Obesogenic sleep patterns among Chinese preschool children: A latent profile and transition analysis of the association sleep patterns and obesity risk

Objective: This paper utilized a person-centered approach to examine whether sleep patterns on school and free days are associated with obesity risk in preschool children aged 3-6 years. Methods: The cross-sectional analysis included 204 children from the Wuhan Healthy Start Project with valid sleep data in at least four consecutive days gathered via Actigraph GT3X+. Based on three domains of sleep duration, sleep onset, and sleep offset, we used latent profile analysis to identify distinct sleep patterns on school and free days separately. Additionally, we conducted latent transition analysis to explore the probabilities of sleep patterns transitions between school and free days. The multivariate logistic regression model investigated the associations of sleep patterns with overweight/obesity (OWO) (BMI & GE; age-and sex-specific 85th percentile) and abdominal obesity (AO) (WC & GE; age-and sex-specific 75th percentile).Results: Two sleep patterns were identified for school days: "EL-sc" (early-to-sleep/longer-duration) (n = 119; 58.3%) and "LS-sc" (late-to-sleep/shorter-duration) (n = 85; 41.7%). Similarly, "LES-fr" (late-to-sleep/early-to-wake/shorter-duration) (n = 118; 57.8%) and "ELL-fr" (early-to-sleep/late-to-wake/longer-duration) (n = 86; 42.2%) patterns were identified for free days. LTA categorized the participants into four distinct transition groups, i.e., "EL-sc & RARR;ELL-fr" (32.9%), "EL-sc & RARR;LES-fr" (24.0%), "LS-sc & RARR;LES-fr" (33.8%), and "LS-sc & RARR;ELL-fr" (9.3%). Compared with the "ELsc & RARR;ELL-fr", the "LS-sc & RARR;LES-fr" had a higher risk of OWO (AOR 4.76; 95% CI: 1.39-20.33) and AO (AOR, 2.78; 95% CI, 1.21-6.62), respectively. Neither "EL-sc & RARR;LES-fr" (AOR, 1.11; 95% CI, 0.14-6.67) nor "LS-sc & RARR;ELL-fr" (AOR, 0.74; 95% CI, 0.03-6.14) was significantly associated with OWO. Likewise, no significant association was observed for "EL-sc & RARR;LES-fr" (AOR, 0.96; 95% CI, 0.35-2.62) and "LS-sc & RARR;ELL-fr" (AOR, 0.56; 95% CI, 0.11-2.18) with AO.Conclusions: "LS-sc & RARR;LES-fr" pattern is significantly associated with an increased risk of general and abdominal obesity, indicating its obesogenic nature. Furthermore, although not statistically associated with obesity out-comes, "LS-sc & RARR;ELL-fr" and "EL-sc & RARR;LES-fr" patterns exhibit a semi-obesogenic characteristic. In addition, we identified a concerning trend that preschool children are at risk of transitioning to and persisting in sleep patterns characterized by delayed and shorter sleep. These findings underscore the importance of implementing in-terventions and strategies to address sleep patterns as a crucial step to minimize the risk of obesity.