Department of Health and Human Development, University of Pittsburgh, Pittsburgh, PA, USA.
School of Nursing, University of Pittsburgh, Pittsburgh, PA, USA.
Int J Obes (Lond). 2021 Mar;45(3):639-649. doi: 10.1038/s41366-020-00728-8. Epub 2021 Jan 7.
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.
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.
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).
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.
先前关于睡眠与减肥尝试之间关系的研究未能认识到睡眠的多维性质。我们研究了在减肥干预中，睡眠健康综合指标与成年人体重和身体成分变化之间的关系。
超重或肥胖的成年人（N=125，50.3±10.6 岁，91%为女性，81%为白人）参加了为期 12 个月的行为减肥干预，在基线、6 个月和 12 个月时评估睡眠、体重、脂肪量和去脂体重。使用问卷和活动记录仪将 6 个睡眠维度（规律性、满意度、警觉性、时间安排、效率和时长）归类为“良好”或“不佳”。通过将“良好”维度的数量相加，计算出综合得分。在一个亚组（n=117）中使用呼吸暂停-低通气指数（AHI）评估阻塞性睡眠呼吸暂停（OSA）严重程度。线性混合模型用于检查睡眠健康与随后 6 个月间隔内体重百分比、脂肪量或去脂体重变化的关系，调整因素包括年龄、性别、床伴和种族；另外一个模型还调整了 AHI。
平均基线和 6 个月的睡眠健康状况分别为 4.5±1.1 和 4.5±1.2。从 0 到 6 个月的体重、脂肪量和去脂体重的平均变化分别为-9.3±6.1%、-16.9±13.5%和-3.4±3.4%，从 6 到 12 个月的体重、脂肪量和去脂体重的平均变化分别为 0.4±4.8%、-0.3±10.3%和 0.7±4.1%。睡眠健康状况较好与随后的体重减轻（P=0.016）和脂肪量减轻（P=0.006）相关，但与去脂体重减轻无关（P=0.232）。调整 AHI 后，睡眠健康与体重减轻之间的关联减弱（P=0.102），但与脂肪量减轻仍有显著关联（P=0.040）。规律性、满意度、时间安排和效率与体重和/或脂肪量减轻均相关（P≤0.041）。
睡眠健康状况较好与体重和脂肪量减轻相关，而在考虑到 OSA 严重程度后，这种关联会减弱。未来的研究应探讨改善睡眠健康、OSA 或两者结合是否能改善减肥效果。
