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Does Chronotype Modify the Relationship Between Sleep Duration and Body Mass Index in Adolescents?

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Does Chronotype Modify the Relationship Between Sleep Duration and Body Mass Index in Adolescents? University of Pennsylvania ScholarlyCommons Publicly Accessible Penn Dissertations 2015 Does Chronotype Modify the Relationship Between Sleep Duration and Body Mass index in Adolescents? Susan Kohl Malone University of Pennsylvania, [email protected] Follow this and additional works at: https://repository.upenn.edu/edissertations Part of the Nursing Commons Recommended Citation Malone, Susan Kohl, "Does Chronotype Modify the Relationship Between Sleep Duration and Body Mass index in Adolescents?" (2015). Publicly Accessible Penn Dissertations. 1876. https://repository.upenn.edu/edissertations/1876 This paper is posted at ScholarlyCommons. https://repository.upenn.edu/edissertations/1876 For more information, please contact [email protected]. Does Chronotype Modify the Relationship Between Sleep Duration and Body Mass index in Adolescents? Abstract Support for an association between sleep duration and body mass index exists. However, not all short sleepers are overweight/obese. The complex interplay between circadian and metabolic processes has become a recent focus in sleep and obesity research and may explain this perplexing observation. Chronotype (as a marker for circadian misalignment) may be able to predict who is at greatest risk for obesity onset when exposed to short sleep duration. The goal of this study was to examine sleep duration and chronotype in racially/ethnically diverse adolescents and to determine whether chronotype modified the association between sleep duration and body mass index. A cross-sectional study design was used to examine these relationships using self-reported sleep data from 115 9th and 10th grade students and actigraphy-estimated sleep data from 69 of these participants. Participants were recruited from a Northeast coastal city high school in NJ. Socio-demographic and behavioral predictors of sleep duration and chronotype were estimated using general linear models. School night and free night sleep duration, chronotype preference, chronotype, and social jet lag were the independent variables of interest for predicting BMI. The moderating effect of chronotype and social jet lag on sleep duration and BMI was also estimated. General linear models were used to estimate these associations while controlling for selected socio-demographic and behavioral characteristics. Black adolescents had shorter free night sleep than Hispanic adolescents. Adolescents with later chronotypes drank more soda, were less physically active, and napped more frequently than adolescents with earlier chronotypes. Longer school night sleep and greater social jet lag predicted higher BMI z scores. Associations between social jet lag and BMI, as well as chronotype and health-related behaviors, suggest that chronobiological approaches to preventing obesity may be warranted. The overall goal of these approaches should be to align daily schedules with individual biological rhythms. Additional approaches to improve the regularity of sleep- wake timing may be needed. Shorter free night sleep duration in Black adolescents indicate that this group may be at greatest risk for the negative consequences of short sleep and irregular sleep-wake timing. Degree Type Dissertation Degree Name Doctor of Philosophy (PhD) Graduate Group Nursing First Advisor Terri H. Lipman Keywords adolescents, body mass index, chronotype, sleep Subject Categories Nursing This dissertation is available at ScholarlyCommons: https://repository.upenn.edu/edissertations/1876 DOES CHRONOTYPE MODIFY THE RELATIONSHIP BETWEEN SLEEP DURATION AND BODY MASS INDEX IN ADOLESCENTS? Susan Kohl Malone A DISSERTATION in Nursing Presented to the Faculties of the University of Pennsylvania in Partial Fulfillment of the Requirements for the Degree of Doctor of Philosophy 2015 Supervisor of Dissertation ________________________ Terri H. Lipman, PhD, CRNP, FAAN Miriam Stirl Endowed Term Professor of Nutrition Professor of Nursing of Children Graduate Group Chairperson _______________________ Connie M. Ulrich, PhD, RN, FAAN Associate Professor of Nursing Associate Professor of Bioethics Department of Medical Ethics, School of Medicine Dissertation Committee Babette Zemel, PhD, Professor of Pediatrics, Perelman School of Medicine Charlene Compher, PhD, RD, CNSC, LDN, FADA, Professor of Nutrition Science Margaret Souders, PhD, CRNP, Assistant Professor of Human Genetics Dedication To Conor, Ellen, Sean, Brianna, and Kelsey, my pride and joy. To Mark, my every-day, ordinary super hero. ii RESEARCH SUPPORT This work was made possible through generous support from the: National Association of School Nurses Ruth L. Kirschstein National Research Service Award F31NR014603 The Rockefeller University Heilbrunn Nurse Scholar Award University of Pennsylvania School of Nursing Biobehavioral Research Center University of Pennsylvania Office of Nursing Research iii ACKNOWLEDGMENTS “To everything there is a season and a time to every purpose under heaven” (Ecclesiastics 3:1). This has been a time of dedication and determination made possible by many. My dissertation chair, Dr. Terri Lipman, has been my mainstay, connecting me to a network of individuals to support this work and a constant reminder that the purpose of this work is to improve the health and well being of youth. Dr. Babette Zemel anchored this work with sound anthropometric measurement and analytic approaches. Dr. Charlene Compher devoted meticulous attention to this study’s detail and encouraged me to expand my thinking. Dr. Margaret Souders gently guided me into the world of sleep research. Dr. Allan Pack provided persistent, but gracious, prodding to publish. Dr. Phil Gehrman generously provided input on all things actigraphy related. Jesse Chittams and Aleda Leis Thompson provided hours of patient, thoughtful, guidance on all things statistical. The Biobehavioral Research Center, particularly Drs. Barbara Riegel and Terry Richmond, provided invaluable feedback on multiple grant applications and opportunities to grow as a scientist. Dr. Yvonne Paterson, welcomed me into the sleep research group giving me a glimpse of the next steps as a post doc. Dr. Barry Coller stirred thoughtful questions that I will ponder as I move forward in my scientific career. The Heilbrunn Center’s support made actigraphy monitoring possible for all participants. This work would not have been possible without the Long Branch School District. Kathleen Celli, school nurse supervisor exemplar, opened every door to make this study a success. Mary Whalen and Margarita Cajas welcomed me into their space and made data collection run like clockwork. Long Branch High School faculty gave me precious class time to recruit participants and collect data. The enthusiasm of the students who iv participated in this study and their diligent record keeping, unparalleled by most adolescent sleep studies, have made me very proud of this work. This dissertation was also possible because of a special network of friends and family for whom chronotype is now a part of their everyday lexicon. Youjeong Kang, Meredith MacKenzie, and Terease Waite, fellow travelers on this journey, gave me laughter, support, empathy, encouragement, and friendship in abundant doses every step of the way. Joan Polsky and Mikel Goldblatt gave me a home away from home making these final steps doable. These friendships have been the gift of my doctoral studies. Carla Lillvik, Isabella Hu, and Ann Roseman, my dear friends, have cheered me along and helped celebrate many milestones along the way. Mary Pat Lamberti, my sister, fellow sleep researcher, and chief commiserator, encouraged me to keep going because the best dissertation is a done dissertation. My parents’ commitment to my firm educational foundation has given me opportunities to stand on the shoulders of leaders. William Kohl, my father, fueled my work ethic and spirit of inquiry for devising better ways of doing things (the Spanish twist for extracting a boat motor). Patricia Kohl, my mother, guided me to pursue nursing and, through her example, instilled in me the value of making a difference in the lives of others. Conor, Sean, Brianna, and Kelsey, my children, have graciously listened to endless aspects of this dissertation while forging ahead successfully with their life’s endeavors – I am so very proud. Mark, my husband, made this dream a reality through his unwavering support. God, through whom all things are possible, has given me this time and the dedication of these fabulous colleagues, friends, and family. I am truly grateful. v ABSTRACT DOES CHRONOTYPE MODIFY THE RELATIONSHIP BETWEEN SLEEP DURATION AND BODY MASS INDEX IN ADOLESCENTS? Susan Kohl Malone Terri H Lipman, PhD, CRNP, FAAN Support for an association between sleep duration and body mass index exists. However, not all short sleepers are overweight/obese. The complex interplay between circadian and metabolic processes has become a recent focus in sleep and obesity research and may explain this perplexing observation. Chronotype (as a marker for circadian misalignment) may be able to predict who is at greatest risk for obesity onset when exposed to short sleep duration. The goal of this study was to examine sleep duration and chronotype in racially/ethnically diverse adolescents and to determine whether chronotype modified the association between sleep duration and body mass index. A cross-sectional study design was used to examine these relationships using self-reported sleep data from 115 9 th and 10 th grade students and actigraphy-estimated sleep
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