1077 Relative Efficacy of Sleep Alone or Together with Targeted Eating and Activity Behaviors for Pediatric Weight Regulation: A Randomized Clinical Trial

Abstract Introduction Sleep plays an important role in pediatric weight regulation. However, the few pediatric clinical trials that have been conducted have focused on large experimental changes in sleep with little attention to the clinical utility of enhancing sleep as a stand-alone or adjunct treatment for pediatric weight control. Thus, the present study assessed the relative efficacy of a behavioral intervention to enhance sleep alone versus together with targeted eating and activity behaviors on change in body mass index z-scores (BMIz). Methods Youth aged 6-11 years (y) who were reported to sleep 9.5 hours/night or less were enrolled between February 2018 and July 2022 and randomly assigned to: optimize sleep (OS; behavioral intervention to enhance nocturnal sleep) or optimize sleep plus (OSP; behavioral intervention to enhance sleep plus reduce sugar sweetened beverages, sweet and salty snack foods, television viewing, and increase physical activity). Interventions were delivered to parent-child dyads in-person/virtually and by phone across eight sessions. Assessments were completed at baseline, 6- (end of treatment/primary outcome) and 12-months. Parents reported demographic information; child height and weight were measured to calculate BMI and BMIz. Intent to treat analyses using regressions and multiple imputation (e.g., Covid pandemic increased missingness) controlled for the respective baseline value of the outcome; those focused on BMI also controlled for child age and biological sex. Results Seventy-eight children (M[SD] age = 8.72y[1.40]; 47% female; 82% African American/Black; 13% Hispanic/Latino; 47% with overweight/obesity; M[SD] sleep period = 514[36] min) were randomized. No between-group differences on key demographics or BMIz/BMI were present at baseline. Children randomized to OSP had greater reductions in BMIz at 6 months (OS: 0.14[0.49] vs. OSP: -0.24[0.63], p = 0.035). Findings for BMI at 6 months were consistent but did not reach statistical significance (p = 0.059). By 12 months, BMI and BMIz did not differ by intervention. Conclusion Children randomized to enhance sleep duration together with specific eating and activity behaviors demonstrated clinically meaningful differences in BMIz at 6 months. Findings need to be considered in light of the Covid-19 pandemic and should be replicated in future studies. Support (if any) National Heart Lung and Blood Institute, R01HL092910-05