Effect of Sleep Extension on Objectively Assessed Energy Intake Among Adults With Overweight in Real-life Settings

Abstract

IMPORTANCE Short sleep duration has been recognized as a risk factor for obesity. Whether extending sleep duration may mitigate this risk remains unknown.OBJECTIVE To determine the effects of a sleep extension intervention on objectively assessed energy intake, energy expenditure, and body weight in real-life settings among adults with overweight who habitually curtailed their sleep duration. DESIGN, SETTING, AND PARTICIPANTSThis single-center, randomized clinical trial was conducted from November 1, 2014, to October 30, 2020. Participants were adults aged 21 to 40 years with a body mass index (calculated as weight in kilograms divided by height in meters squared) between 25.0 and 29.9 and had habitual sleep duration of less than 6.5 hours per night. Data were analyzed according to the intention-to-treat principle.INTERVENTIONS After a 2-week habitual sleep period at baseline, participants were randomized to either an individualized sleep hygiene counseling session that was intended to extend their bedtime to 8.5 hours (sleep extension group) or to continue their habitual sleep (control group). All participants were instructed to continue daily routine activities at home without any prescribed diet or physical activity. MAIN OUTCOMES AND MEASURESThe primary outcome was change in energy intake from baseline, which was objectively assessed as the sum of total energy expenditure and change in body energy stores. Total energy expenditure was measured by the doubly labeled water method. Change in body energy stores was computed using regression of daily home weights and body composition changes from dual-energy x-ray absorptiometry. Sleep duration was monitored by actigraphy. Changes from baseline were compared between the 2 groups using intention-to-treat analysis.RESULTS Data from 80 randomized participants (mean [SD] age, 29.8 [5.1] years; 41 men [51.3%]) were analyzed. Sleep duration was increased by approximately 1.2 hours per night (95% CI, 1.0 to 1.4 hours; P < .001) in the sleep extension group vs the control group. The sleep extension group had a significant decrease in energy intake compared with the control group (−270 kcal/d; 95% CI, −393 to −147 kcal/d; P < .001). The change in sleep duration was inversely correlated with the change in energy intake (r = −0.41; 95% CI, −0.59 to −0.20; P < .001). No significant treatment effect in total energy expenditure was found, resulting in weight reduction in the sleep extension group vs the control group.CONCLUSIONS AND RELEVANCE This trial found that sleep extension reduced energy intake and resulted in a negative energy balance in real-life settings among adults with overweight who habitually curtailed their sleep duration. Improving and maintaining healthy sleep duration over longer periods could be part of obesity prevention and weight loss programs.

Associations between sleep duration and cardiovascular diseases: A meta-review and meta-analysis of observational and Mendelian randomization studies

“…The underlying pathophysiological mechanisms, including sympathetic activation ( 57 , 58 ), cardiac endocrine and metabolic dysfunction ( 11 , 59 ), increased inflammatory mediators ( 60 ), and endothelial dysfunction ( 61 , 62 ), may be involved in the adverse effects of short sleep duration on cardiovascular health. Recent studies have shown that extended sleep duration can reduce the risk of obesity and improve cardiovascular health, especially in people who have long-term sleep deprivation ( 49 , 63 – 65 ). A recent meta-analysis provided preliminary evidence supporting that prolonging sleep duration can improve cardiometabolic health ( 66 ).…”

Management of hyperglycaemia in type 2 diabetes, 2022. A consensus report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD)

“…obesity and HbA 1c ), with both long (>8 h) and short (<6 h) sleep durations having negative impacts [ 97 ]. By extending the sleep duration of short sleepers, it is possible to improve insulin sensitivity and reduce energy intake [ 117 , 125 ]. However, ’catch-up’ weekend sleep alone is not enough to reverse the impact of insufficient sleep [ 126 ].…”

The emerging importance of tackling sleep–diet interactions in lifestyle interventions for weight management

“…These findings align with the observational data and suggest that crosssectional associations between short sleep and higher sugar intake is at least in part attributable to a direct effect of short sleep on consumption of foods high in sugar (34) . Similarly, Tasali et al (35) conducted a parallel 2-arm, 2-week randomised controlled trial in eighty healthy young adults (49 % female) with overweight and reporting sleep < 6•5 h/night; the intervention group receiving personalised sleep hygiene counselling resulted in an increase in sleep duration of 1•2 h per night in the sleep extension group (measured by wrist actigraphy), with no differences in sleep efficiency observed. Again, no dietary advice was provided, but nevertheless energy intake, calculated from changes in body composition and energy expenditure (doubly labelled water), decreased in the sleep extension group by 270 kcal/d relative to the control group, and an inverse correlation between energy intake and sleep duration changes was reported (35) .…”