Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

Short sleep duration and obesity: the role of emotional stress and sleep disturbances

Abstract

Objective: Many epidemiologic studies have reported that obesity is associated with short sleep duration. How the degree of obesity or other clinical characteristics of the obese individuals, such as sleep disturbances or emotional stress, define this relation is not known.

Design: We studied a random sample of 1300 middle-aged men and women from the Penn State Cohort in the sleep laboratory for one night. Sleep disturbances were recorded as insomnia, excessive daytime sleepiness (EDS) or sleep difficulty. Chronic emotional stress was determined by the Minnesota Multiphasic Personality Inventory-2 (MMPI-2).

Results: Obese individuals (body mass index, BMI>30) reported shorter duration of sleep, had a higher incidence of subjective sleep disturbances (47.4 vs 25.5%; P<0.01) and scored higher for chronic emotional stress than nonobese subjects. However, there was no difference in self-reported sleep duration between obese and nonobese individuals without subjective sleep disturbances, while both obese men and women with sleep complaints scored higher in the MMPI-2 compared to obese individuals without sleep complaints. The shortest sleep duration was reported by the obese insomniac patients (5.9 h), followed by obese with EDS (6.3 h) or sleep difficulty (6.6 h). The effect of chronic emotional stress was stronger than that of the BMI on the reported sleep duration, with a synergistic joint effect. The presence of a sleep disturbance was associated with a reduction of reported sleep by 18 min for men and 42 min in women, whereas a 10 kg m−2 increase of BMI was associated with a 16 and 6 min decrease of sleep in men and women, respectively. Interestingly, there was no association between objective sleep duration and BMI.

Conclusion: Self-reported short sleep duration in obese individuals may be a surrogate marker of emotional stress and subjective sleep disturbances, whose detection and management should be the focus of our preventive and therapeutic strategies for obesity.

This is a preview of subscription content

Access options

Buy article

Get time limited or full article access on ReadCube.

$32.00

All prices are NET prices.

Figure 1
Figure 2
Figure 3
Figure 4

References

  1. Flegal KM, Carroll MD, Ogden CL, Johnson CL . Prevalence and trends in obesity among US adults, 1999–2000. JAMA 2002; 288: 1723–1727.

    Article  Google Scholar 

  2. Spiegel A, Nabel E, Volkow N, Landis S, Li TK . Obesity on the brain. Nat Neurosci 2005; 8: 552–553.

    CAS  Article  Google Scholar 

  3. Tune GS . Sleep and wakefulness in normal human adults. BMJ 1968; 2: 269–271.

    CAS  Article  Google Scholar 

  4. National Sleep Foundation. Sleep in America Poll 2005. National Sleep Foundation: Washington, DC.

  5. Kripke DF, Garfinkel L, Wingard DL, Klauber MR, Marler MR . Mortality associated with sleep duration and insomnia. Arch Gen Psychiatry 2002; 59: 131–136.

    Article  Google Scholar 

  6. Gottlieb DJ, Redline S, Nieto FJ, Baldwin CM, Newman AB, Resnick HE et al. Association of usual sleep duration with hypertension: the Sleep Heart Health Study. Sleep 2006; 29: 1009–1014.

    Article  Google Scholar 

  7. Taheri S, Lin L, Austin D, Young T, Mignot E . Short sleep duration is associated with reduced leptin, elevated ghrelin, and increased body mass index. PLoS Med 2004; 1: e62.

    Article  Google Scholar 

  8. Kohatsu ND, Tsai R, Young T, Vangilder R, Burmeister LF, Stromquist AM et al. Sleep duration and body mass index in a rural population. Arch Intern Med 2006; 166: 1701–1705.

    Article  Google Scholar 

  9. Vorona RD, Winn MP, Babineau TW, Eng BP, Feldman HR, Ware JC . Overweight and obese patients in a primary care population report less sleep than patients with a normal body mass index. Arch Intern Med 2005; 165: 25–30.

    Article  Google Scholar 

  10. Gangwisch JE, Malaspina D, Boden-Albala B, Heymsfield SB . Inadequate sleep as a risk factor for obesity: analyses of the NHANES I. Sleep 2005; 28: 1289–1296.

    Article  Google Scholar 

  11. Hasler G, Buysse DJ, Klaghofer R, Gamma A, Ajdacic V, Eich D et al. The association between short sleep duration and obesity in young adults: a 13-year prospective study. Sleep 2004; 27: 661–666.

    Article  Google Scholar 

  12. Spiegel K, Leproult R, van Cauter E . Impact of sleep debt on metabolic land endocrine function. Lancet 1999; 354: 1435–1439.

    CAS  Article  Google Scholar 

  13. Spiegel K, Leproult R, Colecchia EF, L'Hermite-Balériaux M, Nie Z, Copinschi G et al. Adaptation of the 24-h growth hormone profile to a state of sleep debt. Am J Physiol Regul Integr Comp Physiol 2000; 279: R874–R883.

    CAS  Article  Google Scholar 

  14. Bixler EO, Vgontzas AN, Lin HM, Vela-Bueno A, Kales A . Insomnia in Central Pennsylvania. J Psychosom Res 2002; 53: 589–592.

    CAS  Article  Google Scholar 

  15. Bixler EO, Vgontzas AN, Lin HM, Calhoun SL, Vela-Bueno A, Kales A . Excessive daytime sleepiness in a general population sample: the role of sleep apnea, age, obesity, diabetes and depression. J Clin Endocrinol Metab 2005; 90: 4510–4515.

    CAS  Article  Google Scholar 

  16. Bixler EO, Vgontzas AN, Ten Have T, Tyson K, Kales A . Effects of age on sleep apnea in men: I. Prevalence and severity. Am J Respir Crit Care Med 1998; 157: 144–148.

    CAS  Article  Google Scholar 

  17. Bixler EO, Vgontzas AN, Lin HM, Ten Have T, Rein J, Vela-Bueno A et al. Prevalence of sleep-disordered breathing in women. Am J Respir Crit Care Med 2001; 163: 608–613.

    CAS  Article  Google Scholar 

  18. Butcher JN, Dahlstrom WG, Graham JR, Tellegen A, Kaemmer B . Manual for the Standardized Minnesota Multiphasic Personality Inventory: MMPI-2. An administrative and Interpretive Guide 1989. University of Minnesota Press: Minneapolis, MN.

    Google Scholar 

  19. Rechtschaffen A, Kales A . A Manual of Standardized Terminology, Techniques and Scoring System for Sleep Stages of Human Subjects. NIMH Publication 204 1968. US Government Printing Office: Washington, DC.

    Google Scholar 

  20. Kuczmarski RJ, Flegal KM, Campbell SM, Johnson CL . Increasing prevalence of overweight among US adults. The National Health and Nutrition Examination Surveys, 1960–1991. JAMA 1994; 272: 205–211.

    CAS  Article  Google Scholar 

  21. Kuczmarski RJ, Flegal KM . Criteria for definition of overweight in transition: background and recommendations for the United States. Am J Clin Nutr 2000; 72: 1074–1081.

    CAS  Article  Google Scholar 

  22. Young T, Palta M, Dempsey J, Skatrud J, Weber S, Badr S . The occurrence of sleep-disordered breathing among middle-aged adults. N Engl J Med 1993; 328: 1230–1235.

    CAS  Article  Google Scholar 

  23. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders 1994. American Psychiatric Association: Washington, DC.

  24. Flier SJ, Elmquist JK . A good night's sleep: future antidote to the obesity epidemic? Ann Intern Med 2004; 141: 885–886.

    Article  Google Scholar 

  25. Chrousos GP . The role of stress and the hypothalamic-pituitary-adrenal axis in the pathogenesis of the metabolic syndrome: neuron-endocrine and target tissue-related causes. Int J Obes Relat Metab Disord 2000; 24 (Suppl): S50–S55.

    CAS  Article  Google Scholar 

  26. Vgontzas AN, Papanicolaou DA, Bixler EO, Hopper K, Lotsikas A, Lin HM et al. Sleep apnea and daytime sleepiness and fatigue: relation to visceral obesity, insulin resistance, and hypercytokinemia. J Clin Endocrinol Metab 2000; 85: 1151–1158.

    CAS  Article  Google Scholar 

  27. Watson NF, Goldberg J, Arguelles L, Buchwald D . Genetic and environmental influences on insomnia, daytime sleepiness, and obesity in twins. Sleep 2006; 29: 645–649.

    Article  Google Scholar 

  28. Stunkard AJ, Faith MS, Allison KC . Depression and obesity. Biol Psychiatry 2003; 54: 330–337.

    Article  Google Scholar 

  29. Buysse DJ, Reynolds III CF, Kupfer DJ, Thorpy MJ, Bixler E, Manfredi R et al. Clinical diagnoses in 216 insomnia patients using the ICSD and proposed DSM-IV and ICD-10 categories: a report from the APA/NIMH DSM-IV field trials. Sleep 1994; 17: 630–637.

    CAS  Article  Google Scholar 

  30. Friedman EM, Hayney MS, Love GD, Urry HL, Rosenkranz MA, Davidson RJ et al. Social relationships, sleep quality, and interleukin-6 in aging women. Proc Natl Acad Sci USA 2005; 102: 18757–18762.

    CAS  Article  Google Scholar 

  31. Dallman MF, Pecoraro N, Akana SF, La Fleur SE, Gomez F, Houshyar H et al. Chronic stress and obesity: a new view of ‘comfort food’. Proc Natl Acad Sci USA 2003; 100: 11696–11701.

    CAS  Article  Google Scholar 

  32. Pecoraro N, Reyes F, Gomez F, Bhargava A, Dallman MF . Chronic stress promotes palatable feeding, which reduces signs of stress: feedforward and feedback effects of chronic stress. Endocrinology 2004; 145: 3754–3762.

    CAS  Article  Google Scholar 

  33. Centers for Disease Control and Prevention. Trends in intake of energy and macronutrients—United States, 1971–2000. MMWR Morb Mortal Wkly Rep 2004; 53: 80–82.

    Google Scholar 

  34. Centers for Disease Control and Prevention. Physical activity trends—United States, 1990–1998. MMWR Morb Mortal Wkly Rep 2001; 50: 166–169.

    Google Scholar 

  35. Nishitani N, Sakakibara H . Relationship of obesity to job stress and eating behavior in male Japanese workers. Int J Obes 2006; 30: 528–533.

    CAS  Article  Google Scholar 

  36. Williamson DF . Weight change in middle-aged Americans. Am J Prev Med 2004; 27: 81–82.

    Article  Google Scholar 

  37. Lauderdale DS, Knutson KL, Yan LL, Rathouz PJ, Hulley SB, Sidney S et al. Objectively measured sleep characteristics among early-middle-aged adults: the CARDIA study. Am J Epidemiol 2006; 164: 5–16.

    Article  Google Scholar 

  38. Kales A, Kales J . Evaluation and Treatment of Insomnia 1984. Oxford University Press: New York, NY.

    Google Scholar 

  39. Vgontzas AN, Bixler EO, Kales A, Manfredi RL, Tyson K . Validity and clinical utility of sleep laboratory criteria for insomnia. Int J Neurosci 1994; 77: 11–21.

    CAS  Article  Google Scholar 

  40. Vgontzas AN, Tan TL, Bixler EO, Martin LF, Shubert D, Kales A . Sleep apnea and sleep disruption in obese patients. Arch Intern Med 1994; 154: 1705–1711.

    CAS  Article  Google Scholar 

  41. Resta O, Foschino Barbaro MP, Bonfitto P, Giliberti T, Depalo A et al. Low sleep quality and daytime sleepiness in obese patients without obstructive sleep apnoea syndrome. J Intern Med 2003; 253: 536–543.

    CAS  Article  Google Scholar 

  42. Kristenssson E, Sundqvist M, Astin M, Kjerling M, Mattsson H, Dornonville de la Cour C et al. Acute psychological stress raises plasma ghrelin in the rat. Regul Pept 2006; 134: 114–117.

    CAS  Article  Google Scholar 

  43. Lu XY, Kim CS, Frazer A, Zhang W . Leptin: a potential novel antidepressant. Proc Natl Acad Sci USA 2006; 103: 1593–1598.

    CAS  Article  Google Scholar 

  44. Vgontzas AN, Bixler EO, Chrousos GP . Obesity-related sleepiness and fatigue: the role of the stress system and cytokines. Ann NY Acad Sci 2006; 1083: 329–344.

    CAS  Article  Google Scholar 

  45. Vgontzas AN, Pejovic S, Zoumakis E, Lin H-M, Bentley CM, Bixler EO et al. Hypothalamic-pituitary-adrenal axis activity in obese men with and without sleep apnea: effects of continuous positive airway pressure. J Clin Endocrinol Metab 2007; 92: 4199–4207.

    CAS  Article  Google Scholar 

Download references

Acknowledgements

This study was supported in part by the National Institutes of Health Grants R01 40916, R01 51931 and R01 64415.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to A N Vgontzas.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Vgontzas, A., Lin, HM., Papaliaga, M. et al. Short sleep duration and obesity: the role of emotional stress and sleep disturbances. Int J Obes 32, 801–809 (2008). https://doi.org/10.1038/ijo.2008.4

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/ijo.2008.4

Keywords

  • MMPI
  • sleep duration
  • sleep disturbance
  • stress

Further reading

Search

Quick links