Mediterranean Dietary Patterns Related to Sleep Duration and Sleep-Related Problems among Adolescents: The EHDLA Study

Abstract

Purpose: The aim of the present study was to examine the association of adherence to the Mediterranean Diet (MD) and its specific components with both sleep duration and sleep-related disorders in a sample of adolescents from the Valle de Ricote (Region of Murcia, Spain). Methods: This cross-sectional study included a sample of 847 Spanish adolescents (55.3% girls) aged 12–17 years. Adherence to the MD was assessed by the Mediterranean Diet Quality Index for Children and Teenagers. Sleep duration was reported by adolescents for weekdays and weekend days separately. The BEARS (Bedtime problems, Excessive daytime sleepiness, Awakenings during the night, Regularity and duration of sleep, and Sleep-disordered breathing) screening was used to evaluate issues related to sleep, which include difficulties at bedtime, excessive drowsiness during the day, waking up frequently during the night, irregularity, length of sleep, and breathing issues while sleeping. Results: Adolescents who presented a high adherence to the MD were more likely to meet the sleep recommendations (OR = 1.52, 95% CI 1.12–2.06, p = 0.008) and less likely to report at least one sleep-related problem (OR = 0.56, 95% CI 0.43–0.72, p < 0.001). These findings remained significant after adjusting for sex, age, socioeconomic status, waist circumference, energy intake, physical activity, and sedentary behavior, indicating a significant association of adherence to the MD with sleep outcomes (meeting sleep recommendations: OR = 1.40, 95% CI 1.00–1.96, p = 0.050; sleep-related problems: OR = 0.68, 95% CI 0.50–0.92, p = 0.012). Conclusions: Adolescents with high adherence to the MD were more likely to report optimal sleep duration and fewer sleep-related problems. This association was more clearly observed for specific MD components, such as fruits, pulses, fish, having breakfast, dairies, sweets, and baked goods/pastries.

Mediterranean diet adherence and sleep pattern: a systematic review of observational studies

“…All studies were on both gender, except for four articles that were performed on women [ 25 , 31 , 38 , 39 ]. Five studies were on older adults (60–84 y) [ 26 , 27 , 29 , 33 , 37 ] and seven on young adolescents (11–15 y) [ 28 – 30 , 35 , 38 , 40 , 41 ]. All studies had assessed healthy people, except for of study of Castro-Diehl et al [ 29 ] that had included atherosclerosis patients.…”

“…Out of 20 studies, two were carried out in the USA [ 25 , 29 ], four in Italy [ 30 , 32 , 34 , 35 ], five in Spain [ 27 , 28 , 31 , 40 , 41 ], two in Turkey [ 42 , 43 ], two in Greece [ 33 , 37 ] and one each in Sweden [ 26 ], Iran [ 38 ], Jordan [ 39 ], Emirate [ 44 ] and Costa Rica [ 36 ]. All studies were published between 2016 and 2023.…”

“…Calculation of Mediterranean diet score was done by the following methods in the included studies: a validated 16 items KIDMED questionnaire was used in six studies [ 28 , 30 , 35 , 40 , 41 , 44 ] and a 14 items validated PREMED Questionnaire was applied in two studies [ 34 , 39 ]. Three studies mentioned a 10 items validated alternate Mediterranean (aMed) questionnaire [ 25 , 29 , 36 ].…”

“…Sleep quality and quantity were separately considered as primary outcomes. In general, eleven studies assessed sleep quality [ 27 , 28 , 31 – 35 , 37 , 42 – 44 ], ten studies considered sleep duration [ 27 – 29 , 32 , 33 , 35 , 36 , 40 , 41 , 44 ], three studies investigated sleepiness [ 30 , 33 , 35 ], four studies investigated sleep disturbances [ 25 , 31 , 32 , 44 ], three studies examined taking nap [ 30 , 33 , 36 ] and three studies examined sleep efficacy and sleep latency [ 25 , 32 , 44 ]. All other sleep disorders that were assessed in two other studies were need medication to sleep [ 32 , 44 ], day time dysfunction [ 32 , 44 ], sleep initiating problems [ 26 ], sleep maintenance problems [ 26 ], not quiet sleep, awaken short of breath or with a headache, feel drowsy or sleepy during the day, trouble falling asleep, awaken during sleep and have trouble falling asleep, trouble staying awake during the day, snore during sleep, snoring and sleep adequacy [ 33 ], insomnia [ 29 , 38 , 39 ], inconsistent between weekday-weekend sleep [ 36 ] bed time and wake time on weekday and weekend, total sleep time, weekdays sleep time and weekend sleep time [ 30 ].…”

“…A validated self-report questionnaires and pediatric daytime sleepiness scale (PDSS) was used by two studies [ 30 , 35 ]. An Epworth Sleepiness Scale (ESS), an eight items validated questionnaire, was used in the study of Campanini et al [ 27 ] Some other questionnaires were used in the other eight remaining studies [ 26 , 27 , 30 , 33 , 35 , 36 , 40 , 41 ]. Actigraphy [ 29 ] and Wrist-worn accelerometer [ 28 ] were used for sleep duration assessment in just two studies, which allowed for evaluation of sleep phenotype.…”