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

BACKGROUND: While insufficient sleep is associated with poor lifestyle factors, a multidimensional approach assessing multiple sleep health dimensions via subjective and objective measures has emerged as a more comprehensive method of investigating these relationships. We examine the multidimensional association between sleep health, diet, and physical activity (PA). METHODS: We studied 373 adolescents from the Penn State Child Cohort (16.4 ± 2.3 years; 46.6% female; 20.9% racial/ethnic minority), of whom 234 (63.5%) were evaluated while in-school. Sleep dimensions were assessed via self-reports, actigraphy (ACT), and polysomnography (PSG). PA was assessed via ACT and self-reports, metabolic equivalent of task (MET) via ACT, and diet via self-reports. Stepwise multivariable-adjusted regression models tested the association between sleep dimensions and lifestyle factors. RESULTS: Later self-reported and ACT-measured bedtime and rising time were associated with more snacking, higher caloric intake, and sedentarism. A later ACT-measured sleep midpoint was associated with higher carbohydrate intake and more snacking. Higher ACT-measured sleep variability was associated with higher sedentarism. Longer self-reported or ACT-measured sleep latency was associated with more snacking and higher PA and METs. Longer ACT-measured time in bed was associated with lower PA. Sleep dimensions were more strongly associated with diet, PA, and sedentarism among adolescents evaluated while in-school, whereas they were more strongly associated with snacking among those on-break. PSG-measured sleep dimensions were not strongly associated with lifestyle factors; although a greater apnea/hypopnea index was associated with lower METs and greater sedentarism, it was not significant after adjusting for BMI. CONCLUSIONS: Evaluating sleep with a multidimensional approach better captures its association with lifestyle factors. Future research should assess downstream effects on cardiovascular outcomes.