Key points What is the effect of sleep extent on objectively assessed energy intake in overweight adults in their usual home environment? Findings In this randomized clinical trial of 80 overweight adults with habitual sleep of less than 6.5 hours per night, those randomized to a 2-week sleep extension intervention significantly reduced their daily energy intake by approximately 270 kcal compared to the control group. Total energy expenditure did not differ significantly between the sleep extension and control groups, resulting in a negative energy balance with sleep extension. Meaning The findings suggest that improving and maintaining adequate sleep duration could reduce weight and be a viable intervention for weight loss and obesity prevention programs. |
Obesity is a major public health problem. The obesity epidemic appears to coincide with a pattern of less sleep that has been observed in society over the past few decades. For example, one-third of the U.S. population reported not getting the recommended 7 to 9 hours of sleep per night.
Substantial evidence suggests that sleeping less than 7 hours per night on a regular basis is associated with adverse health consequences. In particular, insufficient sleep duration is increasingly recognized as an important risk factor for obesity. Prospective epidemiological studies suggest that short sleep duration is an important risk factor for weight gain.
However, it is still unknown whether extending sleep duration can be an effective strategy to prevent or reverse obesity. Although obesity experts encourage sleep hygiene education, most healthcare professionals and patients do not implement obtaining adequate sleep duration as part of strategies to combat the obesity epidemic.
At the population level, the association between energy flow and body weight implies that increased energy intake is the main driver of body weight increase in modern society. According to dynamic prediction models, a sustained increase in energy intake of even 100 kcal/d would result in weight gain of about 4.5 kg over 3 years.
There is a need to better understand the factors underlying the observed persistent increase in energy intake and mean weight gain at the population level. One of those factors is insufficient sleep duration. Short-term experimental laboratory studies have found that sleep restriction in healthy individuals is associated with an increase in mean energy intake of about 250 to 350 kcal/d with little or no change in energy expenditure.
However, these laboratory studies do not represent real life. The magnitude of sleep restriction was extreme in most cases, and energy intake was determined from a single meal or a few. In a real-life setting where participants continue their normal daily activities, multiple interacting factors (e.g., social interactions and free-living physical activity) can influence energy intake or expenditure and weight. .
To date, it is unknown whether and to what extent an intervention aimed at increasing sleep duration in a real-life setting affects energy balance and body weight. We conducted a randomized clinical trial (RCT) to determine the effects of a sleep extension intervention on energy intake, energy expenditure, and body weight objectively assessed in real-life settings among overweight adults who habitually reduce sleep duration. of the dream.
Summary
A randomized clinical trial
Importance
Short sleep duration has been recognized as a risk factor for obesity. It is still unknown whether extending sleep duration can mitigate this risk.
Aim
To determine the effects of a sleep extension intervention on objectively assessed energy intake, energy expenditure, and body weight in real-life settings among overweight adults who habitually reduce sleep duration.
Design, scope and participants
This single-center randomized clinical trial was conducted from November 1, 2014 to October 30, 2020. Participants were adults ages 21 to 40 with a body mass index (calculated as weight in kilograms divided by height in square meters) between 25.0 and 29.9 and had a typical 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 period of regular sleep at baseline, participants were randomly assigned to an individualized sleep hygiene counseling session that aimed to extend their bedtime to 8.5 hours (sleep extension group). sleep) or continue with their usual sleep (control group).
All participants were instructed to continue daily routine activities at home without any prescribed diet or physical activity.
Main results and measures
The primary outcome was the change in energy intake from baseline, which was objectively assessed as the sum of total energy expenditure and the change in body energy stores.
Total energy expenditure was measured by the doubly labeled water method. Change in body energy stores was calculated using regression of daily household weights and changes in body composition from dual-energy X-ray absorptiometry. Sleep duration was monitored using 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 increased approximately 1.2 hours per night (95% CI, 1.0 to 1.4 hours; P < 0.001) in the sleep extension group versus 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 < 0.001).
Change in sleep duration was inversely correlated with change in energy intake (r = −0.41; 95% CI, −0.59 to −0.20; P < 0.001).
No significant treatment effect was found on total energy expenditure, resulting in weight reduction in the sleep extension group versus the control group.
Conclusions and relevance This trial found that sleep extension reduced energy intake and resulted in negative energy balance in real-life settings among overweight adults who habitually reduced sleep duration. Improving and maintaining healthy sleep duration for longer periods could be part of weight loss and obesity prevention programs. |
ClinicalTrials.gov Trial Registration Identifier: NCT02253368
