Examining the day-to-day bidirectional associations between physical activity, sedentary behavior, screen time, and sleep health during school days in adolescents

Factors Affecting Sleep Quality among University Medical and Nursing Students: A Study in Two Countries in the Mediterranean Region

Poor sleep quality, a global public health concern, poses a significant burden on individuals, particularly health care university students facing intense academic stress. A three-center cross-sectional study was conducted at the Higher Institute of Nursing and Health Sciences in Tetouan (Morocco), Faculty of Medicine in Tangier (Morocco) and Faculty of Nursing in Valencia (Spain). We collected various data using a sociodemographic questionnaire, the Pittsburgh sleep quality questionnaire, the international physical activity questionnaire (IPAQ) and the smartphone addiction questionnaire short-version (SAS-SV). A total of 1210 students were included in our study (mean age 20.4 years, 67.2% female, nursing students (66.2%) and medical students (33.8%), 76.1% students from Morocco and 33.9% from Spain). Analysis revealed a higher prevalence of poor sleep quality among Moroccans students compared to Spanish ones (p < 0.001), that nursing students showed less favorable sleep quality than medical students (p < 0.011) and that living with a chronic disease was linked to less favorable sleep quality (p < 0.001). Lastly, intense or weak physical activity and smartphone addiction were correlated with poor sleep quality (p < 0.001). In the multivariate analysis, an association persisted between poor sleep quality and factors such as the country of study (Odds ratio (OR): 6.25 [95% Confidence Interval (CI): 4.34-9.09]), involvement in nursing studies (OR: 3.50 [95% CI: 2.36-5.27]), and the presence of chronic diseases (OR: 2.70 [95% CI: 1.72-4.16]), (p < 0.01 each). Our findings highlight the multifaceted factors affecting sleep quality in young university students. The implications underscore the imperative of interventions tailored to this demographic group.

Clustering Health Behaviors in Mexican Adolescents: The HELENA-MEX Study

Purpose: The prevalence of excess weight within the adolescent population is rapidly increasing in Mexico, especially in areas with lower socioeconomic status. The present study aimed to identify lifestyle clustered patterns in adolescents and analyze the associations among these clusters and body composition. Method: A final sample of n=259 participants (13 to 17 years old, 58.7% girls), residents in rural and urban areas, were included. Hierarchical and k-means clusters analyses included moderate to vigorous physical activity (MVPA), cardiorespiratory fitness (CRF), handgrip strength, screen time, sleep time, and diet. The associations between cluster membership and body composition were analyzed through general linear models (ANCOVA), including sex, age, place of residence, and socioeconomic status as covariates. Results: Three different clusters were identified: Cluster 1, [Unhealthy] (low values in all lifestyle patterns), Cluster 2, [Low Physical Fitness] (low values in CRF and handgrip strength) and Cluster 3, [High Physical Activity and CRF] (highest values in CRF, handgrip strength and MVPA). Clusters 2 and 3 showed high values in screen time and industrialized food consumption. There were no differences in sleep between the 3 Clusters. ANCOVA analysis revealed that participants belonging to Cluster 3 showed significantly lower adiposity and a higher Fat Free Mass compared with the other two clusters (p < 0.05). Conclusion: Our findings suggest that a lifestyle characterized by high levels of physical activity and physical fitness and low consumption of industrialized food may be protective against the problem of obesity, which could be helpful to develop interventions to reduce excess weight in Mexican adolescents.

Day-to-day directional relationships between sleep duration and negative affect

OBJECTIVE

There is a strong association between sleep disturbance and negative affect. However, the day-to-day directional connections between sleep and negative affect remain unclear. We examined day-to-day relationships between sleep duration and negative affect in community adults.

METHODS

Participants were two subsamples of the Midlife in the United States Study (Sample 1: n = 2,022; Sample 2: n = 782). Daily negative affect and previous night sleep duration were assessed via end-of-day telephone interviews for eight days. Random intercept cross-lagged panel models tested sleep duration as a predictor of next-day negative affect and vice versa, controlling for age, gender, and race.

RESULTS

In both samples, shorter sleep duration predicted higher next-day negative affect, but daily negative affect was not a significant predictor of upcoming-night sleep duration. Follow-up analyses indicated that the relationship between sleep duration and negative affect was nonlinear. Sleeping fewer than 7.5 hours or more than 10.5 hours was associated with greater next-day negative affect than sleeping between 7.5 and 10.5 hours.

CONCLUSIONS

In two large samples of community adults, sleep duration unidirectionally predicted higher next-day negative affect, and this relationship was nonlinear. Sleeping at least 7.5 hours and no more than 10.5 hours appeared to be an optimal range associated with lowest next-day negative affect.

Electronic device and social network use and sleep outcomes among adolescents: the EHDLA study

BACKGROUND

Considering the evident risk in the literature between the use of screen devices and sleep, there are still few studies on the relationship between each electronic screen device, media programs and sleep duration and sleep-related problems among adolescents and which variables interfere in these relationships. Therefore, this study has the following objectives: (1) to determine which are the most common electronic display devices related to sleep time and outcomes and (2) to determine which are the most common social network applications, such as Instagram and WhatsApp, associated with sleep outcomes.

METHODS

This was a cross-sectional study with 1101 Spanish adolescents between 12 and 17 years old. Age, sex, sleep, psychosocial health, adherence to the Mediterranean diet (MD), sport practice, and time spent on screen devices were assessed by an ad hoc questionnaire. Linear regression analyses were applied, adjusting for several covariables. Poisson regression was applied between the sexes. A p value < 0.05 was considered statistically significant.

RESULTS

Cell phone use was more associated with sleep time (13%). In boys, time spent on cell phones (prevalence ratio [PR] = 1.09; p < 0.001) and videogames (PR = 1.08; p = 0.005) had a higher prevalence ratio. When psychosocial health was included in the models, we found the greatest association (Model 2: PR = 1.15; p = 0.007). For girls, time spent on the cell phone was significantly associated with sleep-related problems (PR = 1.12; p < 0.001), and adherence to the MD became the second most important in the model (PR = 1.35; p < 0.001), followed by psychosocial health and cell phone use (PR = 1.24; p = 0.007). Time spent on WhatsApp was associated with sleep-related problems only among girls (PR = 1.31; p = 0.001) and was the most important variable in the model along with MD (PR = 1.26; p = 0.005) and psychosocial health (PR = 1.41; p < 0.001).

CONCLUSIONS

Our results suggest a relationship between cell phones, video games, and social networks with sleep-related problems and time.

Bidirectional associations of sleep and discretionary screen time in adults: Longitudinal analysis of the UK biobank

The direction of the association between discretionary screen time (DST) and sleep in the adult population is largely unknown. We examined the bidirectional associations of DST and sleep patterns in a longitudinal sample of adults in the general population. A total of 31,361 UK Biobank study participants (52% female, 56.1 ± 7.5 years) had two repeated measurements of discretionary screen time (TV viewing and leisure-time computer use) and self-reported sleep patterns (five sleep health characteristics) between 2012 and 2018 (follow-up period of 6.9 ± 2.2 years). We categorised daily DST into three groups (low, <3 h/day; medium, 3-4 h/day; and high, >4 h/day), and calculated a sleep pattern composite score comprising morning chronotype, adequate sleep duration (7-8 h/day), never or rare insomnia, never or rare snoring, and infrequent daytime sleepiness. The overall sleep pattern was categorised into three groups (healthy: ≥ 4; intermediate: 2-3; and poor: ≤ 1 healthy sleep characteristic). Multiple logistic regression analyses were applied to assess associations between DST and sleep with adjustments for potential confounders. Participants with either an intermediate (OR: 1.40; 95% CI: 1.15, 1.71) or a poor (OR: 1.16; 95% CI: 1.10, 1.24) sleep pattern at baseline showed higher odds for high DST at follow-up, compared with those with a healthy baseline sleep pattern. Participants with medium (OR: 1.40; 95% CI: 1.14, 1.71) or high DST (OR: 1.62; 95% CI: 1.30, 2.00) at baseline showed higher odds for poor sleep at follow-up, compared with participants with a low DST. In conclusion, our findings provide consistent evidence that a high DST at baseline is associated with poor sleep over a nearly 7 year follow-up period, and vice versa.

The bidirectional relationship between sleep and externalizing behavior: A systematic review

It is well-established that sleep and behavior are interrelated. Although studies have investigated this association, not many have evaluated the bidirectional relationship between the two. To our knowledge this is the first systematic review providing a comprehensive analysis of a reciprocal relationship between sleep and externalizing behavior. Five databases (PsycINFO, PubMed, Web of Science, Scopus, and Google Scholar) were utilized to yield a total of 3,762 studies of which 20 eligible studies, empirical articles examining bidirectionality of sleep and externalizing behavior, were selected for analysis. According to the guidelines of the Preferred Reporting Items for Systematic Review and Meta-Analysis, the varying methodological approaches used in these studies were analyzed and synthesized, including examining differences and similarities in outcomes between distinct study designs (longitudinal vs cross-sectional), sleep measures (objective vs subjective vs a combination of both), informants (parents, self-report, teachers), and recruited participants (clinical, subclinical and typical populations). The assessment of risk of bias and quality of studies was guided by the instruments employed in research on sleep and behavior in the past. This review establishes that a bidirectional relationship between sleep problems and externalizing behavior clearly exists, and identifies limitations in the existing literature. Furthermore, the importance of early interventions that target both externalizing behaviors and sleep problems is highlighted as a potentially effective way of breaking the sleep-externalizing behavior relationship. Nonetheless, causality cannot be claimed until more trials that manipulate sleep and evaluate changes in externalizing behavior are conducted.

Self-reported changes in sleep patterns and behavior in children and adolescents during COVID-19

The COVID-19 pandemic and lockdowns worldwide forced children and adolescents to change and adapt their lives to an unprecedented situation. Using an online survey, we investigated whether they showed changes in sleep quality and other related factors due to this event. Between February 21st, 2021 and April 19th, 2021, a total of 2,290 Austrian children and adolescents (6-18 years) reported their sleep habits and quality of sleep as well as physical activity, daylight exposure and usage of media devices during and, retrospectively, before the pandemic. Results showed an overall delay of sleep and wake times. Almost twice as many respondents reported having sleeping problems during the pandemic as compared to before, with insomnia, nightmares and daytime sleepiness being the most prevalent problems. Furthermore, sleeping problems and poor quality of sleep correlated positively with COVID-19 related anxiety. Lastly, results showed a change from regular to irregular bedtimes during COVID-19, higher napping rates, a strong to very strong decrease in physical activity and daylight exposure, as well as a high to very high increase in media consumption. We conclude that the increase in sleeping problems in children and adolescent during COVID-19 is concerning. Thus, health promoting measures and programs should be implemented and enforced.

Bidirectional associations between physical activity and sleep in older adults: a multilevel analysis using polysomnography

Although recent studies have examined the bidirectional associations between physical activity and sleep parameters, few have focused on older adults utilizing objective assessments, such as polysomnography. This micro-longitudinal observational study included 92 Japanese older adults (aged 65–86 years) who underwent objective evaluations of sleep quality using polysomnography and completed subjective sleep-related questionnaires. Activity levels were assessed using an accelerometer. Polysomnography, subjective sleep-related questionnaires, and accelerometer were administered for 7 consecutive days. Multilevel models (participant-, day-level) were used to examine the temporal associations of objective and subjective sleep parameters with sedentary behavior and physical activity. In the day-level analysis, higher levels of sedentary behavior during daytime were associated with longer rapid eye movement (REM) sleep, shorter REM latency, lower levels of non-REM sleep (stage N3), and reduced delta power during daytime. Higher levels of low-intensity physical activity during daytime were associated with lower levels of REM sleep, longer REM latency, and increased stage N3 sleep in the day-level analysis. Higher levels of moderate-to-vigorous physical activity were associated with increased REM latency. Longer subjective sleep time was associated with increased next-day moderate-to-vigorous physical activity. Thus, low-intensity physical activity may provide objective benefits related to deep sleep parameters in older adults.

Endogenous circadian temperature rhythms relate to adolescents’ daytime physical activity

Circadian rhythms relate to multiple aspects of health and wellbeing, including physical activity patterns. Susceptible circadian regulation predisposes to circadian misalignment, poor sleep, sleep deprivation, increased sleepiness, and thereby sedentary behavior. Adolescents’ circadian regulation is particularly vulnerable, and may lead to sedentary behavior. To investigate which factors associate strongest between physical activity (PA) and circadian behavior, we conducted multimodal circadian rhythm analyses. We investigate how individual characteristics of habitual circadian patterns associate with objectively measured PA. We studied 312 adolescents [70% females) (56% with delayed sleep phase (DSP)], mean age 16.9 years. Circadian period length, temperature mesor (estimated 24 h midline) and amplitude (difference between mesor and peak) were measured using distally attached thermologgers (ibutton 1922L, 3-day-measurement). We additionally utilized algorithm-formed clusters of circadian rhythmicity. Sleep duration, timing, DSP, and PA were measured using actigraphs (GeneActiv Original, 10-day-measurement). We found that continuous circadian period length was not associated with PA, but lower mesor and higher amplitude were consistently associated with higher levels of PA as indicated by mean Metabolic Equivalent (METmean) and moderate-to-vigorous PA (MVPA), even when controlling for sleep duration. Separate circadian clusters formed by an algorithm also reflected distinct patterns of PA accordingly. Late sleepers and those with DSP were less likely to engage in MVPA compared to non-DSP and had more sedentary behavior. Adolescents who engage in higher levels or high-intensity PA have better circadian regulation, as measured by different objective methods including distal temperature measurements as well as actigraphy-measured sleep-wake behavior.

Physical Exercise and Undergraduate Students’ Subjective Well-Being: Mediating Roles of Basic Psychological Need Satisfaction and Sleep Quality

This study aimed to examine the association between physical exercise and subjective well-being among undergraduate students, as well as its underlying mechanism—the potential mediating roles of basic psychological need satisfaction and sleep quality—from the perspective of self-determination theory. A sample of 770 undergraduate students (mean age was 19.90 ± 1.15 years old; 464 women) were recruited voluntarily to complete a set of measures examining physical exercise habits, psychological need satisfaction in exercise, sleep quality, and subjective well-being. The results indicated that (1) physical exercise was positively associated with undergraduate students’ subjective well-being; (2) psychological need satisfaction and sleep quality could significantly mediate this relation, which contained three pathways—the independent mediating effects of sleep quality and basic psychological need satisfaction and the sequential mediating effect of them. These findings not only reveal the mediating mechanism underlying the relation between physical exercise and subjective well-being by integrating the psychological and physical factors together but also provide an empirical basis for formulating prevention and intervention programs aimed at promoting the health and subjective well-being of undergraduate students.

Association between Recreational Screen Time and Sleep Quality among Adolescents during the Third Wave of the COVID-19 Pandemic in Canada

The study objective was to verify whether recreational screen time was associated with sleep quality among adolescents during the third wave of the COVID-19 pandemic in Canada. Data collection took place in four high schools in the region of Chaudière-Appalaches (Quebec, Canada) from the end of April to mid-May 2021. Recreational screen time and sleep quality were measured using the French versions of validated questionnaires specifically designed for adolescents. A total of 258 adolescents (14−18 years; 66.3% girls) answered the online survey. Adolescent boys had a higher total mean recreational screen time (454.3 ± 197.5 vs. 300.5 ± 129.3 min/day, p < 0.0001) and a higher total mean sleep quality score (4.2 ± 0.9 vs. 3.9 ± 0.8, p = 0.0364) compared to girls. Recreational screen time (β = −0.0012, p = 0.0005) and frequency of concurrent screen use (sometimes: β = −0.3141, p = 0.0269; often: β = −0.4147, p = 0.0048; almost always or always: β = −0.6155, p = 0.0002) were negatively associated with sleep quality while being a boy (β = 0.4276, p = 0.0004) was positively associated with sleep quality and age (p = 0.6321) was not. This model explained 16% of the variance in adolescents’ sleep quality. Public health interventions during and after the COVID-19 pandemic should target recreational screen time, concurrent screen use and especially girls to possibly improve sleep quality and promote adolescents’ physical and mental health.

Temporal relationships between device-derived sedentary behavior, physical activity, and sleep in early childhood

STUDY OBJECTIVES

Understanding the ideal composition of a child's day requires a better understanding of the relations between wake behaviors (sedentary behavior [SB], physical activity [PA]) and sleep. Here, we examine between- and within-person temporal associations between daytime wake behaviors and overnight sleep in early childhood, an important age when healthy behaviors are initiated and 24-hour behaviors are largely determined by caregivers.

METHODS

Daily, repeated measures of wake behavior and overnight sleep were assessed via wrist-worn actigraphy (mean = 9 days/nights) in 240 children (50.8 ± 9.8 months). Multilevel models with lagged effects were used to examine the temporal associations between wake and overnight sleep measures and adjusted for daily nap duration, age, sex, and socioeconomic status.

RESULTS

Between-person associations for sleep outcomes were negative between moderate-to vigorous-intensity PA (MVPA) and total activity for sleep efficiency (SE). Between-person associations for wake outcomes were positive between sleep duration and light PA, and negative between SE and both MVPA and total PA. When children obtained higher SE relative to their individual average, they were more likely to engage in less SB and greater MVPA and total PA the next day.

CONCLUSIONS

Generally, days with greater activity or sleep were not associated with greater subsequent sleep or PA. Most subsequent behaviors were not influenced by children achieving higher activity or sleep relative to their individual average levels, although higher SE was beneficially associated with next day wake behaviors. Future analyses with young children should consider within-person associations and could investigate lagged effects beyond one day.

Anthropometric Measurements, Sociodemographics, and Lifestyle Behaviors among Saudi Adolescents Living in Riyadh Relative to Sex and Activity Energy Expenditure: Findings from the Arab Teens Lifestyle Study 2 (ATLS-2)

The aim of the study was to examine the anthropometric measurements, sociodemographics, and lifestyle behaviors among Saudi adolescents relative to sex and physical activity (PA). A random cross-sectional survey conducted on Saudi adolescents from secondary schools in Riyadh, using a multistage stratified cluster sampling technique. Measurements included demographics, weight, height, waist circumference, PA, sedentary behaviors (SB), sleep duration, and dietary habits using a validated questionnaire. A total of 1262 adolescents (16.4 ± 0.95 years; 52.4% males) were studied. Overweight/obesity was more than 40%. Physical inactivity among adolescents was 53%, which indicates some improvement over the past years, especially among females. More than 80% of adolescents had over three hours/day of screen time, with no significant sex differences. Insufficient sleep was highly prevalent with gender differences. A large proportion of the participants did not consume daily breakfast (65.7%), vegetables (73.2%), fruits (84.2%), or milk/dairy products (62.4%), whereas significant proportions of the adolescents consumed sugar-sweetened drinks, fast food, French fries/potato chips, cake/donuts, and chocolates/candy on at least three days or more per week. It was concluded that non-daily intake of breakfast and vegetables was significantly associated with lower PA. The updated information can aid in effectively planning and implementing promotional programs toward improving the lifestyle behaviors of Saudi adolescent.

Bidirectional associations between sedentary time and sleep duration among 12- to 14-year-old adolescents

Background

The aim of this study was to investigate bidirectional associations between (prolonged) sitting time and sleep duration in 12- to 14-year-old adolescents using a between-subjects and within-subjects analyses approach.

Methods

Observational data were used from 108 adolescents (53% girls; mean age 12.9 (SD 0.7) years) from six schools in Flanders, Belgium. The Axivity AX3 triaxial accelerometer, worn on the thigh, was used to assess daily total sitting time and daily time spent in sedentary bouts of ≥30 min (as a proxy for prolonged sitting time). The Fitbit Charge 3 was used to assess nightly sleep duration. Both monitors were worn on schooldays only (ranging from 4 to 5 days). Linear mixed models were conducted to analyse the associations, resulting in four models. In each model, the independent variable (sleep duration, sitting time or prolonged sitting time) was included as within- as well as between-subjects factor.

Results

Within-subjects analyses showed that when the adolescents sat more and when the adolescents spent more time sitting in bouts of ≥30 min than they usually did on a given day, they slept less during the following night (p = 0.01 and p = 0.05 (borderline significant), respectively). These associations were not significant in the other direction. Between-subjects analyses showed that adolescents who slept more on average, spent less time sitting (p = 0.006) and less time sitting in bouts of ≥30 min (p = 0.004) compared with adolescents who slept less on average. Conversely, adolescents who spent more time sitting on average and adolescents who spent more time sitting in bouts of ≥30 min on average, slept less (p = 0.02 and p = 0.003, respectively).

Conclusions

Based on the between-subjects analyses, interventions focusing on reducing or regularly breaking up sitting time could improve adolescents’ sleep duration on a population level, and vice versa. However, the within-subjects association was only found in one direction and suggests that to sleep sufficiently during the night, adolescents might limit and regularly break up their sitting time the preceding day.

Trial registration

Data have been used from our trial registered at ClinicalTrials.gov (NCT04327414; registered on March 11, 2020).

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-11694-9.

Sleep and physical activity in university students: A systematic review and meta-analysis

University students have low levels of physical activity and report disturbances to sleep, which are independently associated with poor health outcomes. Some research suggests that there is a bi-directional relationship between sleep and physical activity in adults. However, the relationship between sleep and physical activity in university students has not yet been evaluated. Therefore, the aim of this systematic review and meta-analysis was to qualitatively synthesise and quantitatively evaluate the evidence for the association between sleep and physical activity in university students. Twenty-nine eligible studies were included, with a total of 141,035 participants (43% men and 57% women). Only four studies used device-based measures of sleep and/or physical activity, with the remainder including self-report measures. Qualitative synthesis found that the majority of studies did not find any association between sleep and physical activity in university students. However, random-effects meta-analysis showed that moderate-to-high intensity physical activity was associated with lower PSQI scores (e.g., better sleep quality) [r = -0.18, 95% CI (-0.37, 0.03), p = 0.100]. Further, a weak negative association between moderate-to-vigorous physical activity level and sleep duration was also found [r = -0.02, 95% CI (-0.16, 0.12), p = 0.760]. As the findings of this review are predominantly derived from cross-sectional investigations, with limited use of device-based measurement tools, further research is needed to investigate the relationship between sleep and physical activity in university students. Future studies should employ longitudinal designs, with self-report and device-based measures, and consider the intensity and time of physical activity as well as records of napping behaviour.

Sleep Quality and Duration in European Adolescents (The AdolesHealth Study): A Cross-Sectional, Quantitative Study

Sleep is a vital element of adolescents' overall health; it influences their body and mind and thus affects their quality of life. Adequate sleep quality and duration are essential for maintaining optimal metabolic health and lowering the risk of developing several medical conditions, such as cardiovascular disease. The current study aimed to assess the perceived sleep quality and duration of 1717 European adolescents from three different European countries (Spain, Iceland and Estonia) aged 13- to 16-years (900 boys, 817 girls) using the Pittsburgh Sleep Quality Index (PSQI). A multivariate analysis of variance (MANOVA) was performed to examine differences between groups and two-factor analysis of variance (ANOVA) was used to analyze city and age differences. The probability of having poor sleep quality and duration was calculated by Odd-Ratio (OR). Our study found poor sleep quality in 44% of the boys and 53% of the girls, whereas 68% and 69%, respectively did not get the recommended hours of sleep (i.e., 8-10 h). No difference was found between adolescents from Estonia, Iceland and Spain regarding sleep duration. In contrast, Spanish and Estonian adolescents reported higher probabilities of having poor sleep quality. Finally, girls had a significantly higher probability of poor sleep quality than boys.

A systematic review of screen-time literature to inform educational policy and practice during COVID-19

There is an urgent need for consensus around the matter of screen time (ST) during the COVID-19 pandemic. Some governments announced restrictions for online schooling time per day to protect students from perceived risks of prolonged screen-use, but critics and an emerging body of research question such regulations. Our review of 52 empirical studies found (a) an overwhelming majority of literature shows effect sizes too small to be of practical or clinical significance, and (b) findings more specifically on educational ST are inconclusive and critically underrepresented. These facts, along with the undeniable benefits of online learning in the absence of brick-and-mortar schooling and the ominous forecasts of learning loss caused by prolonged school closure, inform our recommendations for a more moderate policy and practical stance on restrictions - one that is focused on responsibly leveraging the educational and social benefits of ST in a world still recovering from the COVID-19 pandemic.