Sleep Quality, Nutritional Habits, and Physical Activity in Pediatric Cancer Survivors: A Dyadic Analysis Approach

Background/objectives: Sleep disturbances are prevalent among pediatric cancer survivors (PCSs) and their caregivers, often leading to poorer dietary choices and reduced physical activity. Additionally, the sleep quality and health behaviors of parents and children can affect each other. This study examined bi-directional associations between PCSs and their parents' sleep quality and health-related behaviors.

Methods: 127 parent-child dyads enrolled in a behavioral intervention for pediatric cancer survivors (Mage = 11.04; 53.2% female) and their families completed the Patient Sleep Quality Inventory (PSQI) and USDA Parent or Child Food and Activity Questionnaire (FAQ). Two actor-partner interdependence models, using multi-level modeling and adjusting for relevant confounds, estimated the bidirectional associations between the parent-child dyad's sleep quality and composite food and physical activity quality.

Results: After controlling for partner BMI and actor and partner age, the effect of children's PSQI scores on parent's FAQ scores was statistically significant (β = -0.23, p = 0.036). Poorer sleep quality in children was associated with worse physical activity and dietary behaviors in parents. Second, after adjusting for race, a significant partner effect for parents' FAQ scores on children's PSQI scores was shown-greater parental food and physical activity quality was associated with better sleep quality in PCS (β = -0.20, p = 0.041).

Conclusions: Better food and activity quality for parents is linked to improved sleep quality for children, while children's poor sleep quality is associated with lower food and activity quality in parents. The findings highlight the prospective value of systems-focused clinical interventions to manage sleep quality and promote positive health behaviors among PCS.