The complexity of obesity in U.K. adolescents: relationships with quantity and type of technology, sleep duration and quality, academic performance and aspiration

Sleep irregularity is associated with night-time technology, dysfunctional sleep beliefs and subjective sleep parameters amongst female university students

Sleep irregularity has been linked to multiple deleterious consequences in clinical populations or community adults and adolescents, but little is known about young adults. In this study, we explored the relationships between two measures of sleep regularity and a wide range of factors (lifestyle behaviors, subjective sleep, clinical outcomes, and academic performance) in a sample of female, university students in the United Arab Emirates. A total of 176 participants were recruited. Objective estimates of sleep-wake patterns were obtained using seven-day wrist actigraphy and data were used to calculate daily sleep regularity with the Sleep Regularity Index (SRI) and weekly sleep regularity with the social jetlag (SJL). Subjective sleep measures were also acquired using the Pittsburgh Sleep Quality Index (PSQI), Dysfunctional Beliefs and Attitudes about Sleep (DBAS), and daytime napping frequency. Self-reported night-time technology use frequency was ascertained using the Technology Use Questionnaire (TUQ). Psychological health was assessed using the Hospital Anxiety and Depression Scale. Objective physical health measurements for body mass index, fasting blood glucose and blood pressure were obtained. No significant associations emerged between sleep regularity and psychological physical health, or academic performance. However, significant relationships were detected between SRI and daytime napping frequency (p-value = 0.0017), PSQI (p-value = 0.0337), and DBAS (p-value = 0.0176), suggesting that daily irregular sleep patterns are associated with more frequent daytime napping, greater dysfunctional sleep beliefs, and poorer subjective sleep quality. Conversely, SJL was significantly associated with the DBAS (p-value = 0.0253), and the TUQ (p-value = 0.0208), indicating that weekly irregular sleep patterns are linked to greater dysfunctional sleep beliefs and increased nighttime technology use. In conclusion, efforts to educate and cultivate sustainable and consistent sleep-wake patterns amongst university students are needed, which can be achieved by raising awareness, promoting good sleep health habits, and minimizing excessive bedtime technology.

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.

Evaluation of chronotype and sleep quality in infertile population and comparison with fertile population: a cross-sectional study

PURPOSE

Infertility is a stressful condition for couples and can affect patients' circadian rhythm and sleep quality. The goal of this study is to assess differences in chronotype and sleep quality between infertile and fertile people.

METHODS

A cross-sectional study was conducted. The infertile patient population consisted study group. Primiparous patients without any known gynecological disease who presented for routine cervical cancer screening follow-up were included in the control group. The Turkish version of the Morningness-Eveningness Questionnaire (MEQ) and Pittsburg Sleep Quality Index (PSQI) scores were evaluated between groups.

RESULTS

A total of 227 patients were assessed. There were 110 patients in the study (infertile) group and 117 patients in the control (fertile) group. The evening chronotype proportion (23.6 vs. 0.9%, p < 0.001) was higher in the infertile group. The median of MEQ score was significantly higher in the fertile patients (50, IQR = 43 - 55 vs. 56, IQR = 51 - 59; p < 0.001), and the median of PSQI score was significantly higher in the infertile patients (5, IQR = 4 - 6, vs. 4, IQR = 3 - 5; p < 0.001).

CONCLUSIONS

In this study, we found significantly worse sleep quality, and more evening chronotype in the patients with infertility.

Body size, form, composition, and a healthy lifestyle associates with health-related quality of life among Portuguese children

OBJECTIVES

This study aimed to describe the relationship between body size, form, and composition, and children's lifestyle on health-related quality of life (HRQoL).

METHODS

This cross-sectional study comprised 1333 children (9.05 ± 0.75 years; 683 females) living in mainland Portugal. Objective anthropometric measures were collected. Parents answered a standardized questionnaire related with children's lifestyle (e.g., sport participation, screen- and sleep-time) and family socioeconomic status (e.g., parental education). HRQoL was measured using the Portuguese version of the KIDSCREEN-27. Scores were categorized into low and high using a sex-specific normative cut-off from European children. A healthier score was created including positive scores for body weight, abdominal obesity, sport participation, sleep- and screen-time.

RESULTS

Body size, form and composition were correlated with children's physical wellbeing. However, sex differences were found in which parameters were associated with wellbeing. Among boys, the body mass index, waist circumference, waist-to-height ratio, subscapular and suprailiac skinfold were most correlated with wellbeing, while waist circumference and subscapular skinfold showed the strongest correlations for girls. Sleep duration and sport participation revealed a significant relationship with girls' HRQoL. A logistic regression analysis (adjusted for parental education) revealed that boys scoring 4 or 5 in the healthier index had an increased likelihood of high HRQoL level compared to those fulfilling none.

CONCLUSIONS

Future programs aimed at reducing obesity, particularly central obesity, and incorporating multiple health indicators and behaviors, such as sport participation and sleep duration may help improve children's health and wellbeing.

Association between sleep quality and depression among institutionalized and community older people - Brazilian Western Amazonia

BACKGROUND

The transition in the population pyramid is a reality in several locations around the world and projections of an increase in the older population in Brazil demonstrate the relevance of studies on factors that may interfere in the functionality and quality of life in this age group. Thus, the present study aims to assess depression levels and their relationship with sleep quality in institutionalized and community older adults.

METHODS

This cross-sectional study included 220 older people of both sexes, divided into two groups, institutionalized older adults, and community older adults. The older adults were monitored by Community Health Agents (CHA), through identification of everyone in their micro area using a method of random name generation, based on geographic location. Due to the small number of institutionalized older adults, all residents in the institutions were recruited, according to the inclusion and exclusion criteria. The Geriatric Depression Scale (GDS-15) and Pittsburgh Sleep Quality Index (PSQI) were used to assess depression and sleep quality.

RESULTS

Among the 220 older adults, 175 were community members and 45 were institutionalized. The survey revealed that institutionalized older adults had a higher percentage of severe depression compared to community dwelling older adults (p <  0.039).

CONCLUSION

Older adults in the community present greater symptoms of depression and better sleep than institutionalized older adults. There was a direct association between sleep quality and depression. In our sample, being institutionalized and female positively influenced and feeling alone negatively influenced depressive symptoms.

The impact of lifestyle and socioeconomic parameters on body fat level in early childhood

The aim of this study was to examine the differences between selected lifestyle and socioeconomic parameters among preschool (3-7 years of age) children of differing adiposity status. The study was conducted from February to June 2018 in 20 randomly selected kindergartens in Kraków, Poland. Triceps, biceps, subscapular, suprailiac, abdominal and calf skinfold thicknesses were measured. The sum of all six skinfolds was calculated and the children were subsequently characterized by low (≤-1 SD [standard deviation]), normal (-1 to 1 SD) or high body fat (≥1 SD). Socioeconomic and lifestyle characteristics were obtained using a questionnaire filled out by the children's parents or legal guardians. Preschool children in the high adiposity category had, on average, fewer siblings and longer screen time; additionally, their parents had lower education and more often worked in manual jobs, in comparison to the children in the low and average adiposity categories. In conclusion, it was observed that children in different adiposity categories varied in terms of some socioeconomic as well as lifestyle characteristics. Knowledge regarding the influence that those factors can have on the metabolic health of children is essential for children's present as well as future well-being. Moreover, it can help health care professionals and parents decide what intervention and/ or preventive measures should be undertaken to ensure the best possible outcomes, as the development of successful obesity prevention strategies should rely on evidence-based information. Nonetheless, future research examining the issue of factors influencing the metabolic health of children, as well as these outcomes later in life, is crucial. Well-planned studies including a large number of individuals, as well as longitudinal research, will be particularly beneficial in this regard.

Prescribing laughter to ameliorate mental health, sleep, and wellbeing in university students: A protocol for a feasibility study of a randomised controlled trial

Objectives

This research is the first study to investigate the potential effects of a laughter prescription on both psychological health and objective sleep parameters in university students. The primary objective is to evaluate the feasibility of prescribing laughter to inform a larger randomised controlled trial. Secondary objectives are to assess if a two-week laughter prescription improves subjective and objective sleep outcomes, wellbeing, and/or psychological health outcomes.

Trial design

To assess the feasibility of a randomised controlled trial for laughter prescription in relation to sleep, psychological health, and wellbeing. Forty university students will be recruited and randomised to one of two conditions (control/experimental).

Methods

Wrist actigraphy and sleep diaries will be used to estimate sleep outcomes during a one-week baseline testing phase and across the two-week intervention. The experimental group will be shown how to record a Laughie (a 1-min recording of their joyful laughter on their smartphone) and prescribed to laugh with it three times daily for 14 days (the control group will only track sleep). All participants will complete the WHO (Five) Well-being Index, and Hospital Anxiety and Depression Scale pre- and post-intervention. The CONSORT checklist, and the Feasibility, Reach-out, Acceptability, Maintenance, Efficacy, Implementation, and Tailorabilty (FRAME-IT) framework will guide intervention planning and evaluation. Participant interviews will be analysed using Differential Qualitative Analysis (DQA).

Results

The feasibility of a two-week laughter prescription in university students and its impact on sleep, wellbeing, and/or psychological health outcomes will be assessed.

Conclusions

Zayed University Research Ethics Committee approved the study in July 2019. The research will be completed following protocol publication.

Trial registration

ClinicalTrials.gov. ID: NCT04171245. Date of registration: 18 October 2019.

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First study to explore the feasibility of a laughter only prescription for university students.

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First assessment of the impact of laughter on psychological health and objective sleep outcomes.

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A combination of wrist actigraphy and the Laughie enables clear measurements of sleep and laughter.

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Provision of a detailed description of the Laughie and how to use it and prescribe it.

Can Physical Activity in Immersive Virtual Reality Be Attractive and Have Sufficient Intensity to Meet Health Recommendations for Obese Children? A Pilot Study

Immersive virtual reality (IVR) is a technology that blurs the line between the physical world and a digital environment. Using appropriate pointing devices, it is possible to engage in physical activity (PA). The main aim of the study was to assess the attractiveness and intensity of physical exercise while playing active video games (AVGs) in IVR on an omnidirectional treadmill by obese children and to present the results compared to health recommendations (PA). It was also assessed whether the AVGs storyline can effectively motivate the participants to undertake locomotor activity by increasing the intensity of their effort (moving in a limited space vs. having to follow a set route). Eleven children aged 8 to 12 years with diagnosed obesity participated in the experiment. The attractiveness of PA was assessed with a questionnaire, while the intensity of exercise was estimated on the basis of heart rate. The answers show that AVGs are attractive and more enjoyable for the respondents than conventional video games. All participants declared their willingness to practice this form of PA. The intensity of PA of obese children during two games was high but during the game where the player was supposed to follow a set route, it was significantly higher (83.3 ± 9.2% HRmax) than during the game whose storyline assumed moving in a limited space (77.4 ± 9.8% HRmax). Due to the high intensity of PA while playing the AVGs studied, it can be assumed that obese children can benefit for their health if the games are used on a regular basis. However, further research is needed to verify this thesis.

Associations of adolescents' lifestyle habits with their daytime functioning in Japan

OBJECTIVE

To assess associations of adolescents' lifestyle habits with their daytime functioning in Japan.

METHODS

A total of 2,722 questionnaires obtained from pupils in grades 5 to 12 in Japan were assessed by the multiple comparison test to determine significant differences in the lifestyle habits among the self-reported academic performance categories (AP1: very good; AP2: good; AP3: not good; AP4: poor).

RESULTS

The average non-school-day screen time of AP4 pupils was significantly longer than that of AP1 pupils in elementary and junior high schools. In junior and senior high schools, AP4 pupils showed more sleepiness and higher occurrence of breakfast skipping than AP2 pupils. In all school types, sleep duration showed no significant differences among the self-reported academic performance categories.

DISCUSSION

Avoiding sleepiness, breakfast skipping, and heavy media usage is expected to ensure adolescents' daytime functioning. Although not studied here, napping might improve adolescents' daytime functioning.

Sleep problems and their association with weight and waist gain - The Brazilian Longitudinal Study of Adult Health (ELSA-Brasil)

OBJECTIVE

To evaluate the association of sleep problems with weight and waist size gain during four years of follow-up.

METHODS

We investigated 13,030 participants (35-74 years) of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil), a multicentric cohort conducted with civil servants from six academic institutions recruited between 2008 and 2010. Sleep problems were assessed at baseline by the Clinical Interview Schedule - Revised (CIS-R), designed to detect common mental disorders based on somatic, depressive and anxiety symptoms. Weight and waist size were measured at baseline and at follow-up (2012-2014). Large weight and waist size gain were defined as ≥ 90th percentile (≥1.65 kg/year and ≥2.41 cm/year, respectively).

RESULTS

Sleep problems were associated with higher risk of a large weight gain (RR = 1.11; 95% CI 1.01-1.24) and large waist size gain (RR = 1.19; 95% CI 1.07-1.32), adjusted for age, sex, ethnicity, income, educational level, investigation center, smoking, alcohol intake, dietary energy intake, leisure-time physical activity and body mass index (BMI) or waist circumference at baseline. After additional adjustment for common mental disorders the associations became non-significant (RR = 0.99; 95% CI 0.88-1.12; RR = 1.08; 95% CI 0.97-1.22, respectively).

CONCLUSION

Sleep problems are associated with increased risk of developing large weight and waist size gain, but are not independently associated with common mental disorders.

Video Games, Obesity, and Children

PURPOSE OF REVIEW

To examine associations between video game play and obesity in children.

RECENT FINDINGS

Based on a scoping review of 26 studies (25 cross-sectional; 1 longitudinal) published in 2013-2018, 14 studies (53%) reported no association between video game play and obesity, and 12 studies reported positive associations. In a review of 8 systematic reviews, there was preliminary evidence on the effectiveness of exergame (physically active) play for weight reduction and to attenuate weight gain but little indication that interventions effectively reduced video game play or general screen time. This review found ambiguous evidence on the extent to which video game play is or is not significantly associated with obesity in children and preliminary evidence of exergame play as a tool for weight reduction and attenuation of weight gain. Several gaps existed in understanding the relationship between video game play and obesity, and prospective and interventional trials are needed.

Insomnia, excessive daytime sleepiness, anxiety, depression and socioeconomic status among customer service employees in Canada

OBJECTIVE

It is the first study investigating deeply symptoms of neuropsychiatric diseases among a large population of customer service employees (n=1238, 640 females and 598 males). The study's goals were document presence of sleep disorders, anxiety and depression among customer service advisors and determine the influence of the socioeconomic status (pSES), duration in position and full-time or part-time shift on the diseases above.

METHODS

Linear regressions and ANOVA with a Tukey multiple comparisons of means was performed to analyze correlation and differences between citizens, international students and immigrants in their pSES and neuropsychiatric diseases.

RESULTS

Customer service employees (578 Canadians, 264 immigrants and 358 international students) are in majority undergraduate students (286 men and 289 females) with a high school degree (280 men and 308 women). They work full-time (560 men and 548 women) and are single (420 men and 560 women). Among customer service advisors, the time spent as an advisor was an excellent predictor of insomnia, sleepiness and anxiety (respectively with R2=91,83%, R2=81,23% and R2=87,46%) but a moderate predictor of depression (R2=69,14%). The pSES was a moderate predictor of sleep disorders (respectively R2=62,04% for insomnia and R2=53,62% for sleepiness) and strongly associated with anxiety and depression (R2=82,95% for anxiety and R2=89,77% for depression).

DISCUSSION

Insomnia, sleepiness and anxiety are more prevalent for full-time employees (higher for immigrants and international students compared to Canadians) compared with part-time employees, while depression was similarly higher for Canadian and immigrants compared to international students. Regarding full-time employees, symptoms of insomnia, anxiety and depression were higher for men compared to women. Regarding part-time employees, symptoms of insomnia and sleepiness were higher for women compared to men. Employees working full-time with rotating shifts are more exposed to insomnia, sleepiness and anxiety than employees working part-time. More research is needed to understand mental health of customer service employees regardless of their area and it is worthy of interest to study the link between sleep disorders and mood disorders with work conditions. Here some practical suggestions are made to reduce neuropsychiatric disorders for customer service employees or to at least mitigate the work burden on their brains.

Sleep, Diet, and Cardiometabolic Health Investigations: a Systematic Review of Analytic Strategies

PURPOSE OF REVIEW

Poor sleep is a risk factor for cardiometabolic morbidity. The relationship of sleep and cardiometabolic health could be confounded, mediated, or modified by diet, yet the incorporation of diet in sleep-cardiometabolic health studies is inconsistent. This rapid systematic literature review evaluates the conceptualization of diet as a confounder, mediator, or effect modifier within sleep-cardiometabolic health investigations, and the statistical approaches utilized.

RECENT FINDINGS

Of 4692 studies identified, 60 were retained (28 adult, 32 pediatric). Most studies included diet patterns, quality, or energy intake as confounders, while a few examined these dietary variables as mediators or effect modifiers. There was some evidence, mostly in pediatric studies, that inclusion of diet altered sleep-cardiometabolic health associations. Diet plays a diverse role within sleep-cardiometabolic health associations. Investigators should carefully consider the conceptualization of diet variables in these relationships and utilize contemporary statistical approaches when applicable.

The relationship between adherence to a Dietary Approach to Stop Hypertension (DASH) dietary pattern and insomnia

BACKGROUND

Adherence to a DASH- style diet has been reported to be associated with several health-related outcomes. A limited number of reports suggest that diet is an important behavioral determinant of insomnia. The current study aimed to explore the relationship between adherence to a DASH diet and the prevalence of insomnia in adolescent girls.

METHODS

A total of 488 adolescent girls aged 12-18 years old were recruited from different regions of Khorasan Razavi in northeastern of Iran, using a random cluster sampling method. DASH scores were determined according to the method of Fung et al. A validated Iranian version of the Insomnia Severity Index questionnaire was used to assess sleep insomnia. To assess the association between the DASH dietary pattern and insomnia, we applied logistic regression analysis in crude and adjusted models.

RESULTS

As may be expected, participants in the upper quintile of the DASH diet had significantly higher intakes of fruits, vegetables, low fat dairy products, fish and nuts and lower consumption of refined grains, red and processed meat, sugar-sweetened beverages and sweets. We found that a high adherence to a DASH-style diet was associated with a lower odds of insomnia (OR: 0.51; 95% CI 0.26-1.00) compared with those with lowest adherence. Similar results were found after adjustment for potential confounders.

CONCLUSIONS

There is an inverse association between adherence to DASH dietary patterns and insomnia. Further prospective studies are required to demonstrate these findings.

The Prospective Association Between Electronic Device Use Before Bedtime and Academic Attainment in Adolescents

PURPOSE

To examine longitudinal associations between five commonly used technology devices prior to bedtime and real-life academic outcomes in adolescents.

METHODS

A total of 853 adolescents were recruited to a three-year prospective cohort study, with annual assessments. Academic grades/levels for three core subjects (English, Mathematics, and Science) were extracted from school records, and standardized (z-scores) were derived at the end of each academic year. A validated questionnaire was used to determine the frequency of using five types of technology (television viewing, video gaming, mobile telephone use, listening to music, and social networking) before bedtime.

RESULTS

After adjustment, English attainment was the subject most affected by prebedtime technology use, where three of five technologies assessed were negatively and prospectively associated (social networking [β = -.07 and p = .024], video gaming [β = -.10 and p = .008], and mobile telephone [β = -.07 and p=.017]). Social networking (β = -.07and p = .042), television viewing (β = -.08 and p = .044), and mobile telephones (β = -.07 and p = .031) were associated with significant impairment in English for girls whereas attainment in boys was most impaired by video gaming (β = -.12 and p = .014).

CONCLUSIONS

The use of electronic devices by adolescents before bedtime may reduce their academic attainment, but apart from video gaming for boys, the negative impact of near bedtime technology use on academic performance is small.

The association between obesity and academic performance in youth: a systematic review

Previous studies have found that obesity could influence academic performance. The aim of this study was to systematically review the scientific evidence on the association between obesity and academic performance in school children. A systematic review of English articles was undertaken by using databases PubMed/Medline, ERIC, LILACS, SciELO and Web of Science. Cross-sectional and longitudinal studies examining the association between obesity and academic performance in children and adolescents, published between January 1990 and December 2016, were included. Risk of bias was assessed by using Strengthening the Reporting of Observational Studies in Epidemiology. Thirty-four studies (23 cross-sectional and 11 longitudinal) matched all inclusion criteria and were included. Seven studies were classified as low risk of bias, 23 as medium risk and four as high risk. After controlling for covariates such as socio-economic status, parental education and physical activity, the association between obesity and academic performance becomes uncertain for most of the studies (55.9%). Therefore, at present, there is insufficient evidence to support a direct link between obesity and poor academic performance in school age children. In order to clarify this issue, we need more longitudinal studies with adequate sample sizes and that control for potential confounders.

Cardiorespiratory Fitness and Muscular Strength as Mediators of the Influence of Fatness on Academic Achievement

OBJECTIVE

To examine the combined association of fatness and physical fitness components (cardiorespiratory fitness [CRF] and muscular strength) with academic achievement, and to determine whether CRF and muscular strength are mediators of the association between fatness and academic achievement in a nationally representative sample of adolescents from Chile.

STUDY DESIGN

Data were obtained for a sample of 36 870 adolescents (mean age, 13.8 years; 55.2% boys) from the Chilean System for the Assessment of Educational Quality test for eighth grade in 2011, 2013, and 2014. Physical fitness tests included CRF (20-m shuttle run) and muscular strength (standing long jump). Weight, height, and waist circumference were assessed, and body mass index and waist circumference-to-height ratio were calculated. Academic achievement in language and mathematics was assessed using standardized tests. The PROCESS script developed by Hayes was used for mediation analysis.

RESULTS

Compared with unfit and high-fatness adolescents, fit and low-fatness adolescents had significantly higher odds for attaining high academic achievement in language and mathematics. However, in language, unfit and low-fatness adolescents did not have significantly higher odds for obtaining high academic achievement. Those with high fatness had higher academic achievement (both language and mathematics) if they were fit. Linear regression models suggest a partial or full mediation of physical fitness in the association of fatness variables with academic achievement.

CONCLUSIONS

CRF and muscular strength may attenuate or even counteract the adverse influence of fatness on academic achievement in adolescents.

The use of entertainment and communication technologies before sleep could affect sleep and weight status: a population-based study among children

Background

Short sleep duration and poor sleep quality have been demonstrated to be associated with childhood obesity. It has been suggested that electronic entertainment and communication devices (EECDs) including TVs, computers, tablets, video games and cell phones interfere with sleep in children and youth. The aim of this study was to assess the impact that the use of EECDs in the hour before bedtime has on sleep and weight status to inform sleep promotion interventions and programs to prevent childhood obesity.

Methods

A provincially representative sample of 2334 grade 5 children and their parents in Alberta, Canada was surveyed. Parents reported their child’s bedtime and wake-up time along with how often their child snored, felt sleepy during the day, woke-up at night and woke-up in the morning feeling unrefreshed. Sleep duration, sleep quality and sleep efficiency were derived from these indicators. Parents also reported on the presence of EECDs in their child’s bedroom, while children reported use of EECDs during the day and frequency of using each of these devices during the hour before sleep. The height and weight of children were measured. Multivariable mixed effect linear and logistic regression models were used to determine how sleep duration, sleep quality, sleep efficiency and weight status are influenced by (i) access to EECDs in children’s bedrooms, (ii) use of EECDs during the hour before sleep, and (iii) calming activities specifically reading during the hour before sleep.

Results

Sleep duration was shorter by −10.8 min (cell phone), −10.2 min (computer) and −7.8 min (TV) for those with bedroom access to and used these EECDs during the hour before sleep compared to no access and no use. Good sleep quality was hindered by bedroom access to and use of all EECDs investigated during the hour before sleep, particularly among users of cell phones (OR = 0.64, 95% CI: 0.58–0.71) and computers (OR = 0.72, 95% CI: 0.65–0.80). Very good sleep efficiency was decreased by access to and frequent use of a TV (54%), cell phone (52%), tablet (51%) and video games (51%). Odds of obesity were doubled by bedroom access to and use of a TV and computer during the hour before sleep. Children who rarely read a printed book in the bedroom during the hour before sleep had a shorter sleep duration and poorer sleep quality and sleep efficiency compared to their peers. Having access to an EECD in the bedroom was associated with increased obesity despite frequently reading during the hour before sleep.

Conclusions

Our findings suggest that sleep duration, sleep quality, sleep efficiency and weight status are better among children who do not have EECDs in the bedroom and frequently read a book during the hour before sleep as opposed to those who use EECDs during this hour. Education of limits against EECD use by parents may improve sleep outcomes. These findings will inform health promotion messages and may give rise to national recommendations regarding EECD use.

Trial registration

ClinicalTrials.gov NCT01914185. Registered 31 July 2013 Retrospectively registered.

Family Environment and Childhood Obesity: A New Framework with Structural Equation Modeling

The main purpose of the current article is to introduce a framework of the complexity of childhood obesity based on the family environment. A conceptual model that quantifies the relationships and interactions among parental socioeconomic status, family food security level, child’s food intake and certain aspects of parental feeding behaviour is presented using the structural equation modeling (SEM) concept. Structural models are analysed in terms of the direct and indirect connections among latent and measurement variables that lead to the child weight indicator. To illustrate the accuracy, fit, reliability and validity of the introduced framework, real data collected from 630 families from Urumqi (Xinjiang, China) were considered. The framework includes two categories of data comprising the normal body mass index (BMI) range and obesity data. The comparison analysis between two models provides some evidence that in obesity modeling, obesity data must be extracted from the dataset and analysis must be done separately from the normal BMI range. This study may be helpful for researchers interested in childhood obesity modeling based on family environment.

Obesity, Cardiorespiratory Fitness, and Self-Reported Sleep Patterns in Chilean School-Aged Children

The aims were to examine the association of sleep patterns with being overweight or obese and to analyze the association of cardiorespiratory fitness (CRF) with sleep patterns in children. The study involved 395 schoolchildren (12-13 years old). Sleep patterns were assessed with the Sleep Self-Report (SSR) questionnaire, grouped into four subscales: sleep quality, sleep-related anxiety, bedtime refusal, and sleep routines. CRF was predicted by the 20-m shuttle-run test. Logistic regression models showed that sleep-related anxiety problems predicted being overweight or obese in both sexes, and sleep quality problems predicted being overweight or obese in girls. Also, girls who had better CRF levels were less susceptible to sleep-related anxiety problems. Studies are required to determine if increasing CRF could be a possible strategy for improving sleep quality.

The association between higher body mass index and poor school performance in high school students

BACKGROUND/OBJECTIVE

This study aimed to examine the association between body mass index (BMI) and school performance in high school students by controlling for relevant mediators such as sleep quality, sleep duration and socioeconomic status.

METHODS

Thirty-seven high school students (mean age: 18.16 ± 0.44 years) attending the same school type, i.e. 'liceo scientifico' (science-based high school), were enrolled. Students' self-reported weight and height were used to calculate BMI. Participants wore an actigraph to objectively assess the quality and duration of sleep. School performance was assessed through the actual grade obtained at the final school-leaving exam, in which higher grades indicate higher performance.

RESULTS

BMI, get-up time, mean motor activity, wake after sleep onset and number of awakenings were negatively correlated with the grade, while sleep efficiency was positively correlated. When performing a multiple regression analysis, BMI proved the only significant (negative) predictor of grade.

CONCLUSIONS

When controlling for sleep quality, sleep duration and socioeconomic status, a higher BMI is associated with a poorer school performance in high school students.

Internet addiction, sleep and health-related life quality among obese individuals: a comparison study of the growing problems in adolescent health

BACKGROUND

The rapid rise in the global prevalence of obesity suggests that environmental factors may be responsible. The increased use of technology is associated with increased rates of obesity due to declines in physical activity and significant sedentary life style. Internet addiction is also a growing health issue associated with diminished physical activity and poor sleep quality as well as various health problems. The purpose of this study was to determine associations between Internet addiction and adolescent obesity-related problems.

DESIGN AND METHODS

In this case-control study, 71 adolescents with obesity were recruited from the outpatient clinic at Tepecik Teaching Hospital and Katip Celebi University Hospital, Department of Pediatric Endocrinology in Izmir, Turkey. The control group consisted of 64 non-obese adolescents that were matched with patients in the study group by age and gender. All subjects completed socio-demographic forms, an Internet addiction scale, the Pediatric Quality of Life Inventory, the Pittsburgh Sleep Quality Index, and the Epworth Sleepiness Scale.

RESULTS

Adolescents with obesity were significantly more likely to have Internet addiction (p = 0.002), lower quality of life (p < 0.001), and higher daytime sleepiness (p = 0.008). Moreover, binary regression analysis showed that Internet addiction and less physical activity were associated with increased odds of obesity.

CONCLUSION

The results indicated a significant association between Internet addiction and obesity. Health practitioners should take possible Internet addiction, online activities, and physical activities into consideration in follow-up of obese adolescents. In addition to pharmacologic therapies and dietary interventions, providing behavioral therapy targeting healthy Internet use may be promising to reduce the effects of obesity in adolescence.

Sleep Quality Prediction From Wearable Data Using Deep Learning

Background

The importance of sleep is paramount to health. Insufficient sleep can reduce physical, emotional, and mental well-being and can lead to a multitude of health complications among people with chronic conditions. Physical activity and sleep are highly interrelated health behaviors. Our physical activity during the day (ie, awake time) influences our quality of sleep, and vice versa. The current popularity of wearables for tracking physical activity and sleep, including actigraphy devices, can foster the development of new advanced data analytics. This can help to develop new electronic health (eHealth) applications and provide more insights into sleep science.

Objective

The objective of this study was to evaluate the feasibility of predicting sleep quality (ie, poor or adequate sleep efficiency) given the physical activity wearable data during awake time. In this study, we focused on predicting good or poor sleep efficiency as an indicator of sleep quality.

Methods

Actigraphy sensors are wearable medical devices used to study sleep and physical activity patterns. The dataset used in our experiments contained the complete actigraphy data from a subset of 92 adolescents over 1 full week. Physical activity data during awake time was used to create predictive models for sleep quality, in particular, poor or good sleep efficiency. The physical activity data from sleep time was used for the evaluation. We compared the predictive performance of traditional logistic regression with more advanced deep learning methods: multilayer perceptron (MLP), convolutional neural network (CNN), simple Elman-type recurrent neural network (RNN), long short-term memory (LSTM-RNN), and a time-batched version of LSTM-RNN (TB-LSTM).

Results

Deep learning models were able to predict the quality of sleep (ie, poor or good sleep efficiency) based on wearable data from awake periods. More specifically, the deep learning methods performed better than traditional linear regression. CNN had the highest specificity and sensitivity, and an overall area under the receiver operating characteristic (ROC) curve (AUC) of 0.9449, which was 46% better as compared with traditional linear regression (0.6463).

Conclusions

Deep learning methods can predict the quality of sleep based on actigraphy data from awake periods. These predictive models can be an important tool for sleep research and to improve eHealth solutions for sleep.

Sleep quality and obesity in young subjects: a meta-analysis

OBJECTIVES

To assess the effect of poor sleep quality on Overweight/Obesity (Ow/Ob) in young subjects, and explore if this association is independent of sleep duration.

METHODS

Pubmed, EMBASE, and MEDLINE databases were searched for papers on sleep quality and overweight/obesity, focusing on children, adolescents, and young adults. Studies based on subjects with medical/psychological problems or published in languages other than English were excluded. Quality effects model was used to pool studies for meta-analysis.

RESULTS

Findings from the systematic review suggest a link between poor sleep quality and Ow/Ob in young subjects. Pooled estimate (from 26,553 subjects) suggest a role of inadequate sleep (including both short duration and poor quality) in Ow/Ob (OR: 1.27 95% CI: 1.05-1.53). Sub-group-analyses suggest considerably higher odds of Ow/Ob (OR = 1.46, 95% CI: 1.24-1.72) in young subjects with poor sleep quality (independent of duration).

CONCLUSIONS

Poor sleep quality seems to be associated with Ow/Ob, and some studies indicate this association to be independent of duration. Therefore, considering only sleep duration might not help in disentangling sleep-obesity association. However, this review is mostly composed of cross-sectional studies. Therefore, a causal link or the stability of the sleep quality and Ow/Ob association could not be established.

Daytime sleep duration and the development of childhood overweight: the KOALA Birth Cohort Study

Reduced nighttime sleep is a risk factor for childhood overweight, but the association between daytime sleep and overweight is unknown. The aim of this study is to evaluate daytime sleep duration as an independent risk factor for childhood overweight. Data from the KOALA Birth Cohort Study on daytime and nighttime sleep at 2 years (N = 2322), and body mass index (BMI) around 2, 5, 6, 7, 8 and 9 years were used. Multivariable general estimating equation regression analyses were performed to examine the associations of sleep duration with BMI (linear) and overweight (logistic). No associations between daytime sleep and BMI or overweight were found, whereas longer nighttime sleep was associated with lower BMI and lower risk of overweight persisting up to age 9. Daytime sleep duration is probably less relevant for prevention of childhood overweight.

Short Sleep Duration and Screen-Based Activities: A Longitudinal Multilevel Analysis

Objective. The aim of this study was to identify lifestyle habits that contribute to night sleep reduction in the Kuwaiti population. Methods. Children were 10 to 12 years old and were approximately equally distributed among 138 elementary schools representing the 6 governorates of Kuwait. In the first phase of the study, data were collected from 8317 children. The same data were collected 2 years later from 6316 of the children from the first phase of the study. Calibrated examiners conducted sleep evaluation, lifestyle habits interviews, and body weight measurements. A multilevel random intercept and slope model was conducted to determine the effect of screen-based activities on the daily night sleep hours at 3 levels: within schools, among children, and over time. The primary dependent variable was the number of daily sleep hours. Independent variables assessed were lifestyle habits including screen-based activity variables including TV and video game use. Results. Screen-based activities were significant factors that reduced daily sleep hours (P < .05). There were statistically significant variations between schools and children over time. Conclusion. Longitudinal analysis of Kuwaiti children revealed that TV and video game use were major risk behaviors contributing to decreased sleep duration with strong clustering effect of the observations within schools across time.

Is sleep education an effective tool for sleep improvement and minimizing metabolic disturbance and obesity in adolescents?

The prevalence of childhood obesity has increased significantly in recent years. Obesity is associated with a range of adverse physiological, psychological and social outcomes and places a huge economical burden on healthcare systems around the world. Insufficient sleep duration is common in adolescents and exacerbated by contemporary lifestyles, but may be a contributor to obesity onset and metabolic disruption. We briefly review the current evidence surrounding the associations between sleep and obesity as well as diabetes. Sleep improvement programs have been suggested as a potential avenue to raise awareness of the importance of sleep and ultimately enhance sleep behaviors/routines. A review of the current literature supporting the efficacy of such programs is tentative. Furthermore, very few studies have investigated if sleep enhancement has downstream positive effects on metabolic function or body weight in adolescents. We highlight biological and social factors that intensify sleep loss in adolescents and recommend that these be targeted components in future interventions aimed at improving adolescent sleep.

The Health Consequences of Obesity in Young Adulthood

Young adults are gaining weight faster than any age group. This weight gain and the appearance of obesity-related comorbidities often commence in adolescence. Psychosocial distress and mental health issues are common and debilitating, and treatment approaches are likely to be similar to those for adolescents. At the same time, young adults may have physical morbidities which will continue and worsen throughout adulthood, such as hypertension, diabetes and polycystic ovarian syndrome. Health consequences of obesity are challenging to manage in young adults as their symptoms may be minimal, they are less likely to engage with healthcare due to other life priorities and their neurocognitive developmental stage makes therapy adherence difficult. Clinicians who manage young adults with obesity need to be aware of these age-specific challenges, as well as the sexual and reproductive health concerns that are present in this age group.

Multiple lifestyle behaviours and overweight and obesity among children aged 9-11 years: results from the UK site of the International Study of Childhood Obesity, Lifestyle and the Environment

OBJECTIVES

The purpose of this study was to explore the independent associations between multiple lifestyle behaviours (physical activity, sleep, screen time (ST) and diet) and overweight and obesity in UK children. The second objective was to compare body mass index (BMI) z-score between children who meet health guidelines for each lifestyle behaviour and those who do not and to explore the impact of interactions between lifestyle behaviours on BMI z-score.

DESIGN, SETTING AND PARTICIPANTS

Cross-sectional study on children aged 9-11 years in the UK (n=374).

OUTCOME MEASURES

Participants were classified as overweight or obese using the WHO BMI cut-points. Moderate-to-vigorous intensity physical activity (MVPA) and sleep duration were measured using an ActiGraph GT3X+ accelerometer, whereas ST and dietary habits were assessed using questionnaires. Multilevel multiple logistic regression was employed to analyse associations between lifestyle behaviours and overweight/obesity. Participants were then categorised according to whether or not they met specific health criteria for MVPA, ST, sleep and diet. Multilevel multiple linear regression was used to compare these groupings on the outcome of BMI z-score and interactions were explored.

RESULTS

MVPA and longer sleep duration were associated with lower odds of overweight or obesity, whereas ST and a healthy diet score were associated with increased odds of overweight/obesity. No association was found for an unhealthy diet score. Meeting MVPA guidelines was significantly associated with a lower BMI z-score in all models, and significant two-way interactions were observed for physical activity and sleep, ST and sleep, and physical activity and diet.

CONCLUSIONS

MVPA, sleep and ST are important lifestyle behaviours associated with overweight/obesity among children. More research is required to confirm the role of diet on adiposity and such work would benefit from objective assessment. Overall, this work suggests that strategies aimed at improving compliance with health guidelines are needed.

TRIAL REGISTRATION NUMBER

NCT01722500.

Is Obesity Associated With School Dropout? Key Developmental and Ethnic Differences

BACKGROUND

We aimed to expand the literature on child obesity and school outcomes by examining associations between obesity and high school dropout, including the role of obesity onset and duration as well as ethnicity.

METHODS

Data on 5066 children obtained between 1986 and 2010 from the child cohort of the 1979 National Longitudinal Study of Youth (NLSY79) were analyzed. Group-based trajectory analysis identified obesity trajectories from 6 to 18 years. School completion information from age 14 into young adulthood was used to calculate school dropout. Chi-square and pairwise comparison tests were used to identify significant associations between obesity trajectories and school dropout.

RESULTS

Adolescents belonging to an increasing trajectory (adolescent-onset obesity) had a higher likelihood of dropping out of high school compared with those belonging to chronic, decreasing (childhood-only obesity), and nonobese trajectories. This association was particularly salient among white adolescents.

CONCLUSIONS

Obesity onset during early adolescence increased risk of high school dropout. White adolescents were particularly vulnerable. Given that early adolescence is marked by significant biological and social changes, future research should seek to identify the underlying processes linking adolescent obesity and school dropout to decrease school dropout risk among this vulnerable population.

Epidemiology of internet behaviors and addiction among adolescents in six Asian countries

Internet addiction has become a serious behavioral health problem in Asia. However, there are no up-to-date country comparisons. The Asian Adolescent Risk Behavior Survey (AARBS) screens and compares the prevalence of Internet behaviors and addiction in adolescents in six Asian countries. A total of 5,366 adolescents aged 12-18 years were recruited from six Asian countries: China, Hong Kong, Japan, South Korea, Malaysia, and the Philippines. Participants completed a structured questionnaire on their Internet use in the 2012-2013 school year. Internet addiction was assessed using the Internet Addiction Test (IAT) and the Revised Chen Internet Addiction Scale (CIAS-R). The variations in Internet behaviors and addiction across countries were examined. The overall prevalence of smartphone ownership is 62%, ranging from 41% in China to 84% in South Korea. Moreover, participation in online gaming ranges from 11% in China to 39% in Japan. Hong Kong has the highest number of adolescents reporting daily or above Internet use (68%). Internet addiction is highest in the Philippines, according to both the IAT (5%) and the CIAS-R (21%). Internet addictive behavior is common among adolescents in Asian countries. Problematic Internet use is prevalent and characterized by risky cyberbehaviors.

Media and technology use predicts ill-being among children, preteens and teenagers independent of the negative health impacts of exercise and eating habits

The American Academy of Pediatrics recommends no screen time for children under the age of 2 and limited screen time for all children. However, no such guidelines have been proposed for preteens and teenagers. Further, research shows that children, preteens, and teenagers are using massive amounts of media and those with more screen time have been shown to have increased obesity, reduced physical activity, and decreased health. This study examined the impact of technology on four areas of ill-being-psychological issues, behavior problems, attention problems and physical health-among children (aged 4-8), preteens (9-12), and teenagers (13-18) by having 1030 parents complete an online, anonymous survey about their own and their child's behaviors. Measures included daily technology use, daily food consumption, daily exercise, and health. Hypothesis 1, which posited that unhealthy eating would predict impaired ill-being, was partially supported, particularly for children and preteens. Hypothesis 2, which posited that reduced physical activity would predict diminished health levels, was partially supported for preteens and supported for teenagers. Hypothesis 3, that increased daily technology use would predict ill-being after factoring out eating habits and physical activity, was supported. For children and preteens, total media consumption predicted illbeing while for preteens specific technology uses, including video gaming and electronic communication, predicted ill-being. For teenagers, nearly every type of technological activity predicted poor health. Practical implications were discussed in terms of setting limits and boundaries on technology use and encouraging healthy eating and physical activity at home and at school.

Daytime sleepiness, poor sleep quality, eveningness chronotype, and common mental disorders among Chilean college students

OBJECTIVES

To evaluate whether daytime sleepiness, poor sleep quality, and morningness and eveningness preferences are associated with common mental disorders (CMDs) among college students.

METHODS

A total of 963 college students completed self-administered questionnaires that collected information about sociodemographic characteristics, sleep quality characteristics, CMDs, and other lifestyle behaviors.

RESULTS

The prevalence of CMDs was 24.3% (95% confidence interval [CI] [21.5%, 27.1%]) among all students. Prevalence estimates of both excessive daytime sleepiness and poor sleep quality were higher among females (35.4% and 54.4%) than males (22.0% and 45.8%). Cigarette smoking was statistically significantly and positively associated with having CMDs (p = .034). Excessive daytime sleepiness (odds ratio [OR] = 3.65; 95% CI [2.56, 4.91]) and poor sleep quality (OR = 4.76; 95% CI [3.11, 7.29]) were associated with increased odds of CMDs.

CONCLUSION

Given the adverse health consequences associated with both sleep disorders and CMDs, improving sleep hygiene among college students is imperative to public health.

Associations between specific technologies and adolescent sleep quantity, sleep quality, and parasomnias

OBJECTIVE

We tested the hypothesis that weekday bedtime use of six technologies would be significantly associated with eight sleep parameters studied relating to sleep quantity, sleep quality, and parasomnias.

METHODS

In our cross-sectional study, we previously administered validated age-appropriate questionnaires (School Sleep Habits Survey, Technology Use Questionnaire). Participating adolescents (n=738; 54.5% boys) were aged 11-13 years and were from the Midlands region of the United Kingdom in 2010.

RESULTS

Frequent use of all technology types was significantly inversely associated with weekday sleep duration (hours). Frequent music listeners and video gamers had significantly prolonged sleep onset (β=7.03 [standard error {SE}, 2.66]; P<.01 and β=6.17 [SE, 2.42]; P<.05, respectively). Frequent early awakening was significantly associated with frequent use of all technology types. The greatest effect was observed in frequent television viewers (odds ratio [OR], 4.05 [95% confidence interval {CI}, 2.06-7.98]). Difficulty falling asleep was significantly associated with frequent mobile telephone use, video gaming, and social networking, with music listeners demonstrating the greatest effect (OR, 2.85 [95%CI, 1.58-5.13]). Music listeners were at increased risk for frequent nightmares (OR, 2.02 [95% CI, 1.22-3.45]). Frequent use of all technologies except for music and mobile telephones was significantly associated with greater cognitive difficulty in shutting off. Frequent television viewers were almost four times more likely to report higher sleepwalking frequency (OR, 3.70 [95% CI, 1.89-7.27]).

CONCLUSIONS

Frequent weekday technology use at bedtime was associated with significant adverse effects on multiple sleep parameters. If confirmed in other samples and longitudinally, improving sleep hygiene through better management of technology could enhance the health and well-being of adolescent populations.

An investigation into the strength of the association and agreement levels between subjective and objective sleep duration in adolescents

Study Objectives

The majority of adolescent sleep research has utilized self-reported sleep duration and some have based information on a solitary question. Whilst some have claimed to have validated sleep survey data with objective actigraphy measures in adolescents, the statistical approach applied only demonstrates the strength of the association between subjective and objective sleep duration data and does not reflect if these different methods actually agree.

Methods

Data were collected as part of the Midlands Adolescents Schools Sleep Education Study (MASSES). Adolescents (n=225) aged 11-13 years provided estimates for weekday, weekend and combined sleep duration based on self-reported survey data, a 7-day sleep diary, and wrist-worn actigraphy.

Results

We assessed the strength of the relationship as well as agreement levels between subjective and objectively determined sleep duration (weekday, weekend and combined). Subjective diary sleep duration was significantly correlated with actigraphy estimates for weekday and weekend sleep duration r=0.30, p≤0.001 and r=0.31, p≤0.001 respectively. Pitman’s test demonstrated no significant difference in the variance between weekend sleep duration (r=0.09, p=0.16) and combined sleep duration (r=0.12, p=0.08) indicating acceptable agreement between actigraphy and sleep diary sleep duration only. Self-reported sleep duration estimates (weekday, weekend and combined) did not agree with actigraphy determined sleep duration.

Conclusions

Sleep diaries are a cost-effective alternative to survey/questionnaire data. Self-reported measures of sleep duration in adolescents do not agree with actigraphy measures and should be avoided where possible. Previous adolescent sleep studies that have utilized self-reported survey data may not provide a complete representation of sleep on the outcome measure of interest.