Physical Activity, Sedentary Behavior, Sleep Efficacy, And Quality Of Life In Children With Intellectual Disabilities

Abstract

PURPOSE: Compared with children with typical development, children with intellectual disabilities (IDs) are found to be less physically active and have lower sleep efficacy and quality of life (QoL). The purpose of the current study was to examine the associations of physical activity and sedentary behavior with sleep efficacy and QoL in children with IDs during the COVID-19 pandemic. METHODS: Children aged between 5 and 17 years with mild and moderate IDs (N = 113) from 11 Hong Kong special schools were included in the cross-sectional study during the COVID-19 pandemic. Time spent in light physical activity (LPA), moderate to vigorous physical activity (MVPA), sedentary behavior, and sleep efficacy was measured by the accelerometer and split into quartiles (Q1-Q4), and QoL was measured by the Pediatric Quality of Life Inventory (PedsQL) ranging from 0 to 100. Multivariable linear regression and independent t-test were used to analyze the associations, mediating, and moderating effects. RESULTS: Positive associations were found between LPA quartiles and QoL in children with IDs during the COVID-19 pandemic, such as Emotional QoL (MD Q4 vs Q1 = 12.41, p < 0.05, 95% CI [0.44, 24.38]), Social QoL (MD Q4 vs Q1 = 17.58, p < 0.05, 95% CI [2.23, 32.93]), School QoL (MD Q2 vs Q1 = 13.50, p < 0.05, 95% CI [2.19, 24.80]), and Total QoL (MD Q4 vs Q1 = 11.78, p < 0.05, 95% CI [0.50, 23.06]). Positive associations were also found between MVPA quartiles and sleep efficacy (MD Q4 vs Q1 = 3.22, p < 0.05, 95% CI [0.09, 6.35]); while sedentary behavior quartiles were negatively associated with Physical QoL and sleep efficacy (Physical QoL: MD Q3 vs Q1 = -18.42, p < 0.05, 95% CI [-36.23, -0.61]; sleep efficacy: MD Q4 vs Q1 = -14.78, p < 0.01, 95% CI [-24.46, -5.10]). Moreover, sleep efficacy mediated the associations of LPA (β = -0.38, p < 0.01) and sedentary behavior (β = -3.76, p < 0.01) with School QoL. Age, gender, and ID level had moderating effects on physical activity, sedentary behavior, sleep efficacy, and QoL. CONCLUSIONS: Physical activity and sedentary behavior were significantly associated with sleep efficacy and QoL in children with IDs during the COVID-19 pandemic. Future studies should aim at promoting physical activity participation, sleep efficacy, and QoL in this under-researched population.