Longitudinal Associations of Sedentary Behavior and Physical Activity With Sleep Duration and Quality in Individuals Living With and Beyond Colorectal Cancer

IntroductionPoor sleep quality and disturbances are common in colorectal cancer (CRC) survivors. However, the impact of sedentary behavior, standing, and physical activity on sleep duration and quality remains under-explored in this population. Therefore, this study examined longitudinal associations of sedentary behavior, standing, and physical activity with sleep outcomes up to 5 years post-treatment.MethodsA prospective cohort study was conducted among 401 survivors of stage I-III CRC, with repeated measures up to 60 months post-treatment. Thigh-worn accelerometers were used to measure sedentary time (per 2h/day), standing (per 1h/day), and various levels of physical activity (per 1h/day). Sleep duration (h/night) and variability (0%-100%; higher variability equals more sleep disruption) were determined from self-reported sleep times. Sleep quality and insomnia symptoms were assessed using the PSQI and EORTC questionnaires, respectively, where higher scores indicated worsened symptoms. Longitudinal associations were analyzed using confounder-adjusted linear mixed models.ResultsTotal mean sedentary time was 10.3 ± 1.8 h/day, mean standing time was 2.9 ± 1.2 h/day, mean total physical activity was 1.5 ± 0.6 h/day, and mean sleep duration was 8.7 ± 1.0 h/night at 6 weeks post-treatment. More sedentary behavior was longitudinally associated with a shorter sleep duration (β = -0.28; 95%CI = -0.35, -0.21). More standing was associated with a shorter sleep duration (β = -0.21; 95%CI = -0.25, -0.16), higher sleep variability (β = 0.29%; 95%CI = 0.03, 0.55), improved sleep quality (β = -0.24; 95%CI = -0.43, -0.04), and reduced insomnia symptoms (β = -2.00; 95%CI = -3.27, -0.72). More total physical activity was associated with a shorter sleep duration (β = -0.31; 95%CI = -0.41, -0.21) and higher sleep variability (β = 0.59%; 95%CI = 0.11, 1.10). More moderate-to-vigorous physical activity was associated with a shorter sleep duration (β = -0.04; 95%CI = -0.07, -0.00) and reduced insomnia symptoms (β = -1.74; 95%CI = -2.69, -0.79).ConclusionOur findings suggest that physical (in)activity and standing are relevant for sleep-related symptoms in CRC survivors. Future studies should examine whether substituting sedentary behavior with standing and/or physical activity may alleviate sleep-related symptoms in CRC survivors.