Abstract
The present study examined associations between sleep and physical activity among a diverse sample of 97 urban children (ages 7–9) with persistent asthma. Differences in associations were evaluated by race/ethnicity and weight status. The extent to which sleep moderated the association between lung function and physical activity was also evaluated. Generalized linear models were utilized to examine associations. Findings indicated that, among the aggregate sample, more frequent nighttime awakenings were associated with less time spent engaging in moderate-to-vigorous physical activity (MVPA). Important differences in these associations were identified by both race/ethnicity and weight status. Better lung function was associated with, (a) higher levels of MVPA for children with better sleep efficiency and fewer nighttime awakenings, and (b) lower levels of MVPA for children with poorer sleep efficiency and more frequent nighttime awakenings. In short, sleep mattered with respect to children’s physical activity levels in this sample.
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Data Availability
The datasets analyzed during the current study are available from the corresponding author on reasonable request.
Code Availability
Analyses completed in SAS version 9.2; code is available from corresponding author on reasonable request.
References
Acebo, C., Sadeh, A., Seifer, R., Tzischinsky, O., Hafer, A., & Carskadon, M. A. (2005). Sleep/wake patterns derived from activity monitoring and maternal report for healthy 1- to 5-year-old children. Sleep, 28(12), 1568–1577.
Akinbami, L. J., Moorman, J. E., Bailey, C., Zahran, H. S., King, M., Johnson, C. A., & Liu, X. (2012). Trends in asthma prevalence, health care use, and mortality in the United States, 2001–2010. NCHS Data Brief (94), 1–8
American Thoracic Society. (1999). Recommendations for standardized procedures for the on-line and off-line measurement of exhaled lover respiratory nitric oxide and nasal nitric oxide in adults and children. American Journal of Respiratory and Critical Care Medicine, 160, 2104–2117.
Bloom, B., Jones, L., & Freeman, G. (2013). Summary health statistics for U.S. children: National Health Interview Survey, 2012 (Vital Health Statistics, Issue).
Boergers, J., & Koinis-Mitchell, D. (2010). Sleep and culture in children with medical conditions. Journal of Pediatric Psychology, 35(9), 915–926. https://doi.org/10.1093/jpepsy/jsq016
Canino, G., & Bravo, M. (1994). The adaptation and testing of diagnostic and outcome measures for cross-cultural research. International Review of Psychiatry, 6(4), 281–286. https://doi.org/10.3109/09540269409023267
Contreras, Z. A., Chen, Z., Roumeliotaki, T., Annesi-Maesano, I., Baïz, N., von Berg, A., Bergström, A., Crozier, S., Duijts, L., Ekström, S., Eller, E., Fantini, M. P., Kjaer, H. F., Forastiere, F., Gerhard, B., Gori, D., Harskamp-van Ginkel, M. W., Heinrich, J., Iñiguez, C., … Chatzi, L. (2018). Does early onset asthma increase childhood obesity risk? A pooled analysis of 16 European cohorts. European Respiratory Journal, 52(3), 1800504. https://doi.org/10.1183/13993003.00504-2018
Coutinho, M. T., McQuaid, E. L., & Koinis-Mitchell, D. (2013). Contextual and cultural risks and their association with family asthma management in urban children. Journal of Child Health Care, 17(2), 138–152. https://doi.org/10.1177/1367493512456109
Eisenberg, S. R., Jelalian, E., Farrow, M., Kopel, S. J., Vehse, N., Mitchell, P., Dunsiger, S., & Koinis-Mitchell, D. (2020). Perceptions of asthma and exercise, and associations with weight status and asthma morbidity in urban children. Academic Pediatrics, 20(1), 55–62. https://doi.org/10.1016/j.acap.2019.07.001
Fagnano, M., Bayer, A. L., Isensee, C. A., Hernandez, T., & Halterman, J. S. (2011). Nocturnal asthma symptoms and poor sleep quality among urban school children with asthma. Academic Pediatrics, 11, 493–499. https://doi.org/10.1016/j.acap.2011.05.006
Fedele, D. A., Rosales, A., Everhart, R. S., Koinis-Michell, D., Canino, G., Fritz, G. K., & McQuaid, E. L. (2014). The role of alternate caregivers in the management of pediatric asthma. Journal of Pediatric Psychology, 39(6), 643–652. https://doi.org/10.1093/jpepsy/jsu025
Francisco, C. D. O., Bhatawadekar, S. A., Babineau, J., Reid, W. D., & Yadollahi, A. (2018). Effects of physical exercise training on nocturnal symptoms in asthma: Systematic review. PLoS ONE, 13(10), e0204953. https://doi.org/10.1371/journal.pone.0204953
Freitas, P. D., Xavier, R. F., Passos, N. F. P., Carvalho-Pinto, R. M., Cukier, A., Martins, M. A., Cavalheri, V., Hill, K., Stelmach, R., & Carvalho, C. R. F. (2019). Effects of a behaviour change intervention aimed at increasing physical activity on clinical control of adults with asthma: Study protocol for a randomised controlled trial. BMC Sports Science, Medicine and Rehabilitation, 11(1), 16. https://doi.org/10.1186/s13102-019-0128-6
Fritz, G. K., McQuaid, E. L., Kopel, S. J., Seifer, R., Klein, R. B., Koinis-Mitchell, D. K., Esteban, C. A., Rodriguez-Santana, J., Colon, A., Alvarez, M., & Canino, G. (2010). Ethnic differences in perception of lung function: A factor in pediatric asthma disparities? American Journal of Respiratory and Critical Care Medicine, 182(1), 12–18. https://doi.org/10.1164/rccm.200906-0836OC
Gennuso, J., Epstein, L. H., Paluch, R. A., & Cerny, F. (1998). The relationship between asthma and obesity in urban minority children and adolescents. Archives of Pediatric Adolescent Medicine, 152(12), 1197–1200.
Glazebrook, C., McPherson, A. C., Macdonald, I. A., Swift, J. A., Ramsay, C., Newbould, R., & Smyth, A. (2006). Asthma as a barrier to children’s physical activity: Implications for body mass index and mental health. Pediatrics, 118(6), 2443–2449. https://doi.org/10.1542/peds.2006-1846
Gomes, E. P., Reboredo, M. M., Carvalho, E. V., Teixeira, D. R., Carvalho, L. F. C. D. O., Filho, G. F. F., Oliveira, J. C. A. D., Sanders-Pinheiro, H., Chebli, J. M. F., Paula, R. B. D., & Pinheiro, B. D. V. (2015). Physical activity in hemodialysis patients measured by triaxial accelerometer. BioMed Research International, 2015, 645645. https://doi.org/10.1155/2015/645645
Holderness, H., Chin, N., Ossip, D. J., Fagnano, M., Reznik, M., & Halterman, J. S. (2017). Physical activity, restrictions in activity, and body mass index among urban children with persistent asthma. Annals of Allergy, Asthma & Immunology, 118(4), 433–438. https://doi.org/10.1016/j.anai.2017.01.014
Koinis-Mitchell, D., Kopel, S. J., Boergers, J., McQuaid, E. L., Esteban, C. A., Seifer, R., Fritz, G. K., Beltran, A. J., Klein, R. B., & LeBourgeois, M. (2015). Good sleep health in urban children with asthma: A risk and resilience approach. Journal of Pediatric Psychology, 40(9), 888–903. https://doi.org/10.1093/jpepsy/jsv046
Koinis-Mitchell, D., Boergers, J., Kopel, S. J., McQuaid, E. L., Farrow, M. L., & LeBourgeois, M. (2019a). Racial and ethnic disparities in sleep outcomes among urban children with and without asthma. Sleep Health, 5(6), 532–538. https://doi.org/10.1016/j.sleh.2019.08.003
Koinis-Mitchell, D., Boergers, J., Kopel, S. J., McQuaid, E. L., Farrow, M. L., & LeBourgeois, M. (2019b). Racial and ethnic disparities in sleep outcomes among urban children with and without asthma. Sleep Health, 5(6), 532–538. https://doi.org/10.1016/j.sleh.2019.08.003
Koinis-Mitchell, D. K. S., Esteban, C., Seifer, R., Vehse, G., Chau, S., & Jelalian, E. (2017). Asthma status and physical activity in urban children. American Thoracic Society.
Koinis-Mitchell, D., McQuaid, E. L., Seifer, R., Kopel, S. J., Esteban, C., Canino, G., Garcia-Coll, C., Klein, R., & Fritz, G. K. (2007). Multiple urban and asthma-related risks and their association with asthma morbidity in children. Journal of Pediatric Psychology, 32(5), 582–595. https://doi.org/10.1093/jpepsy/jsl050
Koinis Mitchell, D., Kopel, S. J., Dunsiger, S., McQuaid, E. L., Miranda, L. G., Mitchell, P., Vehse, N., & Jelalian, E. (In Press). Asthma and Physical Activity In Urban Children. Journal of Pediatric Psychology.
Kuczmarski, R. J., Ogden, C. L., Grummer-Strawn, L. M., Flegal, K. M., Guo, S. S., Wei, R., Mei, Z., Curtin, L. R., Roche, A. F., & Johnson, C. L. (2000). CDC growth charts: United States. Advance Data (314), 1–27.
Lang, D., Butz, A., Duggan, K., & Serwint, J. (2004). Physical activity in urban school-aged children with asthma. Pediatrics, 113(4), 341–346.
Liu, A. H., Zeiger, R., Sorkness, C. A., Mahr, T., Ostrom, N., Burgess, S., Rosenzweig, J. C., & Manjunath, R. (2007). Development and cross-sectional validation of the Childhood Asthma Control Test. Journal of Allergy & Clinical Immunology, 119(4), 817–825. https://doi.org/10.1016/j.jaci.2006.12.662
Liu, J., Hay, J., Joshi, D., Faught, B. E., Wade, T., & Cairney, J. (2011). Sleep difficulties and obesity among preadolescents. Canadian Journal of Public Health, 102(2), 139–143. https://doi.org/10.1007/BF03404163
Lv, N., Xiao, L., & Ma, J. (2015). Weight management interventions in adult and pediatric asthma populations: A systematic review. Journal of Pulmonary & Respiratory Medicine, 5(232), 1000232. https://doi.org/10.4172/2161-105X.1000232
Martin, S. R., Boergers, J., Kopel, S. J., McQuaid, E. L., Seifer, R., LeBourgeois, M., Klein, R. B., Esteban, C. A., Fritz, G. K., & Koinis-Mitchell, D. (2017). Sleep hygiene and sleep outcomes in a sample of urban children with and without asthma. Journal of Pediatric Psychology. https://doi.org/10.1093/jpepsy/jsx052
Meltzer, L. J., Ullrich, M., & Szefler, S. J. (2014). Sleep duration, sleep hygiene, and insomnia in adolescents with asthma. Journal of Allergy and Clinical Immunology, 2(5), 562–569. https://doi.org/10.1016/j.jaip.2014.02.005
Milligan, K. L., Matsui, E., & Sharma, H. (2016). Asthma in urban children: Epidemiology, environmental risk factors, and the public health domain. Current Allergy and Asthma Reports, 16(4), 33. https://doi.org/10.1007/s11882-016-0609-6
Moore, J. B., Beets, M. W., Morris, S. F., & Kolbe, M. B. (2014). Comparison of objectively measured physical activity levels of rural, suburban, and urban youth. American Journal of Preventive Medicine, 46(3), 289–292. https://doi.org/10.1016/j.amepre.2013.11.001
Morrissey, B., Taveras, E., Allender, S., & Strugnell, C. (2020). Sleep and obesity among children: A systematic review of multiple sleep dimensions. Pediatric Obesity, 15(4), e12619. https://doi.org/10.1111/ijpo.12619
National Heart Lung and Blood Institute. (2007). Guidelines for the diagnosis and management of asthma. National Institutes of Health; Bethesda, MD.
Paavonen, E. J., Räikkönen, K., Lahti, J., Komsi, N., Heinonen, K., Pesonen, A. K., Järvenpää, A. L., Strandberg, T., Kajantie, E., & Porkka-Heiskanen, T. (2009). Short sleep duration and behavioral symptoms of attention-deficit/hyperactivity disorder in healthy 7- to 8-year-old children. Pediatrics, 123(5), e857–e864. https://doi.org/10.1542/peds.2008-2164
Paruthi, S., Brooks, L. J., D’Ambrosio, C., Hall, W. A., Kotagal, S., Lloyd, R. M., Malow, B. A., Maski, K., Nichols, C., Quan, S. F., Rosen, C. L., Troester, M. M., & Wise, M. S. (2016). Recommended amount of sleep for pediatric populations: A consensus statement of the American Academy of Sleep Medicine. Journal of Clinical Sleep Medicine : JCSM : Official Publication of the American Academy of Sleep Medicine, 12(6), 785–786. https://doi.org/10.5664/jcsm.5866
Peters, U., Dixon, A. E., & Forno, E. (2018). Obesity and asthma. The Journal of Allergy and Clinical Immunology, 141(4), 1169–1179. https://doi.org/10.1016/j.jaci.2018.02.004
Scholle, S., Beyer, U., Bernhard, M., Eichholz, S., Erler, T., Graness, P., Goldmann-Schnalke, B., Heisch, K., Kirchhoff, F., Klementz, K., Koch, G., Kramer, A., Schmidtlein, C., Schneider, B., Walther, B., Wiater, A., & Scholle, H. C. (2011). Normative values of polysomnographic parameters in childhood and adolescence: Quantitative sleep parameters [Clinical Trial Multicenter Study Research Support, Non-U.S. Gov't Validation Studies]. Sleep Medicine, 12(6), 542–549. https://doi.org/10.1016/j.sleep.2010.11.011
Sitnick, S. L., Goodlin-Jones, B. L., & Anders, T. F. (2008). The use of actigraphy to study sleep disorders in preschoolers: Some concerns about detection of nighttime awakenings. Sleep, 31(3), 395.
Spilsbury, J. C., Storfer-Isser, A., Kirchner, H. L., Nelson, L., Rosen, C. L., Drotar, D., & Redline, S. (2006). Neighborhood disadvantage as a risk factor for pediatric obstructive sleep apnea. Journal of Pediatrics, 149(3), 342–347. https://doi.org/10.1016/j.jpeds.2006.04.061
Strom, M. A., & Silverberg, J. I. (2016). Associations of physical activity and sedentary behavior with atopic disease in United States Children. Journal of Pediatrics, 174, 247-253.e243. https://doi.org/10.1016/j.jpeds.2016.03.063
Trost, S. G., Kerr, L. M., Ward, D. S., & Pate, R. R. (2001). Physical activity and determinants of physical activity in obese and non-obese children. International Journal of Obesity and Related Metabolic Disorders, 25(6), 822–829. https://doi.org/10.1038/sj.ijo.0801621
Trost, S. G., Loprinzi, P. D., Moore, R., & Pfeiffer, K. A. (2011). Comparison of accelerometer cut points for predicting activity intensity in youth. Medicine and Science in Sports and Exercise, 43(7), 1360–1368. https://doi.org/10.1249/MSS.0b013e318206476e
U.S. Department of Health and Human Services. (2005). The 2005 HHS Poverty Guidelines.
U.S. Department of Health and Human Services. (2018). Physical Activity Guidelines for Americans.
Wang, X., Dockery, D. W., Wypij, D., Fay, M. E., & Ferris, B. G., Jr. (1993). Pulmonary function between 6 and 18 years of age. Pediatric Pulmonology, 15(2), 75–88. https://doi.org/10.1002/ppul.1950150204
Wanrooij, V. H., Willeboordse, M., Dompeling, E., & van de Kant, K. D. (2014). Exercise training in children with asthma: A systematic review. British Journal of Sports Medicine, 48(13), 1024–1031. https://doi.org/10.1136/bjsports-2012-091347
Ward, D. S., Evenson, K. R., Vaughn, A., Rodgers, A. B., & Troiano, R. P. (2005). Accelerometer use in physical activity: Best practices and research recommendations. Medicine and Science in Sports and Exercise, 37(11 Suppl), S582-588.
Welsh, L., Kemp, J. G., & Roberts, R. G. D. (2005). Effects of physical conditioning on children and adolescents with asthma. Sports Medicine, 35(2), 127–141. https://doi.org/10.2165/00007256-200535020-00003
Westergren, T., Berntsen, S., Lødrup Carlsen, K. C., Mowinckel, P., Håland, G., Fegran, L., & Carlsen, K.-H. (2017). Perceived exercise limitation in asthma: The role of disease severity, overweight, and physical activity in children. Pediatric Allergy and Immunology, 28(1), 86–92.
Wiesenthal, E. N., Fagnano, M., Cook, S., & Halterman, J. S. (2016). Asthma and overweight/obese: Double trouble for urban children. Journal of Asthma, 53(5), 485–491. https://doi.org/10.3109/02770903.2015.1108435
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All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by DKM, Ph.D., EJ, Ph.D., CD, Ph.D., SD, Ph.D., RN, Sc.M., and SJK, M.Sc. The first draft of the manuscript was written by CD, Ph.D., and DKM, Ph.D. All authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.
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Christina D’Angelo, Elissa Jelalian, Shira Dunsiger, Rebecca Noga, Sheryl J. Kopel, Julie Boergers, Katherine Mitchell, Kate Powers and Daphne Koinis-Mitchell declare that they have no financial or non-financial conflicts of interest relevant to this article to disclose.
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D’Angelo, C., Jelalian, E., Dunsiger, S. et al. Physical Activity Among Urban Children with Asthma: Does Sleep Matter?. J Clin Psychol Med Settings 29, 666–677 (2022). https://doi.org/10.1007/s10880-021-09815-y
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DOI: https://doi.org/10.1007/s10880-021-09815-y