Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep MedicineMar 3, 2023

Sleep and daily activity patterns linked to heart and metabolism health in school-age children

Circadian Biology Weekly Brief ↗PubMed ↗DOI ↗

Updated Mar 29, 2026

Abstract

An increase in nightly awakenings by 2 times is associated with a 0.12 standard deviation lower body mass index in school-age children.

Higher nightly awakenings may correlate with increased blood glucose levels by 0.15 mmol/L.
Among boys, greater variability in daily activity patterns is linked to higher fat mass index (+0.07 kg/m) and visceral fat mass (+0.08 g).
No associations were found between sleep or activity patterns and blood pressure or clustering of cardiometabolic risk factors.
These findings suggest that disruptions in sleep and daily rhythms could be related to changes in body fat distribution in children.

Simplified

STUDY OBJECTIVES: Disturbed sleep and 24-hour activity rhythms are linked to adverse cardiometabolic profiles in adults and adolescents, and these associations may originate in early life. We aimed to study associations of sleep and 24-hour rhythms with cardiometabolic risk factors in school-age children.

METHODS: This cross-sectional population-based study comprised 894 children aged 8-11 years from the Generation R Study. Sleep (duration, efficiency, number of awakenings, and time awake after sleep onset) and 24-hour activity rhythms (social jet lag, interdaily stability, and intradaily variability) were assessed using triaxial wrist actigraphy for 9 consecutive nights. Cardiometabolic risk factors included adiposity (body mass index Z-score, fat mass index using dual-energy X-ray absorptiometry, and visceral fat mass and liver fat fraction using magnetic resonance imaging), blood pressure, and blood markers (glucose, insulin, and lipids). We adjusted for season, age, sociodemographics, and lifestyle factors.

RESULTS: Each increase in interquartile range of nightly awakenings (2 times) was associated with -0.12 standard deviation (95% confidence interval: -0.21, -0.04) lower body mass index and 0.15 mmol/L (0.10, 0.21) higher glucose. Among boys, an increase in interquartile range of intradaily variability (0.12) was associated with higher fat mass index (+0.07 kg/m; 95% confidence interval: 0.03, 0.11) and visceral FM (+0.08 g; 95% confidence interval: 0.02, 0.15). We observed no associations with blood pressure or clustering of cardiometabolic risk factors. 2

CONCLUSIONS: Already at school age, greater fragmentation of the 24-hour activity rhythm is associated with general and organ adiposity. In contrast, more nightly awakenings were associated with lower body mass index. Future research should bring clarity to these disparate observations in order to create potential targets for obesity prevention programs.

CITATION: Beunders VAA, Koopman-Verhoeff ME, Vermeulen MJ, et al. Sleep, 24-hour activity rhythms, and cardiometabolic risk factors in school-age children.. 2023;19(7):1219-1229. J Clin Sleep Med

Funding

Competing interests

All authors had final approval of the version to be published and agreed to be accountable for all aspects of the work. The general design of the Generation R Study was supported by financial support from the Erasmus MC, Rotterdam; Netherlands Organization for Health Research and Development (ZonMw); Netherlands Organization for Scientific Research (NWO); Ministry of Health, Welfare and Sport; and Ministry of Youth and Families. V.W.V.J. received a grant from the European Research Council (Consolidator Grant, ERC-2014-CoG-648916). The financial supporters did not influence the results of this article. The authors report no conflicts of interest.

PubMed

Sleep and daily activity patterns linked to heart and metabolism health in school-age children

Abstract

Funding

Competing interests

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