Objective Sleep Characteristics and Cardiometabolic Health in Young Adolescents

Abstract

: media-1vid110.1542/5778442247001PEDS-VA_2017-4085Video Abstract BACKGROUND AND OBJECTIVES: Shorter sleep duration is associated with childhood obesity. Few studies measure sleep quantity and quality objectively or examine cardiometabolic biomarkers other than obesity.

Methods: This cross-sectional study of 829 adolescents derived sleep duration, efficiency and moderate-to-vigorous physical activity from >5 days of wrist actigraphy recording for >10 hours/day. The main outcome was a metabolic risk score (mean of 5 sex-specific z-scores for waist circumference, systolic blood pressure, high-density lipoprotein cholesterol scaled inversely, and log-transformed triglycerides and homeostatic model assessment of insulin resistance), for which higher scores indicate greater metabolic risk. Secondary outcomes included score components and dual-energy radiograph absorptiometry fat mass. We measured socioeconomic status, race and/or ethnicity, pubertal status, and obesity-related behaviors (television-viewing and fast food and sugar-sweetened beverage consumption) using questionnaires.

Results: The sample was 51.5% girls; mean (SD) age 13.2 (0.9) years, median (interquartile range) sleep duration was 441.1 (54.8) minutes per day and sleep efficiency was 84.0% (6.3). Longer sleep duration was associated with lower metabolic risk scores (-0.11 points; 95% CI: -0.19 to -0.02, per interquartile range). Associations with sleep efficiency were similar and persisted after adjustment for BMI z score and physical activity, television-viewing, and diet quality. Longer sleep duration and greater sleep efficiency were also favorably associated with waist circumference, systolic blood pressure, high-density lipoprotein cholesterol, and fat mass.

Conclusions: Longer sleep duration and higher sleep efficiency were associated with a more favorable cardiometabolic profile in early adolescence, independent of other obesity-related behaviors. These results support the need to assess the role of sleep quantity and quality interventions as strategies for improving cardiovascular risk profiles of adolescents.

FIGURE 1

Multivariable-adjusted associations of sleep duration and efficiency (per interquartile increase) with adiposity outcomes. Results for adiposity outcomes are shown per IQR of the following sleep exposures: duration (55 minutes) and efficiency (6%). Models adjust for maternal education and household income, season of measurement, and adolescent age, sex, race and/or ethnicity, and puberty (Tanner stage). A, BMI z score. B, DXA total fat mass index (in kilograms per meter squared). C, DXA trunk fat index (in kilograms per meter squared). D, Sum of subscapular and triceps skinfolds (millimeters). E, Waist circumference (in centimeters).

FIGURE 2

Multivariable-adjusted associations of sleep duration and efficiency (per interquartile increase) with cardiometabolic biomarker outcomes. Results for cardiometabolic outcomes are shown per IQR of the following sleep exposures: duration (55 minutes) and efficiency (6%). Models adjust for maternal education and household income, season of measurement, and adolescent age, sex, race and/or ethnicity, and puberty (Tanner stage). A, Metabolic risk score (points). B, Systolic blood pressure (in millimeters of mercury). C, HDL cholesterol (in milligrams per deciliter). D, Triglycerides (in milligrams per deciliter). E, HOMA-IR. F, Glucose (in milligrams per deciliter).