Association between body mass index and sleep duration assessed by objective methods in a representative sample of the adult population

doi:10.1016/j.sleep.2012.11.010

Sleep Medicine

Volume 14, Issue 4, April 2013, Pages 312-318

https://doi.org/10.1016/j.sleep.2012.11.010 Get rights and content

Abstract

Introduction

Sleep duration has been associated with overweight individuals in many epidemiological studies; however, few studies have assessed sleep using objective methods. Our study was designed to evaluate the association between body mass index (BMI) and sleep duration measured by actigraphy (Acti), polysomnography (PSG) and the Pittsburgh Sleep Quality Index questionnaire (PSQIO). Furthermore, we evaluated other biochemical and polysomnographic parameters.

Methods

A representative sample of 1042 individuals from Sao Paulo, Brazil, including both genders (20–80 yrs), participated in our protocol. Weight and other anthropometric parameters were measured at the onset of the study. Sleep duration was calculated by Acti, PSG, and the PSQIQ. The population was sorted by sleep duration, body, slow wave sleep (SWS) and REM sleep (REMS) duration subsets. In addition, other biochemical and polysomnographic parameters were analyzed. Differences between population subsets were analyzed by one-way analysis of variance (ANOVA). Linear regression analysis was performed between sleep and anthropometric parameters.

Results

Shorter sleep duration was associated with higher BMI and waist and neck circumference when measured by Acti and PSG (p < 0.05). Lower leptin levels were associated with short sleep in normal-weight (BMI > 18 and ⩽25) individuals (p < 0.01). The association between short sleep duration Acti and higher BMI was present when apnea-hypopnea index (AHI) was less than 15 (p = 0.049). Shorter REMS and SWS also were associated with higher BMI (p < 0.01). Normal-weight individuals tended to sleep longer, have higher sleep efficiency and longer SWS and REMS than obese individuals (Acti, PSG; p = 0.05). Sleep duration was negatively correlated with BMI (Acti, PSG; p < 0.05). Short SWS and REMS were associated with higher cardiovascular risk factors (p < 0.05).

Conclusion

Shorter sleep, SWS, and REMS duration were associated with higher BMI, central adiposity measurements, and cardiovascular risk factors when measured by objective methods.

Introduction

The prevalence of overweight and obese individuals has been increasing worldwide during the recent decades [1]. Increased body weight is associated with psychosocial problems, low self-esteem, increased cardiovascular morbidity and type 2 diabetes mellitus. National surveys in the United States have shown a decline in self-reported sleep duration over the past 50 years by 1.5 to 2 hours [2], which is attributable to changes in lifestyle [3]. In addition, most studies have reported an association between sleep reduction and health concerns, including chronic conditions such as, type 2 diabetes mellitus, hypertension, and obesity [4]. These studies show an association between short sleep duration and increased BMI, which has potential implications for the understanding of weight homeostasis in children and adults. The relationship between short sleep and weight occurs even more consistently in children and young adults than in the elderly population [5], [6]. However, due to the differences in the methodology and target populations, the strength of this association is still debated. Most studies have assessed sleep duration by subjective methods and even when more objective and accurate methodologies were used; the population studied was not representative of the entire population [7]. In addition, the use of different methods to measure weight and other anthropometric variables may have contributed to inconsistent results [8]. Despite the differences in the target population, the methods used to assess sleep duration, and the anthropometric measures, there is growing evidence that confirms the association between sleep duration and BMI. To date, there have been no representative studies of the general population that assess sleep through actigraphy (Acti) and polysomnography (PSG). Given previous research, we hypothesized that there is an association between short sleep duration and BMI that is observed when objective sleep measures are utilized. The objective of our study is thus, to evaluate the association between body mass parameters and sleep duration measured by objective methods such as Acti and PSG in a representative sample of the Sao Paulo Epidemiologic Study cohort.

Section snippets

Population

Our study is a component of a larger Sao Paulo Epidemiologic Sleep Study. The detailed methodology of the Sao Paulo Epidemiologic Sleep Study including the sampling procedures has already been described [9]. Datafolha Research Institute carried out the selection of a representative sample of the city of Sao Paulo, Brazil, from both genders and all ethnicities which included 1056 volunteers [9]. The study protocol was approved by the Ethics Committee for Research of the Universidade Federal de

Gender, anthropometric measures and sleep variables

Gender, anthropometric measures, and sleep variables are shown in Table 1. Our sample consisted of 468 men and 574 women. Women were significantly older than men. Neck and waist circumferences were significantly larger in men compared to women. On average, women slept more than men when sleep duration was measured by Acti. Differences were not found between genders when sleep duration was measured by either PSG or the PSQIQ. Polysomnographic quotient was not significantly different between

Discussion

Our study adds to the literature the inclusion of a representative sample of the adult population whose sleep parameters were assessed by objective methods including PSG and Acti. Most previous studies have shown an association between short sleep duration and higher BMI, though most of them lacked objective measures of sleep duration and had population selection biases [13], [7]. Another potential concern when comparing studies evaluating limited sleep is the lack of standard cutoff values for

Disclosure statement

All the authors have read and approved the manuscript and have nothing to disclose.

Conflict of Interest

The ICMJE Uniform Disclosure Form for Potential Conflicts of Interest associated with this article can be viewed by clicking on the following link: http://dx.doi.org/10.1016/j.sleep.2012.11.010.

. ICMJE Form for Disclosure of Potential Conflicts of Interest form.

Acknowledgments

Supported by Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP), Associação Fundo de Incentivo à Psicofarmacologia (AFIP) and Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq).

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Recently, interest in sleep disturbances, such as sleep disordered breathing (SDB), short sleep duration, and non-restorative sleep (NRS), has been increasing. The potentially large public health implications of sleep disturbances indicate a need to determine their prevalence in a general population. This review describes the characteristics of population-based sleep cohorts from past to present. Unavoidable methodological and baseline characteristic heterogeneity was found between studies. The prevalence of SDB (apnea hypopnea index (AHI), respiratory disturbance index (RDI), or oxygen desaturation index (ODI) ≥5/h) was 24.0–83.8% in men and 9.0–76.6% in women, and that of moderate-to-severe SDB (AHI, RDI, or ODI ≥15/h) was 7.2–67.2% in men and 4.0–50.9% in women. Additionally, the prevalence of SDB in post-menopausal women was 3–6 times higher than in pre-menopausal women. The prevalence of subjective short sleep duration (<6 h) was 7.5–9.6%, while that of objective short sleep duration (<6 h) was 22.1–53.3%. The prevalence of NRS was 19.2–31.0% in men and 26.3–42.1% in women, as determined from studies using a yes-no questionnaire, while a multi-national survey using a telephone-based expert system showed a wide range of prevalence between countries, from 2.4% to 16.1%. An association between SDB, short sleep duration, and NRS has recently been suggested. To gain a better understanding of the burden of sleep disturbances, a consensus on the definition of several sleep disturbances is needed, as methodological heterogeneity exists, including SDB scoring rules, subjective versus objective data collection for short sleep duration, and the definition of NRS itself.

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Original ArticleAssociation between body mass index and sleep duration assessed by objective methods in a representative sample of the adult population

Abstract

Introduction

Methods

Results

Conclusion

Introduction

Section snippets

Population

Gender, anthropometric measures and sleep variables

Discussion

Disclosure statement

Conflict of Interest

Acknowledgments

Sleep Med Rev

Public Health

Sleep Med

Sleep duration and the risk of diabetes mellitus: epidemiologic evidence and pathophysiologic insights

Curr Diab Rep

The influence of sleep and sleep loss upon food intake and metabolism

Nutr Res Rev

Short sleep duration and weight gain: a systematic review

Obesity (Silver Spring)

Meta-analysis of short sleep duration and obesity in children and adults

Sleep

A manual of standardized terminology: techniques and scoring system for sleep stages of human subjects

The AASM manual for the scoring of sleep and associated events: rules, terminology and technical specifications

Actigraphic sleep duration and fragmentation are related to obesity in the elderly: the Rotterdam Study

Int J Obes (Lond)

Original Article
Association between body mass index and sleep duration assessed by objective methods in a representative sample of the adult population