Skip to main content Accessibility help
×
Home

Physical exercise may improve sleep quality in children and adolescents with Fontan circulation

  • Eva R. Hedlund (a1), Li Villard (a2) (a3), Bo Lundell (a1) and Gunnar Sjöberg (a1) (a4)

Abstract

Objective:

To study physical activity and sleep in Fontan patients and healthy controls before and after an endurance training program, and after 1 year.

Method:

Fontan patients (n = 30) and healthy controls (n = 25) wore accelerometers for seven consecutive days and nights during a school week before and after a 12-week endurance training program and after 1 year.

Results:

Patients had similar sleep duration and sleep efficiency as healthy controls. Latency to sleep onset in minutes was longer for patients than controls (22.4 (4.3–55.3) minutes versus 14.8 (8.6–29.4) minutes, p < 0.01). More time in moderate-to-vigorous activity daytime was correlated with increased sleep time (p < 0.05; r2 = 0.20), improved sleep efficiency (p < 0.01; r2 = 0.24) and less time as wake after sleep onset (p < 0.05; r2 = 0.21) for patients but not controls. Sleep variables did not change after the exercise intervention for patients or controls. After 1 year, patients had decreased total sleep time, decreased sleep efficiency, increased accelerometer counts during sleep and more time as wake after sleep onset during sleep time, but not controls.

Conclusions:

Fontan patients have prolonged latency to sleep onset compared with controls. More time in physical activities was correlated with better sleep quality for the patients. Also, subjects with low sleep efficiency and long latency to sleep onset may benefit most from physical exercise. These patients should be encouraged to engage in individually designed physical exercise as this could improve sleep quality.

Copyright

Corresponding author

Author for correspondence: Eva R. Hedlund, MD, PhD, Department of Women’s and Children’s Health, Karolinska Institutet, Karolinska University Hospital, Astrid Lindgren Children’s Hospital Solna, Barnhjärtcentrum, Eugeniavägen 23, C8:34, S-171 76 Stockholm, Sweden. Tel: +46-707421285; Fax: +46-8-51777778; E-mail: eva.rylander-hedlund@sll.se

References

Hide All
1.Bjork, VO, Olin, CL, Bjarke, BB, Thoren, CA. Right atrial-right ventricular anastomosis for correction of tricuspid atresia. J Thorac Cardiovasc Surg 1979; 77: 452458.
2.de Leval, MR, Kilner, P, Gewillig, M, Bull, C. Total cavopulmonary connection: a logical alternative to atriopulmonary connection for complex Fontan operations. Experimental studies and early clinical experience. J Thorac Cardiovasc Surg 1988; 96: 682695.
3.Fontan, F, Baudet, E. Surgical repair of tricuspid atresia. Thorax 1971; 26: 240248.
4.Gewillig, M, Brown, SC. The Fontan circulation after 45 years: update in physiology. Heart 2016; 102: 10811086.
5.Kanakis, MA, Petropoulos, AC, Mitropoulos, FA. Fontan operation. Hellenic J Cardiol 2009; 50: 133141.
6.Hedlund, ER, Lundell, B, Villard, L, Sjoberg, G. Reduced physical exercise and health-related quality of life after Fontan palliation. Acta Paediatr 2016; 105: 13221328.
7.Longmuir, PE, Corey, M, Faulkner, G, Russell, JL, McCrindle, BW. Children after Fontan have strength and body composition similar to healthy peers and can successfully participate in daily moderate-to-vigorous physical activity. Pediatr Cardiol 2015; 36: 759767.
8.McCrindle, BW, Williams, RV, Mital, S, et al. Physical activity levels in children and adolescents are reduced after the Fontan procedure, independent of exercise capacity, and are associated with lower perceived general health. Arch Dis Child 2007; 92: 509514.
9.Jenkins, PC, Chinnock, RE, Jenkins, KJ, et al. Decreased exercise performance with age in children with hypoplastic left heart syndrome. J Pediatr 2008; 152: 507512.
10.Muller, J, Christov, F, Schreiber, C, Hess, J, Hager, A. Exercise capacity, quality of life, and daily activity in the long-term follow-up of patients with univentricular heart and total cavopulmonary connection. Eur Heart J 2009; 30: 29152920.
11.Dulfer, K, Bossers, SS, Utens, EM, et al. Does functional health status predict health-related quality of life in children after Fontan operation?. Cardiol Young 2016; 26: 459468.
12.Knowles, RL, Day, T, Wade, A, et al. Patient-reported quality of life outcomes for children with serious congenital heart defects. Arch Dis Child 2014; 99: 413419.
13.McCrindle, BW, Williams, RV, Mitchell, PD, et al. Relationship of patient and medical characteristics to health status in children and adolescents after the Fontan procedure. Circulation 2006; 113: 11231129.
14.Uzark, K, Jones, K, Slusher, J, Limbers, CA, Burwinkle, TM, Varni, JW. Quality of life in children with heart disease as perceived by children and parents. Pediatrics 2008; 121: e10601067.
15.Uzark, K, Zak, V, Shrader, P, et al. Assessment of quality of life in young patients with single ventricle after the Fontan operation. J Pediatr 2016; 170: 166172 e161.
16.Cole, RJ, Kripke, DF, Gruen, W, Mullaney, DJ, Gillin, JC. Automatic sleep/wake identification from wrist activity. Sleep 1992; 15: 461469.
17.Sadeh, A, Sharkey, KM, Carskadon, MA. Activity-based sleep-wake identification: an empirical test of methodological issues. Sleep 1994; 17: 201207.
18.Weiss, AR, Johnson, NL, Berger, NA, Redline, S. Validity of activity-based devices to estimate sleep. J Clin Sleep Med 2010; 6: 336342.
19.Hedlund, ER, Lundell, B, Soderstrom, L, Sjoberg, G. Can endurance training improve physical capacity and quality of life in young Fontan patients? Cardiol Young 2017: 19.
20.Corder, K, Brage, S, Ekelund, U. Accelerometers and pedometers: methodology and clinical application. Curr Opin Clin Nutr Metab Care 2007; 10: 597603.
21.de Souza, L, Benedito-Silva, AA, Pires, ML, Poyares, D, Tufik, S, Calil, HM. Further validation of actigraphy for sleep studies. Sleep 2003; 26: 8185.
22.Trost, SG, Pate, RR, Freedson, PS, Sallis, JF, Taylor, WC. Using objective physical activity measures with youth: how many days of monitoring are needed?. Med Sci Sports Exerc 2000; 32: 426431.
23.Fairclough, SJ, Noonan, R, Rowlands, AV, Van Hees, V, Knowles, Z, Boddy, LM. Wear compliance and activity in children wearing wrist- and hip-mounted accelerometers. Med Sci Sports Exerc 2016; 48: 245253.
24.Evenson, KR, Catellier, DJ, Gill, K, Ondrak, KS, McMurray, RG. Calibration of two objective measures of physical activity for children. J Sports Sci 2008; 26: 15571565.
25.Trost, SG, Loprinzi, PD, Moore, R, Pfeiffer, KA. Comparison of accelerometer cut points for predicting activity intensity in youth. Med Sci Sports Exerc 2011; 43: 13601368.
26.Eakin, BL, Finta, KM, Serwer, GA, Beekman, RH. Perceived exertion and exercise intensity in children with or without structural heart defects. J Pediatr 1992; 120: 9093.
27.Tremblay, MS, Carson, V, Chaput, JP, et al. Canadian 24-Hour movement guidelines for children and youth: an integration of physical activity, sedentary behaviour, and sleep. Appl Physiol Nutr Metab 2016; 41: S311327.
28.Lang, C, Brand, S, Feldmeth, AK, Holsboer-Trachsler, E, Puhse, U, Gerber, M. Increased self-reported and objectively assessed physical activity predict sleep quality among adolescents. Physiol Behav 2013; 120: 4653.
29.Stone, MR, Stevens, D, Faulkner, GE. Maintaining recommended sleep throughout the week is associated with increased physical activity in children. Prev Med 2013; 56: 112117.
30.Ortega, FB, Ruiz, JR, Labayen, I, et al. Sleep duration and activity levels in Estonian and Swedish children and adolescents. Eur J Appl Physiol 2011; 111: 26152623.
31.Kredlow, MA, Capozzoli, MC, Hearon, BA, Calkins, AW, Otto, MW. The effects of physical activity on sleep: a meta-analytic review. J Behav Med 2015; 38: 427449.
32.Raustorp, A, Pagels, P, Froberg, A, Boldemann, C. Physical activity decreased by a quarter in the 11- to 12-year-old Swedish boys between 2000 and 2013 but was stable in girls: a smartphone effect?. Acta Paediatr 2015; 104: 808814.

Keywords

Metrics

Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed