Are sleep duration and sleep quality associated with diet quality, physical activity, and body weight status? A population-based study of Canadian children

Sleep and diet patterns of college students during the COVID-19 pandemic lockdowns

Introduction: College students experience high levels of depression, anxiety, and stress during the academic year as they juggle the competing demands of young adulthood and their studies. The COVID-19 pandemic heightened this experience. Healthful diets and sleep patterns are associated with improved physical and mental well-being. Purpose: The goal of this study was to identify if there was a relationship between changes in sleep and diet during the COVID-19 pandemic. Methods: A group of college students was surveyed online using Qualtrics software during the first two months of lockdown restrictions at a large, midwestern university in the United States. Results: More participants reported no changes in diet and increased hours of sleep than reported declines or improvements in diet, or reductions or retained sleep patterns. Participants who maintained their diet were likely to maintain their current sleep pattern. Conclusion: College students demonstrated resilience in healthful behaviors during the first two months of COVID-19 lockdown.

Physical Activity Habits and Sleep Duration According to Gender: A Cross-Sectional Study of Elementary School Children

(1) Background: The main goals of this study were to describe the physical activity (PA) and sleep habits of 8-12-year-old children according to their gender and to evaluate the relationship between PA and sleep habits (i.e., duration and timing). (2) Methods: A total of 236 children (114 boys and 122 girls) completed the Physical Activity Questionnaire for Older Children (PAQ-C) and an ad hoc sleep habits questionnaire. (3) Results: Boys were more physically active than girls (2.62 ± 0.51 vs. 2.46 ± 0.48, p = 0.026) and enacted higher PA levels in school recess (3.82 ± 1.36 vs. 3.56 ± 1.38, p = 0.003), during the afternoon (3.37 ± 1.20 vs. 2.89 ± 1.12, p = 0.003), and during weekends (3.54 ± 1.20 vs. 3.18 ± 0.48, p = 0.009). Per sleep habits, boys had a significantly later bedtime (21:53 ± 2:08 vs. 21:34 ± 2:14, p = 0.009) and a significantly smaller total sleep duration (9.64 ± 0.86 vs. 9.89 ± 0.87 h, p = 0.023) than girls. No significant correlations between PA and sleep habits were found. (4) Conclusions: We found differences in the PA and sleep habits between school-age boys and girls. Institutions and entities should consider designing specific interventions to improve PA and sleep habits according to gender.

Association between late bedtime and obesity in children and adolescents: a meta-analysis

Background

Short sleep duration has been related to obesity in children and adolescents. However, it remains unknown whether late bedtime is also associated with obesity and whether the association is independent of sleep duration. A meta-analysis was performed to address this issue.

Methods

In order to accomplish the aim of the meta-analysis, a comprehensive search was conducted on databases including PubMed, Embase, and Web of Science to identify observational studies. The cutoff to determine late bedtime in children in this meta-analysis was consistent with the value used among the included original studies. As for obesity, it was typically defined as a body mass index (BMI) > 95th percentile of age and sex specified reference standards or the International Obesity Task Force defined age- and gender-specific cut-off of BMI. The Cochrane Q test was employed to evaluate heterogeneity among the included studies, while the I2 statistic was estimated. Random-effects models were utilized to merge the results, considering the potential impact of heterogeneity.

Results

Tweleve observational studies with 57,728 participants were included. Among them, 6,815 (11.8%) were obese. Pooled results showed that late bedtime reported by the participants or their caregivers was associated with obesity (odds ratio [OR]: 1.27, 95% confidence interval [CI]: 1.16-1.39, p < 0.001; I2 = 0%). Subgroup analysis showed consistent results in studies with (OR: 1.33, 95% CI: 1.04-1.70, p = 0.02) and without adjustment of sleep duration (OR: 1.27, 95% CI: 1.14-1.41, p < 0.001). Further subgroup analysis also showed that the association was not significantly affected by study location, design, age of the participants, or diagnostic methods for obesity (p for subgroup difference all >0.05).

Conclusion

Late bedtime is associated with obesity in children and adolescents, which may be independent of sleep duration.

The relationship between multiple sleep dimensions and obesity in adolescents: A systematic review

Sleep is an involuntary behaviour, biologically fundamental to survival and wellbeing. However, sleep is increasingly neglected, with significant health implications. Recent research has identified associations between sleep duration, quality, timing and risk of overweight/obesity in children and adults. The aim of this review was to systematically identify and examine research that investigates the relationships between multiple objective and subjective sleep outcomes and objective adiposity measures in adolescents. A systematic review of literature, published to December 2022, was conducted using ten bibliographic databases. Search terms included objective and subjective sleep/circadian rhythm outcomes, objective adiposity measurements, and adolescents aged 8-18 years. Eighty-nine studies were included in the final review. Sleep outcomes were synthesized into three sleep domains: pre-sleep, during sleep and post-sleep outcomes. In summary, pre-sleep outcomes (including poor sleep hygiene, later chronotype and increased variability and later sleep timings) and increased sleep disturbance are consistently significantly associated with increased obesity and adiposity in adolescents. The relationship between during-sleep outcomes (sleep quality and efficiency) with adiposity and obesity measures was mixed. These findings suggest that adapting an individual's schedule to best suit chronotype preference and improving sleep hygiene, including a consistent bedtime routine, could reduce adiposity and obesity in adolescents.

Nutrient intake, alcohol consumption, emotional eating and anxiety in women nursing students

Objective

The aim of the study was to analyze dietary habits, alcohol habits, emotional eating and anxiety in a sample of Spanish nursing students. These students appear to be essential to the field of public health and to teaching their future patients about their own good practices.

Methods

A cross-sectional investigation was conducted. Participants completed the Emotional Eater Questionnaire, the Alcohol Use Disorder Identification Test (AUDIT) test to evaluate alcohol intake, the State-Trait anxiety Inventory (STAI) test to measure levels of anxiety as a state and anxiety as a trait, and self-reported sociodemographic data. Following classroom instruction, three-day food records were used to gauge food intake.

Results

The calorie intake for the macronutrients Ca, Mg, K, and Fe were below the Recommended Dietary Intakes (DRI) and imbalanced. The percentage E of proteins was 132.7 % more than recommended, while the percentage of carbohydrates is below the recommended level. Dietary energy consumption barely equaled 78 % of the total energy consumed by this sex and age group. With respect to emotional eating, nursing women students were low emotional eater (44 %) > emotional eater (30 %) > non-emotional eater (22.7 %). The students' emotional eating is substantially connected with fast food and sweets, or less healthy food intake behaviors. According to the Alcohol Use Disorder Identification Test (AUDIT), 82.7 % of female students used alcohol on a regular basis in a low-risk manner.

Conclusion

The findings demonstrated a link between anxiety and dietary fat intake. Trait anxiety was negatively connected with emotional eating (EE), whereas state anxiety was positively correlated with meat consumption. It is crucial to consider these findings when creating prevention/intervention plans and profiles of harmful eating behaviors.

Physical Activity Trajectories in Early Childhood: Investigating Personal, Environmental, and Participation Factors

INTRODUCTION/PURPOSE

To determine personal, environmental, and participation factors that predict children's physical activity (PA) trajectories from preschool through to school years.

METHODS

Two hundred seventy-nine children (4.5 ± 0.9 yr, 52% boys) were included in this study. Physical activity was collected via accelerometry at six different timepoints over 6.3 ± 0.6 yr. Time-stable variables were collected at baseline and included child's sex and ethnicity. Time-dependent variables were collected at six timepoints (age, years) and included household income (CAD), parental total PA, parental influence on PA, and parent-reported child's quality of life, child's sleep, and child's amount of weekend outdoor PA. Group-based trajectory modeling was applied to identify trajectories of moderate-to-vigorous PA (MVPA) and total PA (TPA). Multivariable regression analysis identified personal, environmental, and participation factors associated with trajectory membership.

RESULTS

Three trajectories were identified for each of MVPA and TPA. Group 3 in MVPA and TPA expressed the most PA over time, with increased activity from timepoints 1 to 3, and then declining from timepoints 4 to 6. For the group 3 MVPA trajectory, male sex (β estimate, 3.437; P = 0.001) and quality of life (β estimate, 0.513; P < 0.001) were the only significant correlates for group membership. For the group 3 TPA trajectory, male sex (β estimate, 1.970; P = 0.035), greater household income (β estimate, 94.615; P < 0.001), and greater parental total PA (β estimate, 0.574; P = 0.023) increased the probability of belonging to this trajectory group.

CONCLUSIONS

These findings suggest a need for interventions and public health campaigns to increase opportunities for PA engagement in girls starting in the early years. Policies and programs to address financial inequities, positive parental modeling, and improving quality of life are also warranted.

Effects of Socioeconomic Environment on Physical Activity Levels and Sleep Quality in Basque Schoolchildren

The socioeconomic and built environment of an area are interrelated with health data and have a direct influence on children’s development. There are facilitators and barriers for schools to promote physical activity depending on the socioeconomic status of the school. The aim of this study was to analyse the relationship between physical activity and sleep and the socioeconomic level of children in the Basque Country. The sample consisted of 1139 schoolchildren between the ages of six and seventeen (566 boys and 573 girls) from 75 schools (43 public and 32 private). Differences between groups were compared using the Mann–Whitney U test (two samples), Kruskal–Wallis one-factor ANOVA (k samples), and Spearman’s Rho correlation. There are sex differences in light (200.8 ± 62.5 vs. 215.9 ± 54.7) and moderate (69.0 ± 34.3 vs. 79.9 ± 32.1) physical activity in favour of the female group of higher socioeconomic status compared to male group of higher socioeconomic status. In the case of vigorous physical activity, the female group performed less than the male group across all socioeconomic statuses, which was statistically significant in the groups of high socioeconomic status (11.6 ± 9.3 vs. 6.9 ± 5.7) in group 2 and medium socioeconomic status (11.1 ± 9.3 vs. 7.7 ± 6.1) in group 3. There is an inverse relationship between sedentary behaviour and BMI, total bed time, total sleep time, and night-time awakenings. There is also an inverse relationship between all levels of physical activity performed with respect to BMI and total sleep efficiency. These data point towards notable inequalities in physical activity and daily sleep in Basque schoolchildren, which in turn may be marginalised in our current school system due to the effects of the socioeconomic environment.

Sleep Reactivity and Related Factors in Adolescence: An Increased Risk for Insomnia? A Longitudinal Assessment

Purpose

The individual vulnerability for stress-related sleep difficulties (eg, sleep reactivity) is known as a predisposing factor of insomnia in adults, yet relatively little is known about sleep reactivity in adolescence. The study goal is to determine factors related to sleep reactivity and to investigate whether sleep reactivity and related factors predict current and new incidents of insomnia in adolescents.

Patients and Methods

At baseline, 11-to-17-year-olds (N = 185, M_age = 14.3 years, SD = 1.8, 54% female) answered an age-appropriate version of the Ford Insomnia Response to Stress Test, questionnaires about sleep, stress, psychological symptoms, and resources, filled out a sleep diary and used actigraphy. Insomnia diagnoses according to ISCD-3 criteria were assessed at baseline, after 9 months and after one and a half years.

Results

Adolescents with high compared to low sleep reactivity had increased pre-sleep arousal, negative sleep-related cognitions, pre-sleep mobile phone use, stress experience, stress vulnerability, internalizing and externalizing symptoms, less social resources, and a later midpoint of bedtime. High sleep reactivity increased the likelihood for currently having insomnia, but not for the development of insomnia at subsequent assessments.

Conclusion

The findings suggest that high sleep reactivity is related to poor sleep health and mental health but cast doubt on sleep reactivity as a pivotal predisposing factor for the development of insomnia in adolescence.

Objectively measured physical activity among treatment seeking children and adolescents with severe obesity and normal weight peers

Background

Treatment seeking children and adolescents with severe obesity often experience barriers to physical activity. Studies objectively measuring physical activity in this group and investigating explanatory factors for physical activity levels could inform clinical practice.

Objectives

This study aimed to compare objectively measured physical activity levels among treatment seeking children and adolescents with severe obesity and normal weight peers, and to investigate explanatory factors for time spent in moderate physical activity and vigorous physical activity among children and adolescents with severe obesity.

Methods

Children with severe obesity (n = 85) were matched 1:1 by age, gender, and the season for accelerometer measurements with normal weight peers (n = 85). Children wore accelerometers for seven consecutive days, yielding measures of physical activity, sleep duration and timing. Parents reported on screen time, parental body mass index and participation in organized sports.

Results

Children and adolescents with severe obesity spent significantly less time in moderate physical activity (12 min, p < 0.001) and vigorous physical activity (21 min, p < 0.001) per day compared to normal weight peers. No difference for time spent in sedentary activity was found between groups. For participants with severe obesity, age ≤12 years (p = 0.009) and participation in organized sports (p = 0.023) were related to more moderate physical activity, while age ≤12 years (p = 0.038) and early sleep timing (p = 0.019) were related to more vigorous physical activity.

Conclusion

Children and adolescents with severe obesity were less physically active than their normal weight peers. Factors related to more moderate and vigorous physical activity in children with severe obesity were lower age, participation in organized sports and earlier sleep timing.

Movement behaviors during COVID-19 among Latin American/Latino toddlers and pre-schoolers in Chile, Mexico and the US

Movement behaviors (physical activity, sedentary behavior, and sleep) have been impacted by the COVID-19 pandemic. We report changes in and factors that influenced movement behaviors during COVID-19 among Latin American/Latino children aged 1 to 5 years in Chile, Mexico, and the USA. We conducted a cross-sectional study between April and August 2020. Caregivers of 4,136 children (mean age [SD], 3.1 [1.4] years; 51% boys) reported family and household characteristics and changes in their child's movement behaviors. The proportion of children who met the WHO Guidelines decreased significantly in all countries, with the largest declines in meeting the physical activity and screen time guidelines. Factors associated with negative changes in movement behaviors were being an older child, unable to attend an early childhood education and care service, higher parental education levels, not having the opportunity to play with someone, and not having access to spaces to play. The findings highlight the need to minimize disparities faced by families by providing access to early childhood education and care and safe places for children to play.

Association between self-reported sleep duration and dietary quality in Mexican school-aged children

Short sleep duration has been associated with poor diet quality in school-aged children in multiple populations. However, investigations of sleep and dietary quality in Mexican school-aged children are scarce. The main objective of this work was to assess the association between sleep duration and dietary quality in Mexican school-aged children stratified by sex. The data were collected from 373 (138 girls and 235 boys) elementary school children aged 6-12 years in Monterrey, Nuevo Leon, Mexico. Surveys collected information on general demographic characteristics and self-reported sleep duration. Diet was assessed with 24-h recalls, and dietary quality was calculated by the Healthy Eating Index (HEI-2015). Results indicated that overall mean sleep duration was 8.23 ± 1.06 h. From the total sample, 6.7% slept ≤6 h (not recommended), 55.8% 7-8 h (may be appropriate), and 37.5% ≥ 9 h (recommended). Average total HEI-2015 score was 64.6 (out of possible 100), with boys having lower HEI-2015 scores than girls (57.7 vs 69.4). Moreover, girls and boys with shorter sleep duration (≤6 h compared to ≥ 9 h) had lower HEI-2015 scores (-1.03 [95% CI -2.74, -0.47; p < .01] and -1.78 [95% CI -3.15, -0.86; p < .001], respectively). Regarding the individual components of dietary quality, those with ≤6 h of sleep had lower scores particularly in vegetables, protein sources, added sugars and saturated fats for girls and boys compared to those with ≥9 h. These findings suggest sleep may be an important determinant of dietary practices within the Mexican children.

Physical Activity and Executive Functions in Adolescents: The Mediating Role of Sleepiness

(1) Background: Both physical activity and sleepiness were found to influence the development of executive functioning. The present study aimed to address the effects of different levels of physical activity on adolescents' executive performance (i.e., working memory and inhibition), and the role of sleepiness in this relationship. It was hypothesized that a higher level of physical activity would be associated with better executive functioning, while this relationship was mediated (at least partially) by reduced sleepiness at school. (2) Methods: 212 adolescents aged from 10 to 17 were recruited, and they were requested to wear accelerometers for seven consecutive days to measure daily levels of physical activity. The Cleveland Adolescent Sleepiness questionnaire (CASQ) was used to assess sleepiness. The working memory and inhibition control were assessed to indicate executive functioning. (3) Results: It was found that sedentary activity was negatively associated with working memory performance, while light and moderate-to-vigorous physical activities were related to better working memory. The relationship between different levels of physical activity and working memory was mediated by reduced sleepiness at school. (4) Conclusions: Our findings provide nuanced evidence that the benefits of light and moderate-to-vigorous physical activity on cognitive development could be explained by reduced sleepiness at school.

Associations between sleep duration, sleep quality, and weight status in Chinese children and adolescents

Background and objective

The high prevalence of obesity is a serious problem, and sleep is considered to be a factor for obesity. This study aimed to examine the relationship between sleep duration, sleep quality, and weight status among children and adolescents in China and to explore whether the relationship between sleep duration and weight status is independent of sleep quality. Sex and age differences were also explored.

Methods

A cross-sectional research was conducted among 2019 children and adolescents (1029 boys and 990 girls) aged 8–16 years in Shanghai. An open-question was used to obtain data on sleep duration, which was categorized into the following four groups based on the age-specific National Sleep Foundation Sleep Duration Recommendations: 1) very short, 2) short, 3) recommended, and 4) long. The Pittsburgh Sleep Quality Index was used to assess sleep quality. Weight and height were measured for all participants. The variable weight status was estimated with the Chinese children and adolescent age- and sex-specific body mass index (BMI) and was categorized into overweight/obesity and normal weight.

Results

Short sleep duration (7–8 and 6–7 h for 6–13 and 14–16 years old, respectively) significantly increased odds of overweight/obesity (OR = 1.32, 95% CI: 1.06–1.64) compared with that of the recommended sleep duration (9–11 and 8–10 h for 6–13 and 14–16 years old, respectively). The relationship between the two variables existed independent of sleep quality. No significant relationship was found between sleep quality and overweight/obesity of children and adolescents. Sleep quality (OR = 1.07, 95% CI: 1.01–1.14) and short sleep duration (OR = 1.51, 95% CI: 1.06–2.13) increased the risk for overweight/obesity among girls, whereas no significant relationships between sleep duration, sleep quality, and overweight/obesity were found among boys. Short sleep duration increased the risk of overweight/obesity in children aged 8–13 years (OR = 1.34, 95% CI: 1.05–1.71), independent of sleep quality, but no significant relationships between these two variables existed for adolescents aged 14–16 years.

Conclusions

Overall, short sleep duration increased the risks of overweight/obesity in children and adolescents in China, independent of sleep quality. This relationship is significant for girls and children aged 8–13 years instead of boys and adolescents aged 14–16 years. Interventions to extend the sleep duration of children and adolescents, especially girls and children aged 8–13 years in China, are necessary to improve their weight status.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-13534-w.

Lockdown due to COVID-19 in Spanish Children Up to 6 Years: Consequences on Diet, Lifestyle, Screen Viewing, and Sleep

Objectives: To record how the habits of children under 6 years of age in Cadiz have changed during lockdown, in order to identify those that could be a handicap for the problem of overweight and obesity. Methods: We developed a new questionnaire to analyse family living habits. The questionnaire was administered online to parents of children aged zero-six years. Eating habits, sedentary lifestyles, screen viewing, and sleep changes were evaluated. Results: Changes were found in family living habits, as shown by the results of McNemar's tests (p-value < 0.01 in all pairs except one, p-value = 0.097). A worsening of habits was also found to be more accentuated in families with low income, low educational level or small size of home. Some positive aspects associated with family meals and parental involvement were found. Conclusions: The lockdown has showed a significant break in the main routines of the children that could affect their health and may add to the worsening of the already poor childhood obesity situation. The positive aspects found can be instrumental in improving the situation in future similar situations.

Sleep quality, valence, energetic arousal, and calmness as predictors of device-based measured physical activity during a three-week mHealth intervention

Physical inactivity is known to be a risk factor for several noncommunicable diseases and has a high prevalence in today’s society. Therefore, it is crucial to understand the psychological factors associated with physical activity (PA). Recent developments in the field of ambulatory assessment and technological advances are promising to enhance our understanding of this relationship by analyzing longitudinal data within- and between-persons. These analyses can reveal important factors to design behavior change interventions to enhance PA. Therefore, this study used an ecological momentary assessment during the 3‑week intervention period in the SMARTFAMILY2.0 trial and aimed to investigate whether valence, calmness, energetic arousal, and sleep quality predict daily steps and moderate to vigorous PA. Overall, 49 adults (35–60 years) and 40 children (5–19 years) were included in this analysis and self-rated their mental state within our smartphone application while also wearing a hip-worn accelerometer for 21 consecutive days (996 days included) during the intervention period. Multilevel analyses were conducted to predict daily PA while considering covariables (e.g., child/adult and non-wear time) both within- and between-persons. The results indicated that higher than average ratings of a person’s valence and energetic arousal on one day predicted increased PA while higher than average calmness predicted decreased PA at the same day within this person. Sleep quality and between-person effects of the affective states showed no clear associations to PA. Overall, these results showed that within-person associations of valence, calmness, and energetic arousal should be considered when designing PA interventions for both children and adults. The influence of sleep quality, as well as between-person effects, should be further explored by future studies.

Sufficient sleep duration in autistic children and the role of physical activity

LAY ABSTRACT

Higher levels of physical activity may be associated with improved sleep in children, but this relationship is still being determined, especially in autistic children. In this study, we used existing data from the 2018 National Survey of Children's Health. Caregivers of children 6-17 years old, including caregivers of autistic children, completed a questionnaire that included questions about physical activity (days active in the past week) and sleep duration. We then determined if children were obtaining the recommended hours of sleep for their age (i.e. sufficient sleep). We found that higher physical activity levels were associated with sufficient sleep duration, but this finding was weaker in autistic children. In particular, this association was not observed in autistic children with more severe autism spectrum disorder, female autistic children, and autistic children 6-12 years old. In conclusion, physical activity is a promising approach to help children obtain sufficient sleep duration. However, more personalized approaches to improving sleep may be needed for certain groups of autistic children.

Associations of Diet Quality and Sleep Quality with Obesity

Short sleep duration or poor sleep quality has been associated with an increased risk of obesity. Although the underlying mechanism remains unclear, one proposed pathway is poor diet quality. This cross-sectional study investigated whether diet quality modifies the association between sleep status and obesity in Korean adults. We used the baseline data and samples of 737 men and 428 women (n = 1165) aged 19–64, who participated in the prospective Ewha–Boramae cohort study. Sleep duration was dichotomized into ≥7 h (adequate) and <7 h (insufficient). Pittsburgh Sleep Quality Index (PSQI) values, reflecting sleep quality, were dichotomized into >5 (poor quality) and ≤5 (good quality). Diet quality was evaluated by the Recommended Food Score (RFS). Obesity was associated with higher rates of insufficient sleep and poor sleep quality in women, but not in men. After adjustment for covariates, women with poor sleep quality had a higher risk of obesity than women with good sleep quality (OR = 2.198; 95% CI = 1.027–4.704); this association occurred only in the group with RFS ≤ median score. Our findings support a significant association between sleep quality and obesity, and this association has been potentially modified by dietary quality in women.

Sleep habits and weight status in Brazilian children aged 4-6 years of age: the PREDI study

OBJECTIVES

To evaluate the association of sleep habits with the weight status of children aged 4-6 years.

METHODS

Data were obtained from the PREDI Study, a Brazilian birth cohort study. The current study was carried out in the homes of the participants during two follow-ups: 2016/17 and 2018. The participants were submitted to anthropometric assessment and demographic, socioeconomic and sleep data were obtained. The child's sleep habits were self-reported by the mother or caregiver on the day of the visit and included information on the following sleep habits during the past week: bedtime routine, rhythmicity, and separation affect determined with the Sleep Habits Inventory for Preschool Children and the Sleep Habits Inventory. Logistic regression and gamma-log regression analyses were used to examine the association of sleep habits with excess body weight of children in the two follow-ups according to sex.

RESULTS

Of the 217 and 185 children included in 2016/17 and 2018, respectively, 66 (30.6%) and 48 (25.9%) had a BMI >85th percentile at 4-6 years, respectively. The median rhythmicity score was higher in children with excess body weight (p = 0.05). Adjusted analysis showed that rhythmicity was associated with excess body weight of girls at ages 4-5 years (OR = 1.42, 95% CI: 1.09-1.86, p = 0.009) and 6 years (OR = 1.32, 95% CI: 1.06-1.65, p = 0.015), even after adjustment for other important covariates. Additionally, the sleep habit "separation affect" was inversely associated with the child's BMI in boys (β = -0.005, 95% CI: -0.010-0.000, p = 0.037).

CONCLUSIONS

In the present study, rhythmicity problems were associated with increased odds of girls aged 4-6 years having excess body weight. These results are important from a public health perspective since strategies aimed at preventing excess body weight in children need to consider the child's sleep quality as a potential risk factor, especially rhythmicity.

Habitual Physical Activity and Sleep Duration in Institutionalized Older Adults

Background: Physical activity and sleep quality are both major factors for improving one's health. Knowledge on the interactions of sleep quality and the amount of physical activity may be helpful for implementing multimodal health interventions in older adults.

Methods: This preliminary cross-sectional study is based on 64 participants [82.1 ± 6.4 years (MD ± SD); 22 male: 42 female]. The amount of physical activity was assessed by means of an accelerometer (MyWellness Key). Self-reported sleep parameters were obtained using the Pittsburgh Sleep Quality Index. The Barthel Index was used for physical disability rating. Bivariate correlations (Spearman's Rho) were used to explore relationships between the amount of physical activity and sleep quality. To analyse differences between categorial subgroups univariate ANOVAs were applied; in cases of significance, these were followed by Tukey-HSD post-hoc analyses.

Results: No linear association between physical activity and sleep quality was found (r = 0.119; p > 0.05). In subgroup analyses (n = 41, Barthel Index ≥90 pts, free of pre-existing conditions), physical activity levels differed significantly between groups of different sleep duration (≥7 h; ≥6 to <7 h; ≥5 to <6 h; <5h; p = 0.037).

Conclusion: There is no general association between higher activity levels and better sleep quality in the investigated cohort. However, a sleep duration of ≥5 to <6 h, corresponding to 7.6 h bed rest time, was associated with a higher level of physical activity.

The Association Between Sleep Duration and Sleep Timing and Insulin Resistance Among Adolescents in Mexico City

PURPOSE

Emerging evidence suggests that short sleep duration and delayed sleep timing may be independently related to insulin resistance (IR), although findings are mixed. Our aim was to investigate associations between sleep duration and timing with insulin resistance among adolescents.

METHODS

The analytic sample included 384 Mexican adolescents from a birth cohort study who took part in a follow-up study beginning in 2015. Insulin and glucose were measured in fasting serum, and Homeostatic Model Assessment of Insulin Resistance (HOMA-IR) was calculated (marker of insulin resistance; [insulin x glucose]/22.5). Sleep duration and midpoint were measured by actigraphy for 7 days after the visit and for analysis were separated by weekdays and weekends. In full and sex-stratified regression analysis, sleep duration and midpoint were exposures, and the log HOMA-IR was the outcome, adjusting for age.

RESULTS

The mean age of the sample was 13.8 ± 1.93 with 51% female. Shorter sleep duration on weekdays was associated with higher log HOMA-IR (β = -.049, 95% confidence interval [CI] -.097 to -.0009). Later midpoints on weekdays and the weekend were independently associated with higher log HOMA-IR (β = .0408, 95% CI -.0049 to .087, and β = .0486, 95% CI .0042 to .093, respectively). Girls showed stronger associations than boys for both sleep duration and timing with HOMA-IR.

CONCLUSIONS

Sleep duration and sleep timing were independently associated with insulin resistance, and associations were more pronounced among girls.

Potential health-related behaviors for pre-school and school-aged children during COVID-19 lockdown: A narrative review

As a consequence of the COVID-19 pandemic, different measures have been implemented by governments from each affected country. Such measures usually involve restrictions on the movement of citizens, and have had a profound effect on usual activities and timetables. As a result of school closures and strict restrictions regarding going outside home, children have been one of the most disadvantaged population groups during the lockdown period. We therefore aimed to investigate potential health risk behaviors amongst isolated pre-school and school-aged children. We retrieved relevant articles from MEDLINE, Web of Science, PsycInfo, and Scopus databases to describe identified health-related behaviors (i.e. screen exposure, environmental influence, physical activity and fitness, sedentariness, sleep patterns, eating habits, psychological response, body composition, and injuries) in relation to social isolation and social deprivation of children without previous illness or conditions. This review depicts the potential health-related behaviors according to related literature, and put the focus on future short and long-term sequels of social isolation. Socio-affective complications and insufficient physical activity are underscored as two of the main concerns, particularly among socio-economic deprived children. Both issues could be effectively addressed with either adequate parental or community guidance.

Bidirectional associations between sleep quality or quantity, and dietary intakes or eating behaviors in children 6-12 years old: a systematic review with evidence mapping

CONTEXT

Although dietary advice has long been a cornerstone of a healthy lifestyle, how sleep quality and quantity may interact with dietary intake or eating behaviors remains unclear.

OBJECTIVE

To consider a bidirectional relationship between sleep and diet in children aged 6-12 years via a systematic review following PRISMA guidelines.

DATA SOURCES

Relevant trials and observational studies were identified by searching the PubMed, Medline, Embase, and CENTRAL databases up to June 1, 2019, without language or date restrictions and supplemented with hand searching. Recognized procedures and reporting standards were applied.

DATA EXTRACTION

Data on participant characteristics, study parameters, diet measures, sleep measures, and findings of study quality assessment criteria were collected.

DATA ANALYSIS

Forty-five articles involving 308 332 participants on a diverse range of topics were included. Meta-analyses were planned but were impossible to perform due to high study heterogeneity. Most studies (82%) were cross-sectional, which prevented examining directionality of the observed associations. Risk of bias was assessed for trial, cohort studies, and cross-sectional studies, using the Cochrane Risk of Bias Tool or Newcastle Ottawa Scale.

RESULTS

Of 16 studies in which the effect of sleep on dietary intake was investigated, 81% (n = 13) reported a significant association. All studies (n = 8) of sugar-sweetened or caffeinated beverages reported a negative association with sleep, and in 6 of 7 studies in which eating behaviors were investigated, associations with sleep were reported. The use of objective measures of sleep and diet were scarce, with most trials and studies relying on subjective measures of sleep (68%) or diet (93%).

CONCLUSION

Because most studies investigating the relationship between sleep and diet in this age group are cross-sectional, temporality could not be determined. Additional randomized controlled trials and long-term cohort studies in middle childhood, particularly those using objective rather than questionnaire measures of sleep, are required to better understand interactions between diet and sleep.

SYSTEMATIC REVIEW REGISTRATION

Prospectively registered with PROSPERO International Prospective Register of Systematic Reviews (CRD42018091647).

Physical activity and academic achievement among Norwegian adolescents: Findings from a longitudinal study

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A longitudinal study of youth explored physical activity and academic achievement.

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Physical activity was assessed by accelerometry and academic achievement by school grades.

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Mediation through changes in waist circumference and sleep duration were explored.

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Changes in physical activity were not associated with changes in academic achievement.

•

There was no mediation via changes in waist circumference or sleep duration.

Regular physical activity (PA) has been associated with academic achievement, but the evidence is mainly based on cross-sectional research and self-reported measures of PA. The purpose of the current study was to explore the longitudinal relationship between objectively measured PA and academic achievement among a cohort of adolescents in Norway between 2016 and 2018. As a secondary aim, an indirect relationship via waist circumference (WC) and sleep duration was assessed. Data from 599 adolescents (54.4% female, mean age at baseline ± SD 13.3 ± 0.3 years) were collected annually during their three years at lower secondary school. PA was measured objectively using accelerometry. Academic achievement was assessed using grade point average (GPA) from school records. Linear regression analysis was performed to explore associations between longitudinal changes in measures of PA (Total PA and moderate-to-vigorous PA [MVPA]) and academic achievement directly or via mediators. Results showed no significant associations between Total PA or MVPA and academic achievement, either in the main analyses or through mediation of WC and sleep duration. The results contribute to a growing evidence base of studies showing no association between objectively measured PA and academic achievement among adolescents.

Tratamento multicomponente para insônia infantil e seus efeitos nos padrões, hábitos e rotinas de sono

Problemas de sono são frequentes na infância e estão associados a problemas de comportamento. O estabelecimento de rotinas pré-sono é recomendado para pais de crianças. Nenhum estudo brasileiro investigou os hábitos e rotinas de crianças que apresentam problemas de sono. Os objetivos deste estudo foram investigar os hábitos e rotinas de crianças com problemas de sono e verificar se a educação parental sobre o sono da criança levou a mudanças nos padrões de sono e de rotina. Participaram 57 crianças com problemas comportamentais relacionados ao sono e suas mães. As mães receberam orientações sobre o sono das crianças e estabelecimento de rotinas pré-sono. Os dados foram avaliados através de medidas parentais. Nossos resultados apontaram que crianças com problemas de sono apresentam em sua maioria, hábitos e rotinas inadequadas antes de dormir e que a modificação destes levam a melhora do sono. Espera-se que este trabalho possa estimular a produção de pesquisas nacionais sobre o tema, servindo como incentivo para o desenvolvimento de medidas preventivas e interventivas para os problemas de sono na infância.

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.

The relationship between sleep habits, lifestyle factors, and achieving guideline-recommended physical activity levels in ten-to-fourteen-year-old Japanese children: A cross-sectional study

The current focus of meeting the physical activity guidelines for children and young people include preventing conditions such as high blood cholesterol, high blood pressure, metabolic syndrome, obesity, low bone density, depression, and injuries. However, the relationship between sleep habits and meeting physical activity guidelines is still unclear. This study aimed to assess this relationship among fifth- to eighth-grade (ages 10-14) Japanese children. This cross-sectional study included 3,123 children (boys: 1,558, girls: 1,565, mean age: 12.5 ± 1.2 years). Questionnaires were used to assess parameters such as moderate-to-vigorous physical activity per day, school and weekend night sleep durations, social jetlag, daytime sleepiness, napping, screen time, and breakfast intake. Participants were divided into an achievement and a non-achievement group depending on their physical activity guideline achievement status (i.e., whether they met the children's physical activity guideline of 60 min or more of moderate-to-vigorous physical activity per day). Then, to determine the sleep habits in relation to the children's achievement of guideline-recommended physical activity levels, multivariate logistic regression analyses were conducted. In fifth- and sixth-grade (ages 10-12) boys, an inverse association was observed between physical activity guideline achievement and daytime sleepiness. In seventh- and eighth-grade (ages 12-14) boys, physical activity guideline achievement was inversely associated with social jetlag and skipping breakfast. Additionally, in seventh- and eighth-grade girls, physical activity guideline achievement was inversely associated with inappropriate sleep duration on weekends and screen time. These results suggest that meeting the physical activity guideline is related to favorable sleep habits in Japanese children. However, their relevance may differ by school type and gender.

Health-Related Behaviors Among School-Aged Children and Adolescents During the Spanish Covid-19 Confinement

In response to the coronavirus disease 2019 (Covid-19) world pandemic, affected countries such as Spain enacted measures comprising compulsory confinement as well as restrictions regarding free movement. Such measures likely influence children's and adolescents' lifestyles. Our study aimed to investigate the impact that the Covid-19 confinement has on health-related behaviors (HRBs) among Spanish children and adolescents. An online survey was administered to 516 parents to collect data about 860 children and adolescents (49.2% girls) aged between 3 and 16 years in relation to physical activity, screen exposure, sleep time, and fruit and vegetable consumption during the Covid-19 confinement. Respectively, t-paired test and t-test between groups served to check differences between HRBs levels before and during the confinement as well as between strict and relaxed confinement. Significant differences were found for a reduction of weekly minutes of physical activity during the confinement (-102.5, SD 159.6) (p < 0.001), an increase of daily hours of screen exposure (2.9, SD 2.1) (p < 0.001), and a reduction of daily fruit and vegetable consumption (-0.2, SD 1.6) (p < 0.001). Sleep time showed a significant difference between strict and relaxed confinement (-0.3, SD 0.1) (p < 0.05), whereas binomial logistic regression adjusted for covariates (age, sex, education of the parents, siblings, current condition, exposure to Covid-19, and previous health risk behavior) showed significantly lower odds for screen exposure risk behavior with relaxed confinement (OR 0.60, 95%CI 0.40-0.91). The present study suggests that Covid-19 confinement reduced physical activity levels, increased both screen exposure and sleep time, and reduced fruit and vegetable consumption. Therefore, most HRBs worsened among this sample of Spanish children and adolescents. Closure of schools, online education, and the lack of policies addressing the conciliation between labor and family life could have played an important role in HRBs worsening among pupils, which might be mitigated with adequate conciliation policies, parental guidance, and community support.

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.

Beyond the growth delay in children with sleep-related breathing disorders: a systematic review

INTRODUCTION

The availability of high-quality studies on the association between sleep-disordered breathing in children and delayed growth associated with the hormonal profile recorded before surgery and at follow-up is limited.

EVIDENCE ACQUISITION

Medline PubMed, Scopus and WebOfScience databases were searched for relevant publications published between January 2008 to January 2020 and a total of 261 potentially eligible studies were identified.

EVIDENCE SYNTHESIS

Following review 19 papers were eligible for inclusion: seven reported a significant postsurgical increase in growth regardless of initial weight status, type of surgery, type of study design, and length of follow-up period. The only high-quality study was a randomized controlled trial that found an increased risk of obstructive sleep apnea syndrome relapse in overweight children. Twelve studies reported the significant increase in growth parameters showing that IGF-1, IGFBP-3, and ghrelin may boost growth after surgery.

CONCLUSIONS

The current systematic review demonstrates a scarcity of high-quality studies on growth delay in children with sleep-disordered breathing. Significant catch-up growth after surgery in the short term and changes in IGF-1, IGFBP-3, ghrelin, and leptin levels has been reported in most published studies.

Sleep and obesity among children: A systematic review of multiple sleep dimensions

The objectives were to systematically investigate the multiple dimensions of sleep and their association with overweight or obesity among primary school-aged children. CINHAL, PsycINFO, SPORTDiscus, Medline, Cochrane, Embase, and PubMed databases were searched for papers reporting on an association between children's sleep and weight status. Studies on clinical populations, published in languages other than English, without objectively measured weight status, or where weight status was reported outside the outlined age bracket (5-13 years) were excluded. A total of 34  248 citations were extracted from our systematic search protocol, of which 112 were included for detailed review. Compared with sleep duration, of which 86/103 articles found a significant inverse association between sleep duration and measured weight status, few studies examined other dimensions of sleep, such as quality, efficiency and bed/wake times, and relationship with weight status. Where studies existed, variation in defining and measurement of these dimensions restricted comparison and potentially influenced discrepancies across results. Overall, the findings of this review warrant the need for further research of the outlined dimensions of sleep. Future research would benefit from clarity on definitions across the different dimensions, along with the use of valid and reliable tools.

Quantity versus quality of objectively measured sleep in relation to body mass index in children: cross-sectional and longitudinal analyses

BACKGROUND/OBJECTIVES

Although sleep duration is well established as a risk factor for child obesity, how measures of sleep quality relate to body size is less certain. The aim of this study was to determine how objectively measured sleep duration, sleep timing, and sleep quality were related to body mass index (BMI) cross-sectionally and longitudinally in school-aged children.

SUBJECTS/METHODS

All measures were obtained at baseline, 12 and 24 months in 823 children (51% female, 53% European, 18% Māori, 12% Pacific, 9% Asian) aged 6-10 years at baseline. Sleep duration, timing, and quality were measured using actigraphy over 7 days, height and weight were measured using standard techniques, and parents completed questionnaires on demographics (baseline only), dietary intake, and television usage. Data were analysed using imputation; mixed models, with random effects for person and age, estimated both a cross-sectional effect and a longitudinal effect on BMI z-score, adjusted for multiple confounders.

RESULTS

The estimate of the effect on BMI z-score for each additional hour of sleep was -0.22 (95% CI: -0.33, -0.11) in cross-sectional analyses and -0.05 (-0.10, -0.004) in longitudinal analyses. A greater effect was observed for weekday sleep duration than weekend sleep duration but variability in duration was not related to BMI z-score. While sleep timing (onset or midpoint of sleep) was not related to BMI, children who were awake in the night more frequently (0.19; 0.06, 0.32) or for longer periods (0.18; 0.06, 0.36) had significantly higher BMI z-scores cross-sectionally, but only the estimates for total time awake (minutes) were significant longitudinally (increase in BMI z-score of 0.04 for each additional hour awake).

CONCLUSION

The beneficial effect of a longer sleep duration on BMI was consistent in children, whereas evidence for markers of sleep quality and timing were more variable.

Sleep and Physical Activity Patterns in Urban American Indian Children

Objectives: In this study, we examined patterns of obesity, physical activity (PA), sleep, and screen time in urban American Indian (AI) youth in the 6th-8th grade. Methods: A youth sample (N = 36) from 3 middle schools was recruited to participate in this observational sample of convenience. Youth completed a demographic and screen time survey, measurements of height and weight, and wore a wrist accelerometer continuously for 7 days to assess PA and sleep. Results: Approximately 42% of participants were overweight or obese. Average weekday screen time was 254.7±98.1 minutes. Compared to weekdays, weekend sedentary activity increased (weekday, 159.2±81.1 minutes vs weekend, 204.3±91.7 minutes; p = .03) and vigorous PA (weekday, 20.9±19.1 minutes vs weekend, 5.7±8.1 minutes; p = .0001) and moderate-to-vigorous PA (weekday, 192.65±62.3 minutes vs weekend, 141±71.7 minutes; p = .002) decreased. Compared to weekdays, weekend total sleep time (weekday, 512.8±48.6 minutes vs weekend, 555.3±84.3 minutes; p = .007) and time in bed (weekday, 487.3±49.6 minutes vs weekend, 528.6±71.2 minutes; p = .01) increased. Conclusions: Weekday to weekend shifts in PA and sleep must be considered when designing targeted obesity prevention interventions.

The Relationship Between Sleep Duration and Participation in Home, School, and Community Activities Among School-Aged Children

Sleep duration has important implications for children’s participation in daily activities; however, past attempts to examine this relationship has been limited to specific types of physical or educational activities. The present study aimed to investigate the relationship between sleep duration and participation in various daily activities among school-aged children. A school-based sample of 391 children aged 5–12 years (boys: 52.4%) participated in this cross-sectional survey. Sleep duration was quantified using parental reports of their children’s bedtime and wake-up time on weekdays and weekends. The parent-reported Participation and Environment Measure for Children and Youth was used to measure their children’s participation frequency and involvement in 25 home, school, and community activities. The results of hierarchical regression analyses showed that, when the demographic variables were controlled for, weekday sleep duration was positively related to homework involvement and negatively related to the frequency of TV viewing; however, it was unrelated to participation in school and community activities. Conversely, weekend sleep duration was positively related to overall participation in school activities, and participation frequency and involvement in some home and community activities. Furthermore, sleep duration was approximately an hour shorter on weekdays than on weekends. These results suggest that weekend sleep duration has stronger positive implications for children’s participation in daily activities than does weekday sleep duration. Interventions aiming to promote children’s activity participation may either prolong children’s weekend sleep duration or address their shorter weekday sleep duration.

Lower physical activity is associated with daytime sleepiness in children aged 9-12 years

This study clarified the prevalence of daytime sleepiness in fourth-, fifth-, and sixth-grade children and examined the association between physical activity (PA) and daytime sleepiness in children aged 9-12 years. This cross-sectional study included 314 children (mean age ± standard deviation: 10.5 ± 1.0 years; male: 52.9%) enrolled in two public elementary schools in Kobe, Japan. PA was assessed using the Physical Activity Questionnaire for Older Children. The outcome was self-reported daytime sleepiness. The prevalence of daytime sleepiness in fourth-, fifth-, and sixth-grade children were 10.8%, 25.2%, and 28.6%, respectively. In univariate analysis, subjects with reported daytime sleepiness had lower PA levels than those without daytime sleepiness (odds ratio (OR) = .67; 95% confidence interval (CI) = .47-.95). Multiple logistic regression analysis demonstrated that lower PA was significantly associated with daytime sleepiness after adjusting for multiple confounders (OR = .54; 95% CI = .37-.81). The prevalence of daytime sleepiness in fifth and sixth grades was higher than fourth grade. Furthermore, this study clarified the significant association between PA and daytime sleepiness and suggested that PA could be one of the factors to prevent daytime sleepiness in children aged 9-12 years.

Impaired sleep quality is associated with concurrent elevations in inflammatory markers: are post-menopausal women at greater risk?

Abstract

Background

Chronic inflammation and impaired sleep increase the risk for cardiovascular disease. Menopausal women may be particularly at risk as a result of impaired sleep. The objective of the current investigation was to assess the relationship between poor sleep and C-reactive protein (CRP), interleukin-6 (IL-6), tumor necrosis factor alpha (TNF-α), and myeloperoxidase (MPO) in healthy non- and postmenopausal women and men.

Methods

A fasting blood draw was obtained from 122 healthy men and women (31 were postmenopausal). Higher scores on the Pittsburgh Sleep Quality Index (PSQI) were used to define poor sleep. Given the sample size and healthy nature of the sample, hierarchical linear regression analyses were performed on a composite inflammatory score involving CRP, IL-6, and TNF-α. Sex/menopausal group and PSQI were entered as predictors, and the interaction of the group by PSQI was entered stepwise. Analyses on MPO were performed separately.

Results

Sleep quality was associated with higher inflammatory activity (β = 0.272, P = 0.003), which remained significant (P = 0.046) after controlling for age, waist circumference, exercise times per week, and depressive symptoms. While in the same direction, sleep quality was not significantly associated with MPO. Dichotomizing sleep quality led to similar results.

Conclusion

Impaired sleep quality is independently associated with greater inflammation in healthy adult men and women. Despite an overall less favorable metabolic and inflammatory profile in postmenopausal women, impaired sleep did not emerge as differentially related to inflammatory activity in this group.

Chronotype: implications for sleep quality in medical students

Medical students who suffer from poor sleep quality may be afflicted by distress. While the change of chronotype may improve sleep quality, few studies have focused on this association. The objective of this study is to analyze the effects of chronotype on sleep quality in medical students while controlling for confounding covariate factors. A cross-sectional survey on sleep quality was conducted among 5497 medical students. Sleep quality, chronotype, and lifestyle were measured according to the Pittsburgh Sleep Quality Index, Morningness-eveningness Questionnaire and Health-promoting Lifestyle Profile. Hierarchical logistic regression was conducted to analyze the influence of various factors, especially chronotype effect on sleep quality. Our results showed that the total score of sleep quality in evening-types was 5.43 ± 2.66, which was significantly higher than that in morning-types (3.88 ± 2.20, P < .001). Morning-type students (OR = 0.40, 95%CI = 0.29-0.55) and intermediate-type students (OR = 0.53, 95%CI = 0.41-0.69) had a lower risk of poor sleep quality compared to evening-types. The strongest predictor of sleep quality was chronotype while controlling for covariates (grade, gender, father's educational level, mother's educational level, internet addiction, mood state, midnight snack frequency, and health-promoting lifestyle profile). Based on the results, we believe that sleep quality among evening-type students may be improved by shifting to keep early hours.

Dietary and Activity Factors Influence Poor Sleep and the Sleep-Obesity Nexus among Children

Background: Behavioral factors such as physical activity, sedentary behavior and diet have previously been found to be key modifiable determinants of childhood overweight and obesity, yet require further investigation to provide an understanding of their potential influence on sleep outcomes along with the sleep-obesity nexus. Methods: The study included 2253 students (ages 8.8-13.5) from two monitoring studies across regional Victoria. Students completed a self-report electronic questionnaire on demographic characteristics, health behaviors (including sleep, physical activity, screen time and diet) and well-being, and were invited to have anthropometric measurements (height and weight) taken. Regression models were used to assess the associations between sleep, behavioral factors and BMI z-scores. Results: Screen time (particularly in bed) and sugar-sweetened beverage (SSB) consumption were shown to increase the likelihood of having more than three sleep problems, while physical activity and other dietary factors were not. After controlling for these behaviors, significance remained for having two or more than three sleep problems and an increased odds of overweight/obesity. Conclusions: This study highlights how the usage of screen devices and SSB consumption behaviors might influence children's weight status via the sleep-obesity nexus.

Cross-sectional associations of objectively assessed sleep duration with physical activity, BMI and television viewing in German primary school children

BACKGROUND

The global incidence of overweight and obesity has increased dramatically among children and adolescents over the past decades. Insufficient sleep duration and physical inactivity are known risk factors for overweight and obesity in children. To engage children in a healthier lifestyle knowledge about associations of sleep duration and behavioural aspects in children are vital. Therefore, this study investigated the mentioned associations in German primary school children.

METHODS

Data of 308 first and second graders (7.1 ± 0.6 years) was used; children's anthropometric data were taken during a school visit. Children's physical activity (PA) and sleep duration were assessed objectively (Actiheart©, CamNtech Ltd., Cambridge, UK); children's daily television time and socio-demographic data were collected via parental questionnaire. Linear mixed-effects regression models as well as logistic regressions were used to determine associations of PA, television viewing, age, gender, BMI z-scores and socio-economic variables on sleep duration.

RESULTS

In linear regression models young age and not having a migration background were significantly associated with long sleep duration (p < 0.001). In logistic regressions, long night time sleep (≥10:08 h; compared to medium and short sleep duration) was significantly associated with not reaching the PA guideline (OR 0.60 [0.36;0.99]), daily television viewing of less than one hour (OR 0.44 [0.24;0.80]), young age (OR 0.38 [0.21;067]), a high parental education level (OR 0.52 [0.27;0.99]) and the lack of migration background (OR 0.21 [0.10;0.48]). However, if controlling for age, gender, parental education level and migration background, reaching the PA guideline stayed no longer significantly associated with a tertiary sleep level.

CONCLUSIONS

Children in the highest sleep category showed a negative association with reaching the PA guideline and a positive association with daily television viewing. This therefore adds to previously primarily subjectively assessed associations of sleep and risk factors for obesity (related behaviours) with a detailed insight based on objective data. Hence, interventions trying to decrease children's BMI and television viewing should also aim at extending children's night-time sleep and inform parents about the importance of sufficient sleep during childhood.

TRIAL REGISTRATION

DRKS-ID: DRKS00000494 .

Assessment and treatment of pediatric behavioral sleep disorders in Canada

OBJECTIVES/BACKGROUND

This paper outlines the current state of Canadian training, clinical services, research, and advocacy initiatives related to non-respiratory sleep disorders, with a specific focus on insomnia, the most common sleep problem in children.

METHODS

Information for this narrative review was collected from peer-reviewed publications, web-resources, and personal communications and experiences.

RESULTS

It is estimated that approximately one-third of Canadian children and youth present with insomnia, and that this is impacting their physical and mental health, as well as learning in school. Training in pediatric sleep is limited and highly inconsistent within and across disciplines. While there are some publicly and privately funded pediatric sleep services available, these are mostly focused on respiratory sleep problems and are not equally accessible across the country.

CONCLUSIONS

Pediatric assessment and treatment services for non-respiratory sleep disorders needs to be more integrated into the Canadian health care system.

Understanding Correlates of Physical Activity in American Indian Families: The Healthy Children Strong Families-2 Study

BACKGROUND

Little is known about factors contributing to physical activity (PA) in American Indian (AI) populations. Addressing this gap is paramount as sedentary activity and obesity continue to increase in this population. The purpose of this study was to determine factors associated with PA among AI families with young children.

METHODS

Height and weight of both adult (n = 423) and child (n = 390) were measured, and surveys assessed demographics, PA, stress (adult only), sleep, and screen time. Separate multivariate logistic regression models were constructed for adults and children (reported as adjusted odds ratios, aORs).

RESULTS

For adults, age (aOR = 0.952; P ≤ .001), television viewing (aOR = 0.997; P = .01), and computer use (aOR = 0.996; P = .003) decreased the odds of being active. For children, high adult activity (aOR = 1.795; P ≤ .01), longer weekday sleep (aOR = 1.004; P = .01), and family income >$35,000 (aOR = 2.772; P = .01) increased the odds of being active. We found no association between adult PA with stress or adult sleep or between child PA with body mass index and screen time.

CONCLUSIONS

Given the complexity of the factors contributing to obesity among AI families, multigenerational interventions focused on healthy lifestyle change such as decreasing adult screen time and increasing child sleep time may be needed to increase PA within AI families.

Cross-sectional and prospective associations between sleep, screen time, active school travel, sports/exercise participation and physical activity in children and adolescents

BACKGROUND

The aim of this study was to investigate how sleep, screen time, active school travel and sport and/or exercise participation associates with moderate-to-vigorous physical activity (MVPA) in nationally representative samples of Norwegian 9- and 15-y-olds, and whether these four behaviors at age nine predict change in MVPA from age nine to 15 years.

METHOD

We pooled cross-sectional accelerometer and questionnaire data from 9- (n = 2366) and 15-y-olds (n = 1554) that participated in the first (2005/06) and second (2011/12) wave of the Physical Activity among Norwegian Children Study to investigate cross-sectional associations. To investigate prospective associations, we used data from a sub-sample that participated in both waves (at age nine and 15 years, n = 517).

RESULTS

Cross-sectional analyses indicated a modest, inverse association between screen time and MVPA among 9- (- 2.2 min/d (95% CI: -3.1, - 1.3)) and 15-y-olds (- 1.7 min/d (95% CI: -2.7, - 0.8)). Compared to their peers with 0-5 min/d of active travel to school, 9- and 15-y-olds with ≥16 min/d accumulated 7.2 (95% CI: 4.0, 10.4) and 9.0 (95% CI: 3.8, 14.1) more min/d of MVPA, respectively. Nine-y-old boys and 15-y-olds reporting ≥8 h/week of sports and/or exercise participation accumulated 14.7 (95% CI: 8.2, 21.3) and 17.9 (95% CI: 14.0, 21.8) more min/d of MVPA, respectively, than those reporting ≤2 h/week. We found no cross-sectional association between sleep duration and MVPA in either age group. None of the four behaviors predicted change in MVPA from age nine to 15 years (p ≥ 0.102).

CONCLUSION

Active travel to school and sport/exercise participation may be important targets for future interventions aimed at increasing MVPA in children and adolescents. However, future studies are needed to determine causality.

Weight gain in first-semester university students: Positive sleep and diet practices associated with protective effects

For university students, alterations in sleep and diet quality are common, and the propensity for weight gain is well established. The role of sleep duration during periods of rapid weight gain is understudied. This study explored the relationships between sleep duration, diet patterns, and body composition in first-year university students. Data collection occurred during the beginning of the fall (August) and spring semesters (January). Anthropometric measures included weight, height, and percent body fat (%BF). Survey questions assessed sleep and diet quality. As a group, participants (N = 60) gained weight (1.8 ± 2.1 kg) over the 4.5-month period of study. Hierarchical cluster analysis (HCA) identified three groups based on weight change between baseline and follow-up visits. Group 1 ("maintainers") (N = 21) gained 0.1 ± 1.3 kg, group 2 ("modest gainers") (N = 24) gained 2.0 ± 1.7 kg, and group 3 ("major gainers") (N = 15) gained 3.8 ± 1.8 kg. No differences in weight, body mass index (BMI), %BF, or average sleep duration existed between clusters at baseline. Minimal differences in baseline dietary behaviors between groups were noted other than maintainers used more fat, e.g., butter, to season vegetables, bread, and potatoes compared to modest gainers (p = .010). At follow-up, sleep duration significantly decreased from baseline among major gainers (7.1 ± 0.7 vs. 6.8 ± 0.7 h, p = .017) while sleep duration increased from baseline among maintainers (7.3 ± 0.9 vs. 7.6 ± 1.0 h, p = .048). Sleep duration at follow-up was significantly shorter among major gainers compared to maintainers (p = .016). Total diet scores for maintainers and modest gainers improved between visits (p = .038 and 0.002, respectively) but did not change among major gainers. Combining sleep and diet education may increase the effectiveness of interventions designed to mitigate weight gain in this high-risk population.