Late-night eating and inactivity: Links to depression and suicide risk in adolescents living in Turkey

OBJECTIVE

Depression, anxiety, and eating disorders are all common during adolescence. This study aims to investigate the potential relationship between eating at night, physical activity, and depression/suicide risk in adolescents.

METHODS

This study followed a cross-sectional descriptive design and involved collecting data from adolescents aged 13-18 years who attend four different high schools. The data collection was done through an online survey using Google Forms. Sociodemographic form, eating at night questionnaire, International Physical Activity Questionnaire (Short Form), Reynolds Adolescent Depression Scale, and Suicide Probability Scale were used for data collection. The data collected were analyzed electronically using descriptive statistics and correlation tests to examine relationships between different parameters.

RESULTS

The study revealed significant associations between academic achievement, daily sleep duration, and daily walking distance with depression and suicide probability (p < 0.05) among the participants. Adolescents who consumed food after 10 pm exhibited higher depression and suicide probability scores than their counterparts (p < 0.05). Additionally, an analysis of physical activity levels demonstrated that highly active adolescents had lower depression and suicide probability scores.

CONCLUSIONS

In conclusion, this study suggests that there is a significant relationship between eating at night, physical activity, and depression/suicide risk in adolescents. Specifically, academic success, daily sleep duration, daily walking distance, and eating habits were found to be associated with depression and suicide probability. Encouraging physical activity and healthy eating habits, particularly avoiding eating late at night, may be beneficial in reducing the risk of depression and suicide among adolescents.

Sleep Profiles in Eating Disorders: A Scientometric Study on 50 Years of Clinical Research

Sleep and diet are essential for maintaining physical and mental health. These two factors are closely intertwined and affect each other in both timing and quality. Eating disorders, including anorexia nervosa and bulimia nervosa, are often accompanied by different sleep problems. In modern society, an increasing number of studies are being conducted on the relationship between eating disorders and sleep. To gain a more comprehensive understanding of this field and highlight influential papers as well as the main research domains in this area, a scientometric approach was used to review 727 publications from 1971 to 2023. All documents were retrieved from Scopus through the following string "TITLE-ABS (("sleep" OR "insomnia") AND ("anorexia nervosa" OR "bulimia nervosa" OR "binge eating" OR "eating disorder*") AND NOT "obes*") AND (LIMIT-TO (LANGUAGE, "English"))". A document co-citation analysis was applied to map the relationship between relevant articles and their cited references as well as the gaps in the literature. Nine publications on sleep and eating disorders were frequently cited, with an article by Vetrugno and colleagues on nocturnal eating being the most impactful in the network. The results also indicated a total of seven major thematic research clusters. The qualitative inspection of clusters strongly highlights the reciprocal influence of disordered eating and sleeping patterns. Researchers have modelled this reciprocal influence by taking into account the role played by pharmacological (e.g., zolpidem, topiramate), hormonal (e.g., ghrelin), and psychological (e.g., anxiety, depression) factors, pharmacological triggers, and treatments for eating disorders and sleep problems. The use of scientometric perspectives provides valuable insights into the field related to sleep and eating disorders, which can guide future research directions and foster a more comprehensive understanding of this important area.

A Scoping Review on the Association between Night Eating Syndrome and Physical Health, Health-Related Quality of Life, Sleep and Weight Status in Adults

Night eating syndrome (NES) is characterised by recurrent episodes of night eating, evident through excessive food consumption after the evening meal or eating after awakening from sleep, often associated with significant distress and/or impairment in functioning. This scoping review was conducted according to PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Scoping Reviews) guidelines. The search was conducted through the use of PubMed, Medline (OVID) and SCOPUS, to identify relevant articles published within the last 10 years. Search terms including "Night eating*" OR "NES" and Boolean phrases were used to refine the search. Additionally, the age of participants was restricted to 18 years and above, to ensure only adult participants were included. The abstracts of the remaining articles were used to screen for those that were relevant. From a total of 663 citations, 30 studies assessing night eating syndrome met the inclusion criteria to be included in the review. We found inconsistent associations of NES with higher body mass index (BMI), less physical activity, type 2 diabetes mellitus (T2DM) and poorer quality of sleep. These inconsistencies may have been due to the use of different measurement methods, lack of power from small sample sizes of NES in some studies and varying ages of participants, with associations being more likely to be found in higher-quality, representative populations than in university student samples. There were no associations of NES with T2DM in clinical populations and with hypertension, OSA and metabolic syndrome, but sample sizes were small. The impacts of NES on these medical conditions should be addressed in future, using well-sized and long-term studies involving representative populations of adults. In conclusion, NES likely has negative impacts on BMI, T2DM, physical activity, and sleep quality, which in turn may increase cardio-metabolic risk. However, further research is needed to elucidate the interaction between NES and its associated features.

Psychiatric and medical comorbidities of eating disorders: findings from a rapid review of the literature

BACKGROUND

Eating disorders (EDs) are potentially severe, complex, and life-threatening illnesses. The mortality rate of EDs is significantly elevated compared to other psychiatric conditions, primarily due to medical complications and suicide. The current rapid review aimed to summarise the literature and identify gaps in knowledge relating to any psychiatric and medical comorbidities of eating disorders.

METHODS

This paper forms part of a rapid review) series scoping the evidence base for the field of EDs, conducted to inform the Australian National Eating Disorders Research and Translation Strategy 2021-2031, funded and released by the Australian Government. ScienceDirect, PubMed and Ovid/Medline were searched for English-language studies focused on the psychiatric and medical comorbidities of EDs, published between 2009 and 2021. High-level evidence such as meta-analyses, large population studies and Randomised Control Trials were prioritised.

RESULTS

A total of 202 studies were included in this review, with 58% pertaining to psychiatric comorbidities and 42% to medical comorbidities. For EDs in general, the most prevalent psychiatric comorbidities were anxiety (up to 62%), mood (up to 54%) and substance use and post-traumatic stress disorders (similar comorbidity rates up to 27%). The review also noted associations between specific EDs and non-suicidal self-injury, personality disorders, and neurodevelopmental disorders. EDs were complicated by medical comorbidities across the neuroendocrine, skeletal, nutritional, gastrointestinal, dental, and reproductive systems. Medical comorbidities can precede, occur alongside or emerge as a complication of the ED.

CONCLUSIONS

This review provides a thorough overview of the comorbid psychiatric and medical conditions co-occurring with EDs. High psychiatric and medical comorbidity rates were observed in people with EDs, with comorbidities contributing to increased ED symptom severity, maintenance of some ED behaviours, and poorer functioning as well as treatment outcomes. Early identification and management of psychiatric and medical comorbidities in people with an ED may improve response to treatment and overall outcomes.

Prevalence and psychiatric comorbidities of night-eating behavior in obese bariatric patients: preliminary evidence for a connection between night-eating and bipolar spectrum disorders

PURPOSE

The co-occurrence of obesity, eating and mood disorders has been frequently reported in clinical and epidemiological settings. This study aimed to explore the prevalence of night-eating obese patients referred for bariatric surgery and to identify associated psychopathology and psychiatric comorbidity.

METHODS

The sample was composed of 121 obese patients consecutively enrolled between November 2010 and May 2012 during psychiatric evaluations for bariatric intervention. Clinical features and psychiatric diagnoses were collected. Night-eating was investigated through the administration of the Night-eating Questionnaires (NEQ) and was defined as the presence of self-reported evening hyperphagia and/or nocturnal ingestions. Binge-eating and purging behaviors and general psychopathology were respectively assessed using the Bulimic Investigatory Test, Edinburgh and the Symptom Checklist-90-Revised.

RESULTS

Night-eating was reported by twenty subjects (16.5%). Patients with night-eating behavior were significantly more frequently diagnosed with bipolar spectrum disorders and with comorbid eating and mood disorders in comparison with other patients. Night-eating patients showed significantly more binging/purging behaviors and greater severity of somatization, obsessive-compulsive symptoms, phobic anxiety, psychoticism and sleep disorders. Patients with bipolar disorder type 1 or 2 scored significantly higher than those without mood disorders at NEQ total score, mood/sleep and nocturnal ingestions subscales, but also scored significantly higher than other patients with mood disorders at the latter subscale.

CONCLUSION

Patients with evening hyperphagia and/or nocturnal ingestions should be carefully evaluated to detect possible bipolar spectrum disorders and other eating disorders. Prompt management of these conditions should be provided before bariatric interventions.

LEVEL OF EVIDENCE

V, cross-sectional descriptive study.

'In the night kitchen': A scoping review on the night eating syndrome

BACKGROUND

First described in 1955, night eating syndrome refers to an abnormal eating behavior clinically defined by the presence of evening hyperphagia (>25% of daily caloric intake) and/or nocturnal awaking with food ingestion occurring ⩾ 2 times per week.

AIMS

Although the syndrome is frequently comorbid with obesity, metabolic and psychiatric disorders, its etiopathogenesis, diagnosis, assessment and treatment still remain not fully understood.

METHODS

This review was conducted according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines; PubMed database was searched until 31 October 2020, using the key terms: 'Night Eating Syndrome' AND 'complications' OR 'diagnosis' OR 'drug therapy' OR 'epidemiology' OR 'etiology' OR 'physiology' OR 'physiopathology' OR 'psychology' OR 'therapy'.

RESULTS

From a total of 239 citations, 120 studies assessing night eating syndrome met the inclusion criteria to be included in the review.

CONCLUSION

The inclusion of night eating syndrome into the Diagnostic and Statistical Manual of Mental Disorders-5 'Other Specified Feeding or Eating Disorders' category should drive the attention of clinician and researchers toward this syndrome that is still defined by evolving diagnostic criteria. The correct identification and assessment of NES could facilitate the detection and the diagnosis of this disorder, whose bio-psycho-social roots support its multifactorial nature. The significant rates of comorbid illnesses associated with NES and the overlapping symptoms with other eating disorders require a focused clinical attention. Treatment options for night eating syndrome include both pharmacological (selective serotonin reuptake inhibitors, topiramate and melatonergic drugs) and non-pharmachological approaches; the combination of such strategies within a multidisciplinary approach should be addressed in future, well-sized and long-term studies.

Effects of night eating and binge eating disorders on general health in university students in Lebanon

BACKGROUND

Eating disorders (EDs) have an important impact on both physical and mental wellbeing, especially in a young population. There is a lack in research about EDs in the Middle East, and especially in Lebanon, where the co-occurring obesity is a widespread health problem.

AIM

Our study aims to assess the relation between night eating syndrome (NES) with binge eating disease (BED) and obesity (BMI) on one hand, and between NES and general health on the other hand, in university students.

MATERIALS AND METHODS

An observational cross-sectional study was conducted on 460 university students in Lebanon. Data collection was carried out using an online questionnaire. Socio-demographic and general health characteristics, BMI, Arabic validated General Health Questionnaire (GHQ-12), Arabic validated Binge Eating Scale (BES) and the Night Eating Diagnostic Questionnaire (NEDQ). Statistical analysis was accomplished on SPSS.

RESULTS

Participants having highest income showed highest NEDQ score. Females and participants with a history of eating disorders were more likely to have BED. A significant correlation was also found between having an ED history and negative impact on general health. BMI was correlated with both NEDQ and BES. Having NES was associated with also having BED. Furthermore, those with NES showed higher scores regarding GHQ-12.

CONCLUSION

Relatively high prevalence of NES and BED was noted in university students in Lebanon. This was correlated to a household income, general health, and BMI. The repercussion on both physical and mental morbidities highlights the importance for stepping up of the Lebanese organizational system to perform periodic screening.

A Cross-Sectional Study of Evening Hyperphagia and Nocturnal Ingestion: Core Constituents of Night Eating Syndrome with Different Background Factors

This web-based cross-sectional survey aimed to elucidate the differences between the two core symptoms of night eating syndrome (NES): evening hyperphagia and nocturnal ingestion in the general Japanese population aged 16–79 years. Participants who consumed at least 25% of daily calories after dinner were defined as having evening hyperphagia. Those who consumed food after sleep initiation at least twice a week were determined to have nocturnal ingestion. Of the 8348 participants, 119 (1.5%) were categorized in the evening hyperphagia group, 208 (2.6%) in the nocturnal ingestion group, and 8024 in the non-NES group. Participants with evening hyperphagia and nocturnal ingestion had significantly higher anxiety scores (p < 0.05 and p < 0.001, respectively) and depression (p < 0.001 for both) than those without NES. Multiple logistic regression analysis revealed that evening hyperphagia was significantly and independently associated with higher body mass index, shorter sleep duration, later sleep-wake schedule, and higher insomnia score, while nocturnal ingestion was significantly and independently associated with younger age, smoking habit, living alone, earlier sleep-wake schedule, and higher insomnia score. Sleep duration and sleep-wake schedule characteristics in the two groups were opposite, suggesting differences in the sleep pathophysiology mechanisms.

Sleep Quality and Eating Disorder-Related Psychopathologies in Patients with Night Eating Syndrome and Binge Eating Disorders

Night eating syndrome (NES) is an eating disorder (ED) characterized by nocturnal ingestion (NI), evening hyperphagia, morning anorexia, as well as mood and sleep disturbances. This study compared subjective and objective sleep quality and ED-related psychopathologies in patients seeking treatment for ED. Method: The sample was composed of 170 women, aged 18–68, who were referred for an ED assessment from 2011 to 2020. The participants were divided into three subgroups: NES-NI only (n = 30), NES+ binge eating (BE) (including binge eating disorders or bulimia nervosa (n = 52), and BE-only (n = 88). The measures consisted of a psychiatric evaluation, objective sleep monitoring measured by an actigraph for 1 week, a subjective sleep self-report, and ED-related psychopathology questionnaires. Results: Objective sleep monitoring revealed significant group differences, with higher sleep efficiency in participants with BE-only and longer sleep durations for the NES-NI only group. Subjectively, the BE-only group described a significantly lower sleep quality than either the NES-NI only or the NES+BE groups. ED-related psychopathology was lower in the NES-NI-only group. A stepwise linear regression revealed that general psychopathology (the brief symptom inventory total score) was a significant predictor of subjective sleep quality. Conclusion: NES-NI-only was correlated with less psychopathology, but with more subjective and objective sleep disturbances. These results lend weight to the supposition that NES lies on a continuum of ED psychopathologies, and that NES-NI-only appears to be a separate entity from NES+BE and BE-only in terms of its psychopathology.

Depression symptoms and night eating in young adulthood

PURPOSE

We estimated cross-sectional and longitudinal associations between depression symptoms and night eating in young adults.

METHODS

Data were drawn from a longitudinal investigation of students age 12-13 years at inception in 1999-2000, in Montreal, Canada. Depression symptoms were measured with the Depressive Symptoms Scale (DSS) 20 times from age 12 to 17, and with the Major Depression Inventory (MDI) post-high school at ages 20 and 24. Night eating was measured at age 24. The association between depression symptoms and night eating was estimated in multivariable logistic regression models adjusted for sex, age and mother university-educated.

RESULTS

9% of 829 participants (n = 77) reported night eating. In cross-sectional analysis, the adjusted odds ratio (OR) estimate for MDI scores (range 0-50) was 1.04 (1.01, 1.07). In longitudinal analyses, the OR estimates were 1.75 (1.20, 2.55) for DSS scores (range 1-4) and 1.03 (1.002, 1.06) for the MDI.

CONCLUSIONS

Depression symptoms are associated with night eating in young adults cross-sectionally and possibly longitudinally. Treatment of depression symptoms may be important in preventing night eating, a core symptom of the Night Eating Syndrome.

LEVEL OF EVIDENCE

Level III, cohort analytic study.

Night-Eating Syndrome and Depressive Symptoms in College Freshmen: Fitness Improvement Tactics in Youths (FITYou) Project

Background

Emerging evidence has shown that night-eating syndrome is correlated to depressive symptoms. However, these studies were mainly small-scale investigations.

Purpose

This study aimed to examine the association of night-eating syndrome with depressive symptoms among college students using a large-scale sample.

Methods

A cross-sectional study, which was a part of the Fitness Improvement Tactics in Youth Project, was conducted in 2017. The current study included 3278 college freshmen from Shenyang, China. They completed self-administered questionnaires and provided their sociodemographic and lifestyle information. Night-eating syndrome was assessed using the night-eating questionnaire (NEQ). Depressive symptoms were measured using the Self-rating Depression Scale (SDS).

Results

Of participants, 5.4% had night-eating syndrome (NEQ score ≥30), and 21.3% had depressive symptoms (SDS score ≥53). Prevalence of night-eating syndrome was higher in male than female students (p = 0.006). Logistic regression analysis indicated that students with night-eating syndrome had a higher prevalence of depressive symptoms than those without the syndrome after adjusting covariates (odds ratios [95% CI]: 3.28 [2.40, 4.48], p < 0.001). Consistent results were found when night-eating syndrome was defined as NEQ score ≥25. In addition, analysis of covariance showed a significant association between NEQ quartiles and SDS score (mean [95% CI]: Q1, 44.4 [43.8, 45.0]; Q2, 43.4 [42.7, 44.0]; Q3, 44.4 [43.7, 45.1]; Q4, 47.5 [46.9, 48.2], p < 0.001 for linear and quadratic trend).

Conclusion

This study showed an association between night-eating syndrome and depressive symptoms among Chinese college freshmen.

Association of Night Eating with Depression and Depressive Symptoms in Korean Women

This study examined the associations of night eating with depression and depressive symptoms in Korean adults. The study used a nationally representative sample of 31,690 Korean adults (≥19 years old) from the Korea National Health and Nutrition Examination Survey from 2008 to 2013. The participants were divided into two groups based on status of night eating: night eaters (consuming ≥25% of total daily energy intake between 21:00 and 06:00) and non-night eaters. Depression was defined based on diagnosis by a doctor, whereas depressive symptoms were defined as feelings of sadness or desperation for more than two weeks in the last one year. Multivariable logistic regression analyses were performed to examine the relationship between night eating and odds of depression and depressive symptoms after controlling for age, education, income, marital status, drinking, smoking, day of recalled intake, physical activity, body mass index, menopausal status (women only), total energy intake, and sleep duration. A total of 14.3% of Korean adults were night eaters. Night eaters were more likely to be men, young, less educated, single, drinkers, current smokers, and not employed (all ps < 0.05). In women, night eaters had higher odds of depression (adjusted odds ratio [AOR], 1.33; 95% confidence interval [CI], 1.02–1.75; p for trend = 0.0389) and depressive symptoms (AOR, 1.20; 95% CI, 1.01–1.41; p for trend = 0.0382) compared with non-night eaters. However, no associations of night eating with depression and depressive symptoms were found in men. Night eaters had higher odds of depression and depressive symptoms only in Korean women. Future studies are warranted to elucidate the underlying psychological and behavioral mechanisms that in turn may shed light on the factors influencing both night eating and odds of depression and depressive symptoms.

Night Eating Syndrome and Its Relationship with Emotional Eating, Sleep Quality and Nutritional Status Among Adolescents' Boys

Current study was aimed to evaluate the relationship between emotional eating and night eating syndrome (NES) with sleep quality among adolescents in Tabriz-Iran. The current study was conducted among eighty adolescent boys aged 12-16 years old from Tabriz-Iran. Night eating syndrome and Emotional eating were measured by validated specific questionnaires. Pittsburgh Sleep Quality Index questionnaire (PSQI) was used for assessment of sleep quality. Emotional and very emotional eaters had significantly higher protein and fat intake. Among components of PSQI, subjective sleep quality, sleep disturbances and daytime dysfunction scores among emotional and very emotional eaters were significantly higher. Moreover, adolescents with NES, had higher PSQI score and lower carbohydrate intake; whereas, intake of fat among NES group was significantly higher (P < 0.05). Our results indicated poor sleep quality and higher dietary fat intake among adolescents with emotional eating disorder and NES. Therefore, it is necessary to consider healthy nutritional pattern including low fat intake in prevention of developing emotional eating and NES among adolescents.

A Review of the Relationship between Night Eating Syndrome and Body Mass Index

PURPOSE OF THE REVIEW

To review literature on night eating syndrome (NES) and body mass index (BMI, kg/m²) published in the last 5 years.

RECENT FINDINGS

Since December, 2013, 11 studies examined the association between NES and BMI. Five of these studies reported a positive relationship, five showed no relationship, and one produced mixed findings. Emotional eating and age were moderators. Twelve studies examined whether there was a difference in BMI between those with and without NES with only five of these finding differences. A primary weakness of the recent literature base is that it is almost entirely cross-sectional. Recent findings regarding the relationship between NES and BMI are mixed. Future research should examine the relationship between these variables longitudinally and continue to examine moderating variables that explain why some individuals manifest excess weight with NES and others do not.

Night eating syndrome in patients with eating disorders: Is night eating syndrome distinct from bulimia nervosa?

BACKGROUND/PURPOSE

Night eating syndrome (NES) is a diagnosis newly introduced in the fifth version of the Diagnostic and Statistical Manual of Mental Disorders. This study investigated the characteristics of NES in individuals with eating disorders and the clinical significance of NES in individuals with bulimia nervosa (BN).

METHODS

We recruited participants with eating problems at psychiatric outpatient clinics and from Internet referrals and age, sex, and educational level-comparable controls from September 2013 to April 2017. All participants received in-face structured clinical interviews to establish their eating disorder and NES diagnoses and completed questionnaires assessing NES, eating attitudes/behaviors, depression, sleep disturbances, morningness/eveningness preference, and functional impairment. Comparisons of measurements were made across patients with eating disorder subtypes and across patients with NES-only, BN-only, comorbid BN and NES, and controls.

RESULTS

NES was identified in 10.3%, 34.9%, and 51.7% of the individuals with anorexia nervosa, BN, and binge-eating disorder, respectively. NES-only group had more frequent binge-eating, higher degrees of eating pathology, depression, sleep disturbances, and functional impairment compared to controls; however, NES-only group shared similar levels of disordered eating, depression, sleep disturbances, and functional impairment with BN-only group. BN-NES group had no difference from BN-only group on most eating pathology, psychopathology, and functional impairment, except for the presence of greater eating and weight concerns.

CONCLUSION

NES has its clinical significance; however, it overlaps with BN in several dimensions of psychopathology. Presence of night eating in a BN group may not contribute clinically meaningful psychopathology.

Night eating in bipolar disorder

OBJECTIVE

Night eating syndrome (NES) involves reduced feeding during the day and evening hyperphagia sometimes accompanied by frequent nocturnal awakenings with conscious episodes of compulsive ingestion of food. Previously, NES has not been evaluated in bipolar disorder (BD). The objective of this study was to identify NES in euthymic BD patients.

PATIENTS/METHODS

Eighty BD patients and 40 controls were examined using the Night Eating Questionnaire, Hamilton Rating Scale for Depression and Anxiety, Young Mania Rating Scale, Functioning Assessment Short-Test and International Physical Activity Questionnaire. Sleep quality (Pittsburgh Sleep Quality Index), daytime sleepiness (Epworth Sleepiness Scale), severity of insomnia (Insomnia Severity Index) and morning-evening preference (Morningness-Eveningness Questionnaire) were also evaluated.

RESULTS

BD patients presented NES in 8.8% while the controls showed no NES. Patients with and without NES were not different with respect to gender, disease duration, smoking, heavy drinking, body mass index, waist-to-hip ratio and neck circumference. BD patients with NES scored higher for functioning as well as for the following specific components: occupational functioning, financial issues, interpersonal relationships and leisure time. They also had more anxiety, higher insomnia severity and worse sleep quality. Furthermore, BD patients with NES were more evening type.

CONCLUSION

NES occurs more frequently in BD patients than in controls. BD patients with NES present more disease-related manifestations such as more anxiety, poorer functioning and worse sleep parameters. Patients with NES were more evening type. We speculate whether changing circadian preference in these patients can reduce NES.

Why I eat at night: A qualitative exploration of the development, maintenance and consequences of Night Eating Syndrome

Night Eating Syndrome (NES), as a diagnosis, presents as a combination of disordered eating, sleep and mood. Patients identified as having both NES and obesity demonstrate poorer outcomes in terms of weight loss compared to those with NES only. However, research focusing on psychological factors associated with NES remains relatively underdeveloped. This study aimed to explore the relationship between NES and the experience of emotion from the perspective of patients accessing a weight management service. Ten adults who met diagnostic criteria for moderate or full NES took part in a semi-structured interview. Data were analysed using a constructivist approach to grounded theory. A core concept to emerge from the analysis was termed 'emotional hunger'; reflecting an urge or need to satiate a set of underlying unmet emotional needs. It was underpinned by the following interrelated themes: (1) Cultivating a dependency on food; (2) Relying on food to regulate emotions; (3) Understanding the significance of night-time; (4) Acknowledging the consequences of night eating. This study provides an in-depth understanding of the relationship between NES and the experience of emotion from the perspective of patients attending a weight management service. Results have potential to inform future service development, particularly around the adoption of a more holistic approach to night eating behaviours.

Is night eating syndrome associated with obstructive sleep apnea, BMI, and depressed mood in patients from a sleep laboratory study?

PURPOSE

The aim of this study was to assess night eating syndrome (NES) in patients referred for polysomnography and its association with obstructive sleep apnea (OSA). We also assessed whether participants with OSA were more likely to get up and eat at night, and whether these behaviors were associated with the apnea-hypopnea sleep index (AHI). We additionally examined whether NES and OSA were associated with BMI, and assessed depressed mood among participants with NES or OSA.

METHODS

The Night Eating Diagnostic Questionnaire (NEDQ), Zung Depression Scale, and demographic and medical questionnaires were used to evaluate 84 qualified participants. Polysomnography was used to assess AHI, and therefore OSA.

RESULTS

Thirty individuals met full or sub-threshold NES (NES[St]) criteria, and 54 had no night eating (Normal). Eighty-nine percent of the sample had OSA with AHI≥5. Neither AHI nor BMI differed between NES(St) and Normal, F(1,82)=1.67, p=0.20 and F(1, 82)=2.2, p=0.14, respectively. Participants with NES(St) were, however, more likely than Normal to have depressed mood (mild, moderately, or severely depressed), χ²=4.47 p=0.03. There was a positive correlation between AHI and BMI, r=0.37, p=0.001. Those with OSA were not more likely to eat at night, F(1,82)=0.04, p=0.84, or get out of bed more often, F(1,13)=0.23, p=0.64, and there was no correlation between AHI and eating at night (r=-0.11, p=0.31). However, there was a positive correlation between AHI and the number of times participants got up out of bed (r=0.81, p<0.001).

CONCLUSIONS

We found that NES was not associated with BMI or AHI severity. The findings show that NES is primarily an eating disorder, rather than a sleep disorder, and that there is an association between NES and depressed mood.

Sleep and Eating Disorders

Insomnia is related to an increased risk of eating disorders, while eating disorders are related to more disrupted sleep. Insomnia is also linked to poorer treatment outcomes for eating disorders. However, over the last decade, studies examining sleep and eating disorders have relied on surveys, with no objective measures of sleep for anorexia nervosa or bulimia nervosa, and only actigraphy data for binge eating disorder. Sleep disturbance is better defined for night eating syndrome, where sleep efficiency is reduced and melatonin release is delayed. Studies that include objectively measured sleep and metabolic parameters combined with psychiatric comorbidity data would help identify under what circumstances eating disorders and sleep disturbance produce an additive effect for symptom severity and for whom poor sleep would increase risk for an eating disorder. Cognitive behavior therapy for insomnia may be a helpful addition to treatment of those with both eating disorder and insomnia.

Optimal management of night eating syndrome: challenges and solutions

Night Eating Syndrome (NES) is a unique disorder characterized by a delayed pattern of food intake in which recurrent episodes of nocturnal eating and/or excessive food consumption occur after the evening meal. NES is a clinically important disorder due to its relationship to obesity, its association with other psychiatric disorders, and problems concerning sleep. However, NES often goes unrecognized by both health professionals and patients. The lack of knowledge regarding NES in clinical settings may lead to inadequate diagnoses and inappropriate treatment approaches. Therefore, the proper diagnosis of NES is the most important issue when identifying NES and providing treatment for this disorder. Clinical assessment tools such as the Night Eating Questionnaire may help health professionals working with populations vulnerable to NES. Although NES treatment studies are still in their infancy, antidepressant treatments and psychological therapies can be used for optimal management of patients with NES. Other treatment options such as melatonergic medications, light therapy, and the anticonvulsant topiramate also hold promise as future treatment options. The purpose of this review is to provide a summary of NES, including its diagnosis, comorbidities, and treatment approaches. Possible challenges addressing patients with NES and management options are also discussed.