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Behavior, Psychology and Sociology

The association between sleep health and weight change during a 12-month behavioral weight loss intervention

Abstract

Background

Prior research on the relationship between sleep and attempted weight loss failed to recognize the multidimensional nature of sleep. We examined the relationship between a composite measure of sleep health and change in weight and body composition among adults in a weight loss intervention.

Methods

Adults (N = 125) with overweight or obesity (50.3 ± 10.6 years, 91% female, 81% white) participated in a 12-month behavioral weight loss intervention, with assessments of sleep, weight, fat mass, and fat-free mass at baseline, 6 months, and 12 months. Six sleep dimensions (regularity, satisfaction, alertness, timing, efficiency, and duration) were categorized as “good” or “poor” using questionnaires and actigraphy. A composite score was calculated by summing the number of “good” dimensions. Obstructive sleep apnea (OSA) was assessed in a subsample (n = 117), using the apnea–hypopnea index (AHI) to determine OSA severity. Linear mixed modeling was used to examine the relationships between sleep health and outcomes of percent weight, fat mass, or fat-free mass change during the subsequent 6-month interval, adjusting for age, sex, bed partner, and race; an additional model adjusted for AHI.

Results

Mean baseline and 6-month sleep health was 4.5 ± 1.1 and 4.5 ± 1.2, respectively. Mean weight, fat mass, and fat-free mass changes from 0 to 6 months were −9.3 ± 6.1%, −16.9 ± 13.5%, and −3.4 ± 3.4%, respectively, and 0.4 ± 4.8%, −0.3 ± 10.3%, and 0.7 ± 4.1% from 6 to 12 months. Better sleep health was associated with greater subsequent weight loss (P = 0.016) and fat loss (P = 0.006), but not fat-free mass loss (P = 0.232). Following AHI adjustment, the association between sleep health and weight loss was attenuated (P = 0.102) but remained significant with fat loss (P = 0.040). Regularity, satisfaction, timing, and efficiency were each associated with weight and/or fat loss (P ≤ 0.041).

Conclusions

Better sleep health was associated with greater weight and fat loss, with associations attenuated after accounting for OSA severity. Future studies should explore whether improving sleep health, OSA, or the combination improves weight loss.

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Funding

Funding for this study was provided by National Institutes of Health (NIH) grant R01HL107370 (PI: LEB). Additional investigator support for CEK, DDM, and ERC was provided by NIH grants K23HL118318 (PI: CEK), R01HL107370-S1 (PI: DDM), and K24NR016685 (PI: ERC). The ApneaLink Plus devices used in this study were donated by ResMed, Inc. ResMed had no role in the study design, data collection and analysis, decision to publish, or preparation of the paper.

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Correspondence to Christopher E. Kline.

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In the past 3 years, DJB has served as a paid consultant to Bayer, BeHealth Solutions, Emmi Solutions, Weight Watchers International, and Pear Therapeutics. He has served as a paid consultant for professional educational programs developed by the American Academy of Physician Assistants, CME Institute, and Emmi Solutions, and received payment for a professional education program sponsored by Eisai. DJB is an author of the PSQI, Pittsburgh Sleep Quality Index Addendum for PTSD (PSQI-A), Brief Pittsburgh Sleep Quality Index (B-PSQI), Daytime Insomnia Symptoms Scale, Pittsburgh Sleep Diary, Insomnia Symptom Questionnaire, and RU_SATED (copyright held by University of Pittsburgh). These instruments have been licensed to commercial entities for fees. He is also co-author of the Consensus Sleep Diary (copyright held by Ryerson University), which is licensed to commercial entities for a fee. No other authors report any conflicts of interest.

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

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