Multidimensional association of sleep health with dietary habits and physical activity in adolescents

While insufficient sleep is associated with poor lifestyle factors, a multidimensional approach assessing multiple sleep health dimensions via subjective and objective measures has emerged as a more comprehensive method of investigating these relationships. We examine the multidimensional association between sleep health, diet, and physical activity (PA).

We studied 373 adolescents from the Penn State Child Cohort (16.4 ± 2.3 years; 46.6% female; 20.9% racial/ethnic minority), of whom 234 (63.5%) were evaluated while in-school. Sleep dimensions were assessed via self-reports, actigraphy (ACT), and polysomnography (PSG). PA was assessed via ACT and self-reports, metabolic equivalent of task (MET) via ACT, and diet via self-reports. Stepwise multivariable-adjusted regression models tested the association between sleep dimensions and lifestyle factors.

Later self-reported and ACT-measured bedtime and rising time were associated with more snacking, higher caloric intake, and sedentarism. A later ACT-measured sleep midpoint was associated with higher carbohydrate intake and more snacking. Higher ACT-measured sleep variability was associated with higher sedentarism. Longer self-reported or ACT-measured sleep latency was associated with more snacking and higher PA and METs. Longer ACT-measured time in bed was associated with lower PA. Sleep dimensions were more strongly associated with diet, PA, and sedentarism among adolescents evaluated while in-school, whereas they were more strongly associated with snacking among those on-break. PSG-measured sleep dimensions were not strongly associated with lifestyle factors; although a greater apnea/hypopnea index was associated with lower METs and greater sedentarism, it was not significant after adjusting for BMI.

Evaluating sleep with a multidimensional approach better captures its association with lifestyle factors. Future research should assess downstream effects on cardiovascular outcomes.