Abstract MP21: Better Sleep Health is Associated With Greater Weight Loss During a 12-month Behavioral Weight Loss Intervention

Abstract

Introduction: Sleep is consistently associated with obesity risk, but minimal research has examined its relationship with attempted weight loss. Most of the available evidence has focused on sleep duration, which fails to recognize the multidimensional nature of sleep. Purpose: To examine the relationship between a composite measure of sleep health and weight change in a sample of adults who participated in a 12-month behavioral weight loss intervention. Methods: 125 adults with overweight or obesity enrolled in the EMPOWER study (50.3±10.6 years, 91% female, 81% white) were included in analyses. All individuals participated in a 12-month behavioral weight loss intervention, with assessments at baseline, 6 months, and 12 months. Six dimensions of sleep were included in our operationalization of sleep health: regularity, satisfaction, alertness, timing, efficiency, and duration. Sleep dimensions were assessed using validated questionnaires and actigraphy, with values dichotomized into ‘good’ and ‘poor’ sleep. A composite sleep health score was calculated based upon the sum of the ‘good’ individual dimensions (range: 0-6), with higher scores indicating better sleep health. Obstructive sleep apnea (OSA) was assessed in a subset of participants (n=117) with a portable home sleep testing device, using the apnea-hypopnea index (AHI) as a marker of OSA severity. Linear mixed modeling was used to examine the relationship between sleep health and weight change during the subsequent 6-month interval with adjustment for age, gender, bed partner, and race. An additional model adjusted for AHI along with the previously noted covariates. Results: Mean sleep health was 4.5±1.1 at baseline and 4.5±1.2 at 6 months, and mean % weight change from 0 to 6 months and 6 to 12 months was -9.3±6.1% and 0.4±4.8%, respectively. In the adjusted model, greater sleep health was associated with greater weight loss (b=-0.77, SE=0.32; P=.02). Following additional adjustment for AHI, the relation between sleep health and weight loss was no longer significant (b=-0.53, SE=0.34; P=.12). Among individual sleep dimensions, only regularity and satisfaction showed trends to be associated with weight change (b=-1.28, SE=0.72 [P=.08] and b=-1.67, SE=0.86 [P=.06], respectively); however, these marginal associations were not retained after AHI adjustment (each P=.15). Conclusions: Better sleep health was associated with greater weight loss, but this association did not persist after accounting for OSA severity. Because OSA negatively impacts sleep health, future research should address whether improving sleep health, OSA, and/or the combination leads to better weight loss.