Effects of sleep fragmentation on appetite and related hormone concentrations over 24 h in healthy men

Is the association between social jetlag and BMI mediated by lifestyle? A cross-sectional survey study in the Dutch general population

OBJECTIVE

Social jetlag is a discordance between the social and biological rhythm and is associated with higher HbA1c, higher BMI, and higher odds of obesity. The pathways that could explain these associations are still debated. This study aims to assess the mediating role of several lifestyle factors in the cross-sectional association between social jetlag and BMI.

METHODS

We used cross-sectional data from 1784 adults from urban areas in the Netherlands, collected in 2019. Social jetlag (difference in midpoint of sleep between week and weekend nights) was categorized as low(<1 h), moderate(1-2h), and high(>2 h). BMI(kg/m2) was calculated from self-reported height and weight. The association between social jetlag and BMI was assessed using linear regression, adjusted for sex, age, education, and sleep duration and stratified for the effect modifier stress (high vs. low). Mediation analysis was performed for self-reported smoking, physical activity, alcohol consumption, and adherence to a healthy diet.

RESULTS

High social jetlag was associated with higher BMI (0.69 kg/m2,95%CI 0.05;1.33). This association was stronger in people with high stress (0.93 kg/m2,95%CI 0.09;1.76). Social jetlag was also associated with higher odds of smoking, lower physical activity, higher alcohol consumption, and lower healthy diet adherence. In people with high stress, these factors mediated 10-15% of the association between social jetlag and BMI.

CONCLUSIONS

Social jetlag is associated with higher BMI and this association is stronger in people with high stress. In people with high stress, healthy diet adherence mediated 12% of this association. Other pathways involved in this association should be further investigated.

Secretion of glucagon, GLP-1 and GIP may be affected by circadian rhythm in healthy males

BACKGROUND

Glucagon is secreted from pancreatic alpha cells in response to low blood glucose and increases hepatic glucose production. Furthermore, glucagon enhances hepatic protein and lipid metabolism during a mixed meal. Glucagon-like peptide-1 (GLP-1) and glucose-dependent insulinotropic polypeptide (GIP) are secreted from gut endocrine cells during meals and control glucose homeostasis by potentiating insulin secretion and inhibiting food intake. Both glucose homeostasis and food intake have been reported to be affected by circadian rhythms and vice versa. In this study, we investigated whether the secretion of glucagon, GLP-1 and GIP was affected by circadian rhythms.

METHODS

A total of 24 healthy men with regular sleep schedules were examined for 24 h at the hospital ward with 15 h of wakefulness and 9 h of sleep. Food intake was standardized, and blood samples were obtained every third hour. Plasma concentrations of glucagon, GLP-1 and GIP were measured, and data were analyzed by rhythmometric statistical methods. Available data on plasma glucose and plasma C-peptide were also included.

RESULTS

Plasma concentrations of glucagon, GLP-1, GIP, C-peptide and glucose fluctuated with a diurnal 24-h rhythm, with the highest levels during the day and the lowest levels during the night: glucagon (p < 0.0001, peak time 18:26 h), GLP-1 (p < 0.0001, peak time 17:28 h), GIP (p < 0.0001, peak time 18:01 h), C-peptide (p < 0.0001, peak time 17.59 h), and glucose (p < 0.0001, peak time 23:26 h). As expected, we found significant correlations between plasma concentrations of C-peptide and GLP-1 and GIP but did not find correlations between glucose concentrations and concentrations of glucagon, GLP-1 and GIP.

CONCLUSIONS

Our results demonstrate that under meal conditions that are similar to that of many free-living individuals, plasma concentrations of glucagon, GLP-1 and GIP were observed to be higher during daytime and evening than overnight. These findings underpin disturbed circadian rhythm as a potential risk factor for diabetes and obesity.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT06166368. Registered 12 December 2023.

The effects of sleep disruption on metabolism, hunger, and satiety, and the influence of psychosocial stress and exercise: A narrative review

Sleep deficiency is a ubiquitous phenomenon among Americans. In fact, in the United States, ∼78% of teens and 35% of adults currently get less sleep than recommended for their age-group, and the quality of sleep appears to be getting worse for many. The consequences of sleep disruption manifest in a myriad of ways, including insulin resistance and disrupted nutrient metabolism, dysregulation of hunger and satiety, and potentially increased body weight and adiposity. Consequently, inadequate sleep is related to an increased risk of various cardiometabolic diseases, including obesity, diabetes, and heart disease. Exercise has the potential to be an effective therapeutic to counteract the deleterious effects of sleep disruption listed above, whereas chronic psychosocial stress may causally promote sleep disruption and cardiometabolic risk. Here, we provide a narrative review of the current evidence on the consequences of short sleep duration and poor sleep quality on substrate metabolism, circulating appetite hormones, hunger and satiety, and weight gain. Secondly, we provide a brief overview of chronic psychosocial stress and its impact on sleep and metabolic health. Finally, we summarise the current evidence regarding the ability of exercise to counteract the adverse metabolic health effects of sleep disruption. Throughout the review, we highlight areas where additional interrogation and future exploration are necessary.

Sleep disturbance correlated with severity of neuropathic pain in sciatic nerve crush injury model

The association between sleep and pain has been investigated widely. However, inconsistent results from animal studies compared with human data show the need for a validated animal model in the sleep-pain association field. Our study aims to validate common neuropathic pain models as a tool for evaluating the sleep-pain association. Electrodes electroencephalogram (EEG) and electromyogram (EMG) were surgically implanted to measure sleep. The von Frey test was used to measure pain sensitivity. Following the baseline data acquisition, two pain-modelling procedures were performed: sciatic nerve crush injury (SCI) and common peroneal nerve ligation (CPL). Post-injury measurements were performed on days 1, 5, 10, and 15 post-surgery. The results presented decreased paw withdrawal thresholds and reduced NREM sleep duration in both models on the first post-surgery day. In the SCI model, NREM sleep duration was negatively correlated with paw withdrawal thresholds (p = 0.0466), but not in the CPL model. Wake alpha and theta EEG powers were also correlated with the pain threshold. The results confirm that the SCI model shows disturbed sleep patterns associated with increased pain sensitivity, suggesting it is a reliable tool for investigating sleep disturbances associated with neuropathic pain.

Attention to Innate Circadian Rhythm and the Impact of Its Disruption on Diabetes

Novel strategies are required to reduce the risk of developing diabetes and/or clinical outcomes and complications of diabetes. In this regard, the role of the circadian system may be a potential candidate for the prevention of diabetes. We reviewed evidence from animal, clinical, and epidemiological studies linking the circadian system to various aspects of the pathophysiology and clinical outcomes of diabetes. The circadian clock governs genetic, metabolic, hormonal, and behavioral signals in anticipation of cyclic 24-hour events through interactions between a "central clock" in the suprachiasmatic nucleus and "peripheral clocks" in the whole body. Currently, circadian rhythmicity in humans can be subjectively or objectively assessed by measuring melatonin and glucocorticoid levels, core body temperature, peripheral blood, oral mucosa, hair follicles, rest-activity cycles, sleep diaries, and circadian chronotypes. In this review, we summarized various circadian misalignments, such as altered light-dark, sleep-wake, rest-activity, fasting-feeding, shift work, evening chronotype, and social jetlag, as well as mutations in clock genes that could contribute to the development of diabetes and poor glycemic status in patients with diabetes. Targeting critical components of the circadian system could deliver potential candidates for the treatment and prevention of type 2 diabetes mellitus in the future.

The relationship between sleep- and circadian rhythm-related parameters with dietary practices and food intake of sedentary adults: a cross-sectional study

We aimed to explore the link between sleep-related parameters and dietary practices. This cross-sectional exploratory study includes sedentary individuals between 20 and 59 years of age. We applied exigent inclusion and exclusion criteria, such as weight stability and without humor- or sleep-related diseases. Also, shift workers were not included. We evaluated sleep quality (by Pittsburg Sleep Quality Index; PSQI), sleepiness (by Epworth Sleepiness Scale), chronotype (by Morningness Eveningness Questionnaire; MEQ), and social jetlag from sleep dairy. Moreover, Food Practices Measurement Scale was used to assess dietary practices. Food intake estimates (i. e., energy, eating window, and late-night dinner eating) were derived from two 24-h food recalls (R24h). For analysis, dietary practices and energy intake from R24h were considered dependent variables, while PSQI, ESS, MEQ, STJ, EW, and LNDE were considered independent variables. Our sample comprises 42 adults (21 women and 21 men; 35.4 (12.5) y; 25.6 (5.21) kg/m2 BMI; 26.5 (7.97) % body fat). We verified that persons with poor sleep quality showed lower dietary practice scores (MD - 6.68; p = 0.021). Besides, in regression analysis, chronotype (β = 0.266; p = 0.039) was positively associated with dietary practices, and eating window was positively associated with energy intake (β = 267 kcal; p = 0.023). In contrast to our hypothesis, other sleep- and circadian-related variables were not associated with dietary practices or energy intake. In summary, we conclude that morning chronotype appears to be related to better dietary practices from the Food Guide for the Brazilian Population guide and that higher eating window was positively associated with energy intake.

Mechanisms of improved body composition among perimenopausal women practicing Meditative Movement: a proposed biobehavioral model

OBJECTIVES

Weight gain and unfavorable body composition are prevalent among midlife/older women throughout menopause. These shifts may negatively impact health, well-being, and longevity. Efforts to attenuate weight and body composition changes are traditionally driven by manipulation of diet and/or exercise; however, sustained results are limited, possibly because the full spectrum of biobehavioral systems is not addressed by diet and exercise alone. We propose a biobehavioral model detailing mechanisms of body composition decline among perimenopausal women and the associated components of Meditative Movement (ie, tai chi, qigong, yoga) that address each of these factors.

METHODS

Based on our previous work and extensive review of the literature, we developed a multifactorial and multidimensional biobehavioral model including factors that most directly relate to body composition among perimenopausal women: 1) psychological (ie, stress and mood, mindfulness and self-compassion, body awareness), 2) behavioral (ie, sleep, physical activity, eating behaviors), and 3) physiological (ie, cortisol, estrogen). Relationships between each factor, Meditative Movement practice components, and predicted effects on body composition were explored in detail.

RESULTS

Our model describes select psychological, behavioral, and physiological factors, and potential mechanistic pathways of Meditative Movement practice driving improved changes in body composition and weight outcomes for perimenopausal women.

CONCLUSIONS

The proposed model details a novel, evidence-supported means to reduce the risk of deleterious shifts in body composition throughout perimenopause and menopause thereafter. We suggest that these changes may occur directly and/or indirectly through psychological, behavioral, and physiological mechanisms that facilitate the desired changes in body composition.

Sleep deprivation in development of obesity, effects on appetite regulation, energy metabolism, and dietary choices

Sleep deprivation, which is a decrease in duration and quality of sleep, is a common problem in today's life. Epidemiological and interventional investigations have suggested a link between sleep deprivation and overweight/obesity. Sleep deprivation affects homeostatic and non-homoeostatic regulation of appetite, with the food reward system playing a dominant role. Factors such as sex and weight status affect this regulation; men and individuals with excess weight seem to be more sensitive to reward-driven and hedonistic regulation of food intake. Sleep deprivation may also affect weight through affecting physical activity and energy expenditure. In addition, sleep deprivation influences food selection and eating behaviours, which are mainly managed by the food reward system. Sleep-deprived individuals mostly crave for palatable energy-dense foods and have low desire for fruit and vegetables. Consumption of meals may not change but energy intake from snacks increases. The individuals have more desire for snacks with high sugar and saturated fat content. The relationship between sleep and the diet is mutual, implying that diet and eating behaviours also affect sleep duration and quality. Consuming healthy diets containing fruit and vegetables and food sources of protein and unsaturated fats and low quantities of saturated fat and sugar may be used as a diet strategy to improve sleep. Since the effects of sleep deficiency differ between animals and humans, only evidence from human subject studies has been included, controversies are discussed and the need for future investigations is highlighted.

Dimensions of sleep quality are related to objectively measured eating behaviors among children at high familial risk for obesity

OBJECTIVE

The aim of this study was to evaluate whether dimensions of sleep quality were associated with homeostatic and hedonic eating behaviors among children with healthy weight (BMI-for-age < 90%) but varying maternal weight status.

METHODS

A total of 77 children (mean [SD], age: 7.4 [0.6] years; BMI z score: -0.10 [0.7]) with healthy weight and high (n = 32) or low (n = 45) familial obesity risk based on maternal weight status were served an ad libitum meal (homeostatic eating) followed by palatable snacks to assess eating in the absence of hunger (EAH; hedonic eating). Habitual sleep quality was quantified from seven nights of wrist actigraphy. Partial correlations, adjusted for child energy needs, pre-meal hunger, food liking, and socioeconomic status, evaluated associations of sleep with meal intake and EAH. Additionally, sleep-by-obesity risk interactions were assessed.

RESULTS

Greater sleep fragmentation was associated with higher homeostatic meal energy intake, but only among children at high familial obesity risk (p value for interaction = 0.001; β high risk = 48.6, p = 0.001). Sleep fragmentation was not associated with total EAH but was related to higher and lower intake of carbohydrates (r = 0.33, p = 0.003) and fat (r = -0.33, p = 0.003), respectively.

CONCLUSIONS

Adverse associations of poor sleep with energy intake may be amplified among children already predisposed to obesity. Furthermore, that fragmented sleep relates to preferential intake of carbohydrates over fat during EAH may suggest alterations in taste preferences with poor sleep.

Social jet lag and (changes in) glycemic and metabolic control in people with type 2 diabetes

OBJECTIVE

Social jet lag, i.e., the discordance among social and biological rhythms, is associated with poor metabolic control. This study aimed to assess cross-sectional and longitudinal associations among social jet lag and glycemic and metabolic control in people with type 2 diabetes.

METHODS

In a prospective cohort (N = 990) with type 2 diabetes, social jet lag was measured at baseline using daily diaries and was categorized (high, moderate, or low). Metabolic outcomes were assessed at baseline and at 1 and 2 years of follow-up. Associations among social jet lag and glycemic and metabolic control were analyzed using linear regression and linear mixed models adjusted for confounding factors. Analyses were stratified for work status (retired vs. working; p value for interaction = 0.007 for glycated hemoglobin [HbA1c]).

RESULTS

In working people, a cross-sectional association between high social jet lag and HbA1c (1.87 mmol/mol [95% CI: 0.75 to 2.99]) and blood pressure (5.81 mm Hg [95% CI: 4.04 to 7.59]) was observed. For retired people, high social jet lag was negatively associated with HbA1c (-1.58 mmol/mol [95% CI: -2.54 to -0.62]), glucose (-0.19 mmoL/L [95% CI:-0.36 to -0.01]), and blood pressure (-3.70 mm Hg [95% CI: -5.36 to -2.04]), and the association with BMI was positive (1.12 kg/m² [95% CI: 0.74 to 1.51]). Prospective associations had the same direction as cross-sectional findings but were nonsignificant for working or retired people.

CONCLUSIONS

Social jet lag was cross-sectionally, but not prospectively, associated with glycemic and metabolic markers. Interaction with work status was present, and directions of the associations were generally detrimental in the working population, whereas higher social jet lag was associated with improved glycemic and metabolic control for retired people.

The role of insufficient sleep and circadian misalignment in obesity

Traditional risk factors for obesity and the metabolic syndrome, such as excess energy intake and lack of physical activity, cannot fully explain the high prevalence of these conditions. Insufficient sleep and circadian misalignment predispose individuals to poor metabolic health and promote weight gain and have received increased research attention in the past 10 years. Insufficient sleep is defined as sleeping less than recommended for health benefits, whereas circadian misalignment is defined as wakefulness and food intake occurring when the internal circadian system is promoting sleep. This Review discusses the impact of insufficient sleep and circadian misalignment in humans on appetite hormones (focusing on ghrelin, leptin and peptide-YY), energy expenditure, food intake and choice, and risk of obesity. Some potential strategies to reduce the adverse effects of sleep disruption on metabolic health are provided and future research priorities are highlighted. Millions of individuals worldwide do not obtain sufficient sleep for healthy metabolic functions. Furthermore, modern working patterns, lifestyles and technologies are often not conducive to adequate sleep at times when the internal physiological clock is promoting it (for example, late-night screen time, shift work and nocturnal social activities). Efforts are needed to highlight the importance of optimal sleep and circadian health in the maintenance of metabolic health and body weight regulation.

Association of Sleep Patterns with Type 2 Diabetes Mellitus: A Cross-Sectional Study Based on Latent Class Analysis

Sleep duration, sleep quality and circadian rhythm disruption indicated by sleep chronotype are associated with type 2 diabetes. Sleep involves multiple dimensions that are closely interrelated. However, the sleep patterns of the population, and whether these sleep patterns are significantly associated with type 2 diabetes, are unknown when considering more sleep dimensions. Our objective was to explore the latent classes of sleep patterns in the population and identify sleep patterns associated with type 2 diabetes. Latent class analysis was used to explore the best latent classes of sleep patterns based on eleven sleep dimensions of the study population. Logistic regression was used to identify sleep patterns associated with type 2 diabetes. A total of 1200 participants were included in the study. There were three classes of sleep patterns in the study population: "circadian disruption with daytime dysfunction" (class 1), "poor sleep status with daytime sleepiness" (class 2), and "favorable sleep status" (class 3). After controlling for all confounding factors, people in class 2 have significantly higher prevalence of type 2 diabetes than those in class 3 (OR: 2.24, 95% CI 1.26-4.00). Sleep problems have aggregated characteristics. People with sleep patterns involving more or worse sleep problems have higher significantly prevalence of T2DM.

Effect of sleep disturbance on biomarkers related to the development of adverse health outcomes: A systematic review of the human literature

Literature suggests that unrestricted and undisturbed sleep is vital for basic human function and performance; however, it is unclear as to what amount of sleep disturbance leads to dysregulation in biomarkers, which may underscore the development of adverse health effects. This systematic review aims to identify the amount of sleep disturbance that contributes to biomarker changes as a potential precursor to the development of adverse health effects. English-language comparative studies available in PubMed, Cochrane Central, EMBASE, and CINAHL databases from 1 January 1980 to 31 July 2021 were searched. Where possible, random-effects meta-analyses were used to examine the effect of sleep disturbances on adverse health effects. The risk of bias of individual studies was assessed using the Cochrane Risk of Bias Tool and the Risk of Bias of Nonrandomised Studies - of Exposures instruments and the certainty of the body of evidence for each outcome was assessed using the Grading of Recommendations Assessment, Development and Evaluation approach. The search identified 92 primary studies reporting on blood pressure, hypertension, heart rate, cardiac arrhythmia, cardiac output, waist circumference, cortisol, adrenaline, noradrenaline, immune system markers, glucose, insulin, cholesterol, and triglyceride levels. Although some meta-analyses suggested there may be an association between sleep disturbances and certain outcomes, the certainty in the evidence was very low due to concerns with risk of bias, inconsistency across exposures, populations, and imprecision in the estimates of effects. Further research is needed to explore the point at which types, levels and duration of sleep disturbances may begin to increase the risk of developing adverse health outcomes to inform and tailor health interventions.

Obstructive Sleep Apnoea and Lipid Metabolism: The Summary of Evidence and Future Perspectives in the Pathophysiology of OSA-Associated Dyslipidaemia

Obstructive sleep apnoea (OSA) is associated with cardiovascular and metabolic comorbidities, including hypertension, dyslipidaemia, insulin resistance and atherosclerosis. Strong evidence suggests that OSA is associated with an altered lipid profile including elevated levels of triglyceride-rich lipoproteins and decreased levels of high-density lipoprotein (HDL). Intermittent hypoxia; sleep fragmentation; and consequential surges in the sympathetic activity, enhanced oxidative stress and systemic inflammation are the postulated mechanisms leading to metabolic alterations in OSA. Although the exact mechanisms of OSA-associated dyslipidaemia have not been fully elucidated, three main points have been found to be impaired: activated lipolysis in the adipose tissue, decreased lipid clearance from the circulation and accelerated de novo lipid synthesis. This is further complicated by the oxidisation of atherogenic lipoproteins, adipose tissue dysfunction, hormonal changes, and the reduced function of HDL particles in OSA. In this comprehensive review, we summarise and critically evaluate the current evidence about the possible mechanisms involved in OSA-associated dyslipidaemia.

A Week of Sleep Restriction Does Not Affect Nighttime Glucose Concentration in Healthy Adult Males When Slow-Wave Sleep Is Maintained

The aim of this laboratory-based study was to examine the effect of sleep restriction on glucose regulation during nighttime sleep. Healthy males were randomly assigned to one of two conditions: 9 h in bed (n = 23, age = 24.0 year) or 5 h in bed (n = 18, age = 21.9 year). Participants had a baseline night with 9 h in bed (23:00-08:00 h), then seven nights of 9 h (23:00-08:00 h) or 5 h (03:00-08:00 h) in bed. Participants were mostly seated during the daytime but had three bouts of treadmill walking (4 km·h^-1 for 10 min) at ~14:40 h, ~17:40 h, and ~20:40 h each day. On the baseline night and night seven, glucose concentration in interstitial fluid was assessed by using continuous glucose monitors, and sleep was assessed by using polysomnography. On night seven, compared to the 9 h group, the 5 h group obtained less total sleep (292 min vs. 465 min) and less REM sleep (81 min vs. 118 min), but their slow-wave sleep did not differ (119 min vs. 120 min), and their glucose concentration during sleep did not differ (5.1 mmol·L^-1 vs. 5.1 mmol·L^-1). These data indicate that sleep restriction does not cause elevated levels of circulating glucose during nighttime sleep when slow-wave sleep is maintained. In the future, it will be important to determine whether increased insulin is required to maintain circulating glucose at a normal level when sleep is restricted.

The role of sleep in PCOS: what we know and what to consider in the future

INTRODUCTION

Sleep disturbance and clinical sleep conditions disrupt endocrine signals, energy expenditure and nutritional intake. Women with polycystic ovary syndrome (PCOS) are at higher risk of sleep disturbances and clinical conditions. It is possible that sleep may contribute to the exacerbation of PCOS. This review aims to explore the relationship between sleep and chronic disease, particularly in women with PCOS.

AREAS COVERED

This review narratively explores what sleep is, how to measure sleep and the possible mechanisms that support the link between sleep in adipose tissue deposition, insulin resistance and the presentation of PCOS.

EXPERT OPINION

Research shows that disturbed sleep and clinical sleep conditions disrupt energy expenditure. This may increase adipose tissue deposition and exacerbate insulin resistance which are known to worsen the presentation of PCOS. Further, sleep disturbance in women with PCOS may ameliorate any positive lifestyle changes made after diagnosis. Cognitive behavioural therapy interventions for sleep are a successful strategy for the management of sleep disturbances in the general population. However, such interventions are yet to be trialled in women with PCOS. Given the proposed implications, interventions to improve sleep could provide additional support for women with PCOS to successfully implement lifestyle strategies and should be further investigated.

A Review of the Associations Between Obstructive Sleep Apnea and Gestational Diabetes Mellitus and Possible Mechanisms of Disease

Obstructive sleep apnea (OSA) usually leads to the occurrence of diabetes. Gestational diabetes mellitus (GDM) is a common gestational complication associated with adverse maternal and fetal outcomes. Increasing studies suggest that women with OSA during pregnancy may be at a significantly greater risk of developing GDM. It is crucial to explore the association between OSA and GDM and the mechanisms underlying this association. In this review, we presented a comprehensive literature review of the following: the association between OSA and GDM, the possible mechanisms of this association, and the effects of continuous positive airway pressure (CPAP) on OSA with GDM. The results showed that most authors suggested that there was an association between OSA and GDM. The intermittent hypoxemia (IH) and reduction of slow-wave sleep (SWS) may be the key to this association. IH induces the products of oxidative stress and inflammation as well as dysregulation of the hypothalamic-pituitary-adrenal, which lead to diabetes. In addition, SWS reduction in OSA enhances the inflammation by increasing the inflammatory cytokines, increases the sympathetic activation, and causes changes in leptin level, which result in the development of GDM. Additionally, whether CPAP is beneficial to GDM remains still unclear.

Polysomnographic comparison of sleep in children with obesity and normal weight without suspected sleep-related breathing disorder

Short sleep and obstructive apneas/hypopneas have been shown to be associated with childhood obesity. Still, few studies have compared sleep in children with obesity, without suspected sleep disordered breathing and normal weight peers by objective sleep measures and compared results with subjective parent assessment of sleep. Children with obesity aged 7-13 years (N = 44) and a matched group of normal weight children (N = 42) completed clinical polysomnography (Embla A10 Recording System). Parents scored their children's sleep on the Children's Sleep Habits Questionnaire (CSHQ). Mann-Whitney U tests were used to compare groups. There was a higher obstructive apnea/hypopnea index (AHI) (median obesity = 1.20 vs. median normal  = 0.66; z = -1.33, U = 560.50, p = 0.002) and number of oxygen desaturation events per hour (median obesity = 0.7 vs. median normal  = 0.2; z = -3.45, U = 402.50, p = 0.001) in the children with obesity compared to children with normal weight. The children with obesity had a significantly longer sleep duration (median obesity 8:50 h = vs. median normal = 8:32 h; z = -2.05, U = 687.00, p = 0.041), longer stage N2 sleep (median obesity = 87 min vs. median normal = 52 min; z = -2.87, U = 576.50, p = 0. 004) and shorter REM sleep (median obesity = 94 min vs. median normal = 121 min; z = 5.05, U = 1477.00, p ≤ .001). No differences were observed for time in sleep stage N1 and N3, wake time after sleep onset or the total arousal index . Further, no group differences were found on the CSHQ sleep-disordered breathing sub-scale (p = 0.399). The children with obesity demonstrated significantly more mild to moderate sleep disordered breathing than children with normal weight, although this was not corroborated by parent report.

Nutrient timing and metabolic regulation symposium review from "Novel dietary approaches to appetite regulation, health and performance (2021)"

Daily (circadian) rhythms coordinate our physiology and behaviour with regular environmental changes. Molecular clocks in peripheral tissues (e.g. liver, skeletal muscle and adipose) give rise to rhythms in macronutrient metabolism, appetite regulation and the components of energy balance such that our bodies can align the periodic delivery of nutrients with ongoing metabolic requirements. The timing of meals both in absolute terms (i.e. relative to clock time) and in relative terms (i.e. relative to other daily events) is therefore relevant to metabolism and health. Experimental manipulation of feeding–fasting cycles can advance understanding of the effect of absolute and relative timing of meals on metabolism and health. Such studies have extended the overnight fast by regular breakfast omission and revealed that morning fasting can alter the metabolic response to subsequent meals later in the day, whilst also eliciting compensatory behavioural responses (i.e. reduced physical activity). Similarly, restricting energy intake via alternate‐day fasting also has the potential to elicit a compensatory reduction in physical activity, and so can undermine weight‐loss efforts (i.e. to preserve body fat stores). Interrupting the usual overnight fast (and therefore also the usual sleep cycle) by nocturnal feeding has also been examined and further research is needed to understand the importance of this period for either nutritional intervention or nutritional withdrawal. In summary, it is important for dietary guidelines for human health to consider nutrient timing (i.e. when we eat) alongside the conventional focus on nutrient quantity and nutrient quality (i.e. how much we eat and what we eat).

Arab Women Adherence to the Mediterranean Diet and Insomnia

Background and objective: Sleeping difficulties affect the overall health, nutrition, and wellbeing. The Mediterranean diet has proven effective in improving the quality of life and overall health of people of all ages. Therefore, this study aimed to determine whether adherence to the Mediterranean diet (MD) is linked to reduced insomnia in Arabic-speaking female adults in Jordan. Materials and Methods: A self-administered, cross-sectional survey was used to detect the relationship between MD and sleep quality in Arabic-speaking female adults. Data were collected from 917 Arabic-speaking female participants of 14 Arab nationalities in Jordan between March and May 2021 via social media. All participants answered the whole questionnaire, including questions on sociodemographic aspects, Mediterranean diet adherence, sleeping habits measured with the Athens Insomnia Scale (AIS), and lifestyle components such as smoking and dietary patterns. Results: The mean age of the 917 Arabic-speaking female participants was 36 ± 10 years. Most participants were unemployed (85%) single females (64%) with an undergraduate degree (74%). Most of them (86%) were non-smokers. More than half of the participants were Jordanians (57%). The BMI was normal for 52% of the participants, whereas 26% of them were overweight, and 12% were obese. One-way ANCOVA showed a statistically significant difference between MD adherence score categories and AIS, F (2, 914) = 3.36, p = 0.015. Among the MD adherence score categories, we found that between groups, MD scores above or equal to 10 were associated with a statistically significant difference in AIS. Cohen's value was calculated for the three MD score categories and indicated a 'small' effect size association between all adherence scores of the MD categories and AIS. Conclusions: In conclusion, our findings provide preliminary evidence that participants' adherence to the MD was significantly associated with better sleep and reduced insomnia symptoms, highlighting the need for further research.

Unacylated ghrelin, leptin, and appetite display diurnal rhythmicity in lean adults

Constant routine and forced desynchrony protocols typically remove the effects of behavioral/environmental cues to examine endogenous circadian rhythms, yet this may not reflect rhythms of appetite regulation in the real world. It is therefore important to understand these rhythms within the same subjects under controlled diurnal conditions of light, sleep, and feeding. Ten healthy adults (9 M/1 F, means ±SD: age, 30 ± 10 yr; body mass index, 24.1 ± 2.7 kg·m^-2) rested supine in the laboratory for 37 h. All data were collected during the final 24 h of this period (i.e., 0800-0800 h). Participants were fed hourly isocaloric liquid meal replacements alongside appetite assessments during waking before a sleep opportunity from 2200 to 0700 h. Hourly blood samples were collected throughout the 24-h period. Dim light melatonin onset occurred at 2318 ± 46 min. A diurnal rhythm in mean plasma unacylated ghrelin concentration was identified (P = 0.04), with the acrophase occurring shortly after waking (0819), falling to a nadir in the evening with a relative amplitude of 9%. Plasma leptin concentration also exhibited a diurnal rhythm (P < 0.01), with the acrophase occurring shortly after lights-out (0032 h) and the lowest concentrations at midday. The amplitude for this rhythm was 25%. Diurnal rhythms were established in all dimensions of appetite except for sweet preference (P = 0.29), with both hunger (2103 h) and prospective food consumption (1955 h) reaching their peak in the evening before falling to their nadir shortly after waking. Under controlled diurnal conditions, simultaneous measurement of leptin, unacylated ghrelin, and subjective appetite over a 24-h period revealed rhythmicity in appetite regulation in lean, healthy humans.NEW & NOTEWORTHY Simultaneous assessment of subjective appetite, unacylated ghrelin, and leptin was carried out over a continuous 37-h protocol for the first time under conditions of controlled light, sleep, and feeding in healthy, lean adults. Rhythms were observed in unacylated ghrelin, leptin, and components of subjective appetite, such as hunger, prospective consumption, and fullness. Concurrent measurement of rhythms in these variables is important to fully understand the temporal relationships between components of appetite as well as the influence of diurnal factors such as sleep, light, and feeding.

Severe sleep restriction suppresses appetite independent of effects on appetite regulating hormones in healthy young men without obesity

OBJECTIVE

Several nights of moderate (4-5 hr/night) sleep restriction increases appetite and energy intake, and may alter circulating concentrations of appetite regulating hormones. Whether more severe sleep restriction has similar effects is unclear. This study aimed to determine the effects of severe, short-term sleep restriction on appetite, ad libitum energy intake during a single meal, appetite regulating hormones, and food preferences.

METHODS

Randomized, crossover study in which 18 healthy men (mean ± SD: BMI 24.4 ± 2.3 kg/m², 20 ± 2 yr) were assigned to three consecutive nights of sleep restriction (SR; 2 hr sleep opportunity/night) or adequate sleep (AS; 7-9 hr sleep opportunity/night) with controlled feeding and activity designed to maintain energy balance throughout the 3-day period. On day 4, participants consumed a standardized breakfast. Appetite, assessed by visual analogue scales, and circulating ghrelin, peptide-YY (PYY), glucagon-like peptide (GLP-1), insulin, and glucose concentrations were measured before and every 20-60 min for 4hr after the meal. Ad libitum energy and macronutrient intakes were then measured at a provided buffet lunch. Food preferences were measured by Leeds Food Preference Questionnaire (LFPQ) administered before and after the lunch.

RESULTS

Area under the curve (AUC) of postprandial hunger (-23%), desire to eat (-23%), and prospective consumption (-18%) ratings were all lower, and postprandial fullness AUC (25%) was higher after SR relative to after AS (p ≤ 0.02). Ad libitum energy intake at the lunch meal was 332 kcal [95% CI: -479, -185] (p<0.001) lower after SR relative to after AS, but relative macronutrient intakes and LFPQ scores did not differ. Postprandial glucose, insulin, PYY, GLP-1, and ghrelin AUCs did not differ between phases. However, mean concentrations of PYY (-11%) and GLP-1 (-4%) over the 4-hr testing period were lower, and glucose concentrations were 6% higher, after SR relative to after AS (p ≤ 0.01).

CONCLUSION

In contrast with reported effects of moderate sleep restriction, severe sleep restriction reduced appetite and energy intake, had no impact food preferences, and had little impact on appetite regulating hormones. Findings suggest that severe sleep restriction may suppress appetite and food intake, at least at a single meal, by a mechanism independent of changes in food preference or appetite regulating hormones.

Association between habitual sleep duration/quality and appetite markers in individuals with obesity

STUDY OBJECTIVES

To assess if habitual sleep duration/quality was associated with appetite in individuals with obesity, and if the association was modulated by sex.

METHODS

Sleep duration/quality was measured with Pittsburgh Sleep Quality Index score in 95 healthy adults with obesity (BMI: 36.6 ± 4.2 kg/m²). Subjective feelings of appetite were assessed using visual analogue scales, and plasma concentrations of active ghrelin, total peptide YY, active glucagon-like peptide 1, cholecystokinin (CCK) and insulin were measured in fasting and every 30 min up to 2.5 h after a meal.

RESULTS

No significant associations were found between sleep duration, or overall quality, and appetite in all participants. However, a worse sleep efficiency was associated with lower postprandial CCK, a shorter habitual sleep was associated with lower postprandial desire to eat and a lower daytime dysfunction was associated with higher prospective food consumption in fasting (P<0.05, for all). In males, a shorter habitual sleep duration and a worse subjective sleep quality were associated with increased basal and postprandial active ghrelin (P<0.05, P<0.01, P<0.01 and P<0.05, respectively). Also, a shorter habitual sleep was associated with lower basal and postprandial insulin (P<0.05 for both) and a worse overall sleep quality with lower postprandial insulin (P<0.05). In females, a worse overall sleep quality was associated with lower postprandial active ghrelin (P<0.05), and short habitual sleep with higher postprandial insulin (P<0.05).

CONCLUSION

A worse habitual sleep efficiency is associated with blunted postprandial CCK secretion in individuals with obesity. The association between habitual sleep duration/quality and insulin and active ghrelin seems to be modulated by sex, but more studies are needed to confirm these findings.

Association of sleep quality with insulin resistance in obese or overweight subjects

Introduction

Obesity or overweight are two factors associated with insulin resistance (IR). There are limited studies with regard to the role of some non-traditional factors such as sleep quality in level of IR in obese individuals. The current study aimed at investigating the association of sleep quality with IR in overweight or obese people.

Material and Methods

In this cross-sectional study, 612 obese or overweight participants of the Qazvin metabolic disease study (QMDS) were evaluated. Sleep quality was measured using the Pittsburgh sleep quality index (PSQI) and compared between two groups of participants with and without IR.

Results

Our findings showed that the total score of sleep quality in the IR group was significantly lower than that in the non-insulin resistant group (8.78±2.78 vs. 8.13±2.70, p=0.008). After adjustment, each unit increase of the sleep latency and subjective sleep quality scores was associated with a 1.23 and 1.33 times increased risk of IR, respectively (p<0.05).

Conclusion

In the obese or overweight people, sleep quality is associated with IR.

Direct and indirect effects of poor sleep quality on BMI and waist circumference in a female population-based study in Southern Brazil

OBJECTIVE

This study aimed to investigate the direct and indirect effects of poor sleep quality on BMI and waist circumference (WC), considering behavioural factors as intermediate variables.

DESIGN

A population-based cross-sectional study design was adopted. Data were collected between February and October 2015. Poor sleep quality was assessed using the Brazilian version of the Pittsburgh Sleep Quality Index (PSQI-BR). Weight, height (used to calculate BMI) and WC were measured using standard protocols. Physical activity, sedentary behaviour and fast food consumption were considered intermediate variables. Non-standardised effects were estimated by path analysis with bootstrapped CI.

SETTING

Urban region of the city of São Leopoldo, southern Brazil.

PARTICIPANTS

Representative sample of 1117 women aged between 20 and 69 years.

RESULTS

Poor sleep quality (higher PSQI-BR scores) was significantly associated with low physical activity levels (β = -0·05; 95 % CI -0·09, -0·01). High physical activity levels were associated with lower BMI (β = -0·21; 95 % CI -0·37, -0·07) and WC (β = -0·64; 95 % CI -1·00, -0·30). There was a non-significant direct effect of poor sleep quality on BMI and WC. However, low physical activity showed a significant indirect effect on the association between poor sleep quality and increased WC (β = 0·03; 95 % CI 0·01, 0·07).

CONCLUSIONS

The results indicate that the association between sleep quality and WC is mediated by physical activity. This finding can assist in the development of strategies to prevent and reduce abdominal obesity in adult women.

Glucose control upon waking is unaffected by hourly sleep fragmentation during the night, but is impaired by morning caffeinated coffee

Morning coffee is a common remedy following disrupted sleep, yet each factor can independently impair glucose tolerance and insulin sensitivity in healthy adults. Remarkably, the combined effects of sleep fragmentation and coffee on glucose control upon waking per se have never been investigated. In a randomised crossover design, twenty-nine adults (mean age: 21 (sd 1) years, BMI: 24·4 (sd 3·3) kg/m2) underwent three oral glucose tolerance tests (OGTT). One following a habitual night of sleep (Control; in bed, lights-off trying to sleep approximately 23.00-07.00 hours), the others following a night of sleep fragmentation (as Control but waking hourly for 5 min), with and without morning coffee approximately 1 h after waking (approximately 300 mg caffeine as black coffee 30 min prior to OGTT). Individualised peak plasma glucose and insulin concentrations were unaffected by sleep quality but were higher following coffee consumption (mean (normalised CI) for Control, Fragmented and Fragmented + Coffee, respectively; glucose: 8·20 (normalised CI 7·93, 8·47) mmol/l v. 8·23 (normalised CI 7·96, 8·50) mmol/l v. 8·96 (normalised CI 8·70, 9·22) mmol/l; insulin: 265 (normalised CI 247, 283) pmol/l; and 235 (normalised CI 218, 253) pmol/l; and 310 (normalised CI 284, 337) pmol/l). Likewise, incremental AUC for plasma glucose was higher in the Fragmented + Coffee trial compared with Fragmented. Whilst sleep fragmentation did not alter glycaemic or insulinaemic responses to morning glucose ingestion, if a strong caffeinated coffee is consumed, then a reduction in glucose tolerance can be expected.

A preliminary investigation of the effects of short-duration, vigorous exercise following sleep restriction, fragmentation and extension on appetite and mood in inactive, middle-aged men

This preliminary study aimed to investigate the effect of exercise on appetite and mood following multiple days of sleep disruption (restriction [RES], fragmentation [FRAG]) or sleep extension (EXT), compared to normal sleep (CONT) in inactive, middle-aged men. Nine men completed four randomised trials initiated by 3 nights (day 1-3) of CONT (6.5-8 hr), RES (4 hr), FRAG (6.5-8 hr, interrupted at 2-hr intervals) or EXT (10 hr). On day 4 between 08:30 and 11:00 hours, perceived appetite, food cravings, appetite-related hormones (acylated ghrelin, leptin, peptide tyrosine-tyrosine [PYY]_total ), glucose, mood states and wellness (stress, fatigue, soreness, and mood) were assessed before (post-sleep manipulation [SM]) and after (post-exercise [EX]) a 20-min vigorous cycling bout (rating of perceived exertion: 15). There was no effect of sleep manipulation or exercise on perceived appetite (p = .34-.62). Some aspects of food craving were altered after RES and EXT, with vigorous exercise attenuating the desire for sweet foods in RES (p = .12). PYY_total was lower after RES compared to EXT and FRAG (p = .03), but was unaltered by exercise (p = .03). Ghrelin was higher for RES and EXT compared to CONT and FRAG after exercise (p = .001-.03). Total wellness was reduced and total mood disturbance (TMD) was higher after RES and FRAG compared to CONT and EXT (p ≤ .05). However, vigorous exercise countered these changes, with wellness and TMD remaining significantly impaired for FRAG compared to EXT only at this time (p = .02-.03). Vigorous exercise mitigates some aspects of food cravings and counters the impaired mood states that exist after multiple days of restricted and fragmented sleep.

Severe paediatric obesity and sleep: A mutual interactive relationship!

Childhood severe obesity is a serious, urgent and complex global health problem with long-term co-morbidities. Obstructive sleep-disordered breathing is more common in obese children and adolescents. Increased body mass index is associated with an increase in apnea-hypopnea index. Obstructive sleep apnea leads to a decrease in rapid eye movement sleep, and obese children have been noted to have a decrease in rapid eye movement sleep, leading to weight gain. Short sleep duration and poor sleep quality are associated with childhood obesity and cardiometabolic risks. Public health strategies for obesity prevention should focus more on sleep. Targeting childhood obesity is important in the prevention and management of obstructive sleep-disordered breathing.

A Mediterranean Dietary Pattern Predicts Better Sleep Quality in US Women from the American Heart Association Go Red for Women Strategically Focused Research Network

Consumption of a Mediterranean diet has been linked to better sleep health in older, European populations. However, whether this dietary pattern is predictive of sleep quality in US women, a group prone to poor sleep, is unknown. This prospective cohort study of 432 US women (20–76 y; 60% racial/ethnic minority) evaluated whether compliance with a Mediterranean diet at baseline predicted sleep quality at 1-y follow-up. Alternate Mediterranean (aMed) diet scores and habitual sleep quality were computed from the validated Block Brief Food Frequency Questionnaire and Pittsburgh Sleep Quality Index (PSQI), respectively. Linear regression models evaluated prospective associations of the aMed diet pattern and its components with measures of sleep quality, after adjustment for age, BMI, race/ethnicity, education, and health insurance status. Higher baseline aMed scores were associated with lower PSQI scores (β = −0.30 ± 0.10, p < 0.01), indicative of better sleep quality, higher sleep efficiency (β = 1.20 ± 0.35, p < 0.001), and fewer sleep disturbances (β = −0.30 ± 0.12, p = 0.01) at 1-y. Fruit and vegetable consumption also predicted lower PSQI scores, higher sleep efficiency and fewer sleep disturbances (all p < 0.05). Higher legume intake predicted better sleep efficiency (β = 1.36 ± 0.55, p = 0.01). These findings suggest that adherence to a Mediterranean diet pattern should be evaluated as a strategy to promote sleep quality in US women.

Long-Term Effects of Continuous Positive Airway Pressure (CPAP) Therapy on Obesity and Cardiovascular Comorbidities in Patients with Obstructive Sleep Apnea and Resistant Hypertension-An Observational Study

BACKGROUND

We sought to investigate whether long-term continuous positive airway pressure (CPAP) treatment in patients with obstructive sleep apnea (OSA) and resistant hypertension (RHTN) could attenuate the cardiovascular disease risk by lowering their body-mass index (BMI).

METHODS

This was a long-term observational study of RHTN patients diagnosed with OSA. Patients were evaluated with polysomnography initially and after a mean follow-up period of four years. The patients were divided into two groups based on their compliance to CPAP therapy.

RESULTS

33 patients (aged 54.67 ± 7.5, 18 men, 54.5%) were included in the study, of which 12 were compliant to CPAP therapy. A significant reduction in BMI at follow-up was noted in patients compliant to CPAP therapy (1.4 ± 3.5 vs. -1.6 ± 2.5, p = 0.006). We also noted a large effect size reduction in abdominal circumference at follow-up in the CPAP group. At follow-up evaluation, the mean heart rate (b/min) was lower in the CPAP group (58.6 ± 9.5 vs. 67.8 ± 7.8), while arrhythmia prevalence increased between initial (28.6%) and follow-up (42.9%) evaluation with an intermediate effect size in non-compliant patients.

CONCLUSIONS

In our cohort of OSA patients with RHTN, long-term adherence to CPAP therapy was associated with weight loss and improvement in cardiac rhythm outcomes.

Poor Sleep Quality Is Associated with Altered Taste Perception in Chinese Adults

BACKGROUND

Small clinical studies have suggested that individuals with insufficient sleep could experience taste dysfunction. However, this notion has not been examined in a large-scale, population-based study.

OBJECTIVE

This study aimed to examine whether overall sleep quality, as assessed by insomnia, daytime sleepiness, snoring, and sleep duration, was associated with the odds of having altered taste perception in a large population-based study.

DESIGN

This was a cross-sectional study that used data from a subcohort of the Kailuan study, an ongoing multicenter cohort study that began in 2006 in Tangshan City, China.

PARTICIPANTS/SETTING

The participants were 11,030 adults aged 25 years or older (mean age 53.7 ± 10.7 years), who were free of neurodegenerative diseases. All the participants had undergone questionnaire assessments and medical examinations at Kailuan General Hospital from June 2012 to October 2013.

MAIN OUTCOME MEASURES

Altered taste and olfactory perception were assessed via a questionnaire with two questions regarding whether participants had any problems with sense of taste or smell for ≥3 months.

STATISTICAL ANALYSES PERFORMED

The association between sleep quality and altered taste/olfactory perception was examined using a logistic regression model, adjusting for age, sex, lifestyle factors (eg, obesity, smoking, alcohol intake, and physical activity) and health status (eg, lipid profiles, blood pressure, modification use, and presence of chronic diseases).

RESULTS

Poor overall sleep quality was associated with a higher risk of having altered taste perception (adjusted odds ratio for low vs high sleep quality 2.03, 95% CI 1.42 to 2.91; P < 0.001). Specifically, insomnia, daytime sleepiness, and short sleep duration, but not prolonged sleep duration and snoring, were significantly associated with altered taste perception. A significant association between overall sleep quality and the risk of having altered olfactory perception was also observed (adjusted odds ratio for low vs high sleep quality 2.17, 95% CI 1.68 to 2.80; P < 0.001).

CONCLUSIONS

In this population-based study, poor sleep quality was associated with a high likelihood of altered taste perception.

Challenging energy balance - during sensitivity to food reward and modulatory factors implying a risk for overweight - during body weight management including dietary restraint and medium-high protein diets

Energy balance is a key concept in the etiology and prevalence of obesity and its co-morbidities, as well as in the development of possible treatments. If energy intake exceeds energy expenditure, a positive energy balance develops and the risk for overweight, obesity, and its co-morbidities increases. Energy balance is determined by energy homeostasis, and challenged by sensitivity to food reward, and to modulatory factors such as circadian misalignment, high altitude, environmental temperature, and physical activity. Food reward and circadian misalignment increase the risk for overweight and obesity, while high altitude, changes in environmental temperature, or physical activity modulate energy balance in different directions. Modulations by hypobaric hypoxia, lowering environmental temperature, or increasing physical activity have been hypothesized to contribute to body weight loss and management, yet no clear evidence has been shown. Dietary approach as part of a lifestyle approach for body weight management should imply reduction of energy intake including control of food reward, thereby sustaining satiety and fat free body mass, sustaining energy expenditure. Green tea catechins and capsaicin in red pepper in part meet these requirements by sustaining energy expenditure and increasing fat oxidation, while capsaicin also suppresses hunger and food intake. Protein intake of at least 0,8 g/kg body weight meets these requirements in that it, during decreased energy intake, increases food intake control including control of food reward, and counteracts adaptive thermogenesis. Prevention of overweight and obesity is underscored by dietary restraint, implying control of sensitivity to challenges to energy balance such as food reward and circadian misalignment. Treatment of overweight and obesity may be possible using a medium-high protein diet (0,8-1,2 g/kg), together with increased dietary restraint, while controlling challenges to energy balance.

Interaction of sleep quality and anxiety on quality of life in individuals with type 2 diabetes mellitus

Purpose

Sleep disturbances and anxious symptoms are very common in people with type 2 diabetes mellitus(T2DM). This study aimed to assess the interactive effects of poor sleep quality and anxious symptoms on the quality of life of people with T2DM.

Methods

Nine hundred and forty-four participants with T2DM were enrolled in a cross-sectional study. Demographic and physiological characteristics were recorded. Each participant completed a Chinese version of the Pittsburgh Sleep Quality Index, the Patient Health Questionnaire-9 and General Anxiety Disorder questionnaire, and the Diabetes Specificity Quality of Life scale. The products of poor sleep quality and anxiety were added to a logistic regression model to evaluate the multiplicative interactions, expressed as the relative excess risk of interaction, the attributable proportion of interaction, and the synergy index.

Results

Poor sleep quality and anxiety symptoms were associated with reduced quality of life. There was a significant interaction between poor sleep quality and anxiety symptoms; this combined effect significantly reduced quality of life scores by 6.09-fold. The relative excess risk of interactions was 1.36.

Conclusions

The combined effect of poor sleep quality and anxiety symptoms reduces quality of life in people with T2DM.

Trial registration

ChiCTR-IOP-16008045. Registered 3 March 2016.

A clinical study to investigate gum infection in patients undergoing kidney dialysis.

High need for recovery from work and sleep problems are associated with workers' unhealthy dietary habits

OBJECTIVE

We aimed to examine the association of recovery from work and sleep with workers' dietary habits.

DESIGN

Cross-sectional study. Need for recovery (NFR) from work was assessed with a validated questionnaire. Sleep was assessed with five questions from the Nordic Sleep Questionnaire and sleep quality question. Dietary habits were estimated using a validated sixteen food groups-containing questionnaire. Ordered logistic regression was used to explore the associations of NFR and sleep with dietary habits adjusted for age, education, marital status, work schedule, working full or part time and occupation.

SETTING

Follow-up visits of type 2 diabetes prevention study cohort in a Finnish airline company.

PARTICIPANTS

The study included 737 men and 605 women.

RESULTS

Poor recovery from work was associated with a higher eating frequency (OR = 1·03, 95 % CI 1·00, 1·06), higher intake of fast food (OR = 1·05, 95 % CI 1·02, 1·08) and sweets (OR = 1·05, 95 % CI 1·02, 1·08) as well as lower intake of vegetables (OR = 0·96, 95 % CI 0·93, 0·98) and fruits (OR = 0·96, 95 % CI 0·93, 0·98) among men. In women, poor recovery from work was associated with higher fast food (OR = 1·06, 95 % CI 1·02, 1·09) and desserts consumption (OR = 1·04, 95 % CI 1·00, 1·07). Among men and women, sleep problems were associated with higher eating frequency (men: OR = 1·04, 95 % CI 1·00, 1·07, women: OR = 1·06, 95 % CI 1·02, 1·11), consumption of fast food (men: OR = 1·07, 95 % CI 1·04, 1·11, women: OR = 1·06, 95 % CI 1·02, 1·10) and sweets (men: OR = 1·05, 95 % CI 1·01, 1·08, women: OR = 1·04, 95 % CI 1·00, 1·08).

CONCLUSIONS

Poor recovery from work and sleep problems were associated with unfavourable dietary habits especially in men.

Measures of Poor Sleep Quality Are Associated With Higher Energy Intake and Poor Diet Quality in a Diverse Sample of Women From the Go Red for Women Strategically Focused Research Network

Background

Poor sleep increases cardiovascular disease risk, and diet likely contributes to this relationship. However, there are limited epidemiological data on the relationship between measures of sleep quality and habitual dietary patterns. This study examined these associations in a diverse sample of women.

Methods and Results

Baseline data from 495 participants in the AHA Go Red for Women prospective cohort study (age: 20–76 years; 61% racial/ethnic minority) were examined. Sleep quality and sleep‐onset latency were measured using the Pittsburgh Sleep Quality Index (PSQI) and insomnia using the Insomnia Severity Index. The validated Block Brief Food Frequency Questionnaire was used to assess diet quantity and quality. Linear regression models adjusted for confounding variables tested relationships between sleep and diet variables. Results showed that higher PSQI scores, indicative of poorer sleep quality, were associated with lower unsaturated fat intake (β=−0.14, P<0.05) and higher food weight (β=14.9, P=0.02) and added sugars consumed (β=0.44, P=0.04). Women with sleep‐onset latency >60 minutes had higher intakes of food by weight (β=235.2, P<0.01) and energy (β=426, P<0.01), and lower intakes of whole grains (β=−0.37, P=0.01) than women with sleep‐onset latency ≤15 minutes. Greater insomnia severity was associated with higher food weight (β=9.4, P=0.02) and energy (β=17, P=0.01) consumed and lower total (β=−0.15, P=0.01) and unsaturated fat intakes (β=−0.11, P<0.01).

Conclusions

Poor sleep quality was associated with greater food intake and lower‐quality diet, which can increase cardiovascular disease risk. Future studies should test whether promoting sleep quality could augment efforts to improve cardiometabolic health in women.

Association of Dietary Variety and Appetite with Sleep Quality in Urban-Dwelling Older Japanese Adults

OBJECTIVES

Although it has been shown that specific foods and nutrients are associated with sleep quality, few studies have examined the association of dietary variety and appetite with sleep quality in older adults.

DESIGN AND SETTING

A cross-sectional study was conducted that examined the association of dietary variety and appetite with sleep quality in Japanese adults aged ≥70 years who resided in the metropolitan area of Tokyo, Japan.

PARTICIPANTS

Data were collected in two steps: a mailed interview survey and an on-site survey. Those who responded to the surveys and met the inclusion criteria were included.

MEASUREMENTS

Dietary variety, appetite, and sleep quality were assessed using a Dietary Variety Score (DVS), Council on Nutrition Appetite Questionnaire (CNAQ) score, and sleep efficiency, respectively. The sleep efficiency is the ratio of sleep duration to total time in bed (retiring time-awakening time). We defined the individuals with a sleep efficiency less than 75% as having poor sleep quality.

RESULTS

Mean DVS and CNAQ score were 3.8 and 29.6 points, respectively. The rate of individuals with poor sleep quality was 11.7%. In the fully adjusted model, the odds ratios (OR) for low sleep efficiency in the middle and highest group categories of the DVS were 0.83 (95% confidence interval [CI], 0.54-1.29) and 0.50 (95% CI, 0.28-0.90), respectively, in reference to the lowest group category (p for trend = 0.023). The OR for low sleep efficiency in the middle and highest group categories of the CNAQ score were 0.73 (95% CI, 0.47-1.14) and 0.54 (95% CI, 0.30-0.96), respectively, in reference to the lowest group category (p for trend = 0.031).

CONCLUSIONS

The higher DVS and CNAQ scores were significantly associated with higher sleep efficiency. Thus, dietary variety and good appetite might help maintain good sleep quality in urban-dwelling older Japanese adults.

Head cooling during sleep improves sleep quality in the luteal phase in female university students: A randomized crossover-controlled pilot study

Although selective head-cooling has been reported to decrease scalp and tympanic temperature and improve sleep quality, whether head-cooling during sleep can improve sleep quality in women during the luteal phase has not been elucidated. This randomized, controlled crossover open trial aimed to investigate the effect of head cooling during sleep on sleep quality in women during the luteal phase. Female university students aged 19–25 years with increased daytime sleepiness during the luteal phase were recruited by poster advertisement at their university from May to June 2016 and from May to June 2017. Fourteen women aged 19–22 years participated in this study. The temperature-controllable cooling sheet containing tubes filled with circulating water was used for head-cooling, and the head-cooling and the controlled temperature were set at 25°C and 35°C, respectively. Electroencephalogram data were obtained using a single-channel portable electroencephalogram device. The difference in sleep-related variables and tympanic temperature between head-cooling and control were analyzed using a linear mixed model. The proportion of arousal was lower with head cooling than with the control. In contrast, the proportion of non-REM3 and the delta power were higher with head cooling than with the control. The proportion of non-REM2 and non-REM3 among sleep EEG stages were positively and negatively correlated with the mean tympanic temperature during sleep, respectively. However, arousal and REM were not correlated with tympanic temperature. We considered the reduction of arousal time by head-cooling might be related to scalp temperature rather than tympanic temperature. Further, our results suggested that head-cooling also improved subjective sleep comfort. In conclusion, head-cooling during sleep could improve sleep quality in young women during the luteal phase.

Sleep duration and quality are associated with eating behavior in low-income toddlers

OBJECTIVE

The present study examined whether different sleep health parameters (duration, timing, and quality) are associated with obesity-related eating behaviors including emotional overeating, food responsiveness, enjoyment of food, satiety responsiveness, and eating in the absence of hunger (EAH), during toddlerhood.

DESIGN

Among 134 low-income 33-month-old children, parents reported on child sleep parameters, including sleep quality (Children's Sleep Wake Scale; CSWS) and usual bedtimes and wake times on weekdays and weekends (weeknight sleep duration, weekday-to-weekend bedtime delay). Child eating behaviors were assessed using both observed and parent-report measures. Child Emotional Overeating, Food Responsiveness, Enjoyment of Food, and Satiety Responsiveness were measured by parent report using the Child Eating Behavior Questionnaire-Toddler. Observed child EAH was evaluated by measuring kilocalories of palatable foods consumed following a meal. Multivariable linear regression was used to examine the associations between sleep parameters and eating behaviors.

RESULTS

Poorer child sleep quality was associated with greater Emotional Overeating (standardized β = -0.20 (SE 0.09), p < .05) and greater Food Responsiveness (β = -0.18 (SE 0.09), p < .05). Shorter child nighttime sleep duration was associated with greater EAH kcal consumed (standardized β = -0.22 (SE 0.09), p < .05). Child bedtime delay was not associated with any of the eating behaviors, and no child sleep variables were associated with either Enjoyment of Food or Satiety Responsiveness.

CONCLUSIONS

Shorter nocturnal sleep duration and poorer sleep quality during toddlerhood were associated with some, but not all, of the obesity-related eating behaviors. Poor sleep health may promote childhood obesity risk through different eating behavior pathways. As children growing up in poverty may experience greater sleep decrements, sleep duration and sleep quality may be important targets for intervention among low-income families with young children.

Association between REM sleep and obstructive sleep apnea in obese and overweight adolescents

PURPOSE

Overweight and obese children have demonstrated reduced rapid eye movement (REM) sleep, affecting energy balance regulation and predisposition to weight gain. Obstructive sleep apnea (OSA) is a known cause of decreased REM sleep. The purpose of this study is to examine the association between the percentage of REM sleep, BMI z-score, and OSA severity in overweight and obese adolescents.

METHODS

We performed a cross-sectional study of 92 (43% female) overweight and obese adolescents (13-17 years old) who underwent overnight polysomnography (PSG) at Children's Hospital Los Angeles between 2010 and 2017.

RESULTS

The average Body Mass Index (BMI) z-score was 2.27 ± 0.47, with 71% having BMI z-score ≥ 2. REM% during PSG was 15.6 ± 6.8, and obstructive apnea-hypopnea index was 17.1 ± 24.3. The distribution across categories of OSA severity was 27% none (≤ 1.5 events/h), 24% mild (> 1.5-5 events/h), 8% moderate (> 5-10 events/h), and 41% severe (> 10 events/h). REM% was not associated with BMI z-score, either on univariate or multivariate regression with adjustment for age, gender, and apnea-hypopnea index (AHI). When subdivided into OSA categories, a 1-unit increase in BMI z-score was associated with a 5.96 (p = 0.03) increase in REM% in mild OSA and an 8.86 (p = 0.02) decrease in REM% in severe OSA. There was no association between BMI z-score and REM% in none and moderate OSA.

CONCLUSION

Among overweight and obese adolescents, BMI z-score was associated with decreased REM% in severe OSA and unexpectedly increased REM% in mild OSA, but there was no association in none or moderate OSA.

The association between sleep duration, sleep quality, and food consumption in adolescents: A cross-sectional study using the Korea Youth Risk Behavior Web-based Survey

OBJECTIVE

This study examined the relationship between sleep duration, sleep quality and food consumption among adolescents.

DESIGN

Cross-sectional study.

SETTING

Data from the 2014 and 2015 Korea Youth Risk Behavior Web-based Survey were used.

PARTICIPANTS

Participants aged 12-18 years (n=118 462 (59 431 males and 59 031 females)) were selected.

PRIMARY AND SECONDARY OUTCOME MEASURES

Sleep duration, sleep quality and the frequencies of fruits, soda, soft drinks, fast food, instant noodle, confectionaries, vegetables and milk consumption.

RESULTS

Short sleep durations (<6 hours) were associated with higher soft drinks and confectionaries intake than longer sleep durations (9+ hours) (adjusted ORs (AORs) (95% CIs) for ≥5 times a week for soft drinks: 1.73 (1.57 to 1.91) and confectionaries: 1.32 (1.20 to 1.46); p<0.001). Poor sleep quality, with 7-8 hours of sleep, was associated with a lower intake of fruits, vegetables and milk (AORs (95% CIs) for ≥5 times a week for fruits: 0.71 (0.65 to 0.77); vegetables: 0.66 (0.58 to 0.75); and milk: 0.80 (0.74 to 0.86); each p<0.001), and higher intake of soda, soft drinks, fast food, instant noodle and confectionaries (AORs (95% CIs) for ≥5 times a week for soda: 1.55 (1.40 to 1.70); soft drinks: 1.58 (1.43 to 1.73); fast food: 1.97 (1.65 to 2.35); instant noodle: 1.55 (1.37 to 1.76); and confectionaries: 1.30 (1.18 to 1.43); each p<0.001) than good sleep quality of the same duration.

CONCLUSION

Short sleep durations and poor sleep quality might be associated with higher consumption of unhealthier foods, such as sugar-sweetened beverages, fast food, instant noodle and confectionaries, and associated with lower consumption of fruits, vegetables and milk.

Murine models of sleep apnea: functional implications of altered macrophage polarity and epigenetic modifications in adipose and vascular tissues

Obstructive sleep apnea (OSA) is a highly prevalent disease across the lifespan, is characterized by chronic intermittent hypoxia and sleep fragmentation, and has been independently associated with substantial cardiometabolic morbidity. However, the reversibility of end-organ morbidity with treatment is not always apparent, suggesting that both tissue remodeling and epigenetic mechanisms may be operationally involved. Here, we review the cumulative evidence focused around murine models of OSA to illustrate the temporal dependencies of cardiometabolic dysfunction and its reversibility, and more particularly to discuss the critical contributions of tissue macrophages to adipose tissue insulin resistance and vascular atherogenesis. In addition, we describe initial findings potentially implicating epigenetic alterations in both the emergence of the cardiometabolic morbidity of OSA, and in its reversibility with treatment. We anticipate that improved understanding of macrophage biology and epigenetics in the context of intermittent hypoxia and sleep fragmentation will lead to discovery of novel therapeutic targets and improved cardiovascular and metabolic outcomes in OSA.

Sleep influences on obesity, insulin resistance, and risk of type 2 diabetes

A large body of epidemiologic evidence has linked insufficient sleep duration and quality to the risk of obesity, insulin resistance and type 2 diabetes. To address putative causal mechanisms, this review focuses on laboratory interventions involving several nights of experimental sleep restriction, fragmentation or extension and examining metabolically relevant outcomes. Sleep restriction has been consistently shown to increase hunger, appetite and food intake, with the increase in caloric intake in excess of the energy requirements of extended wakefulness. Findings regarding decreases in hormones promoting satiety or increases in hormones promoting hunger have been less consistent, possibly because of confounding effects of changes in adiposity when energy intake was not controlled and sampling protocols that did not cover the entire 24-h cycle. Imaging studies revealed alterations in neuronal activity of brain regions involved in food reward. An adverse impact of experimental sleep restriction on insulin resistance, leading to reduced glucose tolerance and increased diabetes risk, has been well-documented. There is limited evidence indicating that sleep fragmentation without reduction in sleep duration also results in a reduction in insulin sensitivity. The adverse metabolic outcomes of sleep disturbances appear to involve multiple mechanistic pathways acting in concert. Emerging evidence supports the benefits of behavioral, but not pharmacological, sleep extension on appetite and glucose metabolism. Further research should focus on the feasibility and efficacy of strategies to optimize sleep duration and quality on obesity and diabetes risk in at-risk populations as well as those with established diseases. Further work is needed to identify mechanistic pathways.

Weight gain in first-semester university students: Positive sleep and diet practices associated with protective effects

For university students, alterations in sleep and diet quality are common, and the propensity for weight gain is well established. The role of sleep duration during periods of rapid weight gain is understudied. This study explored the relationships between sleep duration, diet patterns, and body composition in first-year university students. Data collection occurred during the beginning of the fall (August) and spring semesters (January). Anthropometric measures included weight, height, and percent body fat (%BF). Survey questions assessed sleep and diet quality. As a group, participants (N = 60) gained weight (1.8 ± 2.1 kg) over the 4.5-month period of study. Hierarchical cluster analysis (HCA) identified three groups based on weight change between baseline and follow-up visits. Group 1 ("maintainers") (N = 21) gained 0.1 ± 1.3 kg, group 2 ("modest gainers") (N = 24) gained 2.0 ± 1.7 kg, and group 3 ("major gainers") (N = 15) gained 3.8 ± 1.8 kg. No differences in weight, body mass index (BMI), %BF, or average sleep duration existed between clusters at baseline. Minimal differences in baseline dietary behaviors between groups were noted other than maintainers used more fat, e.g., butter, to season vegetables, bread, and potatoes compared to modest gainers (p = .010). At follow-up, sleep duration significantly decreased from baseline among major gainers (7.1 ± 0.7 vs. 6.8 ± 0.7 h, p = .017) while sleep duration increased from baseline among maintainers (7.3 ± 0.9 vs. 7.6 ± 1.0 h, p = .048). Sleep duration at follow-up was significantly shorter among major gainers compared to maintainers (p = .016). Total diet scores for maintainers and modest gainers improved between visits (p = .038 and 0.002, respectively) but did not change among major gainers. Combining sleep and diet education may increase the effectiveness of interventions designed to mitigate weight gain in this high-risk population.