Abstract
Short sleep duration has been recognized as a risk factor for obesity. Whether extending sleep duration may mitigate this risk remains unknown. To determine the effects of a sleep extension intervention on objectively assessed energy intake, energy expenditure, and body weight in real-life settings among adults with overweight who habitually curtailed their sleep duration. This single-center, randomized clinical trial was conducted from November 1, 2014, to October 30, 2020. Participants were adults aged 21 to 40 years with a body mass index (calculated as weight in kilograms divided by height in meters squared) between 25.0 and 29.9 and had habitual sleep duration of less than 6.5 hours per night. Data were analyzed according to the intention-to-treat principle. After a 2-week habitual sleep period at baseline, participants were randomized to either an individualized sleep hygiene counseling session that was intended to extend their bedtime to 8.5 hours (sleep extension group) or to continue their habitual sleep (control group). All participants were instructed to continue daily routine activities at home without any prescribed diet or physical activity. The primary outcome was change in energy intake from baseline, which was objectively assessed as the sum of total energy expenditure and change in body energy stores. Total energy expenditure was measured by the doubly labeled water method. Change in body energy stores was computed using regression of daily home weights and body composition changes from dual-energy x-ray absorptiometry. Sleep duration was monitored by actigraphy. Changes from baseline were compared between the 2 groups using intention-to-treat analysis. Data from 80 randomized participants (mean [SD] age, 29.8 [5.1] years; 41 men [51.3%]) were analyzed. Sleep duration was increased by approximately 1.2 hours per night (95% CI, 1.0 to 1.4 hours; P < .001) in the sleep extension group vs 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 < .001). The change in sleep duration was inversely correlated with the change in energy intake (r = -0.41; 95% CI, -0.59 to -0.20; P < .001). No significant treatment effect in total energy expenditure was found, resulting in weight reduction in the sleep extension group vs the control group. This trial found that sleep extension reduced energy intake and resulted in a negative energy balance in real-life settings among adults with overweight who habitually curtailed their sleep duration. Improving and maintaining healthy sleep duration over longer periods could be part of obesity prevention and weight loss programs. ClinicalTrials.gov Identifier: NCT02253368.
Highlights
IntroductionThe association between energy flux and body weight implicates that increased energy intake is the main factor in higher body weights in modern society.[13] According to dynamic prediction models, a sustained increase in energy intake of even 100 kcal/d would result in a weight gain of about 4.5 kg over 3 years.[14,15] Factors that underlie the observed persistent increase in energy intake and mean weight gain at the population level need to be better understood
At the population level, the association between energy flux and body weight implicates that increased energy intake is the main factor in higher body weights in modern society.[13]
The obesity epidemic appears to coincide with a pattern of sleeping less that has been observed in society over the past several decades
Summary
The association between energy flux and body weight implicates that increased energy intake is the main factor in higher body weights in modern society.[13] According to dynamic prediction models, a sustained increase in energy intake of even 100 kcal/d would result in a weight gain of about 4.5 kg over 3 years.[14,15] Factors that underlie the observed persistent increase in energy intake and mean weight gain at the population level need to be better understood One such factor is insufficient sleep duration. In a real-life setting in which participants continue their normal daily activities, multiple interacting factors (eg, social interactions and freeliving physical activity) can influence energy intake or expenditure and weight
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