive and negative evaluations from their peers. After which, subjects participated in an ad libitum buffet.

RESULTS

Sleep deprived, relative to non-deprived girls had distinct patterns of neural engagement to positive and negative evaluation in anterior, mid, and posterior aspects of midline brain structures. Moreover, a sleep deprivation-by-evaluation valence-by-caloric intake interaction emerged in bilateral dorsal anterior cingulate. Among sleep deprived girls, greater engagement during negative, but not positive, feedback was associated with lower caloric intake. This was not observed for non-sleep deprived girls.

CONCLUSIONS

Results suggest an interaction between acute sleep loss and social evaluation that predicts emotion-related neural activation and caloric intake in adolescents. This research helps to elucidate the relationship between sleep loss, social stress, and weight status using a novel health neuroscience model.

Impact of Body Mass Index, Socioeconomic Status, and Bedtime Technology Use on Sleep Duration in Adolescents

Factors related to adolescents and sleep are understudied. We evaluate the relationship between bedtime technology use (TU), TV in bedroom, weight, and socioeconomic status in seventh graders (N = 3956) enrolled in a school-based wellness intervention. Sleep quantity was dichotomized to insufficient (<8 hours) or sufficient (≥8 hours); high TU before sleep was defined by use "a few nights each week" or "every, or almost every night." Insufficient sleep (38.7%), having TV in bedroom (72.9%), and high TU (83.1%) were commonly reported. The likelihood of sufficient sleep was lower for those with high TU (odds ratio [OR] = 0.529 [0.463-0.605]), obese students (OR = 0.815 [0.700-0.949]), and those with a TV in the bedroom (OR = 0.817 [0.703-0.950]). Also, attending a school with higher percent low socioeconomic status students was also associated with insufficient sleep (P = .026). Interventions to reduce TU may be important for improving sleep quantity, especially for some vulnerable populations.

Gender-Specific Changes in Life Satisfaction After the COVID-19-Related Lockdown in Dutch Adolescents: A Longitudinal Study

PURPOSE

The purposes of this study were to assess whether mental well-being has changed after introduction of the lockdown measures compared with that before, whether this change differs between boys and girls, and whether this change is associated with COVID-19-related concerns.

METHODS

This is a two-wave prospective study among Dutch adolescents using data collected up to one year before the COVID-19 pandemic (n = 224) and 5-8 weeks after the first introduction of lockdown measures (n = 158). Mental well-being was assessed by three indicators: life satisfaction, internalizing symptoms, and psychosomatic health. General linear model repeated-measures analysis of variance was used to assess whether mental well-being has changed and if this differed by sex. Univariate linear regressions were used to assess associations between COVID-19-related concerns and a change in mental well-being.

RESULTS

Life satisfaction decreased (η2p = .079, p < .001), but no change in internalizing symptoms was observed (η2p = .014, p = .14), and psychosomatic health increased (η2p = .194, p < .001) after the introduction of lockdown measures. Boys scored significantly better on all mental health indicators compared with girls at baseline and follow-up. However, boys' life satisfaction significantly decreased at the follow-up (η2p = .038, p = .015), whereas girls' life satisfaction did not change. Concerns about COVID-19 were significantly associated with a lower life satisfaction and more internalizing symptoms.

CONCLUSIONS

Adolescents', especially boys', life satisfaction decreased during the lockdown. They reported no change in internalizing symptoms and an improved psychosomatic health. Adolescents' mental well-being is expected to vary during the COVID-19 pandemic and should continue to be monitored.

The Current Status of Insufficient Sleep Duration and Its Influencing Factors Among Children and Adolescents: A Household Based Cross-Sectional Study in Zhejiang Province, China

PURPOSE

Insufficient sleep duration is common among children and adolescents worldwide, and the decline of sleep duration during the recent years is troubling. This study aimed to learn the status of insufficient sleep duration and to explore its influencing factors among children and adolescents in Zhejiang Province, China.

DESIGN AND METHODS

A stratified sampling technique was employed in the present cross-sectional study. Demographic characteristics, sports time as well as sedentary behavior were investigated.

RESULTS

A greater proportion of children than adolescents reported insufficient sleep duration (36.4% versus 19.2%, p = 0.001). For children, insufficient sleep duration was associated with age (OR = 1.290, 95%CI: 1.069-1.557), watching movies or TV shows with smartphones after school (OR = 3.098, 95%CI: 1.293-7.420), surf the internet after school (OR = 0.113, 95%CI: 0.013-0.969), walk to school (OR = 0.289, 95%CI: 0.105-0.793). For adolescents, insufficient sleep duration was associated with watch TV after school (OR = 0.379, 95%CI: 0.148-0.970), watching movies or TV shows with smartphones after school (OR = 4.744, 95%CI: 1.799-12.507), do homework after school (OR = 0.265, 95%CI: 0.086-0.813).

CONCLUSIONS

An unhealthy sedentary screen lifestyle profile may have influence on insufficient sleep duration. Urgent actions are needed to improve sleep duration among children and adolescents.

Sleep duration and anthropometric indices in an Iranian population: the Fasa PERSIAN cohort study

Recent decades have seen a dramatic rise in the prevalence of obesity. While genetic factors can influence obesity, environmental factors and lifestyle may play important roles as well. Sleep can be regarded as one of these factors. This study aimed to examine sleep duration, as a potential risk factor for obesity in an Iranian population. In this cross-sectional study, the Fasa PERSIAN cohort study data was used and 10,136 subjects aged 35-70 were entered. Anthropometrics indices have been measured and the total body fat percentage (BFP) was obtained by Bio-Impedance Analysis. Also, physical activity and dietary intake have been recorded. Sleep duration was obtained and individuals categorized into two groups of "< 8" and "≥ 8" h of sleep. The mean age and sleep duration of the participants were 48.63 ± 9.57 years and 6.92 ± 1.62 h in the total population, respectively. All of the anthropometric indices were significantly higher in the "< 8 h of sleep" group than in the "≥ 8 h of sleep" group. Regarding BFP and fat mass index (FMI) the same results was seen (p-value < 0.05). Body mass index (BMI), Waist and hip circumferences (WC, HC), and waist-to-height ratio (WHtR) were in a significant negative association with night time sleep (p-value < 0.001), while these associations with daytime napping were positive (p-value < 0.001). After multi-variable adjusting, BMI, WC, HC, WHtR, and wrist circumference showed significant negative associations with 24-h sleep duration (p-value < 0.05). This study established the association between nocturnal, daytime napping, 24-h sleep duration and obesity parameters. Daytime napping was positively associated with obesity parameters and short 24-h sleep duration was associated with higher risk of overweight/obesity. These results indicate that insufficient sleep can be a screening indicator for an unhealthy lifestyle and poor health outcomes.

Sleep duration, physical activity, and caloric intake are related to weight status in Mexican American children: a longitudinal analysis

BACKGROUND

Obesity is a serious issue, spanning all ages, and, in the U.S., disproportionately affects Latinos and African Americans. Understanding sleep, physical activity and dietary behaviors that may predict childhood obesity can help identify behavioral intervention targets.

METHODS

Data were drawn from a U.S. cohort study of 323 Mexican American 8-10-year-old children and their mothers, who participated in a longitudinal study over a 2-year period. Measures were collected at baseline (BL; child mean age = 8.87, SD = 0.83), year 1 (FU1) and year 2 (FU2). Mothers reported on household income and acculturation at BL. Child height and weight were collected and BMI z-scores (BMIz) were calculated for weight status at BL, FU1, and FU2. Accelerometer-estimated sleep duration (hours) and moderate-to-vigorous physical activity (MVPA; minutes) were collected across 3 days at BL, FU1, and FU2. Two 24-h dietary recalls were performed at each time point; from these, average energy intake (EI, kcals/day) was estimated. Cross-lagged panel analysis was used to examine behavioral predictors on BMIz at each time point and across time.

RESULTS

At BL and FU1, longer sleep duration (β = - 0.22, p < 0.001; β = - 0.17, p < 0.05, respectively) and greater MVPA (β = - 0.13, p < 0.05; β = - 0.20, p < 0.01, respectively) were concurrently related to lower BMIz. At FU2, longer sleep duration (β = - 0.18, p < 0.01) was concurrently related to lower BMIz, whereas greater EI (β = 0.16, p < 0.01) was related to higher BMIz. Longer sleep duration at BL predicted lower BMIz at FU1 (β = - 0.05, p < 0.01).

CONCLUSIONS

Longer sleep duration was concurrently related to lower weight status at each time point from ages 8-10 to 10-12. Higher MVPA was concurrently related to lower weight status in earlier childhood (ages 8-10 and 9-11) and higher EI was concurrently related to higher weight status toward the end of childhood (ages 10-12 years). Furthermore, longer sleep in earlier childhood was protective of children's lower weight status 1 year later. These findings suggest that sleep duration plays a consistent and protective role against childhood obesity; in addition, MVPA and healthy EI remain important independent factors for obtaining a healthy weight.

Dietary patterns and sleep disorders in Mexican adults from a National Health and Nutrition Survey

Given the high prevalence of multiple non-communicable chronic diseases in Mexico, the aim of the present study was to assess the association between dietary patterns and sleep disorders in a national representative sample of 5076 Mexican adults (20–59 years) from the 2016 National Health and Nutrition Survey. Through a cross-sectional study, we used the Berlin sleep symptoms questionnaire to estimate the proportion of adults with insomnia, obstructive sleep apnoea (OSA) and other related problems such as daytime symptoms and inadequate sleep duration. Dietary data were collected through a seven-day semi-quantitative food frequency questionnaire, and dietary patterns were determined through cluster analysis. Associations between dietary patterns and sleep disorders were assessed by multivariate logistic regression models adjusted for age, sex, well-being, rural/urban area type, geographical region, tobacco use, physical activity level and energy intake. Three dietary patterns were identified: traditional (high in legumes and tortilla), industrialised (high in sugar-sweetened beverages, fast foods, and alcohol, coffee or tea) and mixed (high in meat, poultry, fruits and vegetables). Multivariate logistic regression showed that the industrialised pattern yielded higher odds for daytime symptoms (OR 1⋅49; 95 % CI 1⋅12, 1⋅99) and OSA (OR 1⋅63; 95 % CI 1⋅21, 2⋅19) compared with the traditional pattern. In conclusion, dietary patterns are associated with sleep disorders in Mexican adults. Further research is required to break the vicious cycle of poor-quality diet, sleep symptoms and health.

Prevalence, patterns and socio-demographic correlates of sleep duration in adolescents: results from the LabMed study

OBJECTIVE

The aim of this study was to report the prevalence of adequate sleep and the correlates of sleep duration in Portuguese adolescents aged 12-18 years.

METHODS

Cross-sectional analysis with 1017 adolescents (471 girls) aged 14.6 ± 1.8 years. Adolescents self-reported their sleep duration.

RESULTS

The percentage of adolescents meeting the guidelines was 72.7%, 60.7% and 51.3%, during a whole week, on weekdays and on weekends, respectively. Boys were always more compliant with the guidelines than girls, for all week categories. A significant difference was found on sleep duration on weekends, between boys and girls (p < 0.001). During weekdays, more adolescents were classified as short sleepers when compared to long sleepers. Younger adolescents were more likely to meet the guidelines over the whole week and on weekdays (OR = 2.23, OR = 2.13, respectively; p < 0.05) and being long sleepers on weekends (OR = 1.49, p < 0.05). Those of medium and low SES were less likely to meet the sleep guidelines for all week categories (p_trend<0.001). Girls were more likely than boys to meet the guidelines or being long sleepers on weekends (OR = 1.78, OR = 2.85, respectively; p < 0.05).

CONCLUSIONS

During weekends, the percentage of girls sleeping more than recommended is high, indicating a clear compensation of low sleep duration during weekdays. Those of low SES and older adolescents were less likely to meet the sleep guidelines. Policy makers and researchers should consider the potential effects that SES, gender and age might have on sleep duration, when designing targeted interventions to promote adequate sleep duration.

Identifying electronic-sport athletes' sleep-wake cycle characteristics

Organized electronic-sport competitions (e-Sport) is related to several health problems, including sleep disorders. The objective of this study was to evaluate the characteristics of the sleep-wake cycle of League of Legends (LoL) athletes during their pre-training, training, pre-competition, and competition routines. Twenty male elite LoL players completed the questionnaires related to sleep pattern (Pittsburgh Sleep Quality Index), sleepiness (Epworth Sleepiness Scale), and chronotype (Morningness-Eveningness Questionnaire), and they wore an actigraph for 7 days. Pre-training and pre-competition assessments were carried out by questionnaires (n = 20) and training and competition assessments by actigraph (n = 16). The chronotype that most Eathletes presented was a moderately evening type. They presented a poor sleep quality and were borderline for excessive daytime sleepiness. Sleep onset and offset times were significantly prolonged during the competition condition (t = 2.11, p < .05; t = 2.51, p < .05). Correlations showed a relationship between PSQI and Sleepiness in the pre-training and pre-competition conditions (r = 0.50, p = .02) and chronotype with sleep onset (r = 0.61, p = .01), total sleep time (r = 0.55, p = .02), and time awake (r = 0.49, p = .04) in the competition condition. Linear regression analysis indicated associations between the PSQI and sleepiness (25%; p = .02) during pre-training and pre-competition. During the competition there were associations between chronotype and sleep onset (37%; p = .01), chronotype and time awake (24%; p = .04), and chronotype and TST (30%; p = .02). In general, the findings support the conclusion that LoL athletes presented an altered sleep pattern during their training routines.

How do adolescents with short sleep duration spend their extra waking hours? A device-based analysis of physical activity and sedentary behaviour in a Brazilian sample

OBJECTIVES

To compare sedentary behaviour and physical activity between short sleepers and adequate sleepers in a sample of Brazilian adolescents.

MATERIAL AND METHODS

688 adolescents wore accelerometers on the non-dominant wrist for seven days. Sleep duration, sedentary behaviour, light (LPA), moderate (MPA), and vigorous physical activity (VPA) were estimated. Participants were classified as short (<8h/night) or adequate sleepers (≥8h/night). The minutes and the percentage of time spent in each waking behaviour was compared between short and adequate sleepers.

RESULTS

Participants were 16.3 years old, 50.4% were female, and 67.7% were short sleepers. Adequate sleepers engaged in less (min/day) sedentary behaviour (-53.46), LPA (-25.44), MPA (-4.27), and VPA (-0.63) compared to short sleepers. However, no differences were observed for the proportion of time (68% in sedentary behaviour, 28% in LPA, 3% in MPA, and <0.4% in VPA).

CONCLUSION

Patterns of waking behaviours are similar between short and adequate sleepers.

Lifestyle Behaviors Associated With Body Fat Percent in 9- to 11-Year-Old Children

PURPOSE

To examine (1) associations between body fat percent (BF) and lifestyle behaviors in children aged 9-11 years and (2) the consistency of these associations over a 10-year period.

METHODS

In this repeat, cross-sectional study, 15,977 children aged 9-11 years completed an anthropometric assessment and the SportsLinx Lifestyle survey between 2004 and 2013. Body fat was estimated according to the sum of the triceps and subscapular skinfold measurements. Multilevel models were utilized to examine associations between BF and responses to the lifestyle survey while controlling for known covariates.

RESULTS

Lifestyle behaviors explained 8.6% of the total variance in body fat. Specifically, negative associations were found between BF and active transport to school ( β = -0.99 [0.19], P < .001), full-fat milk (-0.07 [0.15], P < .001), and sweetened beverage consumption (-0.40 [0.15], P = .007). Relative to the reference group of ≤8:00 PM, later bedtime was positively associated with BF: 8:00 to 8:59 PM ( β = 1.60 [0.26], P < .001); 9:00 to 10:00 PM ( β = 1.04 [0.24], P < .001); ≥10:00 PM ( β = 1.18 [0.30], P < .001). Two-way interactions revealed opposing associations between BF and the consumption of low-calorie beverages for boys ( β = 0.95 [0.25], P < .001) and girls ( β = -0.85 [0.37], P = .021). There was no significant change in these associations over a 10-year period.

CONCLUSIONS

In this population-level study covering a decade of data collection, lifestyle behaviors were associated with BF. Policies and interventions targeting population-level behavior change, such as active transport to school, sleep time, and consumption of full-fat milk, may offer an opportunity for improvements in BF.

Prospective associations between pre-sleep electronics use and same-night sleep in healthy school-aged children

Electronic devices are routinely associated with adverse effects on sleep; however, prospective studies among healthy children are unavailable. This study examined relationships among specific and total electronic device use within the hour before bed and same-night sleep patterns among 55 pre-pubertal children (7-11 years) without medical, psychiatric or sleep disorders. Sleep was assessed via subjective reports and actigraphy for 5 weeknights and pre-bed device use was assessed via daily diary. Neither total devices use nor any single type predicted sleep parameters the same night. The extent to which pre-bed electronics use impacts sleep in healthy children requires further investigation.

A Good Night's Sleep: Learning About Sleep From Autistic Adolescents' Personal Accounts

Background

Sleep is a strong predictor of quality of life and has been related to cognitive and behavioral functioning. However, research has shown that most autistic people experience sleep problems throughout their life. The most common sleep problems include sleep onset delay, frequent night-time wakings and shorter total sleep time. Despite the importance of sleep on many domains, it is still unclear from first-hand accounts what helps autistic people to sleep. The purpose of this study is to explore together with autistic adolescents their sleep-related practices before bedtime and during the day which contribute to a good night’s sleep.

Methods

Fifty-four autistic adolescents collaborated with an academic researcher in a novel adapted photo-elicitation methodology, rooted in a Lifeworld framework. The adolescents were invited to collect and analyze their data. The data were also presented in a community knowledge exchange event.

Results

Several self-reported practices that facilitate better nocturnal sleep were identified. Those were organized into two thematics: Evening/bedtime factors and Day time factors. These included practices such as personalized sensory and relaxation tools before bed and during night-time, engaging in a range of physical activities during daytime and accommodating personal time to engage with highly preferred and intense focus activities and hobbies. It also included spending time in predictable and fun ways with family members before bedtime.

Conclusion

This is the first time that a study uses a novel methodological approach based on personal accounts elicited by photos rooted in a Lifeworld framework to describe personal sleep-related practices before bedtime and during the day to identify a “good night of sleep” in autistic adolescents. The outcomes from the current study showed that sleep facilitating factors are in a direct contrast to the sleep hygiene recommendations. Therefore, it is thus important for the sleep practitioners and healthcare providers to move beyond providing standardized sleep hygiene interventions. A Lifeworld led care model that pays attention to personal experiences, promotes sense of agency, evaluates both autism-specific strengths and struggles could and should complement biomedical approaches.

Lay Summary

This is the first study to examine autistic adolescents’ self-reported sleep habits and factors which facilitate autistic adolescents’ sleep by employing adapted photo-elicitation interviews. This study is innovative in at least three ways. First, it examines the factors that may facilitate a good night’s sleep through personal accounts of autistic adolescents. Second, this is the first sleep study to adopt a collaborative, flexible approach to understanding positive sleep factors in the lives of autistic adolescents. This study employed a personalized approach into collecting, categorizing, coding, and analyzing qualitative data allowing autistic adolescents and the researcher to work together across key stages of data collection and data analysis. Third, we adopted a theoretical framework that allows us to consider autistic adolescents in both agency and vulnerability positions when it comes to their sleep difficulties. Our results highlight that sleep should be treated individually and in relation to the environmental and personal factors that affect each autistic person. Hence, researchers and professionals may benefit from working collaboratively with autistic adolescents with the aim to identify individual strengths and adopt a positive narrative around sleep. Furthermore, it is important to further examine both the daytime and evening factors that may affect bedtime and the quality and quantity of sleep as well as the role of intense focused interests and physical activities that cultivate positive feelings and help autistic people to relax before bedtime.

A chrononutrition perspective of diet quality and eating behaviors of Brazilian adolescents in associated with sleep duration

It is well recognized that sleep and food intake exhibit 24-h patterns and disturbances of these patterns can lead to health problems. Cross-sectional and prospective studies suggest that diet quality and eating behaviors are negatively affected by short sleep duration. Adolescence is a particularly vulnerable period for the emergence of inadequate sleep and diet patterns. The aim of the study was to investigate associations, from a chrononutrition perspective, of diet quality, nutrients intake, and eating behaviors (eating frequency, eating period, and time-interval between eating occasions) in relation to sleep duration among a multi-ethnic cohort of Brazilian adolescents. Data were collected by the 2015 ISA-Capital survey, a population-based cross-sectional study comprising 419 adolescents of both sexes (12-19 years old) of São Paulo, Brazil. Demographic, socioeconomic, anthropometric, and lifestyle, including sleep duration, data were obtained from an interviewer-administered structured questionnaire. Dietary data were obtained by 24-h dietary recall (24-HDR), and diet quality was assessed by the Brazilian Healthy Eating Index - Revised (BHEI-R), validated for the Brazilian population. The independent associations between sleep duration categories (i.e., <8 h as short sleep and 8-10 h as adequate sleep), and dietary variables were assessed after adjustments for covariates. Multiple linear, logistic, and Poison regression models were used, depending on the variable. Diet quality, nutrients intake, and eating behaviors differed according to adolescents' sleep duration. Approximately 36% of adolescents were sleep deprived. They presented poorer diet quality (53 points, p = .034) and eating behaviors characterized by lower probability of having lunch (88%, p < .001) and dinner (71%, p < .001) and higher probabilities of eating breakfast (87%, p < .001) and morning snack (26%, p = .001). These adolescents compared to those with adequate sleep duration also had, from snacks and in the 24-h cycle, higher contribution of available carbohydrates (8%, p < .001; 50%, p = .024) and total sugar (6%, p < .001; 21%, p < .001) and added sugar (3%, p < .001; 15%, p < .001). The chrononutrition characteristics of sleep-deprived adolescents were marked by longer eating periods (12 h, p < .001) and time-interval between eating occasions (3 h, p < .001) than adolescents with adequate sleep duration. These differences point to the relevance of the interrelation between sleep and diet, i.e., disruption of circadian cycles and consequent metabolic health problems, to inform public health policies and clinical interventions.

Sleep duration and behavioral correlates in middle and high school students: a cross-sectional study in Zhejiang province, China

OBJECTIVE

To investigate the sleep duration and correlates from lifestyle, dietary and weight control behaviors in Chinese adolescents.

METHODS

Data were from 2017 Zhejiang Youth Risk Behavior Survey. A total of 17059 adolescents were included in this study and sleep duration and other behaviors information was collected via a self-reported questionnaire. Regression coefficients (β), calculated by multivariable linear regression, were used to assess the effects of related behaviors on sleep duration, adjusting for potential confounding factors.

RESULTS

Overall, the mean sleep duration in adolescents was 7.99 h. Ever smoking, engaging in moderate physical activity and muscle strengthening activity, attending physical education classes, and watching television were significantly associated with longer sleep duration (P _trend ≦0.01 for all). Adolescents with breakfast, fruits, vegetables, milk and soft drinks intake were more likely to have longer sleep duration (P _trend <0.05 for all). Weight perception of overweight and weight control behaviors including exercising and eating less food, fewer calories were significantly associated with the short sleep duration (P _trend <0.05 for all).

CONCLUSION

Chinese adolescents slept less than the counterparts in Western countries. Various lifestyle, dietary and weight control behaviors were associated with sleep duration.

Lifestyle Clusters and Cardiometabolic Risks in Adolescents: A Chinese School-Based Study Using a Latent Class Analysis Approach

Background: Unhealthy dietary and lifestyle behaviors are associated with a higher prevalence of non-communicable chronic diseases and higher mortality in adults. However, there remains some uncertainty about the magnitude of the associations between lifestyle behaviors and cardiovascular factors in adolescents. Methods: We conducted a school-based cross-sectional study of 895 Chinese adolescents aged 15-19 years. They participated in a questionnaire survey, physical examination, and blood sample collection. Latent class analysis (LCA) was used to identify heterogeneous subgroups of lifestyle behaviors. A set of 12 latent class indicators, which reflected lifestyle behaviors including dietary habits, physical activity, sleep duration, screen time, and pressure perception, were included in the analysis. Logistic regression analysis was performed to determine whether the derived classes were related to a cardiometabolic risk. Results: In total, 13.7 and 5.6% of the participants were overweight and obese, respectively, and 8.4 and 14.1% reported having pre-hypertension and hypertension, respectively. A two-class model provided the best fit with a healthy lifestyle pattern (65.8%) and a sub-healthy lifestyle pattern (34.2%). There were more female participants with a healthy lifestyle (56.2 vs. 43.8%), whereas there were more males with a sub-healthy lifestyle (45.4 vs. 54.6%), (all P = 0.002). Increased risk of cardiometabolic abnormality (BMI categories, blood pressure and lipids) was not significant across lifestyle patterns, except for waist circumference (70.5 vs 69.1 cm, P = 0.044). There was no significant difference in physical activity and intake of fruit and vegetable between the two patterns. Conclusion: Primary prevention based on lifestyle modification should target patterns of behaviors at high risk in adolescents. Due to the complex effect of lifestyle clusters on cardiometabolic risks, well-designed and prospective studies in adolescents are needed in the future.

Appetite Control Might not Be Improved after Weight Loss in Adolescents with Obesity, Despite Non-Persistent Metabolic Syndrome

The aim of this study was to evaluate the effect of a multidisciplinary weight loss intervention on energy intake and appetite sensations in adolescents with obesity, depending on the initial diagnosis or persistence of the metabolic syndrome. Ninety-two adolescents with obesity (12-15 years) followed a 16-week multidisciplinary weight loss intervention. Anthropometric and body composition characteristics, metabolic profile, ad libitum daily energy intake, and appetite sensations were assessed before and after the intervention. The presence of metabolic syndrome (MS) was determined at baseline (MS vs. non-MS) and after the program (persistent vs. non-persistent). While the intervention was effective in inducing weight loss (body weight T0: 87.1 ± 14.9 vs. T1: 81.2 ± 13.0 kg; p < 0.001) and body composition improvements in both adolescents with and without MS, energy intake (p = 0.07), hunger (p = 0.008), and prospective food consumption (p = 0.03) increased, while fullness decreased (p = 0.04) in both groups. Energy intake and appetite were not improved in non-persistent MS after the program and remained significantly higher among non-persistent adolescents compared with initially non-MS adolescents. To conclude, appetite control seems impaired in obese adolescents, irrespective of being affected by MS or not, whereas the treatment of MS in this population might fail to effectively preclude the adolescents from potential post-intervention compensatory food intake and subsequent weight regain.

Association between physical activity, screen time activities, diet patterns and daytime sleepiness in a sample of Brazilian adolescents

OBJECTIVE

To examine the association between physical activity, screen time, eating habits and daytime sleepiness among Brazilian adolescents.

METHODS

Adolescents from three high schools (n = 876, 49.8% female, 16.4 ± 1.2 years) participated in this cross-sectional survey. Variables related to lifestyle behaviors (ie, physical activity, screen time, eating habits, sleep duration) were collected through an online questionnaire. Daytime sleepiness was assessed using the Pediatric Daytime Sleepiness Scale (PDSS). Excessive daytime sleepiness was defined as a PDSS score ≥20.

RESULTS

The average PDSS score was 18.9 (SD ± 4.8) points and 46.8% of adolescents were classified as having excessive daytime sleepiness. Physical activity was inversely associated with PDSS score (β = -0.29, 95% CI -0.47; -0.11). Consuming processed foods frequently (β = 1.16, 95% CI 0.85; 1.47) and using social media (β = 0.22, 95% CI 0.14; 0.30) were positively associated with PDSS score. Similar findings were observed for the odds of excessive daytime sleepiness. Physical activity was inversely associated (OR = 0.91, 95% CI 0.84; 0.99), while frequent consumption of processed foods (OR = 1.55, 95% CI 1.33; 1.82) and using social media (OR = 1.13, 95% CI 1.02; 1.24) were positively associated with excessive daytime sleepiness.

CONCLUSIONS

Lower physical activity level, a higher consumption processed foods, and higher social media use were associated with daytime sleepiness in this sample of Brazilian adolescents.

Perceived Barriers and Facilitating Factors in Implementing Delayed School Start Times to Improve Adolescent Sleep Patterns

BACKGROUND

Most adolescents in the United States do not obtain sufficient sleep. Early school start times play a significant role in adolescent sleep deprivation. Most primary and secondary schools begin classes earlier than the 8:30 am. Perceived barriers to implementing a delayed school start time have been suggested in the literature but have not been quantified. This study explored perceived barriers and facilitating factors for implementing delayed high-school start times.

METHODS

A cross-sectional study. School administrators who had delayed their school start times were invited to complete an online questionnaire ranking the perceived barriers and facilitating factors for implementing the delayed start times.

RESULTS

Most commonly cited perceived barriers were lack of a tiered bus system, school athletes missing more afternoon classes, and less time after school for athletics. Most commonly cited facilitating factors were school-administrator involvement in the decision-making process and sleep education for family members and school administrators.

CONCLUSIONS

Participants found that providing sleep education to fellow administrators, teachers, school staff members, families, and students and including them in the decision-making process positively facilitated the implementation of delayed school start times. Perceived barriers to implementation may be overcome with support from stakeholders and planning committees.

Anthropometric, Familial- and Lifestyle-Related Characteristics of School Children Skipping Breakfast in Jeddah, Saudi Arabia

Breakfast is a vital meal that provides children with important nutrients and energy. This study examined the anthropometric, familial- and lifestyle-related characteristics of school children skipping breakfast. A total of 1149 children (boys: 45.5%), 6 to 12 years old (mean and SD: 9.3 ± 1.7 years), were randomly selected from elementary schools in Jeddah. Weight and height were measured. Breakfast eating frequency, socio-demographics, and lifestyle behaviors were assessed using a specifically designed self-report questionnaire reported by the parents. Nearly 80% of the children skipped daily breakfast at home with no significant age or gender differences. The most common reasons for skipping breakfast at home included not feeling hungry and waking up late for school. Fried egg sandwiches and breakfast cereals were most frequently consumed for breakfast. Strong parental support for breakfast as the main daily meal was significantly associated with daily breakfast intake. Logistic regression analyses, adjusted for age, gender, and socio-demographics, revealed that paternal education (aOR = 1.212, 95% CI = 1.020–1.440, p = 0.029), maternal education (aOR = 1.212, 95% CI = 1.003–1.464, p=0.046), insufficient sleep (aOR = 0.735, 95% CI = 0.567–0.951, p = 0.019), and BMI <25 kg/m² (aOR = 1.333, 95% CI = 1.015–1.752, p = 0.039) were significantly associated with breakfast intake. The findings have implications for children’s health and school performance. Concerted effort is required to promote breakfast consumption among Saudi children.

Insomnia in Relation to Academic Performance, Self-Reported Health, Physical Activity, and Substance Use Among Adolescents

Purpose: Insomnia affects up to one in four adolescents and has been shown to have a negative impact on their mental and physical health. This study aimed to investigate the association between insomnia, academic performance, self-reported health, physical activity, school start time, and substance use among adolescents. Methods: A survey with a cross-sectional design was completed by adolescents (15–17 years old; n = 1504) in southern Sweden. The Minimal Insomnia Symptoms Scale (MISS) was used to operationalize insomnia. A multiple logistic regression analysis was used to analyze the relationship between insomnia and self-reported health, failed school courses, substance use, school start time, family financial situation, screen time, and gender. Results: Insomnia (MISS ≥ 6) was associated with poor self-reported health (OR: 4.35), failed school courses (OR: 1.47), and use of alcohol and/or cigarettes (OR: 1.43). When the combined effect of self-reported health and physical activity were investigated, a combination of low physical activity (≤1 time/week) and poor self-reported health was strongly associated with insomnia (OR: 18.87). Conclusions: Insomnia was associated with other problems that in themselves are risk factors for poor health. This highlights the need for a holistic health-promoting approach to prevent insomnia, such as efforts to promote physical activity, school success, and the reduction of alcohol/cigarette use.

Analysis of the Relationship between Sleep Duration and Body Mass Index among Korean Adolescents Using Data from the 2013-2015 Korea National Health and Nutrition Examination Survey

BACKGROUND

Obesity in adolescence can continue up to adulthood and lead to various complications. There has been a continuous increase in the obesity incidence among adolescents, which is an emerging social issue. Studies have reported that decreased sleep duration in adolescents can have negative effects on health, leading to obesity. Therefore, in the present study, we aimed to investigate the relationship between sleep duration and body mass index among South Korean middle and high school students aged 12-18 years.

METHODS

The participants of the Sixth National Health and Nutrition Survey conducted during 2013-2015 were screened. We selected 1,177 adolescents aged between 12 and 18 years who were enrolled in middle and high school or on leave of absence and had available data for sleep duration and body mass index (BMI) in the survey. Analyses of variance and covariance were performed after adjusting for confounding variables, including age, gender, waist circumference, and drinking experience, that showed significant correlations in univariate logistic regression.

RESULTS

The analysis of covariance revealed that an increase in sleep duration led to a corresponding decrease in the mean BMI among all students and middle school students.

CONCLUSION

Significant negative correlations were confirmed between sleep duration and BMI in all students and middle school students.

Evaluating Relationships Between Sleep and Next-Day Physical Activity in Young Women

BACKGROUND

To evaluate the relationship between sleep and next-day physical activity (PA) under free-living conditions in women.

METHODS

Sleep and PA were measured objectively for 7 consecutive days by accelerometry in 330 young adult women (aged 17-25 y). A structural equation model was used to evaluate the relationship between the driving factor of sleep (total sleep or morning wake time) and the amount of nonsleep sedentary (SED) and moderate to vigorous physical activity (MVPA) each day.

RESULTS

With sleep duration as the driving factor, the estimates of βSED and βMVPA were -0.415 and -0.093, respectively (P ≤ .05). For every hour slept, a 24.9-minute reduction in SED time and a 5.58-minute reduction in MVPA were observed. With wake time as the driving factor, the estimates of βSED and βMVPA were -0.636 and -0.149, respectively. For every wake time that was 1 hour later, a 38.2-minute decrease in SED and a 8.9-minute decrease in MVPA (P ≤ .05) were observed.

CONCLUSIONS

Women who wake later or who sleep longer tend to get less MVPA throughout the day. Getting up earlier and going to bed earlier may support behaviors that improve PA and lifestyle.

Living in Rural and Urban Areas of New Caledonia: Impact on Food Consumption, Sleep Duration and Anthropometric Parameters Among Melanesian Adolescents

BACKGROUND

Food consumption, sleep duration and overweight were assessed in rural and urban Melanesian adolescents.

METHODS

A cross-sectional survey of 312 rural and 104 urban adolescents (11-16 years old) was conducted. Food intakes were assessed by a 26-item food frequency questionnaire and then categorised into the number of serves from each of the three recommended Pacific food groups (energy foods, protective foods, bodybuilding foods), with two additional categories for foods and drinks to be avoided i.e., processed foods and sugary drinks. Number of food serves were compared with the guidelines of 50% serves from energy foods, 35% serves from protective foods and 15% serves from bodybuilding foods. Sleep duration as hours per day was self-reported and body mass index (BMI) was calculated from measured weight and height.

RESULTS

Approximately 17.9% of rural and 26.9% of urban adolescents met the guidelines for energy foods; 61.5% rural and 69.2% urban met the serves for protective foods and 88.5% and 94.2% met the serves for bodybuilding foods. Less than 6.4% rural and 1.9% urban adolescents avoided processed foods but 61.5% rural and 56.7% urban avoided sugary beverages. Sleep duration for school days was below the international recommendations and did not significantly differ between rural and urban groups: respectively, 8.16 ± 1.10 and 8.31 ± 1.29 h. Overweight/obesity percentage was 38.1% for rural and 31.7% for urban adolescents.

CONCLUSIONS

Although traditional foods, including protective food, are still part of the adolescents' diet, low consumption of the energy food group and high consumption of processed food occurs regardless of location. As poor eating habits and insufficient sleep may contribute to overweight/obesity, educational nutrition programs should target these lifestyle variables.

The relationship between sleep and autonomic health

Objective: To examine the relationship between sleep and resting autonomic nervous system (ANS) functioning in college students. Participants: Participants were 141 undergraduate students (52 males) recruited from a large southeastern university during September-October 2017. Methods: Participants completed self-report inventories (demographic and sleep characteristics). Resting state skin conductance (SC) and heart rate variability (HRV) were measured in a laboratory setting for ANS functioning. Results: SC was positively associated with sleep quality (p = 0.027), sleep latency (p = 0.040), and use of sleep medication (p < 0.001). Analyses yielded a negative association between the standard deviation of the normal-normal interval of heart beats (SDNN) and the self-reported amount of time to fall asleep each night (p = 0.041). Sleep efficiency was negatively correlated with low frequency HRV (p = 0.002). Conclusions: Sleep components are associated with resting ANS activity, and targeted interventions focused on improved ANS functioning may benefit sleep quality in college students.

Exploring Relationships of Sleep Duration with Eating and Physical Activity Behaviors among Canadian University Students

BACKGROUND

Students pursuing postsecondary education are a population described as vulnerable for sleep problems, poor dietary habits, weight gain, and reduced physical activity. The primary goal of this study was to examine relationships of sleep behaviors with eating and physical activity behaviors in a sample of undergraduate health sciences students.

METHODS

Using a cross-sectional design, undergraduate health sciences students in a small Canadian university were recruited to complete an on-line questionnaire about their sleep, eating, and physical activity behaviors using valid and reliable instruments. Key sociodemographic characteristics and self-reported height and weight data were also captured.

RESULTS

The participants (n = 245) were on average 23 years of age, female (86%), and the majority were full-time students (92%). The mean BMI was within a healthy range (mean 24.58 SD 5.55) with the majority reporting low physical activity levels (65%). Despite self-reports of very or fairly good (65%) sleep quality in the past month, the mean global sleep scores (scores > 5, mean 7.4, SD 3.3) indicated poor overall sleep quality. Poorer sleep quality was associated with higher BMIs (r = 0.265, p < 0.001).

CONCLUSIONS

The findings highlight the need to expand the scope of on-campus wellness programs to promote healthy sleep habits in a vulnerable university population.

Cross-sectional research on sleep hygiene and health complaints among Pakistani college students

With recent technological advancement, a major shift in the lifestyle of individuals has been observed. This change is more evident in youth in terms of sleep pattern changes and socialization. It is therefore important to assess the quality of life in this productive group of society. The protocol consisted of the Urdu version of the demographic questionnaires, the Pittsburgh Sleep Quality Index (PSQI), the Cohen-Hoberman Inventory of Physical symptoms (CHIPS) and the World Health Organization Quality of Life (WHOQOL-BREF). A total of 150 young adults (boys = 62, girls = 88) were included through convenience sampling. A significant positive association was found between poor sleep quality and health complaints (r = 0.53**). However, a significant negative association was found between poor sleep and quality of life in terms of physical health, psychological health, social relationships and the environment (r = -0.57**, -0.35**, -0.39**, -0.33**), respectively, which indicates the importance of sleep in determining quality of life. Furthermore, the majority of the participants (57%) reported good sleep quality and low health complaints [M = 15.08, standard deviation (SD) = 13.29] whereas 43% of participants reported poor sleep quality, more health complaints (M = 32.94, SD = 22.59) and poor quality of life. It shows that most of the participants are healthy and able to manage their daily routine, work commitment and provide services for country's development.

Are Eating Habits Associated with Adequate Sleep among High School Students?

BACKGROUND

Sleep deprivation adversely impacts cognitive performance. A nutritious diet is one strategy that can prevent sleep deprivation and its adverse effects. However, few data exist regarding the influence of diet on sleep duration among adolescents. Hence, it is important to assess whether dietary habits are linked to adequate sleep among adolescents.

METHODS

The 2013 Youth Risk Behavior Survey data were used in the analysis. Nationally representative samples of adolescents were obtained using a 3-stage cluster design. Selected survey items included number of hours slept on a school night, fruit and vegetable intake, soda and milk intake, breakfast consumption, and demographic variables. Data were analyzed with SAS 9.4 using a logistic regression model.

RESULTS

Holding other variables constant, an increase in total daily consumption of vegetables, milk, and breakfast increased the odds of sleeping ≥8 hours among participants (p < .01). An increase in daily soda intake decreased the odds of sleeping ≥8 hours among participants (p < .01). Separate logistic models for males and females yielded similar findings (p < .01).

CONCLUSIONS

Promoting healthy eating habits such as intake of vegetables, milk, and breakfast consumption among adolescents may increase their likelihood of getting adequate sleep.

Promoting Healthy Lifestyle in High School Students: Determination of the Lifestyle Status through the Healthy Lifestyle Screen (HLS) Assessment

Background

Healthy lifestyle behaviors have given emphasis as an important characteristic in health promotion and to prevent diseases. Individuals who practiced healthy lifestyle behaviors in the early stage of life can withstand health risks in later life. To this end, researchers conducted a healthy lifestyle assessment as the initial step in school-based programs promoting healthy lifestyle and wellness among high school students. The aim of this study was to determine the lifestyle status among students and further assess lifestyle components that could affect them.

Methods

Data were collected from 380 high school students from grades eighth (n = 192) and tenth (n = 188). The Healthy Lifestyle Screen (HLS) was utilized to assess the lifestyle condition of the subjects of this study and it has components consisting dietary behavior, exercise or physical activity, water intake, sunshine exposure, temperance or self-control, quality of air, quality of rest or sleep, trust of which the higher score denotes healthier lifestyle.

Results

The results showed that respondents of the study are in the unstable lifestyle status as they obtained low mean sub-scale scores on lifestyle components such as water, rest and exercise. Lifestyle components included in HLS showed significant differences comprising the physical/mental, behavioral and environmental aspects (p < 0.001) associated with the general characteristics of the high school students.

Conclusion

Findings of this study showed the necessity in assessing the lifestyle status as an initial step for promoting, maintaining and establishing a well-balanced life and preventing the increase of health-risk behaviors and thus, highlighted the need of transforming healthy lifestyle behaviors among students through school-based intervention programs.

Unhealthy snack intake modifies the association between screen-based sedentary time and metabolic syndrome in Brazilian adolescents

Background

Excessive screen time has been associated with metabolic syndrome (MetS) among adolescents; however, snack intake in front of screens may play a role in this association. Therefore, our objective was to investigate the association between screen-based sedentary time with MetS and whether this association is modified by unhealthy snack intake in front of screens.

Methods

This study was a nationwide, cross-sectional, school-based survey in Brazil including adolescents aged 12 to 17 years. The frequency of snack consumption in front of screen and screen-based sedentary time (TV view, computers and videogames use) were self-reported. Thereafter, screen time was categorized (≤2, 3–5 and ≥ 6 h/day); snack consumption in front of screens was dichotomized. Metabolic syndrome diagnosis was defined based on the International Diabetes Federation criteria. Associations between screen time and MetS were investigated using logistic regression in overall sample and after stratification by snack intake in front of screens.

Results

A total of 33,900 adolescents were included in the analysis. The final adjusted model, which included sociodemographic data, physical activity, and energy intake, showed that adolescents who spent ≥6 h/day in front of screens had an increased odds ratio for MetS (OR = 1.68, 95%CI: 1.03–2.74). However, after stratifying the sample according to reported snack intake, the association between higher screen-based sedentary time and MetS remained significant only for adolescents who reported consumption of snacks in front of screens.

Conclusion

Longer screen-based sedentary times were directly associated with MetS. However, this association seems to be modified by reported snack intake in front of screens.

A Multimethod, Case-Controlled Study of Sleep-Wake Disturbances in Adolescents With Spina Bifida

Objective

This study aimed to compare sleep-wake disturbances in adolescents with spina bifida (SB) to typically developing (TD) peers. Exploratory analyses examined sex as moderator of disrupted sleep.

Methods

Adolescents with SB (ages 12-18 years; N = 37) and a demographically matched sample of TD adolescents (N = 37) completed validated sleep questionnaires and underwent 10 days of actigraphy monitoring.

Results

Adolescents with SB evidenced worse sleep quality, shorter sleep duration, greater sleep maintenance difficulties, and higher levels of fatigue compared with their TD peers. Exploratory analyses revealed females with SB were particularly vulnerable to developing sleep disturbances.

Conclusions

Adolescents with SB are at risk for nighttime sleep disturbances and daytime fatigue. Additional research will need to identify mechanisms and adverse consequences of poor sleep to develop interventions addressing sleep deficiency. Sex-specific disparities in sleep patterns in pediatric SB is a novel finding that requires assessment of etiological underpinnings to clarify clinical implications.

Associations between Sleep Pattern and Quality and Cardiovascular Risk Factors among Macao School Students

Background: Despite accumulating evidence showing that sleep duration and cardiometabolic health are correlated, the association of sleep regularity and quality with cardiovascular risk factors in children and adolescents remains inconclusive. Therefore, we examined the relationship between sleep regularity/quality and cardiovascular risk factors in children and adolescents in Macao, China. Methods: We conducted a cross-sectional study among primary and secondary school students (age range: 9-18 years) in Macao, China. Body weight, height, waist circumference (WC), and serum lipid levels were measured. Sleep regularity and sleep quality were assessed by using the Pittsburgh Sleep Quality Index. Multivariable logistic regression was conducted to examine the relationship of sleep variables with the increased likelihood of body mass index (BMI)-classified overweight/obesity, WC-classified obesity, and dyslipidemia. Results: A total of 1078 school students were included in the analysis. Differences of >2 hours between weekday and weekend bedtimes were associated with the increased risk of BMI-classified overweight/obesity (odds ratio = 2.58, 95% confidence interval = 1.55-4.31, p < 0.01) after being adjusted for sleep variables and lifestyle factors. No statistically significant association was found between poor sleep quality and any other outcome. Conclusions: Irregular bedtime was associated with elevated body weight regardless of sleep amount and quality. Thus, regular bedtimes are recommended as a simple but practical strategy for preventing obesity.

Association of Perceived Immigration Policy Vulnerability With Mental and Physical Health Among US-Born Latino Adolescents in California

IMPORTANCE

Current US immigration policy targets immigrants from Mexico and other Latin American countries; anti-immigration rhetoric has possible implications for the US-born children of immigrant parents.

OBJECTIVE

To assess whether concerns about immigration policy are associated with worse mental and physical health among US citizen children of Latino immigrants.

DESIGN, SETTING, AND PARTICIPANTS

This study of cohort data from the Center for the Health Assessment of Mothers and Children of Salinas (CHAMACOS), a long-term study of Mexican farmworker families in the Salinas Valley region of California, included a sample of US-born adolescents (n = 397) with at least 1 immigrant parent. These adolescents underwent a health assessment before the 2016 presidential election (at age 14 years) and in the first year after the election (at age 16 years). Data were analyzed from March 23, 2018, to February 14, 2019.

EXPOSURES

Adolescents aged 16 years self-reported their concern about immigration policy using 2 subscales (Threat to Family and Children's Vulnerability) of the Perceived Immigration Policy Effects Scale (PIPES) instrument.

MAIN OUTCOMES AND MEASURES

Resting systolic blood pressure, diastolic blood pressure, and mean arterial pressure; body mass index; maternal- and self-reported depression and anxiety problems (using Behavioral Assessment System for Children, 2nd edition); self-reported sleep quality (using Pittsburgh Sleep Quality Index [PSQI]); and maternal rating of child's overall health. All measures except sleep quality were assessed at both the aged-14-years and aged-16-years visits. Health outcomes at age 16 years and the change in outcomes between ages 14 and 16 years were examined among youth participants who reported low or moderate PIPES scores vs high PIPES scores.

RESULTS

In the sample of 397 US-born Latino adolescents (207 [52.1%] female) and primarily Mexican American individuals, nearly half of the youth participants worried at least sometimes about the personal consequences of the US immigration policy (n = 178 [44.8%]), family separation because of deportation (177 [44.6%]), and being reported to the immigration office (164 [41.3%]). Those with high compared with low or moderate PIPES scores had higher self-reported mean anxiety T scores (5.43; 95% CI, 2.64-8.23), higher maternally reported anxiety T scores (2.98; 95% CI, 0.53-5.44), and worse PSQI scores (0.98; 95% CI, 0.36-1.59). Youth participants with high PIPES scores reported statistically significantly increased levels of anxiety over the 2 visits (adjusted mean difference-in-differences, 2.91; 95% CI, 0.20-5.61) and not significantly increased levels of depression (adjusted mean difference-in-differences, 2.63; 95% CI, -0.28 to 5.54).

CONCLUSIONS AND RELEVANCE

Fear and worry about the personal consequences of current US immigration policy and rhetoric appear to be associated with higher anxiety levels, sleep problems, and blood pressure changes among US-born Latino adolescents; anxiety significantly increased after the 2016 presidential election.

Magnitude and Determinants of Patients at Risk of Developing Obstructive Sleep Apnea in a Non-Communicable Disease Clinic

Background and Objective: Obstructive sleep apnea (OSA) is a common chronic disorder worldwide, which can adversely affect the cardiovascular system among non-communicable disease (NCD) patients. It is underdiagnosed—or rather not diagnosed—in primary care settings due to the costly diagnostic techniques involved. This study aimed to assess the number of study participants at risk of developing OSA and to assess and quantify the risk factors associated with this disorder. Materials and Methods: A cross-sectional study was performed in an NCD clinic of a rural health training center, Karikalampakkam, Puducherry of South India from August 2018 to October 2018. A Modified Berlin Questionnaire (MBQ) was used to screen the study participants at risk for OSA. Four-hundred-and-seventy-three people aged 18 years and above were included in the study, using systematic random sampling. Respondents’ socio-demographic and morbidity characteristics, as well as clinical and anthropometric parameters including body weight, height, blood pressure, neck, hip and waist circumference were collected. Data was captured using Epicollect5 and analyzed using SPSS version 20.0. Results: One-fourth (25.8%) of the respondents were at high risk of developing OSA. In terms of gender, 27.9% of the men and 23.8% of the women were at high risk for OSA. In univariate analyses, the risk of developing OSA was significantly associated with a history of diabetes mellitus, hypertension, dyslipidemia and gastro-esophageal reflux disease, weight, body mass index, neck, waist and hip circumference, waist–hip ratio, and systolic and diastolic blood pressure. Multivariate logistic regression analysis showed that a history of dyslipidemia (aOR, 95% CI = 2.34, 1.22–4.48), body mass index (aOR, 95% CI = 1.15, 1.06–1.22) and waist circumference (aOR, 95% CI = 1.10, 1.07–1.14) emerged as significant predictors of risk for OSA. Conclusions: A considerable proportion of NCD patients with easily detectable attributes are at risk of developing OSA, but still remain undiagnosed at a primary health care setting. The results obtained using MBQ in this study were comparable to studies performed using polysomnography. Dyslipidemia, body mass index and waist circumference were independent risk factors for predicting a risk of developing OSA. Prospective studies are needed to confirm whether a reduction in these risk factors could reduce the risk for OSA.