|dc.description.abstract||OBJECTIVES: Although evidence is accumulating on the importance of a good night’s sleep for healthy eating and activity
behaviors, existing research has mainly been conducted in high-income, developed countries with limited sociocultural variability.
This study is the first to examine the associations between sleep patterns and lifestyle behaviors in children from 12 countries in
five major geographic regions of the world.
METHODS: This observational, multinational cross-sectional study included 5777 children aged 9–11 years from sites in Australia,
Brazil, Canada, China, Colombia, Finland, India, Kenya, Portugal, South Africa, the United Kingdom and the United States. Nocturnal
sleep duration (hours per night), sleep efficiency (%) and bedtime (h:min) were monitored over 7 consecutive days using an
accelerometer. Lifestyle behaviors included moderate-to-vigorous physical activity (MVPA), total sedentary time (SED), self-reported
screen time (ST) and healthy/unhealthy diet patterns (HDP/UDP). Multilevel modeling analyses were used to account for the
hierarchical nature of the data.
RESULTS: Overall, participants averaged 8.8 (s.d. 0.9) hours of sleep with 96.2% (s.d. 1.4) sleep efficiency and a mean bedtime of
2218 hours. After adjustment for age, sex, highest parental education and BMI z-score, results showed that (i) sleep duration was
negatively associated with MVPA, SED and UDP score; (ii) sleep efficiency was negatively associated with MVPA and UDP score, and
positively associated with SED; and (iii) later bedtime was positively associated with SED, ST and UDP score, and negatively
associated with MVPA and HDP score. Results using categories of sleep patterns were consistent with the linear associations. Results
also revealed that associations between sleep patterns and MVPA, SED and ST were significantly different between study sites, with
stronger associations in high-income countries compared with low/middle-income countries.
CONCLUSIONS: Sleep characteristics are important correlates of lifestyle behaviors in children. Differences between countries
suggest that interventions aimed at improving sleep and lifestyle behaviors should be culturally adapted.||en_US