Bidirectional Associations between Objective Physical Activity and Sleep Patterns in Spanish School Children.

Physical activity (PA) and sleep contribute to better children's health. Nonetheless, the bidirectional relationship between both of these health-related factors is unclear when using objective measures. The aims of this study were (1) to describe the PA (light PA and moderate-to-vigorous PA (MVPA) and sleep (duration, latency, and efficiency) patterns of children and compare them with recommendations, and (2) to analyze the bidirectional association between PA levels and sleep patterns in 470 Spanish children according to sex (average age of 8.4 (0.4) years, 51.9% boys). A tri-axial accelerometer and sleep logs were used to measure PA (light PA and MVPA) and sleep patterns (duration, latency, and efficiency) in the children for seven consecutive days. Linear mixed models were conducted to analyze the bidirectional association (PA ⇒ sleep and sleep ⇒ PA) adjusted for the child, the sex, the school, and the day of observation. The results showed that, overall, the children did not meet the sleep duration recommendations per day. Regarding the bidirectional association, increased light PA and MVPA during the day was related to decreased sleep duration but an improvement in sleep efficiency that night. However, sleep duration and sleep efficiency were only related negatively and positively to light PA the following day, respectively. Regarding sex, light PA was associated with decreased sleep duration in both sexes, although the average value was lower in boys. In addition, light PA was also related only to an improvement in sleep efficiency the same night in both sexes, with girls generally having more efficient sleep. More studies in a representative sample of children that use objective measures to corroborate these results are needed.