Table 1.
Description of Findings of Studies that Assessed the Association between Sleep Duration and Obesity Risk in Children and Adolescents (N = 30).
| STUDY COUNTRY | SAMPLE CHARACTERISTICS | SLEEP MEASURE and REFERENCE VALUE | MEASURE OF BMI STATUSa | CONFOUNDERS CONTROLLED | MAIN FINDINGS |
|---|---|---|---|---|---|
| CROSS-SECTIONAL STUDIES | |||||
| Locard et al. (1992) FRANCE | 5 years old (N=1,031) | Caretaker-reported Referent ≥ 11 hrs |
Measured height and weight; weight-for-height and sex Zscore > 2 = OB | --------- | OB : < 11 hrs: OR = 1.4 (1.0-2.0) |
| Sekine et al. (2002)b JAPAN | 2.5 to 4.3 years old (N=8,941) | Caretaker-report (24-hour sleep) Referent ≥11 hrs |
Measured height and weight; OB: age/sex BMI cut-off points by Cole et al |
Age, gender, parental OB, and outdoor playing time | OB: <9 hrs: N/S 9 to 10 hrs: ORadj = 1.34 (1.05 – 1.72) 10 to 11 hrs: N/S |
| Sekine et al. (2002)b JAPAN | 6 to 7 years (N=8,274) | Caretaker-report (24-hour sleep) Referent ≥10 hrs |
Measured height and weight; OB: age/sex BMI cut-off points by Cole et al |
Age, sex, parental OB, PA%, TV watching, frequency of breakfast, and frequency of snack | OB : 9 to 10 hrs: ORadj = 1.49 (1.08 – 2.14) 8 to 9hrs: 1.89 (1.34 – 2.73) < 8hrs: 2.87 (1.61 – 5.05) |
| Von Kries et al. (2002) GERMANY | 5 to 6.99 years (N=6,645) | Caretaker-report (WD$ sleep) Referent ≤10 hrs |
Measured height and weight; OW: age/sex BMI > 90th centile, OB >97th centile based on local norms | Parent education, parent OB, single parent, and maternal smoking | OW: 10.5 to 11 hrs: ORadj = .77 (.59 - .99) ≥11 hrs .54 (.40 - .73) OB: 10.5 to 11 hrs: ORadj = .53 (.35 - .80) ≥11 hrs .45 (.28 - .75) |
| Gupta et al. (2002) USA | 11 to 16 years old (N=308) | Actigraphy (1 night) Referent: sleep duration as continuous |
Measured height and weight; BMI > 85th percentile (CDC) | For every additional hour of sleep time, odds of OB decreased by 80%: OR = .20 (95th CI = 0.11) |
|
| Hui et al. (2003) CHINA | 6 to 7 years old (N = 343) | Caretaker-reported Referent: < 9 hrs |
Measured height and weight; BMI ≥ 92nd centile, using Hong Kong cross-sectional growth survey as reference | Paternal and maternal obesity | OW: 9 to 11 hrs: ORadj = .54 (0.30-0.97) ≥ 11 hrs = .31 (0.11-0.87) |
| Padez et al. (2005)d PORTUGAL | 7 to 9.5 years (N = 4,511) | Caretaker-reported Referent: 8 hrs |
Measured height and weight; age/sex BMI cut-off points by Cole et al | Sex and age | OW: 9 to 10 hrs: ORadj = .46 (.40 - .51) ≥11 hrs .44 (.38 - .49) OB: 9 to 10 hrs: ORadj = .44 (.40 - .47) ≥11 hrs .39 (.35 - .42) |
| Chen et al. (2006) TAIWAN | 13 to 18 years (N = 656) | Self-report of 6 to 8 hrs of sleep (WD sleep) Referent ≥4 nights/week |
Measured height and weight; OW: BMI ≥85thpercentile for age/sex (DOH) | -------- | OW: < 4 nights/week: OR = 1.74 (1.3 – 2.4) |
| Chaput et al. (2006) CANADA | 5 to 10 years (N=422) | Caretaker-report (WD sleep) Referent: 12 to 13 hrs |
Measured height and weight; OW/OB: age/sex BMI cut-off points by Cole et al |
Age, sex, parental OB | 10.5 to 11.5 hrs: ORadj = 1.42 (1.09 - 1.98) 8 to 10 hrs 3.45 (2.61 – 4.67) *Relationship stronger for males (per personal communication) |
| Eisenmann et al. (2006)c AUSTRALIA | 12.4 years (N=6,321) | Self-report Referent ≥10 hrs |
Measured height and weight; OW/OB: age/sex BMI cut-off points by Cole et al |
Age | OW/OB: Males only: 9 to 10 hrs: ORadj = 1.61 (1.19 - 2.17) 8 to 9 hrs 1.83 (1.30 – 2.58) ≤ 8 hrs 3.06 (2.11 – 4.46) |
| Seicean et al. (2007) USA | 15.6 +/- 1.23 years (N = 509) | Self-reported (WD sleep) Referent >8 hrs |
Self-reported height and weight (30% weighed themselves using a scale on scene); OW: age/sex ZBMI >85th percentile; OB > 95th percentile (CDC) | Gender, age, irregular eating, health status, and caffeine intake | OW: < 5 hrs: ORadj = 7.65 (1.87 -31.30) 5 to 6: N/S 7 to 8: N/S 6 to 7 hrs 2.55 (1.02 – 6.38) |
| Kuriyan et al. (2007) INDIA | 6 to 16 years (N = 598) | Caretaker-report (younger) or Self-report (older) Referent >9.5 hrs |
Measured height and weight; OW: age/sex BMI cut-off points by Cole et al | Age, gender, living location, and SES | OW: ≤8 hrs: ORadj = 6.7 (1.5 – 30.2) |
| Knutson et al. (2007) USA | 10 to 19 years (N=1,546) | A) Self-report B) Self-report using time diaries Referents: A) 9.2 to 19.0 hrs B)10.08-16.17 hrs |
Measured height and weight; OW: BMI ≥95th percentile for age and gender (CDC) | Race, age, family income, education, TV viewing, physical activity, and media use | OW: A) 7 to 8 hrs ORadj = 1.85: (1.01 – 3.38) 8.1 to 9 hrs: 1.93 (1.10 – 3.37) B) All sleep categories NS. |
| Nixon et al. (2008) NEW ZEALAND | 7.3 years (N=519) | Actigraphy (1 night) Referent ≥9 hrs |
Measured height and weight; OW/OB: age/sex BMI cut-off points by Cole et al |
Maternal BMI, maternal age, gender, hrs of TV, and sedentary activity | OW/OB: < 9hrs : ORadj = 3.32 (1.40 – 7.87) |
| Ivers-Landis et al. (2008) USA | 8 to 11 years (N=819) | A) Caretaker-report of sleep duration B) Caretaker-assisted report using 7-day sleep diary Referent: duration as continuous |
Measured height and weight (PC); OB: age/sex BMI ≥95th percentile (CDC) |
Age, gender, preterm status, psychosocial functioning, and parental stress | OB: A) ORadj = 1.41 (1.12 – 1.76) Odd of being OB increase by 41% with every 1 hour of sleep decline B) ORadj = 1.45 (1.09 – 1.94) Odds of being OB increase by 45% with every 1 hour of sleep decline |
| Liu et al. (2008) USA | 7 to 17 years (N=335) | Self-reported 7-day sleep diary Referent: duration as continuous |
Measured height and weight; at risk: age/sex ZBMI 85th to 95th percentile; OW ZBMI ≥ 95th percentile (CDC) | Age, sex, SESΩ, ethnicity, puberty, and psychiatric diagnosis | OW: Reduced sleep (1 hour less of): ORadj = 2.12 (1.05 – 4.28) |
| Wells et al. (2008) BRAZIL | 10 to 12 years (N=4,452) | Self-report (WD sleep) Referent < 9 hrs |
Measured height & weight; IOTF guidelines used to define OW & OB | Sex, birth weight & length, maternal smoking and alcohol consumption during pregnancy, maternal pre-pregnancy BMI, SES, PA, systolic & diastolic BP, TV hrs | OB: ORadj = 9-10 N/S >10h N/S Odds of being OB decreased by 14% with every additional hour of sleep |
| Bawazeer et al. (2009) SAUDI ARABIA | 10 to 19 years (N=5,877) | Caretaker-report Referent >7 hrs |
Measured height, weight, waist circumference & hip circumference; OB defined as >95th percentile BMI for age & gender | ------ | OB: Males ≤ 7h: OR = 1.28 (1.09 - 1.50) Females ≤ 7h 1.38 (1.02 - 1.89) |
| Wing et al. (2009) CHINA | 5 to 15 years (N=5,159) | Caretaker-report Referent > 10 hrs |
Parent report of height & weight converted to ZBMI (OW ZBMI between 85th and 95th percentile; OB ZBMI > 95th percentile per CDC guidelines) | Age, gender, TV viewing, time to do homework, parent education, & eating 1 hr before going to bed. | OW/OB: Weekdays: ≤ 8hrs: ORadj = 1.74 (1.23-2.45) 8.01-9 hrs 1.51 (1.13-2.03) 9.01-10 hr 1.30 (0.97-1.76) Weekends: ≤ 8hrs: ORadj = 1.80 (1.05-3.09) 8.01-9 hrs 1.66 (1.30-2.13) 9.01-10 hrs 1.36 (1.12-1.66) |
| Hitze et al. (2009) GERMANY | 6 to 19 years (N=414) | Caretaker-report (younger) and self-report (older) (WD sleep) Referent: “Long sleep” (9 to 10 hrs for younger; 8 to 9 hrs for older) |
Measured height & weight; German references used to define OW & OB | Paternal BMI, birth weight, change in weight birth-2 years, duration of breastfeeding | OB: Girls only: Short sleep: ORadj = 5.5 (1.3-23.5) |
| Jiang et al. (2009) CHINA | 3 to 4 years (N=1,311) | Caretaker-report Referent ≥ 11 hrs |
Measured height & weight; Country norms used to define obesity (>95th percentile) | Age, sex, appetite, birth weight, maternal age at delivery, mother & father education, household income, & geographic location. | OB: <9hrs 4.76: ORadj = (1.28-17.69) 9hrs 3.42 (1.12-10.46) 9.5 hrs = N/S 10 hrs = N/S 10.5 hrs = N/S |
| Ozturk et al. (2009) TURKEY | 6 to 7 years (N=5,358) | Caretaker-report Referent ≥10 hrs |
Measured height & weight; IOTF guidelines used to define OW & OB | ------ | OW/OB: Boys only: ≤8h: OR = 2.06 (1.31-3.24) 8.1- 8.9hrs 1.74 (1.10-2.75) 9.0-9.9hrs 1.86 (1.17-2.97) |
| Sun et al. (2009)b JAPAN | 12 to 13 years (N=5,753) | Self-report Referent 8 to 9 hrs |
Measured height & weight; IOTF guidelines used to define OW & OB | Age, paternal overweight, maternal overweight, breakfast frequency, snacking frequency, nighttime snacking, eating speed, eating volume, physical activity, TV watching, video game playing. | OW: Girls only: <7hrs: ORadj = 1.81 (1.21-2.72) 7-8 hrs 1.37 (1.00-1.88) ≥9 hrs = NS |
| Anderson & Whitaker (2010) USA | ∼ 4 years (N=8,750) | Caretaker-report Referent ≥ 10.5 hrs |
Measured height & weight; CDC guidelines used to define OB (≥ 95th percentile for age & gender) | Eating dinner as a family, screen viewing time, child age, gender, race/ethnic group, household income-to-poverty ratio, single-parent household, maternal education, maternal BMI, & maternal age. | OB: < 10.5 hrs: ORadj = .86 (0.71-1.03) |
| LONGITUDINAL STUDIES | |||||
| Reilly et al. (2005) UK | 30 months to 7 years (N=7,758) | Caretaker-report (nocturnal sleep duration at 30 months) Referent >12 hrs |
Measured height and weight at 7 years; OB = BMI ≥95th centile using UK reference data | Maternal education, child's sex, and energy intake at 3 years | OB: < 10.5 hrs: ORadj = 1.45 (1.10 – 1.89) 10.5 to 10.9 hrs 1.35 (1.02 -1.79) |
| Snell et al. (2007) USA | 3 to 18 years (Time 1: 3 to 12 years; Time 2: 8 to 18 years; N = 1,441) | Caretaker-report (younger) or self-report (older) | Measured height at all time points, caretaker-reported weight at T1; OW/OB: age/sex BMI cut-off points by Cole et al |
Race, age, sex, BMI at T1, parent income, and parent education | Sleeping > 11 hrs relative to 9 – 9.9 hrs associated with a 17.1% reduction in OW Every additional hr at T1 decreased BMI at T2 by .75 kg/m |
| Lumeng et al. (2007) USA | 9 years to ∼12 years (N=785) | Caretaker-report (24-hour sleep) Referent: duration as a continuous variable |
Measured height and weight; OW: BMI ≥95th percentile for age and gender (NCHS) | Gender, race, maternal education, ZBMI in 3rd grade, and change in sleep duration | OW: Longitudinal: ORadj =.60 (.36 - .99) For every additional hour of sleep at 9 yrs child 40% less likely to be OW at 12 yrs Cross-sectional: For every additional hour of sleep in 6th grade, child ∼20% less likely to be OW |
| Landhuis et al. (2008) NEW ZEALAND | 5 through 32 years (N=780) | Caretaker-report (averaged over ages 5, 7, 9, and 11) Referent: duration as a continuous variable |
Measured height and weight at 32 years; BMI calculated | Sex, SES, parent BMI, TV, parental control, smoking as an adult, and adult PA | OB: ORadj =.65 (.43 - .97) For every additional hour of sleep in childhood, 35% less likely to be OB at 32 |
| Touchette et al. (2008) CANADA | 2.5 to 6 years (N=1,138) | Caretaker-report (averaged over 2.5, 3.5, 4, 5 and 6 yrs) Referent: 11-hr persistent sleep duration |
BMI calculated at 2.5 & 6 yrs; IOTF guidelines used to define OW and OB. | Perinatal variables (e.g., birth weight, parent education), child weight & nap duration at 2.5 yrs; lifestyle variables (e.g., child overeating, snacking, snoring, TV, PA) | OW/OB: Short persistent sleepers (< 10 hrs/night): ORadj = 2.9 (1.0-8.5) Short increasing & 10-hr persistent = NS. |
| Taveras et al. (2008) USA | 6 months to 3 years (N=915) | Caretaker-reported (24-hour sleep averaged over the 6 month, 1 year, and 2 year assessment) Referent ≥12 hrs per day |
Measured height and weight; OW: age/sex BMI ≥95th percentile; (NCHS) | Maternal education, income, prepregnancy BMI, marital status, prenatal smoking, breastfeeding duration, child's race/ethnicity, birth weight, 6-month weight for length, average TV viewing, and daily active play | OW: ORadj = 2.04 (1.07 – 3.91) |
BMI: Body Mass Index; OW: Overweight; OB: Obese; OR = Odds ratio (OR = raw; ORadj = adjusted for confounders); PA = physical activity; WD = weekday; CDC = Centers for Disease Control;PC = Personal communication; SES = Socio-economic status; IOTF = The International Obesity Task Force; ZBMI = Body Mass Index Z-score for sex and age; NCHS = National Center for Health Statistics; DOH = Department of Heath
a
OR (Confidence Interval [CI])s reflect comparison to sleep referent for that study;
b
represents studies sampled from the Toyama Birth Cohort;
c
Biggs and Dollman (2007) supported these findings on the same dataset controlling for PA and diet;
d
Padez et al. (2009) presented similar findings on the sample controlling for parent education, parent obesity, PA, and TV watching.