Sleep, sedentary behaviour, physical activity and health‐related quality of life in children and adolescents: A systematic review

Abstract Purpose This systematic review summarizes the associations between sleep, sedentary behaviour and physical activity and HRQoL in children and adolescents. Methods PubMed, Embase, PsycINFO and SPORTDiscus were searched from inception until April 2023. Studies conducted in healthy children and adolescents, aged ≤17.9 years at baseline, with validated instruments to assess HRQoL were considered. Results Of 6914 reports, 92 (72 cross‐sectional, 10 longitudinal, 10 randomized controlled trials) were included, representing 149,760 participants aged 3–20 years. Results provide consistent evidence on (i) the detrimental associations between poor sleep quality and HRQoL; and (ii) beneficial associations between total physical activity and sports participation on HRQoL. There is some support for the detrimental associations between short sleep duration or excessive screen time and HRQoL, and beneficial associations between long sleep and HRQoL. Cross‐sectional reports dominated over longitudinal and RCTs, limiting event sequencing and causal inferences, respectively. There were few sleep studies compared to other exposures. The studies' quality varied from very low to moderate. Conclusions Results support limiting screen time during leisure time to <2 h/day, but do not provide sufficient evidence to establish a limit for total sedentary time/day, as well as promoting moderate‐to‐vigorous physical activity (> 60 min/day) and sports participation. Nevertheless, high‐quality studies are necessary in the future. Registration The protocol of this systematic review was registered in PROSPERO (CRD42023414970).