Intermittent Fasting and Sleep: A Review of Human Trials

This review examines the effects of two popular intermittent fasting regimens on sleep in adults with overweight and obesity. Specifically, the effects of time restricted eating (TRE; eating all food within a 4–10 h window) and alternate day fasting (ADF; 600 kcal fast day alternated with ad libitum feast day) on sleep quality, sleep duration, sleep latency, sleep efficiency, insomnia severity, and risk of obstructive sleep apnea, will be summarized. The role of weight loss will also be discussed. Results from our review reveal that the majority of these trials produced weight loss in the range of 1–6% from baseline. Sleep quality and sleep duration remained unaltered with TRE and ADF, as assessed by the Pittsburgh Sleep Quality Index (PSQI). The effects of intermittent fasting on sleep latency and sleep efficiency are mixed, with one study showing worsening of these parameters, and others showing no effect. Insomnia severity and the risk of obstructive sleep apnea remained unchanged in the trials assessing these metrics. Taken together, these preliminary findings suggest that TRE and ADF produce mild to moderate weight loss (1–6%) but their effects on sleep remain unclear. Solid conclusions are difficult to establish since participants in the studies had healthy sleep durations and no clinical insomnia at baseline, leaving little room for improvement in these metrics. Moreover, none of the trials were adequately powered to detect statistically significant changes in any measure of sleep. Future well-powered trials, conducted in individuals with diagnosed sleep disturbances, will be necessary to elucidate the effect of these popular diets on sleep.

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Alternate Day Fasting Combined with a Low Carbohydrate Diet: Effect on Sleep Quality, Duration, Insomnia Severity and Risk of Obstructive Sleep Apnea in Adults with Obesity

Nutrients ◽

10.3390/nu13010211 ◽

2021 ◽

Vol 13 (1) ◽

pp. 211

Author(s):

Faiza Kalam ◽

Kelsey Gabel ◽

Sofia Cienfuegos ◽

Mark Ezpeleta ◽

Eric Wiseman ◽

...

Keyword(s):

Weight Loss ◽

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Sleep Quality ◽

Weight Maintenance ◽

Carbohydrate Diet ◽

Low Carbohydrate Diet ◽

Obstructive Sleep ◽

Low Carbohydrate ◽

Insomnia Severity

Background: Alternate day fasting combined with a low carbohydrate diet (ADF-LC) is an effective weight loss regimen. Whether the weight loss induced by ADF-LC can improve sleep, remains unknown. Objective: This study examined the effect an ADF-LC diet on sleep quality, duration, insomnia severity and the risk of obstructive sleep apnea. Methods: Adults with obesity (n = 31) participated in ADF (600 kcal “fast day”; ad libitum intake “feast day”) with a low-carbohydrate diet (30% carbohydrates, 35% protein, and 35% fat). The 6-month trial consisted of a 3-month weight loss period followed by a 3-month weight maintenance period. Results: Reductions in body weight (−5 ± 1 kg, p < 0.001) and fat mass (−4 ± 1 kg, p < 0.01) were noted during the weight loss period, and these reductions were sustained during the weight maintenance period. Lean mass and visceral fat remained unchanged. The Pittsburgh Sleep Quality Index (PSQI) score indicated poor sleep quality at baseline (6.4 ± 0.7) with no change by month 3 or 6, versus baseline. ISI score indicated subthreshold insomnia at baseline (8.5 ± 1.0), with no change by month 3 or 6, versus baseline. The percent of subjects with high risk of obstructive sleep apnea at baseline was 45%, with no change by month 3 or 6. Wake time, bedtime, and sleep duration remained unchanged. Conclusion: The ADF-LC diet does not impact sleep quality, duration, insomnia severity or the risk of obstructive sleep apnea in adults with obesity.

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Alternate Day Fasting Combined With a Low Carbohydrate Diet: Effect on Sleep Quality, Duration, Insomnia Severity and Risk of Obstructive Sleep Apnea in Adults With Obesity

Current Developments in Nutrition ◽

10.1093/cdn/nzab055_030 ◽

2021 ◽

Vol 5 (Supplement_2) ◽

pp. 1220-1220

Author(s):

Faiza Kalam

Keyword(s):

Weight Loss ◽

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Sleep Quality ◽

Weight Maintenance ◽

Carbohydrate Diet ◽

Low Carbohydrate Diet ◽

Obstructive Sleep ◽

Low Carbohydrate ◽

Insomnia Severity

Abstract Objectives Alternate day fasting combined with a low carbohydrate diet (ADF-LC) is an effective weight loss regimen. Whether the weight loss induced by ADF-LC can improve sleep remains unknown. This study examined an ADF-LC diet's effect on sleep quality, duration, insomnia severity, and the risk of obstructive sleep apnea. Methods Adults with obesity (n = 31) participated in ADF (600 kcal “fast day”; ad libitum intake “feast day”) with a low-carbohydrate diet (30% carbohydrates, 35% protein, and 35% fat). The 6-month trial consisted of a 3-month weight-loss period followed by a 3-month weight maintenance period. Results Reductions in body weight (−5 ± 1 kg, P < 0.001) and fat mass (−4 ± 1 kg, P < 0.01) were noted during the weight-loss period, and these reductions were sustained during the weight maintenance period. Lean mass and visceral fat remained unchanged. The Pittsburgh Sleep Quality Index (PSQI) score indicated poor sleep quality at baseline (6.4 ± 0.7) with no change by month 3 or 6, versus baseline. ISI score indicated subthreshold insomnia at baseline (8.5 ± 1.0), with no change by month 3 or 6, versus baseline. The % of subjects with a high risk of obstructive sleep apnea was 45% at baseline, with no change by month 3 or 6. Wake time, bedtime, and sleep duration remained unchanged. Conclusions The ADF-LC diet does not impact sleep quality, duration, insomnia severity, or the risk of obstructive sleep apnea in adults with obesity. Funding Sources Nestle Health Sciences.

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The effect of 4-h versus 6-h time restricted feeding on sleep quality, duration, insomnia severity and obstructive sleep apnea in adults with obesity

Nutrition and Health ◽

10.1177/02601060211002347 ◽

2021 ◽

pp. 026010602110023

Author(s):

Sofia Cienfuegos ◽

Kelsey Gabel ◽

Faiza Kalam ◽

Mark Ezpeleta ◽

Vicky Pavlou ◽

...

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Sleep Quality ◽

Sleep Onset ◽

Control Group ◽

Sleep Onset Latency ◽

Restricted Feeding ◽

Wake Time ◽

Obstructive Sleep ◽

Insomnia Severity

Background: Time restricted feeding (TRF) involves deliberately restricting the times during which energy is ingested. Preliminary findings suggest that 8–10-h TRF improves sleep. However, the effects of shorter TRF windows (4–6 h) on sleep, remain unknown. Aims: This study compared the effects of 4-h versus 6-h TRF on sleep quality, duration, insomnia severity and the risk of obstructive sleep apnea. Methods: Adults with obesity ( n = 49) were randomized into one of three groups: 4-h TRF (eating only between 3 and 7 p.m.), 6-h TRF (eating only between 1 and 7 p.m.), or a control group (no meal timing restrictions) for 8 weeks. Results: After 8 weeks, body weight decreased ( p < 0.001) similarly by 4-h TRF (–3.9 ± 0.4 kg) and 6-h TRF (–3.4 ± 0.4 kg), versus controls. Sleep quality, measured by the Pittsburgh Sleep Quality Index (PSQI), did not change by 4-h TRF (baseline: 5.9 ± 0.7; week 8: 4.8 ± 0.6) or 6-h TRF (baseline: 6.4 ± 0.8; week 8: 5.3 ± 0.9), versus controls. Wake time, bedtime, sleep duration and sleep onset latency also remained unchanged. Insomnia severity did not change by 4-h TRF (baseline: 4.4 ± 1.0; week 8: 4.7 ± 0.9) or 6-h TRF (baseline: 8.3 ± 1.2; week 8: 5.5 ± 1.1), versus controls. Percent of participants reporting obstructive sleep apnea symptoms did not change by 4-h TRF (baseline: 44%; week 8: 25%) or 6-h TRF (baseline: 47%; week 8: 20%), versus controls. Conclusion: These findings suggest that 4- and 6-h TRF have no effect on sleep quality, duration, insomnia severity, or the risk of obstructive sleep apnea.

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Insomnia Severity, Subjective Sleep Quality, and Risk for Obstructive Sleep Apnea in Veterans With Gulf War Illness

Military Medicine ◽

10.7205/milmed-d-15-00474 ◽

2016 ◽

Vol 181 (9) ◽

pp. 1127-1134 ◽

Cited By ~ 3

Author(s):

Linda L. Chao ◽

Linda R. Abadjian ◽

Iva L. Esparza ◽

Rosemary Reeb

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Sleep Quality ◽

Gulf War ◽

Gulf War Illness ◽

Subjective Sleep Quality ◽

Subjective Sleep ◽

Obstructive Sleep ◽

Insomnia Severity

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0679 Effects Of Cannabimimetic Enhancement On Subjective Sleep Quality And Function In Obstructive Sleep Apnea

SLEEP ◽

10.1093/sleep/zsaa056.675 ◽

2020 ◽

Vol 43 (Supplement_1) ◽

pp. A259-A259

Author(s):

G - Yin ◽

K Reid ◽

D Carley ◽

B Prasad ◽

P Zee

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Sleep Quality ◽

Sleep Efficiency ◽

Dependent Manner ◽

Subjective Sleep Quality ◽

Subjective Sleep ◽

Obstructive Sleep ◽

Significant Difference ◽

Daytime Function

Abstract Introduction We previously reported that dronabinol a tetrahydrocannobinol, reduced the apnea hypopnea index (AHI) in patients with obstructive sleep apnea (OSA) in a dose-dependent manner. The aim of this report is to assess the effects of dronabinol on subjective sleep quality and daytime function in the Pharmacotherapy of Apnea by Cannabimimetic Enhancement (PACE) II trial. Methods By random assignment, 73 adults with moderate or severe OSA received either placebo (N = 25), 2.5 mg dronabinol (N = 21), or 10 mg dronabinol (N = 27) daily, 1 hour before bedtime for 6 weeks. Participants completed the Pittsburgh sleep quality index (PSQI) and Functional Outcomes of Sleep Questionnaire (FOSQ-10) at baseline and at the end of intervention. Results Between group comparisons were performed using a one-way ANOVA. At baseline, there were no significant difference between groups in the PSQI or FOSQ-10. When compared to placebo, the 10 mg group had a significant reduction in the global PSQI score (p=0.039). Paired t-test analysis showed, in comparison to the baseline, the subscale and total score of the FOSQ-10 were significantly increased (P=0.005); the global PSQI score, subjective sleep quality score, habitual sleep efficiency score and daytime dysfunction score were significantly reduced (p<0.001, p<0.001, p=0.024, p=0.007 respectively) in the 10 mg group, while no improvement was found in the 2.5 mg or placebo groups. Bivariate correlational analysis was used to identify the relationship between the changes of variables. Both ∆ global PSQI and ∆ total FOSQ were correlated with ∆ESS, but not with change in AHI or sleep parameters such as sleep stage percentage, sleep efficiency, arousal index, minutes of wake after sleep onset, time and duration of oxygen saturation below 90% percent. Conclusion These findings indicate that in addition to its ability to reduce the AHI, dronabinol can improve subjective sleep quality and daytime function in patients with moderate to severe OSA. Support This study was funded by National Institutes of Health, National Heart Lung and Blood Institute Grant Number UM1-HL112856 and National Center for Advancing Translational Sciences, Grant Numbers UL1TR001422 and UL1TR002003.

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Accuracy of Actigraphy Compared to Concomitant Ambulatory Polysomnography in Narcolepsy and Other Sleep Disorders

Frontiers in Neurology ◽

10.3389/fneur.2021.629709 ◽

2021 ◽

Vol 12 ◽

Author(s):

Anniina Alakuijala ◽

Tomi Sarkanen ◽

Tomi Jokela ◽

Markku Partinen

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Sleep Disorders ◽

Sleep Latency ◽

Sleep Time ◽

Sleep Efficiency ◽

Obstructive Sleep ◽

Periodic Leg Movement ◽

Single Night ◽

Clinical Measurements

Actigraphy provides longitudinal sleep data over multiple nights. It is a less expensive and less cumbersome method for measuring sleep than polysomnography. Studies assessing accuracy of actigraphy compared to ambulatory polysomnography in different sleep-disordered patients are rare. We aimed to compare the concordance between these methods in clinical setting. We included 290 clinical measurements of 281 sleep laboratory patients (mean age 37.9 years, 182 female). Concomitant ambulatory polysomnography and actigraphy were analyzed to determine the agreement in patients with obstructive sleep apnea, narcolepsy, periodic leg movement disorder, hypersomnia, other rarer sleep disorders, or no organic sleep disorder. Bland-Altman plots showed excellent accuracy, but poor precision in single night results between the two methods in the measurement of sleep time, sleep efficiency, and sleep latency. On average, actigraphy tended to overestimate sleep time by a negligible amount, −0.13 min, 95% confidence interval [−5.9, 5.6] min in the whole sample. Overestimation was largest, −12.8 [−25.1, −0.9] min, in patients with obstructive sleep apnea. By contrast, in patients with narcolepsy, actigraphy tended to underestimate sleep time by 24.3 [12.4, 36.1] min. As for sleep efficiency, actigraphy underestimated it by 0.18 [−0.99, 1.35] % and sleep latency by 11.0 [8.5, 13.6] min compared to polysomnography. We conclude that, in measuring sleep time, actigraphy is reasonably reliable and helpful to be used for a week or two to exclude insufficient sleep in patients with the suspicion of narcolepsy. However, the effectiveness of actigraphy in determining sleep seems to decrease in subjects with low sleep efficiencies.

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