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. 2014 Oct 27;4(10):e144.
doi: 10.1038/nutd.2014.41.

Higher sleep fragmentation predicts a lower magnitude of weight loss in overweight and obese women participating in a weight-loss intervention

R Sawamoto  1 , T Nozaki  1 , T Furukawa  1 , T Tanahashi  1 , C Morita  1 , T Hata  1 , G Komaki  2 , N Sudo  1
Affiliations

Higher sleep fragmentation predicts a lower magnitude of weight loss in overweight and obese women participating in a weight-loss intervention

R Sawamoto et al. Nutr Diabetes. .

Abstract

Background: Sleep has been identified as having an influence on the success of weight-loss interventions; however, knowledge of the mechanisms and the extent to which sleep disturbances affect the magnitude of weight reduction is inconclusive.

Objective: To determine if sleep duration and quality can predict the magnitude of weight reduction in a weight-loss intervention program for overweight and obese women.

Methods: Ninety overweight and obese women aged 25-65 years completed the 7-month weight-loss phase of our weight-loss intervention. Sleep duration and quality were evaluated before the intervention by the Pittsburg Sleep Quality Index (PSQI), a self-report questionnaire, and by actigraphy. Serum levels of ghrelin, leptin, cortisol and insulin also were measured at baseline. Insulin resistance was measured by the homeostasis model assessment of insulin resistance (HOMA-IR).

Results: The mean reduction rate of body mass index (BMI) after the intervention was 13.6%. Multiple linear regression revealed that the number of wake episodes (WEs) per night had a significant relationship with the reduction of BMI even after adjusting for other clinical variables (β=-0.341, P=0.001). The participants with five or more WEs per night (high-WE group) had a significantly lower reduction in BMI compared with those with fewer than five (normal-WE group), after adjusting for confounding variables. In contrast, the PSQI-assessed parameters, reflecting the subjective assessments of sleep quality and duration, failed to detect an association with the reduction in BMI. Baseline HOMA-IR was significantly higher in the high-WE group than in the normal-WE group after adjusting for confounding variables.

Conclusions: Higher sleep fragmentation, as manifested by the increased number of WEs, predicts a lower magnitude of weight reduction in persons participating in weight-loss programs.

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Figures

Figure 1
Figure 1
Flow diagram of participants. Of 230 persons who contacted us by telephone or e-mail to participate in the study, 81 were excluded because of not meeting inclusion criteria (n=45), schedule conflicts (n=20) or not being interested in the study (n=16). Of the remaining 149 persons, 14 did not appear in the group information session because of unknown reasons, and 6 refused to participate in the study after the group information session. Of the remaining 129 persons who attended the screening visit, 10 were excluded because of not meeting the inclusion criteria. The remaining 119 participants agreed to participate in the weight loss program. After the program was initiated, 29 persons dropped out because of their unwillingness to continue with the program (n=14), schedule conflicts (n=6), family problems (n=5) and health problems unrelated to the program (n=4). Complete sets of data were collected from 90 of the initial 119 participants.
Figure 2
Figure 2
Differences in BMI reduction between the normal- and high-WE groups. All data are expressed as the mean±s.d. The mean reduction of BMI in the normal- and high-WE group was 15.4% and 11.7%, respectively. The difference was significant after adjusting for age, baseline BMI, smoking status, CES-D scores, average daily caloric intake and average daily number of steps during treatment using ANCOVA (F=6.289, *P=0.014).
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