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Published on: October 11, 2018
Where does the time go when children don't sleep? A randomized crossover study
Silke Morrison1, Jillian J Haszard2, Barbara C Galland3
1Department of Medicine, University of Otago, Dunedin, New Zealand.
Insights
Mild sleep deprivation in children did not reduce physical activity. When children slept less, the extra awake time was proportionally reallocated to sedentary behavior and physical activity, not preferentially.
Area of Science:
- Pediatric Sleep Science
- Childhood Movement Behaviors
- Behavioral Pediatrics
Background:
- Understanding the impact of sleep duration on children's daily activities is crucial for public health.
- Previous research suggests a link between short sleep and increased sedentary time, but the reallocation of time is not fully understood.
Purpose of the Study:
- To investigate how mild sleep deprivation affects the time children spend in physical activity and sedentary behavior.
- To determine the reallocation patterns of awake time gained from reduced sleep.
Main Methods:
- A randomized controlled trial involving 105 children who underwent a 1-week sleep extension (1 hour earlier bedtime) and a 1-week sleep restriction (1 hour later bedtime) with a 1-week washout period.
- Twenty-four-hour movement behaviors, including physical activity and sedentary time, were objectively measured using waist-worn actigraphy.
- Mixed-effects regression models were used to analyze mean differences in time use between sleep conditions.
Main Results:
- Children gained approximately 49 minutes of awake time during sleep restriction compared to sleep extension.
- This additional awake time was primarily reallocated to sedentary behavior (28 minutes) and physical activity (22 minutes).
- When analyzed as a percentage of total time, the overall composition of movement behaviors remained consistent across sleep conditions.
Conclusions:
- Mild sleep deprivation in children does not lead to a decrease in overall physical activity levels.
- The time gained from reduced sleep is proportionally distributed between sedentary behavior and physical activity.
- These findings challenge the notion that reduced physical activity is the primary mechanism linking short sleep duration to obesity in children.
Objective:
This study aimed to describe how mild sleep deprivation in children changes time spent physically active and sedentary.
Methods:
In 2018 through 2020, children (n = 105) with normal sleep were randomized to go to bed 1 hour earlier (extension) or 1 hour later (restriction) than their usual bedtime for 1 week, each separated by a 1-week washout. Twenty-four-hour movement behaviors were measured with waist-worn actigraphy and expressed in minutes and proportions (percentages). Mixed-effects regression models determined mean differences in time use (95% CI) between conditions. Time gained from sleep lost that was reallocated to other movement behaviors in the 24-hour day was modeled using regression.
Results:
Children (n = 96) gained ~49 minutes of awake time when sleep was restricted compared with extended. This time was mostly reallocated to sedentary behavior (28 minutes; 95% CI: 19-37), followed by physical activity (22 minutes; 95% CI: 14-30). When time was expressed as a percentage, the overall composition of movement behavior remained similar across both sleep conditions.
Conclusions:
Children were not less physically active when mildly sleep deprived. Time gained from sleeping less was proportionally, rather than preferentially, reallocated to sedentary time and physical activity. These findings suggest that decreased physical activity seems unlikely to explain the association between short sleep and obesity in children.
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Cause and Effect
Crossover Experiments
Crossover designs are performed even with smaller sample sizes since the samples can act as their controls. These are better than simple randomized trials since patients are exposed to all the treatments.

