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

Introduction: Poor 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. Methods: A 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. Results: Total 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). Conclusion: Our 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.