Correlation between sleep quality and physical activity among school-going children in South Delhi

Mosab Aldabbas; Tarushi Tanwar; Zubia Veqar

doi:10.4103/jsip.jsip_11_21

ORIGINAL ARTICLE

Year : 2022 | Volume : 6 | Issue : 1 | Page : 27-32

Correlation between sleep quality and physical activity among school-going children in South Delhi

Mosab Aldabbas, Tarushi Tanwar, Zubia Veqar
Centre for Physiotherapy and Rehabilitation Sciences, Jamia Millia Islamia, New Delhi 110025, India

Date of Submission	10-Aug-2021
Date of Acceptance	18-Feb-2022
Date of Web Publication	21-Mar-2022

Correspondence Address:
Dr. Zubia Veqar
Centre for Physiotherapy and Rehabilitation Sciences, Jamia Millia Islamia, New Delhi 110025.
India

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/jsip.jsip_11_21

Abstract

Background: Adolescents are going through major lifestyle as well as hormonal changes. To manage the stress of these changes, the first health risk behavior usually exhibited is lack of sleep and reduced physical activity (PA). Aims: The current study was designed to investigate the association among sleep, daytime sleepiness, and PA status of urban school-going children in South Delhi, India. Furthermore, it aims at finding out any existing gender bias (boys vs. girls). Materials and Methods: The study included 72 participants (47 males and 25 females) from a secondary school (11–13 years). The students completed the Physical Activity questionnaires for children, Pittsburgh Sleep Quality Index, and Epworth Sleepiness Scale. Results: PA was not associated with sleep quality (r = −0.290) and daytime sleepiness (r = −0.099). Daytime sleepiness was correlated with sleep quality (r = 0.456; P < 0.01). It was further demonstrated that the level of PA of boys was higher than that of girls. Daytime sleepiness is more in girls 7.08 (3.45) than in boys 5.98 (3.18). There is a slight difference in the sleep quality among both genders: 4.44 (1.91) for girls and 4.45 (1.92) for boys. Conclusion: In school-going children from South Delhi, India, poor sleep quality was associated with daytime sleepiness and weakly associated with the level of PA. There exist gender differences in PA and daytime sleepiness between boys and girls. More research is required to confirm the causality between these variables.

Keywords: Day time sleepiness, physical activity, sleep quality

How to cite this article:
Aldabbas M, Tanwar T, Veqar Z. Correlation between sleep quality and physical activity among school-going children in South Delhi. J Soc Indian Physiother 2022;6:27-32

How to cite this URL:
Aldabbas M, Tanwar T, Veqar Z. Correlation between sleep quality and physical activity among school-going children in South Delhi. J Soc Indian Physiother [serial online] 2022 [cited 2022 May 23];6:27-32. Available from: http://www.jsip.ac.in/text.asp?2022/6/1/27/339811

Introduction

Participation of school-going children in regular physical activity (PA) has long been acknowledged as a significant part of adolescent lifestyle.^[1] Adolescent engagement in the desired amount of PA may have a positive effect on muscle health, bone mass, well-being, academic performance, cholesterol level, movement skills, and blood pressure.^[2] The global recommendation of PA for children and adolescents (5–17 years) is to gather at least 60 min daily of moderate-to-vigorous PA.^[3]

Decrease in PA levels has been reported across various time spans.^[4] For example, 80% of American adolescents do not meet the recommended level of PA.^[5] This drop in the amount of PA among adolescents is concerning and has been linked with development of various diseases and disorders.^[6],[7]

Gender differences exist with regard to PA levels in adolescents, for example, the boys are more active than girls, and the girls are more impacted by daytime sleepiness than boys.^[8],[9] European adolescents have shown that 21% of 9-year-old males were more physically active compared with girls, whereas it increased to 26% by the time they reach 15.^[5]

Sleep is one of the factors that have been hypothesized to play an essential role in growth.^[10] Poor sleep quality is common at the time of adolescence.^[11] Adolescent did not get enough sleep.^[12] Also, a study which was conducted among secondary schoolchildren in New Zealand reported that the New Zealand teenagers are not getting enough sleep and they sleep on an average of 8 h and 40 min.^[13]

The National Sleep Foundation reported that children and adolescents aged 6–13 years should sleep an average of 9–11 h per night for health benefits and physical and mental development.^[14] Adolescents in the USA have been reported to be suffering from insufficient sleep, and this issue is getting worse over time.^[4] Inadequate sleep has been linked with behavioral problems, obesity, poor sociability, and learning disorders.^[15]

Excessive daytime sleepiness (EDS) is one of the common negative consequences of inadequate sleep.^[16] EDS is associated with poor sleep quality, decreased sleep duration, or combination of both sleep domains.^[17] It is also used as a predictor for lower-level PA and reduces functional outcomes in adolescents.^[18]

Attaining the recommended levels of PA and sleep must be considered as central components to keeping a healthy lifestyle in adolescents and youth.^[11] PA is associated with longer sleep duration and improved quality of sleep in adolescents and youth.^[19] It is postulated that the alterations in quantity and quality of sleep and the daytime sleepiness could diminish the PA level in adolescents,^[13] and deficient sleep along with daytime sleepiness could eventually decrease the motivation to exercise.^[20] To the best of our knowledge, few studies have examined the correlation of PA, sleep, and daytime sleepiness in school-going children in India. Therefore, the present study was designed to:

Investigate the relationship of PA status with sleep quality and daytime sleepiness in schoolchildren in South Delhi.

Investigate if the said relationship is influenced by gender.

Materials and Methods

Ethical considerations

This study followed the ethical guidelines of the Declaration of Helsinki and fulfilled the ethical research criteria applicable to humans: informed consent from parents/teachers and students, right to information and privacy, no discrimination, cause-free status, and being given a choice to exit the study at any point of time. Prior to the commencement, the study was approved by the Institutional Ethics Committee of Jamia Millia Islamia, New Delhi, India and conducted as per the guidelines of Indian Council of Medical Research, India. Consent forms were signed accordingly by parents prior to the participation in the study. Assent has been obtained from the children and school.

Study design

The present study was an observational correlational analysis study design. The data collection for the study was done as a single session study from December 2016 to April 2017.

Participants

The study was conducted in Secondary School, South Delhi, India. Students (47 males and 25 females) aged between 11 and 13 years who were attending regular classes and could read and understand English were invited to participate in the study. Students currently suffering from any kind of medical or mental disorders or were on any kind of medication were excluded from the study.

Measures

Sleep quality

It was assessed by the Pittsburgh Sleep Quality Index (PSQI) which is a self-reported questionnaire that was developed by Buysse et al.^[21] The PSQI was developed as an easy tool which can be used by clinicians and scientists to differentiate between “good” and “bad” sleepers.^[22] This 10-item assessment measures sleep quality over the past 1-month time interval and potential sleep disturbances such as having a roommate or episodes of disorientation or confusion during sleep.^[23] The PSQI is a multiple-choice paper pencil test that takes around 10–15 min to complete. It is valid for assessing the sleep quality in adolescents. It has moderate reliability and high internal consistency.^[22]

Physical activity

It was measured by the Physical Activity Questionnaire for older children (PAQ-C). It is a self-administered, 7-day recall instrument. PAQ-C was developed to evaluate general PA level throughout the grade school year for students in grades 4–8 correlating to 8–14 years of age. The PAQ-C can be delivered in a classroom setting and gives a summary of PA score derived from nine items, each scored on a 5-point scale. A score of 1 indicates low PA, whereas a score of 5 indicates high PA.^[24] PAQ-C has good convergent validity and good reliability.^[25]

Day time sleepiness

Epworth Sleepiness Score (ESS) was used to assess the general level of daytime sleepiness. ESS was developed by Dr Murray John in 1990.^[26] It has 8 items, each item has a score of 0–3, with 0 meaning you would never fall asleep in a given situation and 3 meaning there is a very high chance that you would fall asleep in a given situation. ESS gives a good reliable measure of propensity to sleepiness.^[27]

Procedure

Two sections were randomly selected by the chit method from standard 8 of Senior Secondary School. The selected sections had a combined strength of 84 students. Eighty students were present on the day the study was conducted out of which 72 were recruited for the study according to the inclusion criteria. The students were given an envelope containing the three questionnaires (ESS, PSQI, and PAQ-C). The researchers briefly explained the questionnaires to the students and answered the questions regarding the same. The researchers were available in the room when the students were completing the questionnaires to answer any queries regarding the same. The students placed the completed questionnaires in the envelope and submitted it to the researchers.

Sample size

The sample size was calculated using the software G*Power (University Kiel, Germany). A sample size of 72 subjects was required to be necessary to achieve a statistical power of 80% at an alpha of 0.05 with the medium effect size 0.03, which was assumed based on the findings of Foti (2011), the study was conducted to examine whether PA and sedentary behaviors are associated with sleep duration.^[28]

Data Analysis and Results

Data analysis

The statistical analysis was performed by Statistical Package for Social Sciences (SPSS) version 22.0. Descriptive data are presented as mean and standard deviation. Normality of the data was examined using the Kolmogorov–Smirnov test. Considering that majority of the data was not normally distributed, non-parametric statistics was applied for further analysis. Spearman’s rank correlation coefficient was calculated to investigate the association between the PA levels and sleep quality, PA level, and daytime sleepiness and between daytime sleepiness and sleep quality. The PA levels and sleep quality outcomes were compared between the boys and girls using the Mann–Whitney U-test. Statistical significance was set at 5%. Descriptive data are shown in [Table 1].

Table 1: Descriptive data of the subjects for age and independent variables (n = 72)

Click here to view

PA and sleep

The correlation analysis demonstrated a weak correlation between PAQ-C and global PSQI score (r = −0.29; P = 0.013). Also, a non-significant weak correlation was found between PAQ-C and ESS (r = −0.10; P = 0.408). Global PSQI score was found to be moderately correlated with the ESS (r = 0.46; P < 0.001) [Table 2].

Table 2: Correlation matrix of Spearman’s coefficient of PAC-C, PSQI, and ESS

Click here to view

Comparison of PA levels, sleep quality, and daytime sleepiness between boys and girls

When the results were analyzed according to gender, they revealed that the PA of boys, 2.90 (0.74), was greater than that of girls, 2.38 (0.46) [Table 3]. The girls had higher levels of daytime sleepiness [7.08 (3.45)] than boys [5.98 (3.18)]. A slight difference was found in the sleep quality between boys 4.45 (1.92) and girls 4.44 (1.91).

Table 3: Correlation of gender differences in physical activity, sleep quality, and daytime sleepiness between males and females

Click here to view

Discussion

A growing interest in literatures has documented the prevalence and adverse consequences of sleep disturbances, physical inactivity, and daytime sleepiness in schoolchildren. In the present study, using a relatively medium sample of Indian adolescents, we found a weak association between PA and sleep quality. Sleep quality and daytime sleepiness were moderately associated with each other. There was a weak correlation between PA and daytime sleepiness, and there was a marked difference which depicts boys are more physically active than girls, and the girls are more impacted by daytime sleepiness.

The results of this study did not support the hypothesis that sleep quality and daytime sleepiness are significantly associated with PA. These results were in accordance with a previous study conducted on US schoolchildren, which reported an inverse association between the number of sleeping hours/night and number of physical activities bouts.^[29],[30] Hyperactive schoolchildren have less night-time sleeping hours compared with those who are less active.^[31] Moreover, sleep quality was not associated with self-reported PA level.^[32] However, our results are inconsistent with the majority of the previous experimental studies which reveal that higher levels of PA are associated with better sleep quality, quantity, and daytime sleepiness.^[33],[34]

Our results have noticed that daytime sleepiness and sleep quality were moderately correlated (r =0.456; P< 0.01). In concordance with our results, EDS is generally supposed to be as a result of disrupted or insufficient sleep.^[11] A cross-sectional study of 144 participants conducted in the UK reported that low sleep quality is common among participants with EDS (r = 0.31; P<0.001).^[23] Another cross-sectional study made up of 986 South African adolescents has shown that half of the participants with sleep disturbance reported remarkable EDS.^[35]

PA status of boys and girls was also explored in this study. Our results revealed a gender-based variance in PA among adolescents, in which boys are more active than girls. This has been one of the most persistent findings whereby boys are consistently shown to be more active than girls.^[36] European boys had also been reported to be more active when compared with girls.^[37] Moreover, boys had been reported to be more physically active than girls in all countries studied.^[38]

Recognizing the underlying factors of gender differences in PA might play a role to successfully creating intervention plans to increase the level of PA in adolescents. A particular reason for the gender difference in PA is that girls have given low and sometimes neglected levels of support to be physically active.^[28] Another possible reason is the possibility of a lack of social support provided to the girls in engaging in various types of PA.^[39] Also, biological reasons can also lead to gender differences in PA; it is shown that lower PA levels in girls may be related to maturing at an earlier chronological age.^[40]

Our results noticed also that girls are more impacted by daytime sleepiness than boys. Recent preliminary results show that adolescent girls reported higher levels of daytime sleepiness than boys, which is depicted by the adolescent girls having difficulties staying awake during class in the morning, afternoon, and during homework hours than adolescent boys.^[9] Our results have not found a gender difference in sleep quality measured by PSQI. A previous study noted the existence of gender difference in sleep quality, in which females had a higher prevalence of poor sleep quality than boys.^[41] Demographic differences and differences in sample size could explain the dissimilarities in the results. Further studies will need to be conducted among subjects with a broader age range, introducing more objective measures to evaluate qualitative and quantitative aspects of sleep such as activity monitor devices or night-time polysomnography. Accelerometer and/or actigraphy can be used to further substantiate the results. A comparison of various age groups based on the levels of maturity can be conducted.

Limitations of the study

This study is cross-sectional, and thus causation cannot be directly tested. PA measures did not include its intensity. Lack of information on anxiety, depression, and other factors could affect sleep and PA, as well as affect the accuracy of our results.

Conclusion

These findings suggest a weak relationship between PA and various parameters of sleep. Moderate relationship exists between daytime sleepiness and sleep quality. The daytime sleepiness and PA characteristics of this unique population revealed a marked gender difference, in which boys are more active than girls, and the girls are more affected by daytime sleepiness than boys.

Acknowledgments

We would like to thank our colleagues from the Centre for Physiotherapy and Rehabilitation Sciences, Jamia Millia Islamia, New Delhi, India, who provided insight and expertise that greatly assisted the research.

Financial support and sponsorship

Nil.

Conflicts of interest

The authors declare that they have no conflicts of interest.

References

1.	Zhou J, Heim D, O’Brien K. Alcohol consumption, athlete identity, and happiness among student sportspeople as a function of sport-type. Alcohol Alcohol 2015;50:617-23.
2.	Landry BW, Driscoll SW. Physical activity in children and adolescents. PM R 2012;4:826-32.
3.	Bull FC, Al-Ansari SS, Biddle S, Borodulin K, Buman MP, Cardon G, et al. World Health Organization guidelines on physical activity and sedentary behaviour. Br J Sports Med 2020;54:1451-62.
4.	Williams JA, Zimmerman FJ, Bell JF. Norms and trends of sleep time among US children and adolescents. JAMA Pediatr 2013;167:55-60.
5.	Riddoch CJ, Andersen LB, Wedderkopp N, Harro M, Klasson-heggebØ L, Sardinha LB, et al. Physical activity levels and patterns of 9-and 15-yr-old European children. Med Sci Sports Exerc 2004;36:86-92.
6.	Hardy LL, Denney-Wilson E, Thrift AP, Okely AD, Baur LA. Screen time and metabolic risk factors among adolescents. Arch Pediatr Adolesc Med 2010;164:643-9.
7.	Ogden CL, Carroll MD, Curtin LR, Lamb MM, Flegal KM. Prevalence of high body mass index in US children and adolescents, 2007-2008. JAMA 2010;303:242-9.
8.	Telford RM, Telford RD, Olive LS, Cochrane T, Davey R. Why are girls less physically active than boys? Findings from the LOOK longitudinal study. PLoS One 2016;11:e0150041.
9.	American Academy of Sleep Medicine. Teenage girls are more impacted by sleepiness than teen boys are: Sleep disturbances in girls associated with more difficulties staying awake in and out of school. ScienceDaily. Available from: https://www.sciencedaily.com/releases/2018/06/180606143714.htm. [Last accessed on 6 Jun 2018].
10.	Blader JC, Koplewicz HS, Abikoff H, Foley C. Sleep problems of elementary school children. A community survey. Arch Pediatr Adolesc Med 1997;151:473-80.
11.	Mendelson M, Borowik A, Michallet AS, Perrin C, Monneret D, Faure P, et al. Sleep quality, sleep duration and physical activity in obese adolescents: Effects of exercise training. Pediatr Obes 2016;11:26-32.
12.	Gibson ES, Powles AC, Thabane L, O’Brien S, Molnar DS, Trajanovic N, et al. “Sleepiness” is serious in adolescence: Two surveys of 3235 Canadian students. BMC Public Health 2006;6:116.
13.	Dorofaeff TF, Denny S. Sleep and adolescence. Do New Zealand teenagers get enough? J Paediatr Child Health 2006;42: 515-20.
14.	Children and Sleep [Internet]. Sleepfoundation.org. 2018. Available from: https://www.sleepfoundation.org/children-and-sleep. [Last accessed on 13 Nov 2018].
15.	Chervin RD, Dillon JE, Bassetti C, Ganoczy DA, Pituch KJ. Symptoms of sleep disorders, inattention, and hyperactivity in children. Sleep 1997;20:1185-92.
16.	Fallone G, Owens JA, Deane J. Sleepiness in children and adolescents: Clinical implications. Sleep Med Rev 2002;6:287-306.
17.	Roehrs T, Kapke A, Roth T, Breslau N. Sex differences in the polysomnographic sleep of young adults: A community-based study. Sleep Med 2006;7:49-53.
18.	Chasens ER, Sereika SM, Weaver TE, Umlauf MG. Daytime sleepiness, exercise, and physical function in older adults. J Sleep Res 2007;16:60-5.
19.	Brand S, Gerber M, Beck J, Hatzinger M, Pühse U, Holsboer-Trachsler E. High exercise levels are related to favorable sleep patterns and psychological functioning in adolescents: A comparison of athletes and controls. J Adolesc Health 2010;46:133-41.
20.	Chaput JP, Lambert M, Gray-Donald K, McGrath JJ, Tremblay MS, O’Loughlin J, et al. Short sleep duration is independently associated with overweight and obesity in Quebec children. Can J Public Health 2011;102:369-74.
21.	Buysse DJ, Reynolds CF III, Monk TH, Berman SR, Kupfer DJ. The Pittsburgh Sleep Quality Index: A new instrument for psychiatric practice and research. Psychiatry Res 1989;28:193-213.
22.	Passos MH, Silva HA, Pitangui AC, Oliveira VM, Lima AS, Araújo RC. Reliability and validity of the Brazilian version of the Pittsburgh Sleep Quality Index in adolescents. J Pediatr (Rio J) 2017;93:200-6.
23.	Cleator J, Abbott J, Judd P, Wilding JP, Sutton CJ. Correlations between night eating, sleep quality, and excessive daytime sleepiness in a severely obese UK population. Sleep Med 2013;14:1151-6.
24.	Kowalski KC, Crocker PR, Donen RM. The Physical Activity Questionnaire for Older Children (PAQ-C) and Adolescents (PAQ-A) manual. Coll Kinesiol Univ Saskatchewan 2004;87:1-38.
25.	Thomas EL, Upton D. Psychometric properties of the Physical Activity Questionnaire for older children (PAQ-C) in the UK. Psychol Sport Exerc 2014;15:280-7.
26.	Johns MW. A new method for measuring daytime sleepiness: The Epworth Sleepiness Scale. Sleep 1991;14:540-5.
27.	Pilcher JJ, Switzer FS III, Munc A, Donnelly J, Jellen JC, Lamm C. Psychometric properties of the Epworth Sleepiness Scale: A factor analysis and item-response theory approach. Chronobiol Int 2018;35:533-45.
28.	Davison KK. Activity-related support from parents, peers, and siblings and adolescents’ physical activity: Are there gender differences? J Phys Activity and Health 2004;1:363-76.
29.	Ekstedt M, Nyberg G, Ingre M, Ekblom Ö, Marcus C. Sleep, physical activity and BMI in six to ten-year-old children measured by accelerometry: A cross-sectional study. Int J Behav Nutr Phys Act 2013;10:82.
30.	Laurson KR, Lee JA, Gentile DA, Walsh DA, Eisenmann JC. Concurrent associations between physical activity, screen time, and sleep duration with childhood obesity. ISRN Obes 2014;2014:204540.
31.	Touchette E, Côté SM, Petit D, Liu X, Boivin M, Falissard B, et al. Short nighttime sleep-duration and hyperactivity trajectories in early childhood. Pediatrics 2009;124:e985-93.
32.	Kakinami L, O’Loughlin EK, Brunet J, Dugas EN, Constantin E, Sabiston CM, et al. Associations between physical activity and sedentary behavior with sleep quality and quantity in young adults. Sleep Health 2017;3:56-61.
33.	Lira FS, Pimentel GD, Santos RV, Oyama LM, Damaso AR, Oller do Nascimento CM, et al. Exercise training improves sleep pattern and metabolic profile in elderly people in a time-dependent manner. Lipids Health Dis 2011;10:1-6.
34.	Chasens ER, Umlauf MG, Weaver TE. Sleepiness, physical activity, and functional outcomes in veterans with type 2 diabetes. Appl Nurs Res 2009;22:176-82.
35.	Reid A, Baker FC. Perceived sleep quality and sleepiness in South African university students. South Afr J Psychol 2008;38:287-303.
36.	Sallis JF, McKenzie TL, Alcaraz JE. Habitual physical activity and health-related physical fitness in fourth-grade children. Am J Dis Child 1993;147:890-6.
37.	Ekelund U, Wijndaele K, Sherar L, Cooper A. Birth weight, sedentary time and abdominal adiposity in youth: The International Children’s Accelerometry Database (ICAD). J Sci Med Sport 2012;15:S41.
38.	Telama R. Physical Fitness, Sporting Lifestyles and Olympic Ideals: Cross-cultural Studies on Youth Sport in Europe. Schorndorf:Hofmann; 2002.
39.	Edwardson CL, Gorely T, Pearson N, Atkin A. Sources of activity-related social support and adolescents objectively measured after-school and weekend physical activity: Gender and age differences. J Phys Activity Health 2013;10: 1153-8.
40.	Wickel EE, Eisenmann JC, Welk GJ. Maturity-related variation in moderate-to-vigorous physical activity among 9–14-year-olds. J Phys Activity Health 2009;6:597-605.
41.	Fatima Y, Doi SA, Najman JM, Mamun AA. Exploring gender difference in sleep quality of young adults: Findings from a large population study. Clin Med Res 2016;14:138-44.