Quantity versus quality of objectively measured sleep in relation to body mass index in children: cross-sectional and longitudinal analyses



Although sleep duration is well established as a risk factor for child obesity, how measures of sleep quality relate to body size is less certain. The aim of this study was to determine how objectively measured sleep duration, sleep timing, and sleep quality were related to body mass index (BMI) cross-sectionally and longitudinally in school-aged children.


All measures were obtained at baseline, 12 and 24 months in 823 children (51% female, 53% European, 18% Māori, 12% Pacific, 9% Asian) aged 6–10 years at baseline. Sleep duration, timing, and quality were measured using actigraphy over 7 days, height and weight were measured using standard techniques, and parents completed questionnaires on demographics (baseline only), dietary intake, and television usage. Data were analysed using imputation; mixed models, with random effects for person and age, estimated both a cross-sectional effect and a longitudinal effect on BMI z-score, adjusted for multiple confounders.


The estimate of the effect on BMI z-score for each additional hour of sleep was −0.22 (95% CI: −0.33, −0.11) in cross-sectional analyses and −0.05 (−0.10, −0.004) in longitudinal analyses. A greater effect was observed for weekday sleep duration than weekend sleep duration but variability in duration was not related to BMI z-score. While sleep timing (onset or midpoint of sleep) was not related to BMI, children who were awake in the night more frequently (0.19; 0.06, 0.32) or for longer periods (0.18; 0.06, 0.36) had significantly higher BMI z-scores cross-sectionally, but only the estimates for total time awake (minutes) were significant longitudinally (increase in BMI z-score of 0.04 for each additional hour awake).


The beneficial effect of a longer sleep duration on BMI was consistent in children, whereas evidence for markers of sleep quality and timing were more variable.

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The PLAY Study was funded by the Health Research Council of New Zealand (09/087 A). RWT is supported by a Fellowship from Karitane Products Society and VF was in receipt of a Lotteries Doctoral Fellowship. The funding sources had no role in the design and conduct of the study; collection, management, analysis, or interpretation of the data; preparation, review, or approval of the manuscript; or the decision to submit the manuscript for publication.

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RT had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. RT was the Principal Investigator of the PLAY study, obtained the funding, and developed the study concept and design along with co-investigators SW, VF and JM. BG provided expert guidance on the assessment of sleep and KM on physical activity. All authors were involved in the acquisition, analysis or interpretation of data. SW designed and undertook all statistical analyses. RT wrote the first and subsequent drafts of the manuscript, and authors critically revised the manuscript for important intellectual content.

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Correspondence to Rachael W. Taylor.

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Taylor, R.W., Williams, S.M., Galland, B.C. et al. Quantity versus quality of objectively measured sleep in relation to body mass index in children: cross-sectional and longitudinal analyses. Int J Obes 44, 803–811 (2020).

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