Elsevier

Sleep Medicine

Volume 72, August 2020, Pages 65-74
Sleep Medicine

Original Article
Association between objectively assessed physical activity and sleep quality in adolescence. Results from the GINIplus and LISA studies

https://doi.org/10.1016/j.sleep.2020.03.007Get rights and content

Highlights

  • Moderate-to-vigorous activity results in better sleep quality among adolescents.

  • Effect sizes are small and only sleep quality the following night is affected.

  • Lifestyle activity (eg walking) is related to low sleep quality among adolescents.

  • Females benefit from a greater than three-hour gap between leisure sport and sleep.

Abstract

Study objectives

Population-based studies on the association of objectively assessed physical activity (PA) with sleep among adolescents are rare. We examined this association by applying accelerometry and accounting for the day-by-day variability.

Methods

Accelerometers (Actigraph GT3X) were worn for one week by 1223 participants during the 15-year follow-up of the German birth cohorts (German infant study on the Influence of Nutrition Intervention plus air pollution and genetics on allergy development, GINIplus) and (Influence of Lifestyle factors on the development of the Immune System and Allergies in East and West Germany, LISA) to measure PA and sleep. PA was categorised into sedentary, lifestyle and moderate-to-vigorous physical activity (MVPA) referring to Sasaki and Romanzini. Sleep was analysed according to the algorithm developed by Sadeh. Sleep quality was represented by sleep efficiency (SE), sleep onset latency (SOL) and time awake per hour after sleep onset (TAPH). Sleep and activity were additionally reported by diaries. Linear and generalized mixed-effects-models with logit-link with subject specific random intercepts were used stratified by sex and adjusted for confounding variables.

Results

Physical activity appears to be associated only with sleep quality the following night. Among female participants, SE improved (β = 0.12 [95% CI = (0.05; 0.18)]) per 10 minutes increase of MVPA. SOL decreased (OR = 0.83 [95% CI = (0.69; 0.99)]) among male participants with at least 60 min of MVPA per day. Engaging in leisure sport MVPA was associated with higher SE among female (β = 0.70 [95% CI = (0.22; 1.17)]) and male participants (β = 0.76 [95% CI = (0.18; 1.34)]). Also, TAPH among female (β = −0.37 [95% CI = (−0.65; −0.09)]) and SOL among male subjects (OR = 0.70 [95% CI = (0.57; 0.85)]) decreased. Increasing lifestyle activity was related to longer SOL among female (OR = 1.36 [95% CI = (1.15; 1.62)]) and male subjects (OR = 1.32 [95% CI = (1.10; 1.58)]).

Conclusions

In this large population-based sample of German adolescents MVPA and leisure sport improved short term sleep quality, supporting regular PA in adolescents for their health benefit.

Introduction

Adolescence is a crucial period of life which affects behaviour in many forms, lasting then well into adulthood [[1], [2], [3]]. According to the physical activity factsheet 2018 of Germany only 12% of the 14–17-years old meet the 60 min of moderate-to-vigorous physical activity (MVPA) per day that are recommended by the World Health Organisation (WHO) [4,5]. These observations were not only made in Germany but also in the US where only 26% of the juveniles in high school declared to engage in 60 min MVPA every day [6]. Furthermore, adolescence is when sleep behaviour changes, moreover; a French study showed that total sleep time shortens from about 9 h in childhood to about 8 h [7]. Yet, sleep duration in adolescents is shortening even more, with about 35–37% of adolescents having less than seven hours of sleep most nights in 2009 versus 41–43% of adolescents in 2015, as stated by an US-American study [8]. Additionally, the incidence of sleep problems persisting until early adulthood is high [1]. Furthermore, increasing screen-time and social media use were shown to promote poorer sleep quality [9,10]. The National Sleep Foundation offers advice on sleep hygiene and recommendations include exercising during the day and with enough distance to bedtime to enhance one's sleep quality [11]. A possible biochemical pathway explaining a sleep improving effect of physical activity might be associated with an increase of adenosine levels during high intense exercise [12]. Adenosine is considered to play a sleep promoting role in the central nervous system [13]. Moreover, exercising for more than three times a week was seen to be reducing the persistence of sleep problems from adolescence into young adulthood [1]. There are few publications addressing the association of physical activity (eg moderate-to-vigorous physical activity) with sleep (sleep efficiency (SE), sleep onset latency (SOL) and sleep duration) among adolescents [[14], [15], [16]]. Fewer are based on objectively measured physical activity and sleep parameters [15,16]. This lack of publications using objectively assessed data of adolescents was also pointed out by Lang et al., in a clinical review [17]. The existing literature is aside from that inconclusive regarding its results. Despite using the same approach two publications from Stockholm, Sweden and Helsinki, Finland had contrary findings regarding the association of moderate-to-vigorous physical activity with sleep efficiency and sleep onset latency among children. The analyses of Ekstedt et al., showed positive associations between moderate-to-vigorous physical activity and sleep efficiency but not sleep duration whereas Pesonen et al., found negative associations between moderate-to-vigorous physical activity and sleep efficiency, sleep latency and sleep duration [18,19]. Others did not find significant associations of moderate-to-vigorous physical activity with sleep efficiency [20]. Furthermore, the number of participants was often small. The aim of this study is therefore to investigate the association of physical activity with sleep quality (SE, SOL, time awake per hour after sleep onset, [TAPH]) with emphasis on a day-to-day level analysis using accelerometry among a large sample of adolescents from Germany.

Section snippets

Study procedure

The data used in this study has been collected as part of the 15-year follow up of the two German birth cohorts GINIplus (German infant study on the Influence of Nutrition Intervention plus air pollution and genetics on allergy development) and LISA (Influence of Lifestyle factors on the development of the Immune System and Allergies in East and West Germany). The recruitment has been described in more detail in earlier publications [[21], [22], [23]]. In brief, the recruiting of healthy

Results

In total, 1223 participants had valid physical activity and sleep data on 7780 days as well as complete information on the covariates. About 96% of the participants had equal or more than five valid days. Characteristics of the subjects stratified by sex are shown in Table 1. The average age was 15.6 years and 673 female (55.0%) and 550 male (45.0%) participants were included in the analyses. More adolescents from Munich than from Wesel participated and BMI was higher in female participants

Discussion

This study investigated the association of physical activity with sleep quality parameters, represented by SE, SOL, and TAPH in adolescents over a week on a day-to-day basis. Overall, beneficial associations of MVPA with sleep quality parameters were observed, while time spent in lifestyle activity had an inverse association with sleep. Specifically, SE improved the following night with increasing time spent in MVPA among female participants. Male subjects who had at least 60 min of MVPA per

Conclusion

We could show in a large population-based sample of German adolescents that MVPA and leisure sport MVPA in particular improve sleep quality among adolescents. Lifestyle activity on the contrary impaired SE among female participants and prolonged sleep onset latency among both sexes. But associations of physical activity with sleep quality seem to be limited to the following night only. The aim should therefore be to motivate and support adolescents to join sport clubs and to regularly spend

Funding

The GINIplus study was mainly supported for the first three years by the Federal Ministry for Education, Science, Research and Technology (interventional arm) and Helmholtz Zentrum Munich (former GSF) (observational arm). The 4-year, 6-year and 10-year follow-up examinations of the GINIplus study were covered by the respective budgets of the five study centres (Helmholtz Zentrum Munich (former GSF), Research Institute at Marien-Hospital Wesel, LMU Munich, TU Munich, and from six years onwards

CRediT authorship contribution statement

Laura Negele: Formal analysis, Writing - original draft. Claudia Flexeder: Supervision, Data curation, Writing - review & editing. Sibylle Koletzko: Investigation, Writing - review & editing. Carl-Peter Bauer: Investigation, Writing - review & editing. Andrea von Berg: Investigation, Writing - review & editing. Dietrich Berdel: Investigation, Writing - review & editing. Tamara Schikowski: Investigation, Writing - review & editing. Marie Standl: Writing - review & editing, Investigation,

Acknowledgements

The authors thank all the families for their participation in the GINIplus and LISA studies. Furthermore, we thank all members of the GINIplus and LISA Study Groups for their excellent work.

The GINIplus Study group consists of the following: Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg (Heinrich J, Brüske I, Schulz H, Flexeder C, Zeller C, Standl M, Schnappinger M, Ferland M, Thiering E, Tiesler C); Department of Pediatrics,

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