Diagnosis-Specific Links Between Physical Activity and Sleep Duration in Youth with Disabilities: A Systematic Review with Quantitative Synthesis

Highlights: Public health relevance—How does this work relate to a public health issue? Children and adolescents with disabilities experience disproportionately low physical activity and inadequate sleep, two behaviors central to lifelong health and functioning. This review addresses a critical gap in population health evidence by examining how physical activity and sleep are linked across diverse disability groups. Public health significance—Why is this work of significance to public health? Diagnosis type was a key determinant of sleep duration, revealing substantial heterogeneity in sleep health among youth with disabilities. Meeting physical activity guidelines may support longer sleep duration among youth with autism spectrum disorder, identifying physical activity as a potentially modifiable behavior for improving sleep health. Public health implications—What are the key implications or messages for practitioners, policy makers, and/or researchers in public health? Public health strategies should prioritize accessible, diagnosis-specific physical activity opportunities within schools, communities, and clinical care settings to support sleep health. Researchers and policy makers should move beyond one-size-fits-all recommendations and consider diagnosis-specific approaches when developing inclusive physical activity and sleep interventions. Children and adolescents with disabilities experience disproportionate challenges in achieving recommended levels of physical activity (PA) and adequate sleep, two core determinants of health and functional well-being. This systematic review examined associations between meeting PA guidelines and sleep duration among youth with disabilities. Following PRISMA guidelines, MEDLINE, PsycARTICLES, and SPORTDiscus were searched through Spring 2024 for studies assessing PA and sleep in children and adolescents (<18 years) with disabilities using subjective or objective measures. Data were extracted from 28 studies (N = 138,016) and synthesized using qualitative methods and regression-based quantitative analyses to examine the effects of diagnosis category and PA guideline adherence on sleep duration. The diagnosis type was associated with sleep duration, with youth with autism spectrum disorder (ASD) exhibiting shorter sleep than those with physical disabilities. Meeting PA guidelines (≥60 min/day) was associated with longer sleep duration among youth with ASD, but not consistently across other diagnostic groups. Qualitative findings further indicated diagnosis-specific variability, with PA positively associated with sleep outcomes in ASD, attention deficit/hyperactivity disorder, and epilepsy, and mixed associations observed for cerebral palsy and intellectual disability. These findings suggest that PA may support sleep health in specific disability groups. Given persistently low PA participation among youth with disabilities, integrating accessible, diagnosis-specific PA opportunities within school, community, and clinical settings may represent a feasible strategy to improve sleep and overall health.