Direct and Indirect Relationships Between Impaired Sleep, Obesity Risk Factors and Overweight and Obesity

PurposeThe relationship between impaired sleep and overweight/obesity may be explained by sleep-disrupting behaviour that are practised by overweight people (e.g. night-eating, insufficient physical activity [PA], electronic device use) and stress/affective distress. Thus, we evaluated whether sleep parameters predicted overweight/obesity after taking into account the behaviour and affective state.MethodsOnline questionnaires asked about sleep quality, night-eating, PA, electronic device use and stress/affective distress at T1 (baseline) and T2 (3-months later). Height, weight and waist and hip circumference were measured. PA and sleep were assessed over 24-hours on two occasions using actigraphy in 161 participants at T1 and T2.ResultsAt T1, high body mass index (BMI)/waist-to-hip ratio (WHR) and obesity category were together related to more sleep disturbances (subjective) and longer awake time (objective), after controlling covariates (e.g. watching TV) and demographics (e.g. older age, male gender). At T2, high WHR was predicted by older age and male gender after controlling T1 WHR, demographics and covariates. Mediational analyses showed that sleep disturbances mediated nocturnal indigestion (NI) to BMI, poor subjective sleep quality mediated NI to WHR and high daytime dysfunction mediated NI to obesity category relationships.ConclusionMore time spent awake during the night (experienced as more sleep disturbances) was related to overweight/obesity indices even after taking into account other obesity risk factors (e.g. night-eating, insufficient PA, affect) and demographics. Mediational results suggest that NI parsimoniously explained the impaired sleep - overweight/obesity relationship.Level of Evidence: Level III, evidence obtained from well-designed cohort.

Night Eating Syndrome in Patients With Obesity and Binge Eating Disorder: A Systematic Review

Night eating syndrome (NES) is currently classified as an Other Specified Feeding or Eating Disorder (OSFED) under the Diagnostic Statistical Manual−5 (DSM-5). This systematic review aims to consolidate the studies that describe the sociodemographic, clinical and psychological features of NES in a population of patients with eating disorders (ED), obesity, or those undergoing bariatric surgery, and were published after the publication of the DSM-5. A further aim was to compare, where possible, NES with BED on the aforementioned variables. Lastly, we aimed to appraise the quality of the studies being included in the review. We conducted a systematic search on three databases (MEDLINE, PubMed and Embase) which resulted in the selection of 22 studies for the review. We included the articles that studied patients with NES and their sociodemographic, clinical and psychological features in a clinical (i.e., ED, obese or bariatric surgery) population, through a quantitative study design. Articles were excluded if the NES patients included in the study had a comorbid psychological disorder, and/or the sample was collected from a university/non-clinical population, and/or the study design was qualitative, and/or NES features were compared with any other disorder, except BED. Our study found that no conclusions about the link between any sociodemographic feature (such as, age, gender, income, etc.) and an NES diagnosis could be made. Further, NES patients presented with elevated ED pathology (including emotional eating and loss of control eating) and higher occurrence of depressive symptoms than controls. Contrary to the literature suggesting that NES and Binge Eating Disorder (BED; an ED subtype which is also comorbid with obesity) patients often report overlapping features, questioning the validity of NES as an ED diagnosis, we found that BED can be differentiated from NES by the higher occurrence of emotional eating, body related concerns and abnormal eating episodes. The review also suggested an overlap between NES and Sleep-Related Eating Disorder. We recommend that it is essential to study NES as an independent disorder to further develop its diagnostic criteria and treatment options, thereby, increasing the quality of life of the patients suffering from this syndrome.

Effects of Anxiety, Depression, and Stress on Sleep Disorder and Night Eating Syndrome in Adolescents: Results of an Internet Survey

PurposeThe current study examined how sleep quality is related to night eating syndrome (NES) via the indirect effects of anxiety, depression, and stress to determine the mechanism of its development. MethodsThis cross-sectional web-based study included 171 adolescents aged 12-18 years (55.0% girls). Participants completed the self-report Night Eating Questionnaire (NEQ), Scales for Outcomes in Parkinson’s disease (SCOPA) Sleep Scale, and Depression, Anxiety and Stress Scale–21 items (DASS-21). ResultsThe results showed that anxiety, depression, and stress directly influenced the NEQ. AMOS path analysis was used to examine whether these also had an indirect influence on the NEQ. Moreover, for the anxiety, depression, and stress subscales, only the anxiety subscale influenced nighttime eating problems due to increased sleep problems, which in turn increased the difficulty of morning sleepiness and falling asleep at night. ConclusionConsequently, depression and stress directly increased nighttime eating problems. Anxiety exacerbates eating problems, both directly and indirectly, through sleep. Behavioral and psychological interventions to reduce anxiety, depression, and stress may be helpful strategies for the treatment of night eating syndrome.Level of evidence: Level IV

Night-eating, Overweight/obesity and Sleep Quality

PurposeImpaired sleep has been reported to be a consequence of overweight/obesity. However, sleep-disrupting behaviour that tend to coexist with overweight/obesity are also independent risk factors for impaired sleep such as night-eating, alcohol use, insufficient physical activity (PA), electronic device use and stress/affective distress. Thus, it is unclear whether night-eating and measures of body fatness will still predict sleep quality once concurrent behaviour and affective state are taken into account. MethodsOnline questionnaires asked participants about sleep quality, night-eating, alcohol use, electronic device use and stress/affective distress at T1 (baseline) and T2 (3-months later). Height, weight and waist and hip circumference was measured at T1 and objective physical activity (PA) was assessed over 24-hours (using actigraphy) in 161 participants at T1 and T2. ResultsAt T1, night-eating was related to poorer subjective sleep quality, longer sleep onset latency, lower sleep efficacy, more sleep disturbances and daytime dysfunction and obesity category was related to daytime dysfunction after controlling demographics and covariates. At T2, high BMI predicted lower sleep efficacy after controlling T1 sleep components, demographics and covariates. ConclusionNight-eating and obesity category were associated with multiple impairments in sleep quality, but only high BMI predicted sleep quality at T2. Thus, night-eating and measures of body fatness predicted sleep quality components at T1 and T2 even after co-existing behaviour and emotional states were taken into account.Level of EvidenceLevel III, evidence obtained from well-designed cohort.

A Cross-Sectional Study of Evening Hyperphagia and Nocturnal Ingestion: Core Constituents of Night Eating Syndrome with Different Background Factors

This web-based cross-sectional survey aimed to elucidate the differences between the two core symptoms of night eating syndrome (NES): evening hyperphagia and nocturnal ingestion in the general Japanese population aged 16–79 years. Participants who consumed at least 25% of daily calories after dinner were defined as having evening hyperphagia. Those who consumed food after sleep initiation at least twice a week were determined to have nocturnal ingestion. Of the 8348 participants, 119 (1.5%) were categorized in the evening hyperphagia group, 208 (2.6%) in the nocturnal ingestion group, and 8024 in the non-NES group. Participants with evening hyperphagia and nocturnal ingestion had significantly higher anxiety scores (p < 0.05 and p < 0.001, respectively) and depression (p < 0.001 for both) than those without NES. Multiple logistic regression analysis revealed that evening hyperphagia was significantly and independently associated with higher body mass index, shorter sleep duration, later sleep-wake schedule, and higher insomnia score, while nocturnal ingestion was significantly and independently associated with younger age, smoking habit, living alone, earlier sleep-wake schedule, and higher insomnia score. Sleep duration and sleep-wake schedule characteristics in the two groups were opposite, suggesting differences in the sleep pathophysiology mechanisms.

The dark side of the quarantine: night eating, sleep quality and the health locus of control in women

Purpose Staying at home for a prolonged period, the stress during COVID-19 quarantine may affect sleep quality, night eating behaviours of individuals. This paper aims to identify the relationship between night eating behaviour, sleep quality, perceptions of health locus of control in women during the pandemic. Design/methodology/approach An anonymous, Web based, cross-sectional study was conducted for the duration of a month (April-May, 2020). The study evaluated the nutritional habits of the participants. Anthropometric measurements were noted. Night Eating Syndrome Questionnaire (NESQ), Pittsburgh Sleep Quality Index (PSQI), Multi-dimensional Health Locus of Control-A were used for data collection. Findings With a mean age of 33 ± 8 years, 529 women participated in the study. The mean NESQ score was 14.4 ± 4.7, PSQI score was 6.4 ± 2.9. Higher night eating scores were observed in participants with chance locus of control (CLC) perception when compared to participants with internal health locus of control (IHLC) perception (p < 0.05). Lower sleep quality was observed in obese participants compared to normal/overweight participants (p < 0.05). It was also found that night eating behaviours significantly predicted sleep quality (R = 0.36, R2 = 0.13; p < 0.01), explaining about 13.3% of total variance of sleep quality. Research limitations/implications Only internet users and women participated in the study, and the questionnaire form was applied online; the information was obtained in the form of the participants' own statements. Practical implications It was found that night eating behaviour significantly predicted sleep quality during the pandemic. It was also determined that the individuals with high chance locus of control perception had higher NES scores than the individuals with high internal locus of control perception. Originality/value The night eating behaviours significantly predict sleep quality, individuals with a high perception of CLC had a higher night eating score than individuals with high perception of IHLC during the pandemic.

Опитувальник для визначення синдрому нічного переїдання (NEQ) – валідація та адаптація для української популяції

Синдром нічного переїдання (СНП, night-eating syndrome) належить до «Інших специфічних порушень харчової поведінки». СНП характеризується наявністю нічного вживання їжі, безсонням, ранковою анорексією та розладами настрою і сну. Цей вид порушення харчової поведінки (ПХП) притаманний пацієнтам з ожирінням або надлишковою масою тіла та цукровим діабетом 2-го типу (ЦД2). Наявність СНП погіршує метаболічний контроль ЦД2 та ускладнює лікування цього захворювання. Наразі існує лише один метод, який дозволяє діагностувати цей синдром — опитувальник для визначення СНП (Night Eating Questionnaire, NEQ). На жаль, він не адаптований для використання в україномовній популяції. Мета: адаптувати та оцінити валідність української версії NEQ для застосування серед пацієнтів із ЦД2 та ожирінням або надлишковою масою тіла. Матеріал і методи. 105 осіб (37 чоловіків та 68 жінок, вік — 60,3±7,2 року, індекс маси тіла (ІМТ) — 31,9±3,7 кг/м2) із встановленим діагнозом ЦД2 та ожирінням або надлишковою масою тіла заповнили перекладену версію NEQ. Внутрішню узгодженість опитувальника оцінювали за допомогою показника α-Кронбаха. Конвергентну валідність встановлювали за допомогою кореляції з «Опитувальником щодо розладів харчової поведінки» (Eating Disorder Examination Questionnaire, EDE-Q). Через 3 тижні 34 учасники пройшли ретестування. Результати. У 17 учасників (16,2%) було встановлено діагноз СНП. Середній загальний бал опитувальника становив 17,3±5,1. Загальна надійність шкали (α-Кронбаха) для всього тесту становила 0,76, міжкласовакореляція — 0,81. Була встановлена 4-факторна структура опитувальника, яка відповідала оригінальній версії. Загальний бал NEQ корелював із результатом EDE-Q (r=0,56). Надійність ретесту була висока (0,71). Показник ІМТ та HbA1c cтатистично не відрізнявся в пацієнтів із та без СНП. Середній загальний бал опитувальника не корелював з ІМТ (p>0,05). Висновки. Поширеність СНП серед пацієнтів із ЦД2 становить 16,2%. Україномовна версія опитувальника є надійною та валідною для оцінки наявності СНП. Опитувальник може використовуватися в цієї категорії пацієнтів для встановлення діагнозу та вибору відповідного лікування. Необхідні подальші дослідження ефективності NEQ серед пацієнтів із ЦД2 та нормальною масою тіла, а також в осіб з ожирінням або надлишковою масою тіла, але без цукрового діабету.

Sleep Quality and Eating Disorder-Related Psychopathologies in Patients with Night Eating Syndrome and Binge Eating Disorders

Night eating syndrome (NES) is an eating disorder (ED) characterized by nocturnal ingestion (NI), evening hyperphagia, morning anorexia, as well as mood and sleep disturbances. This study compared subjective and objective sleep quality and ED-related psychopathologies in patients seeking treatment for ED. Method: The sample was composed of 170 women, aged 18–68, who were referred for an ED assessment from 2011 to 2020. The participants were divided into three subgroups: NES-NI only (n = 30), NES+ binge eating (BE) (including binge eating disorders or bulimia nervosa (n = 52), and BE-only (n = 88). The measures consisted of a psychiatric evaluation, objective sleep monitoring measured by an actigraph for 1 week, a subjective sleep self-report, and ED-related psychopathology questionnaires. Results: Objective sleep monitoring revealed significant group differences, with higher sleep efficiency in participants with BE-only and longer sleep durations for the NES-NI only group. Subjectively, the BE-only group described a significantly lower sleep quality than either the NES-NI only or the NES+BE groups. ED-related psychopathology was lower in the NES-NI-only group. A stepwise linear regression revealed that general psychopathology (the brief symptom inventory total score) was a significant predictor of subjective sleep quality. Conclusion: NES-NI-only was correlated with less psychopathology, but with more subjective and objective sleep disturbances. These results lend weight to the supposition that NES lies on a continuum of ED psychopathologies, and that NES-NI-only appears to be a separate entity from NES+BE and BE-only in terms of its psychopathology.

Prevalence and psychiatric comorbidities of night-eating behavior in obese bariatric patients: preliminary evidence for a connection between night-eating and bipolar spectrum disorders

Purpose The co-occurrence of obesity, eating and mood disorders has been frequently reported in clinical and epidemiological settings. This study aimed to explore the prevalence of night-eating obese patients referred for bariatric surgery and to identify associated psychopathology and psychiatric comorbidity. Methods The sample was composed of 121 obese patients consecutively enrolled between November 2010 and May 2012 during psychiatric evaluations for bariatric intervention. Clinical features and psychiatric diagnoses were collected. Night-eating was investigated through the administration of the Night-eating Questionnaires (NEQ) and was defined as the presence of self-reported evening hyperphagia and/or nocturnal ingestions. Binge-eating and purging behaviors and general psychopathology were respectively assessed using the Bulimic Investigatory Test, Edinburgh and the Symptom Checklist-90-Revised. Results Night-eating was reported by twenty subjects (16.5%). Patients with night-eating behavior were significantly more frequently diagnosed with bipolar spectrum disorders and with comorbid eating and mood disorders in comparison with other patients. Night-eating patients showed significantly more binging/purging behaviors and greater severity of somatization, obsessive–compulsive symptoms, phobic anxiety, psychoticism and sleep disorders. Patients with bipolar disorder type 1 or 2 scored significantly higher than those without mood disorders at NEQ total score, mood/sleep and nocturnal ingestions subscales, but also scored significantly higher than other patients with mood disorders at the latter subscale. Conclusion Patients with evening hyperphagia and/or nocturnal ingestions should be carefully evaluated to detect possible bipolar spectrum disorders and other eating disorders. Prompt management of these conditions should be provided before bariatric interventions. Level of evidence V, cross-sectional descriptive study.