Associations Between Sleep and Metabolic Outcomes in Preadolescent Children

Jasmin Marie Alves, Ting Chow, Selena Nguyen-Rodriguez, Brendan Angelo, Alexis Defendis, Shan Luo, Alexandro Smith, Alexandra Grace Yunker, Anny H Xiang, Kathleen Alanna Page, Jasmin Marie Alves, Ting Chow, Selena Nguyen-Rodriguez, Brendan Angelo, Alexis Defendis, Shan Luo, Alexandro Smith, Alexandra Grace Yunker, Anny H Xiang, Kathleen Alanna Page

Abstract

Context: Growing evidence suggests an important role for sleep for the metabolic health of children.

Objective: We aimed to determine how sleep is related to insulin sensitivity, insulin secretion, beta-cell function, and adiposity (BMI z-scores, body fat %, waist to height ratio) using objectively measured sleep and oral glucose tolerance test (OGTT)-derived measures.

Methods: Sixty-two children aged 7-11 years, born at Kaiser Permanente Southern California, wore wrist accelerometers for 7 days to objectively measure sleep, completed an OGTT, and had anthropometric measures (height [cm], weight [kg], waist [cm], body fat [%]) collected. Using linear regression, associations between Matsuda insulin sensitivity index (ISI), insulinogenic index (IGI), disposition index (DI), BMI z-score, waist to height ratio, and body fat % with sleep parameters [total sleep time (TST; min), sleep efficiency (SE; %), time in bed (TIB; min), wake after sleep onset (WASO; min), and sleep latency (SL; min)] were assessed. Body fat % was tested as a mediator of the relationship between TST and ISI.

Results: Longer TST was associated with better insulin sensitivity (P = 0.02), but not after adjusting for body fat %. Sleep parameters were not associated with IGI or DI. Longer TST was associated with lower % body fat (P = 0.01) and lower waist-to-height-ratios (P = 0.05). Body fat % explained 62% (P = 0.01) of the relationship between TST and ISI. Longer TIB was associated with lower adiposity measures (P < 0.05). There were no associations between SE, WASO, or SL and metabolic outcomes.

Conclusion: Objectively measured sleep duration was associated with lower adiposity, and the relationship between sleep duration and ISI appeared partly through adiposity levels in preadolescent children. Longer sleep duration may be important for metabolic health.

Keywords: actigraphy; adiposity; insulin sensitivity; preadolescence; sleep.

© The Author(s) 2022. Published by Oxford University Press on behalf of the Endocrine Society.

Figures

Figure 1.
Figure 1.
Sleep Parameters with OGTT-derived measures before (panel A) and after (panel B) adjusting for BMI Z-score associations between total sleep time (TST) and sleep efficiency (SE) with OGTT-derived measures before (Panel A) and after (panel B) adjusting for body fat %. A, Standardized β coefficient (represents 1 SD increase/decrease in sleep parameters with 1 SD change in OGTT-derived measures) with 95% CI, adjusted for child age, sex, Tanner stage of development, moderate to vigorous physical activity, and socioeconomic status. B, Further adjusted for child body fat %. Abbreviations: DI, disposition index; IGI, insulinogenic index (IGI); ISI, Matsuda insulin sensitivity index. *Indicates significant P value, P < 0.05.
Figure 2.
Figure 2.
Sleep parameters and adiposity measures. Associations between total sleep time (TST) and sleep efficiency (SE) with adiposity measures. Standardized β coefficient (represents 1 SD increase/decrease in sleep parameters with 1 SD change in adiposity measures) with 95% CI adjusted for child age, sex, Tanner stage of development, moderate to vigorous physical activity, and socioeconomic status.
Figure 3.
Figure 3.
Body fat as a mediator between TST and ISI. Body fat % was a significant mediator of the association between total sleep time (TST) with ISI (Matsuda insulin sensitivity index) P = 0.01. Before adjusting for body fat %, TST was significantly associated with ISI (P = 0.02). After accounting for body fat %, the association between TST and ISI was attenuated (P = 0.32). Standardized β coefficient for direct comparisons. Analyses adjusted for child age, sex, Tanner stage of development, moderate to vigorous physical activity, and socioeconomic status.

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