Nighttime Sleep Duration and Sleep Behaviors among Toddlers from Low-Income Families: Associations with Obesogenic Behaviors and Obesity and the Role of Parenting

Abstract

Background: Shortened sleep duration is associated with poor health and obesity among young children. Little is known about relationships among nighttime sleep duration, sleep behaviors, and obesogenic behaviors/obesity among toddlers. This study characterizes sleep behaviors/duration and examines relationships with obesogenic behaviors/obesity among toddlers from low-income families.Methods: Mothers of toddlers (age 12-32 months) were recruited from urban/suburban sites serving low-income families. Mothers provided demographic information and completed the Brief Infant Sleep Questionnaire (BISQ); a 6-item Toddler Sleep Behavior Scale was derived (TSBS-BISQ, higher score reflects more recommended behaviors). Toddler weight/length were measured; obesity defined as ‡95th percentile weight-for-length. Results: Sample included 240 toddlers (mean age = 20.2 months), 55% male, 69% black, 59% urban. Toddlers spent 55.4 minutes/ day in MVPA, mean HEI-2005 score was 55.4, 13% were obese. Mean sleep duration was 9.1 hours, with 35% endorsing 5-6 recommended sleep behaviors (TSBS-BISQ). In multivariable models, MVPA was positively related to sleep duration; obese toddlers had a shorter nighttime sleep duration than healthy weight toddlers [odds ratio = 0.69, p = 0.014]. Nighttime sleep duration was associated with high TSBS-BISQ scores, F = 6.1, p = 0.003.Conclusions: Toddlers with a shorter nighttime sleep duration are at higher risk for obesity and inactivity. Interventions to promote healthy sleep behaviors among toddlers from low-income families may improve nighttime sleep duration and reduce obesogenic behaviors/obesity.

Sleep duration and bedtime in preschool‐age children with obesity: Relation to BMI and diet following a weight management intervention

“…The impetus to incorporate sleep into weight management treatment protocols is rooted in correlational studies that have found a strong relationship between longer sleep, bedtimes before 9 pm and obesity risk in preschoolers . Although the exact mechanisms for this association are not clear, insufficient sleep may lead to a greater number of eating opportunities due to increased waking hours, greater daytime fatigue and (potential) consequential lower energy expenditure, and/or fluctuations in appetite and hunger hormones . Other factors such as greater time spent watching television may also influence these relationships .…”

“…Sleep duration is concurrently and prospectively associated with obesity in preschoolers and children with obesity at ages 4 and 5 sleep less and have later bedtimes than their lean peers, though it is unclear whether poor sleep is a cause or consequence of adiposity. Researchers have suggested that inadequate sleep may be associated with an energy imbalance such that poor sleep may (a) increase energy intake given the greater number of waking hours and opportunities to eat; (b) lead to greater daytime fatigue resulting in lower activity levels and energy expenditure; and/or (c) contribute to the dysregulation of appetite and glucose …”

“…Researchers have suggested that inadequate sleep may be associated with an energy imbalance such that poor sleep may (a) increase energy intake given the greater number of waking hours and opportunities to eat; [5][6][7][8] (b) lead to greater daytime fatigue resulting in lower activity levels and energy expenditure; [9][10][11] and/or (c) contribute to the dysregulation of appetite and glucose. 12 Multicomponent behavioural weight management interventions have resulted in lower body mass index (BMI) for preschoolers with overweight and obesity [13][14][15] and may serve as an opportune occasion to incorporate recommendations for healthy sleep.…”

The cross‐sectional and prospective associations between sleep characteristics and adiposity in toddlers: Results from the GET UP! Study

“…Evidence in adults suggests that total sleep deprivation could lead to lower resting and postprandial energy expenditure, while chronic partial sleep deprivation could cause the feeling of fatigue, which in turn may reduce physical activity and increase sedentary behaviour . It has been reported in children that short sleep duration is associated with decreased physical activity and increased screen time …”

“…Our results suggest that shorter total sleep duration was crosssectionally associated with higher adiposity in toddlers, which is consistent with a number of cross-sectional findings in preschoolers 11,25,26 and in toddlers. 27,28 Indeed, short sleep duration has been suggested to influence the energy balance process through several biological and behavioural mechanisms, which in turn may increase adiposity. 5 Laboratory studies in adults have shown that short sleep duration could affect appetite regulation through relevant hormonal change, specifically leptin and ghrelin.…”