Division of Nutritional Sciences, College of Human Ecology, Cornell University, Ithaca, NY, USA.
Department of Nutrition, Texas A&M University, College Station, TX, USA.
BMC Public Health. 2024 Jan 29;24(1):321. doi: 10.1186/s12889-024-17708-6.
Childhood obesity remains a significant public health concern. Sleep duration and quality among children and youth are suboptimal worldwide. Accumulating evidence suggests an association between inadequate sleep and obesity risk, yet it is unclear whether this relationship is causal. This systematic review examines the efficacy of sleep interventions alone or as a part of lifestyle interventions for the management of overweight or obesity among children and adolescents.
A keyword/reference search was performed twice, in January 2021 and May 2022 in MEDLINE/PubMed, EMBASE/Ovid, PsycINFO/EBSCO, The Cochrane Library, Web of Science Core Collection/Web of Science, SciELO/Web of Science, and CINAHL/EBSCO. Study eligibility criteria included youth with overweight or obesity between 5 and 17, were RCTs or quasi-randomized, and focused on the treatment of overweight and obesity with a sleep behavior intervention component. Risk of bias was assessed using the Cochrane Risk of Bias assessment tool (RoB2). A Meta-analysis was conducted to estimate the effect of interventions with a sleep component on BMI. The study protocol was registered in PROSPERO (CRD42021233329).
A total of 8 studies (2 quasi-experiments, 6 RCTs) met inclusion criteria and accounted for 2,231 participants across 7 countries. Only one study design isolated the effect of sleep in the intervention and reported statistically significant decreases in weight and waist circumference compared to control, though we rated it at high risk of bias. Our meta-analysis showed no significant overall effect on children's BMI as a result of participation in an intervention with a sleep component (Cohen's d = 0.18, 95% CI= -0.04, 0.40, Z = 1.56, P = .11), though caution is warranted due to substantial heterogeneity observed across studies (Tau = 0.08; X = 23.05, df = 7; I = 83.73%).
There were mixed results on the effect of sleep interventions across included studies on BMI, other weight-related outcomes, diet, physical activity, and sleep. Except for one study at low risk of bias, three were rated as 'some concerns' and four 'high risk of bias'. Findings from this study highlight the need for additional RCTs isolating sleep as a component, focusing on children and adolescents living with overweight and obesity.
儿童肥胖仍然是一个严重的公共卫生问题。儿童和青少年的睡眠时长和质量在全球范围内都不理想。越来越多的证据表明，睡眠不足与肥胖风险之间存在关联，但尚不清楚这种关系是否具有因果关系。本系统评价研究了单纯睡眠干预或作为生活方式干预的一部分，对管理儿童和青少年超重或肥胖的效果。
2021 年 1 月和 2022 年 5 月，在 MEDLINE/PubMed、EMBASE/Ovid、PsycINFO/EBSCO、Cochrane 图书馆、Web of Science 核心合集/Web of Science、SciELO/Web of Science 和 CINAHL/EBSCO 中进行了关键字/参考文献搜索。研究纳入标准包括年龄在 5 至 17 岁之间、超重或肥胖的青少年，为 RCT 或准随机对照试验，并专注于治疗超重和肥胖的睡眠行为干预。使用 Cochrane 偏倚风险评估工具（RoB2）评估偏倚风险。对包含睡眠成分的干预措施对 BMI 的影响进行了 Meta 分析。研究方案已在 PROSPERO（CRD42021233329）中注册。
共有 8 项研究（2 项准实验，6 项 RCT）符合纳入标准，来自 7 个国家的 2231 名参与者。只有一项研究设计将睡眠的影响在干预中单独分离出来，并报告与对照组相比，体重和腰围有统计学意义的下降，但我们认为其存在高度偏倚风险。我们的 Meta 分析显示，由于参与睡眠成分干预，儿童 BMI 没有显著的总体影响（Cohen's d = 0.18，95%CI = -0.04，0.40，Z = 1.56，P = 0.11），但由于研究之间存在明显的异质性，因此需要谨慎（Tau = 0.08；X = 23.05，df = 7；I = 83.73%）。
纳入的研究中，睡眠干预对 BMI 及其他体重相关结局、饮食、身体活动和睡眠的影响结果不一。除了一项偏倚风险较低的研究外，有三项研究被评为“存在一些关注”，四项研究被评为“高偏倚风险”。本研究的结果强调了需要进行更多的 RCT 研究，将睡眠作为一个单独的成分，针对患有超重和肥胖的儿童和青少年。
