Sleep and eating behavior in adults at risk for type 2 diabetes

The Role of Anxiety and Depression in the Relationship Among Emotional Eating, Sleep Quality, and Impulsivity

ABSTRACT

The aim of this study was to investigate the relationship among sleep quality, impulsivity, anxiety, and depression in individuals with emotional eating behavior. The study was designed as a cross-sectional study. The study included 92 individuals (age 31.29 ± 9.17; female, 67.4% [ n = 62]; male, 32.6% [ n = 30]) with symptoms of emotional eating but no previous psychiatric diagnosis or treatment. Participants were administered a Structured Clinical Interview for DSM-5 Disorders interview form, a sociodemographic data form, the Emotional Eating Scale, the Beck Depression Scale, the Barratt Impulsivity Scale, the Beck Anxiety Scale, and the Pittsburgh Sleep Quality Index Scale. Emotional eating is positively correlated with anxiety ( r = 0.377, p = 0.001), depression ( r = 0.375, p = 0.001), impulsivity ( r = 0.250, p = 0.016), and poor sleep quality ( r = 0.478, p = 0.001). Obese individuals (defined as having a body mass index of 30 or higher) showed higher emotional eating ( z = -2.552, p = 0.016) and poorer sleep quality ( z = -2.089, p = 0.044) than nonobese individuals, and women showed higher emotional eating ( t = 2116, p = 0.037) and poorer sleep quality ( z = -2537, p = 0.010) than men. Poor sleep quality was associated with emotional eating. In this relationship, poor sleep quality influenced emotional eating through all mediators, including anxiety and depression ( B = 3.491; standardized effect, 0.485; p = 0.001). Poor sleep quality directly influenced emotional eating ( B = 2.806; standardized effect, 0.390; p = 0.001). The findings of the study suggest that emotional eating is associated with higher levels of anxiety, depression, impulsivity, and sleep problems, especially in women. It suggests that the interrelationships of psychological factors associated with emotional eating should be investigated.

The relationship between the intake of branched-chain and aromatic amino acids and individuals' sleep quality based on body mass index, gender, and age

Sleep disorder is a relatively common problem that causes chronic conditions such as obesity, diabetes, and cardiovascular diseases. It is believed that diet regulates sleep. So, investigating the relationship between branched-chain amino acids (BCAAs) and aromatic amino acids intake with sleep quality based on age, gender and Body Mass Index (BMI) is important. A total of 172 males and females aged 18-65 participated in this study. The questionnaires were given online to them, included demographic information, food frequency questionnaire (FFQ), International Physical Activity Questionnaire, and Pittsburgh Sleep Quality Index. The Chalder fatigue scale (CFQ) was also used to measure the extent and severity of fatigue. The intake of amino acids was investigated by FFQ. The relationship between amino acids intake and sleep quality was investigated using Pearson's test. The results showed that intake of energy, macronutrients, and some micronutrients had a significant relationship with the quality of sleep of men compared to that of women (P < 0.05). No difference in sleep duration was observed between the two genders. There was a significant, positive association between sleep duration and the intake of BCAA (CC = 0.205, P = 0.031) and aromatic amino acids (CC = 0.22, P = 0.02) in the participants with normal BMI. Significant differences were seen in the intake of BCAA according to BMI which these differences were between lean and obese people, lean and overweight people, obese and normal, and overweight people. It demonstrated that in individuals with normal BMI, amino acids, protein, and carbohydrate intake may affect sleep duration and with modification of these factors sleep quality may get better. More study is needed to confirm these findings.

Association between poor sleep quality and emotional eating in US Latinx adults and the mediating role of negative emotions

INTRODUCTION

Poor sleep quality is associated with negative emotions and may modulate emotional eating (EE). However, this has not been studied among US Latinx adults, a group experiencing sleep disparities.

OBJECTIVE

To examine the association between sleep quality and EE in Latinx adults and explore the mediating role of negative emotions.

METHODS

This cross-sectional analysis used data from the Latino Health and Well-being Study. Sleep quality was measured with the Pittsburgh Sleep Quality Index. EE was measured with the EE subscale of the Three Factor Eating Questionnaire R18-V2 (categorized as no EE, low EE, and high EE). Negative emotions were measured via a composite score that included depression, anxiety, and perceived stress. Poisson regression models with robust variance errors estimated prevalence ratios (PR) and 95% confidence intervals (CI). Mediation was evaluated with the Karlsson-Holm-Breen method.

RESULTS

More individuals with poor (vs. good) sleep quality experienced high EE (39.1% vs. 17.9%). Individuals with poor (vs. good) sleep quality were more likely to experience high EE vs. no EE (total effect = 1.74; 95% CI = 1.34, 2.26). Controlling for negative emotions, the effect of poor sleep on high EE was reduced to 1.23 (95% CI = 0.92, 1.65), leaving an indirect effect of 1.41 (95% CI = 1.25, 1.60); 62.6% of the effect was explained by negative emotions.

CONCLUSION

Poor sleep quality was associated with high EE in US Latinx adults and negative emotions partially mediated this relationship. Longitudinal studies are needed. Interventions and clinical programs should concomitantly address sleep quality and negative emotions to help prevent dysfunctional eating behaviors.

Patterns of Eating Associated with Sleep Characteristics: A Pilot Study among Individuals of Mexican Descent at the US-Mexico Border

Introduction: Previous studies have linked sleep to risk of diabetes and obesity, at least partially via alterations in food intake. Diabetes and obesity are common among Hispanics/Latinos, and studies are needed to better clarify the role of sleep in health among this group. Utilizing the revised TFEQ-R-18, this study will examine whether eating behaviors such as cognitive restraint, emotional eating and uncontrolled eating are related to self-reported sleep experiences. Specifically, we hypothesized that poor eating habits would be associated with (1) more insomnia symptoms, (2) overall worse sleep quality, (3) increased daytime sleepiness, and (4) shorter sleep duration.Methods: Data were collected from N = 100 adults (age 18-60, 47% female) of Mexican descent in the city of Nogales, AZ (34% not born in the US). Surveys were presented in English or Spanish. Eating Patterns were assessed with the Three-Factor Eating Questionnaire (TFEQ), which resulted in a total score and subscales for "cognitive restraint," "uncontrolled eating," and "emotional eating." Insomnia was assessed with the use of the Insomnia Severity Index (ISI), Sleepiness with the use of the Epworth Sleepiness Scale (ESS), Sleep quality with the use of the Pittsburgh Sleep Quality Index (PSQI), and weekday and weekend sleep duration with the use of the Sleep Timing Questionnaire (STQ). Covariates included age, sex, Body Mass Index (BMI), education and immigrant status.Results: Overall TFEQ score (problematic eating) was positively associated with greater insomnia, poorer sleep quality, more sleepiness, and less weekend (but not weekday) sleep. Mean TFEQ score in the sample was 18.7 (range 0-51). In adjusted analyses, every point on the TFEQ was associated with 0.6 ISI points, 0.8 PSQI points, 0.5 ESS points, and 1.1 minutes of less weekend sleep duration. Regarding subscale scores, relationships were generally seenbetween sleep and emotional eating and unrestricted eating, and not cognitive restraint.Conclusions: Greater insomnia, poorer sleep quality, increased daytime sleepiness and decreased weekend sleep duration were associated with eating patterns at the US-Mexico border, particularly in the area of unrestricted eating and emotional eating. This suggests possible mechanisms linking sleep and obesity in Hispanic/Latinos.

Actigraphy-Derived Sleep Is Associated with Eating Behavior Characteristics

Poor sleep is a determinant of obesity, with overconsumption of energy contributing to this relationship. Eating behavior characteristics are predictive of energy intake and weight change and may underlie observed associations of sleep with weight status and obesity risk factors. However, relationships between sleep and dimensions of eating behavior, as well as possible individual differences in these relations, are not well characterized. Therefore, the aim of this study was to evaluate whether sleep behaviors, including duration, timing, quality, and regularity relate to dietary restraint, disinhibition, and tendency towards hunger and to explore whether these associations differ by sex. This cross-sectional study included 179 adults aged 20–73 years (68.7% women, 64.8% with BMI ≥ 25 kg/m²). Sleep was evaluated by accelerometry over 2 weeks. Eating behavior dimensions were measured with the Three-Factor Eating Questionnaire. Prolonged wake after sleep onset (WASO) (0.029 ± 0.011, p = 0.007), greater sleep fragmentation index (0.074 ± 0.036, p = 0.041), and lower sleep efficiency (−0.133 ± 0.051, p = 0.010) were associated with higher dietary restraint. However, higher restraint attenuated associations of higher WASO and sleep fragmentation with higher BMI (p-interactions < 0.10). In terms of individual differences, sex influenced associations of sleep quality measures with tendency towards hunger (p-interactions < 0.10). Stratified analyses showed that, in men only, higher sleep fragmentation index, longer sleep onset latency, and lower sleep efficiency were associated with greater tendency towards hunger (β = 0.115 ± 0.037, p = 0.003, β = 0.169 ± 0.072, p = 0.023, β = −0.150 ± 0.055, p = 0.009, respectively). Results of this analysis suggest that the association of poor sleep on food intake could be exacerbated in those with eating behavior traits that predispose to overeating, and this sleep-eating behavior relation may be sex-dependent. Strategies to counter overconsumption in the context of poor quality sleep should be evaluated in light of eating behavior traits.

Associations of short sleep duration with appetite-regulating hormones and adipokines: A systematic review and meta-analysis

In the current study, a systematic review and meta-analysis were conducted to summarize and assess whether short sleep duration is associated with appetite-regulating hormones and adipokine levels. Reference databases were searched for studies related to sleep and appetite-regulating hormones and adipokines. Qualitative and quantitative syntheses were conducted to evaluate the relationship between sleep duration and the level of appetite-regulating hormones and adipokines, including leptin, ghrelin, adiponectin, resistin, and orexin. Twenty-one of 3536 studies, covering a total of 2250 participants, met the inclusion criteria. Leptin, ghrelin, and adiponectin were included in the meta-analysis. Ghrelin levels were higher in the short sleep group (standard mean difference [SMD] = 0.14, 95% CI [0.03, 0.25], p = 0.01). Significant differences between the short sleep group and recommended sleep group were also noted in leptin level experimental subgroup studies (SMD = 0.19, 95% CI [0.03, 0.35], p = 0.02) and ghrelin level cross-sectional subgroup studies (SMD = 0.14, 95% CI [0.02, 0.27], p = 0.03). A rise in leptin and ghrelin levels were also observed in sleep deprivation groups (SMD = 0.24, 95% CI [0.10, 0.39], p = 0.001 and SMD = 0.18, 95% CI [0.04, 0.33], p = 0.01, respectively). In conclusion, short sleep duration is associated with an increased ghrelin level, while sleep deprivation had a significant effect on the levels of both leptin and ghrelin.

Relationship between Sleep and Hedonic Appetite in Shift Workers

Short and/or poor sleep are established behavioral factors which can contribute to excess food intake, and emerging evidence suggests that disturbed circadian rhythms may also impact food intake regulation. Together, disturbed sleep and circadian rhythms may help explain the excess risk for obesity seen in shift workers. To date, however, the details of how shift work may impact food intake regulation are still not fully defined. Here we examined the relationship between sleep characteristics and hedonic control of appetite in shift workers. A total of 63 shift workers (mean (M) age: 36.7 years, standard deviation (SD): 12.0; 59% women) completed an online survey comprising self-reported measures of body weight regulation, sleep (Pittsburgh Sleep Quality Index, Sleep Hygiene Index), and hedonic control of appetite (Food Craving Inventory, Power of Food Scale). Seventy-one percent reported some weight change since starting shift work, and 84% of those reported weight gain (M = +11.3 kg, SD = 9.1). Worse sleep quality and shorter sleep duration were associated with more food cravings, and worse sleep quality and hygiene were associated with higher appetitive drive to consume palatable food (greater hedonic drive). This preliminary study suggests hedonic pathways are potentially contributing to weight gain in shift workers with disturbed sleep.

Low energy intake and dietary quality are associated with low objective sleep quality in young Japanese women

Literature reports suggest that subjective sleep quality is associated with nutrient intake in elderly people and workers. However, few studies have suggested an association between objective sleep quality and dietary intake in adolescents and young women. We hypothesized that objective sleep quality is associated with dietary intake in adolescents and young women. We evaluated the association between energy and nutrient intake and objective sleep quality in adolescents and young Japanese women. In a cross-sectional study of 80 women aged 18-27 years, dietary intake was assessed using the self-administered diet history questionnaire. Objective sleep quality was assessed by actigraphy. Lifestyle characteristics, dietary habits, and mental health were assessed using specific questionnaires. Subjects were classified into 3 groups according to sleep efficiency (SE <80%, 80%-85%, and ≥85%), and the relationships between dietary intake and objective sleep quality were statistically evaluated. No significant differences occurred in lifestyle characteristics, physical activity levels, eating behavior, and mental health status among the 3 SE groups. Energy intake was significantly lower in the low-SE group than in the middle- (P = .004) and high- (P = .015) SE groups. Protein intake was significantly lower in the low-SE group than in the high-SE group (P = .034). The mean energy-adjusted intakes of vitamin K, vitamin B₂, potassium, magnesium, iron, zinc, copper, and tryptophan were significantly lower in the low-SE group than in the high-SE group. Adequate energy intake and a high-quality diet including vitamins, minerals, and tryptophan may result in high sleep quality and help prevent sleep problems.

Sleep Quality and the Mediating Role of Stress Management on Eating by Nursing Personnel

(1) Background: The work schedule of nursing personnel often involves double or continuous shifts and sources of stress derived from the work context, making it necessary to ensure their rest and eating habits contribute to a healthy lifestyle. The objective of this study was to analyze the mediating role of stress management on the effect that sleep quality has on uncontrolled and emotional eating by nursing professionals. The Three-Factor Eating Questionnaire-R18 was applied to measure uncontrolled and emotional eating, the Pittsburgh Sleep Quality Index as a measure of sleep quality, and the EQ-i-20M for the stress management component of emotional intelligence. (2) Methods: A sample of 1073 nurses aged 22 to 57 years was selected for this purpose. (3) Results: The main result of this study was that stress management was a mediator in the effect of sleep quality on uncontrolled and emotional eating. Furthermore, low scores for sleeping problems correlated with high scores for stress management. The results also revealed a strong negative association between stress management and uncontrolled and emotional eating. (4) Conclusions: The results are discussed from the perspective of promoting health at work as well as improving the psychosocial wellbeing of nursing professionals and increasing the quality of patient care.

Could emotional eating act as a mediator between sleep quality and food intake in female students?

Background

Poor sleep quality is associated with overeating and unhealthy eating. The aim of this study was to investigate if emotional eating could act as a mediator between poor sleep quality and energy/macronutrients intake.

Methods

This cross-sectional study was performed with 150 female school-age students, 13 to 19 years old, living in Tabriz, Iran. The Pittsburgh Sleep Quality Index (PSQI) and Emotional Eating Questionnaire (EEQ) were completed for data collection. Intake of energy and proportion of calorie from carbohydrate, protein, and fat were evaluated by a semi-quantified food frequency questionnaire. The data were analyzed using structural equation modeling.

Results

The mean (SD) of age, weight, and BMI were not statistically different between poor and good sleepers. The mean (SD) of PSQI score was 6.73 ± 2.88, with 75.3% of the participants experiencing poor sleep quality (PSQI> 5). Students with poor sleep quality had increased energy intake and their proportion of calorie intake from fat was higher (p<0.05). There was a positive correlation between poor sleep quality and emotional eating; however, emotional eating did not mediate the relationship between poor sleep quality and energy/macronutrients intake.

Conclusions

Emotional eating did not act as a mediator between poor sleep quality and energy/macronutrients intake in female students. However, poor sleep quality directly influenced energy intake and the proportion of calorie intake from fat as well as emotional eating.

Associations between fatigue, sleep disturbance and eating style in adults with type 2 diabetes: A correlational study

AIMS AND OBJECTIVES

To test the hypothesis that fatigue and sleep disturbance account for a significant amount of variation in eating styles among people with type 2 diabetes (T2D).

BACKGROUND

Healthy eating is an important component of diabetes self-care but remains a major challenge. In people with T2D, symptoms of fatigue and sleep disturbance are pervasive. However, there is limited understanding of whether fatigue and sleep disturbance are associated with eating style in people with T2D.

DESIGN

Correlational design.

METHODS

This study was reported following the STROBE checklist. Data were collected between February 2017 and January 2018. A convenience sample of 64 T2D adults completed the Three-Factor Eating Questionnaire-R18V2 to measure eating style (e.g., emotional eating, cognitive restraint and uncontrolled eating). Diabetes distress, fatigue and sleep disturbance were measured using validated questionnaires. Hierarchical regression analyses were performed.

RESULTS

Only age was a significant predictor (β = -0.344) of cognitive restraint. Participant demographics, psychological factor and health-related factors contribute significantly to the model predicting emotional eating, but only diabetes distress was a significant predictor (β = 0.433). Introducing fatigue and poor sleep quality explained an additional 12.0% of the variation in emotional eating. The final model explained 24.9% of the variation in emotional eating; both diabetes distress (β = 0.294) and fatigue (β = 0.360) were significant predictors.

CONCLUSION

There is a strong, independent relationship of fatigue and diabetes distress with emotional eating T2D patients. The effect of improving fatigue and diabetes distress on eating style should be explored.

RELEVANCE TO CLINICAL PRACTICE

In clinical practice, nurses are recommended to include a detailed assessment of fatigue and distress in patients with diabetes. Additional to the conventional nutrition therapy focusing on diet advice, eating style should also be incorporated in diet education by diabetes nurses.

DNA methylation changes and improved sleep quality in adults with obstructive sleep apnea and diabetes

OBJECTIVE

Obstructive sleep apnea (OSA) is common among adults with diabetes. However, little is known about the impact of OSA treatment on DNA methylation levels. The purpose of this study is to explore changes in DNA methylation levels among adults with these conditions enrolled in a randomized controlled trial.

RESEARCH DESIGN AND METHODS

Participants were randomized to continuous positive airway pressure (CPAP) treatment or sham-CPAP placebo for 12 weeks. All participants received diabetes education and counseling. At baseline and 12 weeks, white blood cell DNA methylation levels for five candidate genes (ANGPTL4, DAPK3, KAT5, PER1, and TNFAIP3) and hemoglobin A1C (A1C) levels were obtained from blood. The Pittsburgh Sleep Quality Index (PSQI) and the Epworth Sleepiness Scale (ESS) assessed sleep quality and daytime sleepiness, respectively. T-tests examined within-subject changes from baseline to 12 weeks. Regression analyses explored associations between DNA methylation changes and baseline variables, minutes of therapeutic CPAP use, and changes in A1C levels, PSQI scores, and ESS scores.

RESULTS

Participants (n=10) were 70% female, 80% white, and 61.7±7.9 years old. Among all participants from baseline and 12 weeks, TNFAIP3 and PER1 DNA methylation levels decreased. At baseline, PER1 methylation levels were significantly higher in males and sex-based difference in methylation level changes was observed from baseline to 12 weeks. Changes in DNA methylation levels were not associated with minutes of therapeutic CPAP use or changes in A1C, PSQI scores, and ESS scores.

CONCLUSIONS

While DNA methylation level changes were observed in the study, the causal mechanism is unclear and additional work is needed. Although the methylation changes were small, the long-term effects are unknown.

Dietary disinhibition mediates the relationship between poor sleep quality and body weight

BACKGROUND

Inadequate sleep independently influences eating habits and weight status. However, the relationship between these three factors has not been well quantified. The objective of this study was to examine if eating behavior (i.e. dietary restraint, disinhibition and hunger) mediates the relationship between sleep and body mass index (BMI) in a large sample of American adults.

METHOD

Cross-sectional data from the Nathan Kline Institute Rockland sample were assessed (n = 602; 38.9 ± 14.5 years). Self-reported sleep and eating behavior were measured using the Pittsburgh Sleep Quality Index and Three Factor Eating Questionnaire, respectively. Path analysis was used to examine relationships amongst the construct, with mediation tested via bootstrapped confidence intervals.

RESULTS

Poorer sleep quality was associated with both greater hunger (P = 0.03) and higher disinhibited eating (overeating in the presence of palatable foods or other disinhibiting stimuli like emotional stress; P < 0.001) behaviors. Higher disinhibited eating behavior was also associated with higher BMI (P < 0.001). There was a significant indirect relationship between sleep quality and BMI via disinhibition (b [95% CI] = 0.13 [0.06, 0.21], P = 0.001). No significant effects were found when total sleep time or time in bed were replaced as predictors in the mediation model.

CONCLUSION

Disinhibited eating behavior mediated the relationship between sleep quality and weight status in both males and females. This mediation was due to aspects of sleep quality other than duration. These results suggest that improving sleep quality may benefit weight loss by helping to reduce an individuals' susceptibility to overeating.

Overweight in youth and sleep quality: is there a link?

OBJECTIVE

Overweight seems to be related to a higher prevalence of sleep disturbances. Decreased sleep duration and altered sleep quality are risk factors for obesity. Our aim was to compare the sleep pattern of overweight children with that of a matched control group and assess the relationship between sleep quality and obesity.

MATERIALS AND METHODS

Retrospective cohort study comparing 41 overweight children with a normal-weight control group, both submitted to polysomnography. The samples were matched for age, sex, and apnea-hypopnea index. Body mass index (BMI) z-scores were calculated using World Health Organization (WHO) growth charts. Insulin resistance in the study group was determined using the homeostatic model assessment for insulin resistance (HOMA-IR). Sleep patterns were compared. The statistical analysis was performed using SPSS® version 21.

RESULTS

The mean age (± standard deviation) of the population was 10 ± 3.4 years (min. 5 years; max. 17 years). Fifty-six percent of the participants in both groups were girls. N3% was lower in the study group (18.95 ± 6.18%) compared with the control group (21.61 ± 7.39%; t (40) = 2.156, p = 0.037). We found a correlation in the study group between HOMA-IR and N3% (Rs = -0.434, p = 0.008).

CONCLUSION

The present study suggests a link between overweight/obesity and altered sleep quality due to compromised non-rapid eye movement sleep, an indirect marker of sleep quality. There was also a link between slow-wave sleep duration and insulin resistance. We must find a strategy to provide adequate slow-wave sleep duration to reduce the obesity epidemic at young ages. Further research is needed.

Relationship between sleep characteristics and measures of body size and composition in a nationally-representative sample

BACKGROUND

Short sleep has been linked to obesity. However, sleep is a multidimensional behavior that cannot be characterized solely by sleep duration. There is limited study that comprehensively examined different sleep characteristics in relation to obesity.

METHODS

We examined various aspects of sleep in relation to adiposity in 2005-2006 NHANES participants who were 18 or older and free of cardiovascular disease, cancer, emphysema, chronic bronchitis and depression (N = 3995). Sleep characteristics were self-reported, and included duration, overall quality, onset latency, fragmentation, daytime sleepiness, snoring, and sleep disorders. Body measurements included weight, height, waist circumference, and dual-energy X-ray absorptiometry measured fat mass.

RESULTS

Snoring was associated with higher BMI (adjusted difference in kg/m² comparing snoring for 5+ nights/week with no snoring (95 % confidence interval), 1.85 (0.88, 2.83)), larger waist circumference (cm, 4.52 (2.29, 6.75)), higher percentage of body fat (%, 1.61 (0.84, 2.38)), and higher android/gynoid ratio (0.03 (0.01, 0.06)). The associations were independent of sleep duration and sleep quality, and cannot be explained by the existence of sleep disorders such as sleep apnea. Poor sleep quality (two or more problematic sleep conditions) and short sleep duration (<6 h) were also associated with higher measures of body size and fat composition, although the effects were attenuated after snoring was adjusted.

CONCLUSION

In a nationally representative sample of healthy US adults, snoring, short sleep, and poor sleep quality were associated with higher adiposity.

Self-reported sleep quality, weight status and depression in young adult twins and siblings

Background

Research supporting relationships between sleep quality, weight, depression and anxiety has typically examined the relationships separately rather than simultaneously, potentially hampering insights into the characteristics of reported links. This study aimed to fill this gap in the research to provide further insight into the factors associated with sleep.

Methods

Data from wave 4 of the G1219 cohort were used in cross-sectional analyses. The sample comprised 1392 adult twins and siblings aged 18–27 years. Participants completed a self-report questionnaire which included the Pittsburgh Sleep Quality Index as a measure of sleep quality, the Short Mood and Feelings Questionnaire as a measure of depression symptoms and the Revised Symptoms of Anxiety Scale as a measure of anxiety symptoms. Participants were asked to self-report general health and weight and height so researchers could derive weight status from measures of body mass index.

Results

An analysis of covariance including weight status, depression, anxiety and general health as predictors and sleep quality as the outcome revealed main effects of depression (F(3,1163) = 10.93, p < 0.001) and general health (F(4,1163) = 5.72, p < 0.001) only.

Conclusions

A direct relationship between weight and sleep should not be assumed as it is possible that the relationship is at least in part accounted for by depression symptoms or general health. Depression symptoms and general health may also account for the association between sleep quality and anxiety symptoms in young adults.

Eating behavior traits and sleep as determinants of weight loss in overweight and obese adults

Objective:

To examine the associations between eating behavior traits and weight loss according to sleep quality and duration in adults enrolled in common weight-loss interventions.

Methods:

Participants included overweight and obese men and women (n=150) (mean±s.d. age, 38.8±8.6 years; mean±s.d. body mass index (BMI), 33.3±3.5 kg m⁻²) who were subjected to a dietary intervention over a period of 12–16 weeks. Anthropometric measurements, eating behavior traits (Three-Factor Eating Questionnaire), sleep quality (total Pittsburgh Sleep Quality Index (PSQI) score) and sleep duration (hours per night, self-reported from the PSQI) were assessed at both baseline and post intervention. Linear regression analysis was used to quantify the relationships between eating behavior traits and changes in anthropometric markers for all subjects and by sleep categories (short sleep: <7 h per night vs recommended sleep: ⩾7 h per night; poor sleep quality: ⩾5 PSQI score vs good sleep quality: <5 PSQI score). We adjusted for age, sex and baseline BMI in analyses.

Results:

Baseline eating behavior traits were modest predictors of weight-loss success, but they were all significantly associated with their changes over the weight-loss intervention (P<0.01). The diet intervention induced significant changes in eating behavior traits and even more for those having a non-favorable eating behavior profile at baseline. We observed that changes in flexible control and strategic dieting behavior were constantly negatively associated with changes in body weight and fat mass (P<0.05) for recommended duration sleepers. The change in situational susceptibility to disinhibition was positively associated with the change in fat mass and body weight for those having healthy sleeping habits (P<0.05). For poor quality sleepers, the change in avoidance of fattening foods was negatively associated with changes in adiposity (P<0.05).

Conclusion:

Eating behavior traits and sleep may act together to influence the outcome of weight-loss programs.

The role of sleep duration in the regulation of energy balance: effects on energy intakes and expenditure

Short sleep duration and obesity are common occurrence in today's society. An extensive literature from cross-sectional and longitudinal epidemiological studies shows a relationship between short sleep and prevalence of obesity and weight gain. However, causality cannot be inferred from such studies. Clinical intervention studies have examined whether reducing sleep in normal sleepers, typically sleeping 7-9 h/night, can affect energy intake, energy expenditure, and endocrine regulators of energy balance. The aim of this review is to evaluate studies that have assessed food intake, energy expenditure, and leptin and ghrelin levels after periods of restricted and normal sleep. Most studies support the notion that restricting sleep increases food intake, but the effects on energy expenditure are mixed. Differences in methodology and component of energy expenditure analyzed may account for the discrepancies. Studies examining the effects of sleep on leptin and ghrelin have provided conflicting results with increased, reduced, or unchanged leptin and ghrelin levels after restricted sleep compared to normal sleep. Energy balance of study participants and potential sex differences may account for the varied results. Studies should strive for constant energy balance and feeding schedules when assessing the role of sleep on hormonal profile. Although studies suggest that restricting sleep may lead to weight gain via increased food intake, research is needed to examine the impact on energy expenditure and endocrine controls. Also, studies have been of short duration, and there is little knowledge on the reverse question: does increasing sleep duration in short sleepers lead to negative energy balance?

Short sleep duration, glucose dysregulation and hormonal regulation of appetite in men and women

STUDY OBJECTIVE

To determine the hormonal effects of reducing sleep duration under controlled feeding conditions.

DESIGN

Randomized, crossover study.

SETTING

Inpatient.

PARTICIPANTS

Twenty-seven normal weight, 30- to 45-yr-old men and women habitually sleeping 7-9 hr/night.

INTERVENTION

PARTICIPANTS WERE STUDIED UNDER TWO SLEEP CONDITIONS: short (4 hr in bed) or habitual (9 hr in bed) sleep. A controlled diet was provided for each 4-day study period.

MEASUREMENTS AND RESULTS

Fasting blood samples were obtained daily and frequent blood samples were obtained throughout day 4. The main outcomes measures included glucose, insulin, leptin, ghrelin, adiponectin, total glucagon-like peptide 1 (GLP-1) and peptide YY(3-36) (PYY(3-36)) concentrations. Body weights were reduced by 2.2 ± 0.4 lb and 1.7 ± 0.4 lb during the habitual and short sleep phases, respectively (both P < 0.0001). There was no effect of sleep duration on glucose, insulin, and leptin profiles (all P > 0.05). Ghrelin and GLP-1 responses differed by sex. Short sleep increased fasting (P = 0.054) and morning (08:00-12:00) (P = 0.042) total ghrelin in men but not women. The reverse was observed for GLP-1: afternoon levels (12:30-19:00) were lower (P = 0.016) after short sleep compared with habitual sleep in women but not men.

CONCLUSIONS

These data suggest that, in the context of negative energy balance, short sleep does not lead to a state of increased insulin resistance, but may predispose to overeating via separate mechanisms in men and women.

CLINICAL TRIAL INFORMATION

Trial registration on http://www.clinicaltrials.gov. #NCT00935402.

Sleep duration and disorders in pregnancy: implications for glucose metabolism and pregnancy outcomes

Humans have an innate requirement for sleep that is intrinsically governed by circadian and endocrine systems. More recently, reduced sleep duration has gained significant attention for its possible contribution to metabolic dysfunction. Significant evidence suggests that reduced sleep duration may elevate the risk for impaired glucose functioning, insulin resistance and type 2 diabetes. However, to date, few studies have determined the implications of reduced sleep duration with regard to glucose control during pregnancy. With the high prevalence of overweight and obesity in women of reproductive age, the occurrence of gestational diabetes mellitus (GDM) is increasing. GDM results in elevated risk of maternal and fetal complications, as well as increased risk of type 2 diabetes postpartum. Infants born to women with GDM also carry a life-long risk of obesity and type 2 diabetes. The impact of reduced sleep on glucose management during pregnancy has not yet been fully assessed and a paucity of literature currently exits. Herein, we review the association between reduced sleep and impaired carbohydrate metabolism and propose how reduced sleep during pregnancy may result in further dysfunction of the carbohydrate axis. A particular focus will be given to sleep-disordered breathing, as well as GDM-complicated pregnancies. Putative mechanisms of action by which reduced sleep may adversely affect maternal and infant outcomes are also discussed. Finally, we will outline important research questions that need to be addressed.

Interacting epidemics? Sleep curtailment, insulin resistance, and obesity

In the last 50 years, the average self-reported sleep duration in the United States has decreased by 1.5-2 hours in parallel with an increasing prevalence of obesity and diabetes. Epidemiological studies and meta-analyses report a strong relationship between short or disturbed sleep, obesity, and abnormalities in glucose metabolism. This relationship is likely to be bidirectional and causal in nature, but many aspects remain to be elucidated. Sleep and the internal circadian clock influence a host of endocrine parameters. Sleep curtailment in humans alters multiple metabolic pathways, leading to more insulin resistance, possibly decreased energy expenditure, increased appetite, and immunological changes. On the other hand, psychological, endocrine, and anatomical abnormalities in individuals with obesity and/or diabetes can interfere with sleep duration and quality, thus creating a vicious cycle. In this review, we address mechanisms linking sleep with metabolism, highlight the need for studies conducted in real-life settings, and explore therapeutic interventions to improve sleep, with a potential beneficial effect on obesity and its comorbidities.

Update on energy homeostasis and insufficient sleep

Driven by the demands and opportunities of modern life, many people habitually sleep less than 6 h a night. In the sleep clinic, chronic sleep restriction is recognized by the diagnosis of insufficient sleep syndrome (ICSD-9, 307.49-4), which is receiving increased scrutiny as a potential risk to metabolic health. Its relevance for the practicing endocrinologist is highlighted by a stream of epidemiological data that show an association of insufficient sleep with increased incidence of obesity and related morbidities. A central theme of this update is the notion that sleep loss incurs additional metabolic cost, which triggers a set of neuroendocrine, metabolic, and behavioral adaptations aimed at increasing food intake and conserving energy. Although this coordinated response may have evolved to offset the metabolic demands of extended wakefulness in natural habitats with limited food availability, it can be maladaptive in the context of a modern environment that allows many to overeat while maintaining a sedentary lifestyle without sufficient sleep. Importantly, such sleep loss-related metabolic adaptation may undermine the success of behavioral interventions based on reduced caloric intake and increased physical activity to lower metabolic risk in obesity-prone individuals. This emerging perspective is based on data from recently published human interventional studies and requires further experimental support. Nevertheless, it now seems prudent to recommend that overweight and obese individuals attempting to reduce their caloric intake and maintain increased physical activity should obtain adequate sleep and, if needed, seek effective treatment for any coexisting sleep disorders.