Inadequate sleep &amp; obesity: Breaking the vicious cycle

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doi:doi: 10.12788/jfp.0674

Applied Evidence

Inadequate sleep & obesity: Breaking the vicious cycle

J Fam Pract. 2023 October;72(8):332-338 | doi: 10.12788/jfp.0674

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References

1. Aminoff MJ, Boller F, Swaab DF. We spend about one-third of our life either sleeping or attempting to do so. Handb Clin Neurol. 2011;98:vii. doi: 10.1016/B978-0-444-52006-7.00047-2

2. Watson NF, Badr MS, Belenky G, et al. Recommended amount of sleep for a healthy adult: a joint consensus statement of the American Academy of Sleep Medicine and Sleep Research Society. Sleep. 2015;38:843-844. doi: 10.5665/sleep.4716

3. CDC. Sleep and sleep disorders, adults. Accessed September 21, 2023. www.cdc.gov/sleep/data-and-statistics/adults.html

4. Chattu VK, Manzar MD, Kumary S. The global problem of insufficient sleep and its serious public health implications. Healthcare (Basel). 2019;7:1. doi: 10.3390/healthcare7010001

5. Taheri S, Lin L, Austin D, et al. Short sleep duration is associated with reduced leptin, elevated ghrelin, and increased body mass index. PLoS Med. 2004;1:e62. doi: 10.1371/journal.pmed.0010062

6. Hafner M, Stepanek M, Taylor J, et al. Why sleep matters—the economic costs of insufficient sleep. Rand Health Q. 2017;6:11.

7. Hisler G, Twenge JM, Krizan Z. Associations between screen time and short sleep duration among adolescents varies by media type: evidence from a cohort study. Sleep Med. 2020;66:92-102. doi: 10.1016/j.sleep.2019.08.007

8. Ogilvie RP, Patel SR. The epidemiology of sleep and obesity. Sleep Health. 2017;3:383-388. doi: 10.1016/j.sleh.2017.07.013

9. CDC. Sleep and sleep disorders: How much sleep do I need? Accessed September 21, 2023. www.cdc.gov/sleep/about_sleep/how_much_sleep.html

10. van Egmond LT, Meth EMS, Engström J, et al. Effects of acute sleep loss on leptin, ghrelin, and adiponectin in adults with healthy weight and obesity: a laboratory study. Obesity (Silver Spring). 2023;31:635-641. doi: 10.1002/oby.23616

11. Spiegel K, Tasali E, Penev P, et al. Brief communication: sleep curtailment in healthy young men is associated with decreased leptin levels, elevated ghrelin levels, and increased hunger and appetite. Ann Intern Med. 2004;141:846-850. doi: 10.7326/0003-4819-141-11-200412070-00008

12. Antza C, Kostopoulos G, Mostafa S, et al. The links between sleep duration, obesity and type 2 diabetes mellitus. J Endocrinol. 2021;252:125-141. doi: 10.1530/JOE-21-0155

13. Baron KG, Reid KJ, Kern AS, et al. Role of sleep timing in caloric intake and BMI. Obesity (Silver Spring). 2011;19:1374-1381. doi: 10.1038/oby.2011.100

14. Liu XY, Zheng CL, Xu C, et al. Nighttime snacking is associated with risk of obesity and hyperglycemia in adults: a cross-sectional survey from Chinese adult teachers J Biomed Res. 2017;31:541-547. doi: 10.7555/JBR.31.20160083

15. Cai Z, Yang Y, Zhang J, et al. The relationship between daytime napping and obesity: a systematic review and meta-analysis. Sci Rep. 2023.13:12124. doi: 10.1038/s41598-023-37883-7

16. Nedeltcheva AV, Kilkus JM, Imperial J, et al. Insufficient sleep undermines dietary efforts to reduce adiposity. Ann Intern Med. 2010;153:435-441. doi: 10.7326/0003-4819-153-7-201010050-00006

17. Chaput JP, Tremblay A. Adequate sleep to improve the treatment of obesity. CMAJ. 2012;184:1975-1976. doi: 10.1503/cmaj.120876

18. Kelsey MM, Zaepfel A, Bjornstad P, et al. Age-related consequences of childhood obesity. Gerontology. 2014;60:222-228. doi: 10.1159/000356023

19. Fryar CD, Carroll MD, Afful J. Prevalence of overweight, obesity, and severe obesity among children and adolescents aged 2-19 years: United States, 1963-1965 through 2017-2018. National Center for Health Statistics Health E-Stats. Updated January 29, 2021. Accessed September 21, 2021. www.cdc.gov/nchs/data/hestat/obesity-child-17-18/overweight-obesity-child-H.pdf

20. Fatima Y, Doi SAR, Mamun AA. Sleep quality and obesity in young subjects: a meta-analysis. Obes Rev. 2016;17:1154-1166. doi: 10.1111/obr.12444

21. Gohil A, Hannon TS. Poor sleep and obesity: concurrent epidemics in adolescent youth. Front Endocrinol. 2018;9:364. doi: 10.3389/fendo.2018.00364

22. Golley RK, Maher CA, Matricciani L, et al. Sleep duration or bedtime? Exploring the association between sleep timing behaviour, diet and BMI in children and adolescents. Int J Obes (Lond). 2013;37:546-551. doi: 10.1038/ijo.2012.212

23. Alessi CA. Sleep issues. In: Harper GM, Lyons WL, Potter JF, eds. Geriatrics Review Syllabus (GRS 10). Updated January 2021. Accessed August 29, 2023. http://geriatricscareonline.org

24. Patel SR, Blackwell T, Redline S, et al. The association between sleep duration and obesity in older adults. Int J Obes (Lond). 2008;32:1825-1834. doi: 10.1038/ijo.2008.198

25. Cai GH, Theorell-Haglöw J, Janson C, et al. Insomnia symptoms and sleep duration and their combined effects in relation to associations with obesity and central obesity. Sleep Med. 2018;46:81-87. doi: 10.1016/j.sleep.2018.03.009

26. Beccuti G, Pannain S. Sleep and obesity. Curr Opin Clin Nutr Metab Care. 2011;14:402-412. doi: 10.1097/MCO.0b013 e3283479109

27. Franklin KA, Lindberg E. Obstructive sleep apnea is a common disorder in the population–a review on the epidemiology of sleep apnea. J Thorac Dis. 2015;7:1311-1322. doi: 10.3978/j.issn.2072-1439.2015.06.11

28. USPSTF. Bibbins-Domingo K, Grossman DC, Curry SJ, et al. Screening for obstructive sleep apnea in adults: US Preventive Services Task Force recommendation statement. JAMA. 2017;317:407-414. doi: 10.1001/jama.2016.20325

29. Goyal M, Johnson J. Obstructive sleep apnea diagnosis and management. Mo Med. 2017;114:120-124.

30. American Academy of Sleep Medicine. Hidden health crisis costing America billions: underdiagnosing and undertreating obstructive sleep apnea draining healthcare system. 2016. Accessed September 25, 2023. https://aasm.org/wp-content/uploads/2017/10/sleep-apnea-economic-crisis.pdf

31. Devaraj, NK. Knowledge, attitude, and practice regarding obstructive sleep apnea among primary care physicians. Sleep Breath. 2020;24:1581-1590. doi: 10.1007/s11325-020-02040-1

32. Mysliwiec V, Martin JL, Ulmer CS, et al. The management of chronic insomnia disorder and obstructive sleep apnea: synopsis of the 2019 U.S. Department of Veterans Affairs and U.S. Department of Defense Clinical Practice Guidelines. Ann Intern Med. 2020;172:325-336. doi: 10.7326/M19-3575

33. Kuna ST, Reboussin DM, Strotmeyer ES, et al. Effects of weight loss on obstructive sleep apnea severity. Ten-year results of the Sleep AHEAD study. Am J Respir Crit Care Med. 2021;203:221-229. doi: 10.1164/rccm.201912-2511OC

34. St-Onge MP, Tasali E. Weight loss is integral to obstructive sleep apnea management. Ten-year follow-up in Sleep AHEAD. Am J Respir Crit Care Med. 2021;203:161-162. doi: 10.1164/rccm.202007-2906ED

35. Zheng D, Yuan X, Ma C, et al. Alcohol consumption and sleep quality: a community-based study. Public Health Nutr. 2021;24:4851-4858. doi: 10.1017/S1368980020004553

36. Chakravorty S, Chaudhary NS, Brower KJ. Alcohol dependence and its relationship with insomnia and other sleep disorders. Alcohol Clin Exp Res. 2016;40:2271-2282. doi: 10.1111/acer.13217

37. Elmenhorst EM, Elmenhorst D, Benderoth S, et al. Cognitive impairments by alcohol and sleep deprivation indicate trait characteristics and a potential role for adenosine A1 receptors. Proc Natl Acad Sci U S A. 2018;115:8009-8014. doi: 10.1073/pnas.1803770115

38. Traversy G, Chaput JP. Alcohol consumption and obesity: an update. Curr Obes Rep. 2015;4:122-130. doi: 10.1007/s13679-014-0129-4

39. McCann UD, Sgambati FP, Schwartz AR, et al. Sleep apnea in young abstinent recreational MDMA (“ecstasy”) consumers. Neurology. 2009;73:2011-2017. doi: 10.1212/WNL.0b013e3181c51a62

40. Grau-López L, Grau-López L, Daigre C, et al. Insomnia symptoms in patients with substance use disorders during detoxification and associated clinical features. Front Psychiatry. 2020;11:540022. doi: 10.3389/fpsyt.2020.540022

41. Boehm MA, Lei QM, Lloyd RM, et al. Depression, anxiety, and tobacco use: overlapping impediments to sleep in a national sample of college students. J Am Coll Health. 2016;64:565-574. doi: 10.1080/07448481.2016.1205073

42. Gracious BL, Meyer AE. Psychotropic-induced weight gain and potential pharmacologic treatment strategies. Psychiatry (Edgmont). 2005;2:36-42.

43. Ratliff JC, Barber JA, Palmese LB, et al. Association of prescription H1 antihistamine use with obesity: results from the National Health and Nutrition Examination Survey. Obesity (Silver Spring). 2010;18:2398-2400. doi: 10.1038/oby.2010.176

44. Pataka A, Daskalopoulou E, Kalamaras G, et al. Evaluation of five different questionnaires for assessing sleep apnea syndrome in a sleep clinic. Sleep Med. 2014;15:776-781. doi: 10.1016/j.sleep.2014.03.012

45. Kline CE, Chasens ER, Bizhanova Z, et al. The association between sleep health and weight change during a 12-month behavioral weight loss intervention. Int J Obes (Lond). 2021;45:639-649. doi: 10.1038/s41366-020-00728-8

46. CDC. How much physical activity do adults need? Accessed August 23, 2023. www.cdc.gov/physicalactivity/basics/adults/index.htm

47. Flack KD, Hays HM, Moreland J, et al. Exercise for weight loss: further evaluating energy compensation with exercise. Med Sci Sports Exerc. 2020;52:2466-2475. doi: 10.1249/MSS.0000000000002376

48. Swift DL, Johannsen NM, Lavie CJ, et al. The role of exercise and physical activity in weight loss and maintenance. Prog Cardiovasc Dis. 2014;56:441-447. doi: 10.1016/j.pcad.2013.09.012

49. Irish LA, Kline CE, Gunn HE, et al. The role of sleep hygiene in promoting public health: a review of empirical evidence. Sleep Med Rev. 2015;22:23-36. doi: 10.1016/j.smrv.2014.10.001

50. CDC. Tips for better sleep. 2022. Accessed August 4, 2023. www.cdc.gov/sleep/about_sleep/sleep_hygiene.html

51. Qaseem A, Kansagara D, Forciea MA, et al. Management of chronic insomnia disorder in adults: a clinical practice guideline from the American College of Physicians. Ann Intern Med. 2016;165:125-133. doi: 10.7326/M15-2175

52. Logue EE, Bourguet CC, Palmieri PA, et al. The better weight-better sleep study: a pilot intervention in primary care. Am J Health Behav. 2012;36:319-334. doi: 10.5993/AJHB.36.3.4

53. Leach MJ, Page AT. Herbal medicine for insomnia: a systematic review and meta-analysis. Sleep Med Rev. 2015;24:1-12. doi: 10.1016/j.smrv.2014.12.003

54. Sateia MJ, Buysse DJ, Krystal AD, et al. Clinical practice guideline for the pharmacologic treatment of chronic insomnia in adults: an American Academy of Sleep Medicine clinical practice guideline. J Clin Sleep Med. 2017;13:307-349. doi: 10.5664/jcsm.6470

In contrast, those with alcohol or cannabis use disorder tend to have more sleep-onset insomnia.⁴⁰ Not only do illicit drugs interrupt sleep, but daily tobacco use also has been correlated with increased insomnia and shorter sleep duration since nicotine is a stimulant.⁴¹

Insomnia is commonly treated with sedative antidepressants and hypnotics—eg, mirtazapine and olanzapine—that contribute to weight gain.⁴² In addition, other common pharmaceuticals used for sleep disorders, such as diphenhydramine, have sedative properties and tend to lead to weight gain.⁴³ Because so many medications affect sleep and weight, carefully review patients’ medication lists and switch offending agents to weight-neutral drugs if possible.

Treatment and tools to improve sleep in patients with obesity

Given the strong correlation between obesity and sleep disorders, validated screening tools should be used to assess sleep quality, including onset and potential symptoms associated with poor sleep (TABLE 1⁴⁴). For weight management to succeed in patients with obesity, it is crucial to address sleep in addition to nutrition and physical activity.^17,45

It falls upon the clinician and patient to weigh the benefits and burdens of the pharmacologic treatments of insomnia.

Physical activity has many benefits to overall health, especially for chronic diseases such as type 2 diabetes and hypertension. The Centers for Disease Control and Prevention recommends at least 150 minutes of moderate-intensity aerobic activity or 75 minutes of vigorous-intensity aerobic exercise per week in addition to muscle-strengthening activities 2 or more days per week.⁴⁶ However, approximately 300 minutes of moderate-intensity activity per week is suggested for successful weight loss with exercise alone.⁴⁷

Physical activity and diet in combination are vital, but diet restriction has a more substantial effect on weight loss than physical activity alone.⁴⁸ Still, physical activity is essential in helping maintain and prevent weight regain.

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