Associations of disordered sleep with body fat distribution, physical activity and diet among overweight middle-aged men

Eating habits and sleep quality in individuals with type 1 diabetes on continuous glucose monitoring and insulin pump

BACKGROUND AND AIMS

Sleep disorders are bidirectionally linked with eating behaviors and glucose metabolism, which could be clinically relevant in type 1 diabetes (T1D). We investigated the relationship between dietary habits and sleep quality in individuals with T1D on insulin pumps and continuous glucose monitoring (CGM).

METHODS AND RESULTS

In a cross-sectional study, dietary habits (7-day food diary, EPIC questionnaire) and sleep quality (Pittsburgh Sleep Quality Index questionnaire) were assessed in 59 men and 58 women with T1D, aged 19-79 years, using CGM and insulin pump. Differences in dietary habits and blood glucose after dinner (6 h) between participants differing in sleep quality, sleep duration, and sleep onset latency were evaluated. Bad Sleepers (n = 81) were twice as prevalent as Good Sleepers (n = 36) and had a significantly higher intake of fat than Good Sleepers (dinner: 30.7 ± 10.7 vs. 24.0 ± 10.5 g, p = 0.004). Short sleepers had a significantly higher usual intake (g/1000 kcal) of coffee and tea (90.4 ± 71.7 vs. 62.0 ± 35.6), alcoholic (47.8 ± 51.1 vs. 28.9 ± 31.5) and carbonated beverages (21.8 ± 38.1 vs. 9.3 ± 17.2) (p < 0.05 for all) than Long Sleepers. Long Sleep Onset Latency was associated with a significantly higher fat intake at dinner (41.8 ± 7.4 vs. 38.1 ± 9.1 % total energy, p = 0.029) than Short Sleep Onset Latency. No significant differences in post-dinner blood glucose levels were detected between participants with good or bad sleep quality.

CONCLUSION

Sleep disruption is common in T1D and is associated with unhealthy dietary choices, especially at dinner, independently of post-dinner blood glucose control.

Overall Obesity Not Abdominal Obesity Has a Causal Relationship with Obstructive Sleep Apnea in Individual Level Data

Objective

Both obstructive sleep apnea (OSA) and obesity are highly prevalent worldwide, and are intrinsically linked. Previous studies showed that obesity is one of the major risk factors for OSA, but the causality of the relationship is still unclear. The study was to investigate the causal relationships of overall obesity and abdominal obesity with OSA and its quantitative traits.

Methods

In this case-control study, a total of 7134 participants, including 4335 moderate-to-severe OSA diagnosed by standard polysomnography and 2799 community-based controls were enrolled. Anthropometric and biochemical data were collected. Mendelian randomization (MR) analyses were performed using the genetic risk score, based on 29 body mass index (BMI)- and 11 waist-hip-ratio (WHR)-associated single nucleotide polymorphisms as instrumental variables. The causal associations of these genetic scores with OSA and its quantitative phenotypes were analyzed.

Results

Obesity was strongly correlated with OSA in observational analysis (β= 0.055, P = 3.7 × 10-5). In MR analysis, each increase by one standard deviation in BMI was associated with increased OSA risk [odds ratio (OR): 2.21, 95% confidence interval (CI): 1.62-3.02, P = 5.57 × 10-7] and with 2.72-, 4.68-, and 3.25-fold increases in AHI, ODI, and MAI, respectively (all P < 0.05) in men. However, no causal associations were found between WHR and OSA risk or OSA quantitative traits in men and women.

Conclusion

Compared to abdominal obesity, overall obesity showed a causal relationship with OSA and its quantitative traits, especially in men.

Adherence to a "Western-type" dietary pattern is positively associated with the Apnea-Hypopnea Index in adults with obstructive sleep apnea

Dietary habits have been associated with obstructive sleep apnea (OSA); however, the underlying mechanisms remain unclear. We hypothesized that adherence to dietary patterns may be associated with Apnea-Hypopnea Index (AHI) and OSA severity and that insulin resistance, oxidative stress, and inflammation may act as potential mediators of these associations. This was a cross-sectional study among 269 adult participants with polysomnography-diagnosed moderate-to-severe OSA. Dietary and physical activity habits were assessed through validated questionnaires, and biochemical, inflammatory, and oxidative stress markers were measured for all volunteers. Dietary patterns were identified using principal component analysis, and mediation analyses was also performed. A "Western-type" dietary pattern (characterized by high intakes of full-fat dairy, refined grains, potatoes, red meat, sweets, salty snacks, and soft drinks and low intakes of low-fat dairy and whole grains) was positively associated with AHI. Mediation analyses also revealed that insulin resistance partially explained this association. In multivariable models controlling for age, sex, smoking, socioeconomic status, obesity presence, energy intake, and physical activity level, participants in the highest quartile of adherence to the Western-type dietary pattern had ∼3.5 times higher likelihood of suffering from severe OSA, compared with participants in the lowest quartile of adherence (odds ratio [95% confidence interval]: 3.45 [1.21-9.94], P trend across quartiles: 0.024). After further adjustment for Homeostasis Model of Assessment-Insulin Resistance and high-sensitivity C-reactive protein, this association lost significance. Higher adherence to a less healthy, Western-type dietary pattern is positively associated with AHI and OSA severity, which may partially be mediated through insulin resistance.

The association between cholesterol/saturated fat index (CSI) and quality of sleep, and circadian rhythm among overweight and obese women: a cross-sectional study

BACKGROUND

The decline in sleep quality is one of the main public health problems affecting the global population. Some studies have shown that a high-fat diet may be linked to changes in circadian rhythm and sleep quality. The cholesterol/saturated fatty acid index (CSI) determines the amount of cholesterol and saturated fatty acid (SFA) in people's dietary patterns and can affect the quality of sleep and circadian rhythm. However, to date, no studies have investigated the effect of this index on these two variables. Therefore, our aim was to investigate the relationship between CSI on circadian rhythm and sleep quality in obese and overweight women.

METHOD

This cross-sectional study included 378 adult women who were obese or overweight. Using accepted techniques, anthropometric measurements, blood pressure readings, and biochemical variables were evaluated. A validated and trustworthy semi-quantitative food frequency questionnaire (FFQ 147 items) was used to gauge dietary intake. The CSI was measured to find out how much cholesterol and saturated fats were in the diet. Additionally, to assess circadian rhythm and sleep quality, respectively, the valid morning-evening questionnaire (MEQ) and Pittsburgh sleep quality index (PSQI) questionnaires were utilized.

RESULT

The results of the multinomial logistic regression model of our analysis showed that a significant association was observed between circadian rhythm status with CSI score, and participants with one higher unit of CSI had a 7.3% more chance of being in the eveningness group than being in morningness category in the crude model (OR: 1.07; 95% CI 1.00, 1.14; P = 0.026). This association remains marginally significant when adjusting for age, energy intake, BMI, job status, thyroid, and smoking status (OR = 1.08; 95% CI 1.00, 1.16; P = 0.051). The binary logistic regression model showed that after controlling for potentially confounding variables, there was no significant association between sleep quality with CSI score, however, those with one higher unit of CSI had 1.6% more chance of having sleep problems (OR: 1.01; 95% CI 0.96, 1.06; P = 0.503).

CONCLUSION

Our results indicated a direct marginally significant association between CSI with evening type in overweight and obese women. Future studies are needed to clarify the precise link between circadian rhythm and sleep behavior with fatty acid quality index.

Alternate-day modified fasting diet improves weight loss, subjective sleep quality and daytime dysfunction in women with obesity or overweight: a randomized, controlled trial

Background

Both sleep time and quality can be associated with overweight or obesity. In obese people, visceral fat tissue develops, which results in an increment in the production of cytokines. The increased production of inflammatory cytokines can disturb the sleep/wake cycle. Therefore, weight loss by reducing fat tissue can improve sleep disorders. Intermittent fasting diets are popular and effective diets that can decrease body weight and improve anthropometric data and body composition. The present study aimed to evaluate the effect of Alternate-day Modified Fasting (ADMF) on sleep quality, body weight, and daytime sleepiness.

Methods

Classification of 56 obese or overweight women, based on age and body mass index (BMI), was done using stratified randomization. Then individuals were assigned to the ADMF group (intervention) or Daily Calorie Restriction (CR) group (control) using the random numbers table for 8 weeks. We measured the Pittsburgh sleep quality Index (PSQI), weight, BMI, and the Epworth sleepiness scale (ESS) as primary outcomes and assessed subjective sleep quality (SSQ), sleep latency, sleep disturbances, habitual sleep efficiency, daytime dysfunction, and sleep duration as secondary outcomes at baseline and after the study.

Results

Following an ADMF diet resulted in a greater decrease in weight (kg) [-5.23 (1.73) vs. -3.15 (0.88); P < 0.001] and BMI (kg/m²) [-2.05 (0.66) vs. -1.17 (0.34); P < 0.001] compared to CR. No significant differences were found in the changes of PSQI [-0.39 (1.43) vs. -0.45 (1.88); P = 0.73] and ESS [-0.22 (1.24) vs. -0.54 (1.67); P = 0.43] between two groups. Also, following the ADMF diet led to significant changes in SSQ [-0.69 (0.47) vs. -0.08 (0.40); P = <0.001], and daytime dysfunction [-0.65 (0.57) vs. 0.04 (0.75); P: 0.001] in compare with CR diet.

Conclusion

These results suggested that an ADMF could be a beneficial diet for controlling body weight and BMI. The ADMF diet didn't affect PSQI and ESS in women with overweight or obesity but significantly improved SSQ and daytime dysfunction.

Clinical Trial Registration

The Iranian Registry of Clinical Trials (IRCT20220522054958N3), https://www.irct.ir/trial/64510.

Shorter sleep duration is associated with greater visceral fat mass in US adults: Findings from NHANES, 2011-2014

Habitual declines in sleep duration and increased rates of obesity are public health concerns worldwide. Accumulating evidence suggests a prominent link between reduced sleep duration and weight gain. Our cross-sectional study investigated the relationship between sleep duration and body fat distribution in US adults. We extracted data for 5151 participants (2575 men and 2576 women) aged 18-59 years from the US National Health and Nutrition Examination Survey 2011-2012 and 2013-2014. Weekday or workday night-time sleep duration was estimated using an in-home interview questionnaire. Dual-energy x-ray absorptiometry scans were used to determine regional body fat mass (arms, legs, trunk [android and gynoid], and abdominal [subcutaneous and visceral]). Multiple linear regression and restricted cubic spline analyses were performed after adjusting for several demographic, anthropometric, and nutritional covariates. There was a significant negative association between sleep duration and visceral fat mass overall (β: -12.139, P < 0.001) and by sex (men: β: -10.096, P < 0.001; women: β: -11.545, P = 0.038), after adjusting for age, ethnicity, body mass index, total body fat mass, daily energy and alcohol intake, sleep quality and sleep disorder status. Sleep duration and visceral fat appeared to plateau at ≥ 8 h of daily sleep. Sleep duration is negatively associated with visceral fat mass accumulation during adulthood with possibly no benefits beyond 8 h of sleep per day. Mechanistic and prospective studies are required to confirm the effect of sleep duration on visceral adiposity and determine its causes.

Objective sleep characteristics and continuous glucose monitoring profiles of type 2 diabetes patients in real-life settings

AIM

To investigate the association between objective sleep parameters and glycaemic variability determined by continous glucose monitoring (CGM) among patients with type 2 diabetes, given the significant role of sleep in glycaemic control.

METHODS

In this study, CGM was carried out in 28 patients with T2D (aged 62.3 ± 4.8 years, 57% women). Sleep characteristics were assessed by actigraphy within the CGM period. CGM-derived outcomes included glucose level, and percentages of time in range (TIR) and time above range (TAR) during the monitoring period. Associations between intraindividual night-to-night variations in sleep characteristics and overall CGM outcomes were analysed using linear regression. Associations between sleep characteristics during each night and time-matched CGM outcomes were analysed using linear mixed models.

RESULTS

A total of 249 person-days of CGM, coupled with 221 nights of sleep characteristics, were documented. Greater standard deviation (SD) of objective sleep duration (minutes) between measurement nights was associated with higher glucose level (coefficient 0.018 mmol/L [95% confidence interval {CI} 0.004, 0.033], P = 0.017), smaller proportion of TIR (% in observation period; coefficient -0.20% [95% CI -0.36, -0.03], P = 0.023), and greater proportion of TAR (coefficient 0.22% [95% CI 0.06, 0.39], P = 0.011). Later sleep midpoint (minutes from midnight) was associated with greater SD of glucose during the same sleep period (coefficient 0.002 minutes [95% CI 0.0001, 0.003], P = 0.037), longer nocturnal sleep duration was associated with smaller coefficient of variation of glucose level in the upcoming day (-0.015% [95% CI -0.03, -0.001], P = 0.041).

CONCLUSION

Objectively determined sleep duration and sleep midpoint, as well as their daily variability, are associated with CGM-derived glucose profiles in T2D patients.

The association of dietary glycemic index and glycemic load with the risk of insomnia in the adult population

BACKGROUND

A dietary pattern with a high glycemic index (GI) and glycemic load (GL) can be a precursor to sleep disorders that link to many chronic diseases. We aimed to assess the association of dietary GI and GL with the risk of insomnia in Iranian adults.

METHODS

A total of 111 newly diagnosed insomnia cases and 333 controls aged 18-60 years were included in this case-control study. The participants' dietary intakes were collected using a valid and reliable food frequency questionnaire. The diagnosis of insomnia in subjects was performed by a neurologist using the Insomnia Severity Index (ISI) questionnaire. Multivariable logistic regression models, adjusted for the potential confounders, were used to determine the risk of insomnia according to tertiles of dietary glycemic indices.

RESULTS

The mean (SD) age and BMI of the study population (78.6% female) were 31.8 (10.0) years and 24.70 (3.62) kg/m², respectively. The median (IQR) of dietary GI and GL in subjects was 62.7 (57.0-68.6) and 213.5(167.4-268.5), respectively. Based on the multivariable-adjusted model, after controlling for age, sex, physical activity, obesity, smoking, socioeconomic score, general health questionnaire (GHQ) score, and dietary energy intake, the odds of insomnia were increased across tertiles of dietary GL[(OR:2.72,95%CI:1.10-6.70),(P_trend = 0.017)], however, no significant association was observed between high GI diet and insomnia risk [(OR:1.38,95%CI:0.77-2.47),(P_trend = 0.298)].

CONCLUSIONS

Our results revealed that greater adherence to dietary pattern with high GL could be increased the odds of insomnia in Iranian adults.

Examining the relationship between obstructive sleep apnoea and eating behaviours and attitudes: A systematic review

BACKGROUND

Between 60 and 90% of adults with OSA are reported as overweight. The co-existence of obesity and OSA can greatly increase an individual's risk of type 2 diabetes, metabolic syndrome and cardiovascular disease. To better understand this relationship between OSA and weight, this review aimed to investigate if there is evidence of certain eating behaviours or eating attitudes that might be found in adults living with OSA.

METHODS

We searched four databases (MEDLINE, Embase, PsycInfo and Web of Science) on January 17th, 2022, to identify studies assessing the association between eating patterns and OSA in adults. Twenty-one studies met the inclusion criteria. A narrative synthesis was conducted on the included studies, following the vote-counting method.

RESULTS

There is preliminary evidence that the time of day when calories are consumed is associated with lower OSA severity. No other clear patterns of eating behaviours or attitudes were identified however this may be due to disparity within research studies and their reported results.

CONCLUSION

Further research is needed to examine the relationship between eating times and OSA severity. We recommend standardising the approach to examining the eating patterns of those living with OSA and the relationship that this might have on OSA symptoms as well as looking at attitudes towards food in this population. This may prove helpful in providing a better understanding of the relationship between OSA and persons with overweight and help in future intervention development.

Comparison of the effect of modified intermittent fasting and daily calorie restriction on sleep quality, anthropometric data, and body composition in women with obesity or overweight: study protocol of a randomized controlled trial

BACKGROUND

Sleep disturbances are common in nearly one-third of adults. Both low quality of sleep and sleep time could be related to increased obesity. An increase in visceral adipose tissue can result in the secretion of inflammatory cytokines. Inflammatory cytokines can lead to a disturbance of the sleep-wake rhythm. Therefore, weight loss may improve sleep quality and duration. Intermittent fasting diet as a popular diet reduces body weight and improves anthropometric indices. This study is performed to further investigate the effect of a modified intermittent fasting diet on sleep quality and anthropometric indices.

METHODS

This is an open-label randomized controlled trial to evaluate the effect of daily calorie restriction (control) and modified intermittent fasting (intervention) on sleep quality, anthropometric data, and body composition in women with obesity or overweight for 8 weeks. Fifty-six participants will be classified using stratified randomization based on body mass index (BMI) and age. Then, participants will be assigned to one of the two groups of intervention or control using the random numbers table. The sleep quality, daytime sleepiness, and insomnia will be evaluated by using the Pittsburgh Sleep Quality Index (PSQI), the Epworth Sleepiness Scale (ESS), and the Insomnia Severity Index respectively. The primary outcomes chosen for the study were as follows: the difference in sleep quality, daytime sleepiness, insomnia, BMI, fat-free mass (FFM), body fat mass, waist circumference, and waist-to-hip ratio from baseline to 8 weeks. Secondary outcomes chosen for the study were as follows: the difference in hip circumference, the visceral fat area, percent body fat, soft lean mass, skeletal muscle mass, extracellular water ratio, and total body water from baseline to 8 weeks.

DISCUSSION

This study will investigate the effect of intermittent fasting intervention compared with daily calorie restriction on sleep quality and anthropometric indices. The information gained will enhance our understanding of fasting interventions, which can be used to improve clinical dietary recommendations. The findings will help to disclose as yet the unknown relationship between diet and sleep quality.

TRIAL REGISTRATION

Iranian Registry of Clinical Trials IRCT20220522054958N3. Registered on 8 July 2022. https://www.irct.ir/trial/64510 .

Associations between the Timing and Nutritional Characteristics of Bedtime Meals and Sleep Quality for Nurses after a Rotating Night Shift: A Cross-Sectional Analysis

The purpose of this study was to investigate the associations of the timing and nutritional characteristics of bedtime meals with sleep quality in nurses after rotating night shifts. In total, 128 nurses from a university hospital in South Korea participated in this cross-sectional study. Data were collected on the first night of two or three consecutive routine night shifts. Participants recorded all food eaten before going to bed after work. An accelerometer was used to objectively measure sleep quality, and subjective sleep quality was assessed by self-report using the Korean version of the Verran and Snyder-Halpern Sleep Scale. The associations of timing and nutritional characteristics of bedtime meals with sleep quality after night shifts were analyzed using multivariate linear regression. A short time interval between meals and sleep was associated with longer objectively measured total sleep time (β = -0.37, p = 0.002), and the proportion of protein in meals was associated with better objectively measured sleep efficiency (β = 0.31, p = 0.007). The shorter the time interval, the better the subjective sleep quality (β = -0.23, p = 0.048), and high-calorie meals were positively associated with subjective sleep quality (β = 0.23, p = 0.043). Based on our findings, we encourage nurses to have protein-rich meals after night shifts and reduce the delay between meals and sleep. Although high-calorie meals were shown to have a positive effect on subjective sleep quality, it is necessary to confirm this effect through additional research.

Isocaloric Diets with Different Protein-Carbohydrate Ratios: The Effect on Sleep, Melatonin Secretion and Subsequent Nutritional Response in Healthy Young Men

This study aimed to determine the short-term effect of two isocaloric diets differing in the ratio of protein−carbohydrate on melatonin levels, sleep, and subsequent dietary intake and physical activity in healthy young men. Twenty-four healthy men took part in a crossover design including two sessions of three days on isocaloric diets whether high-protein, low-carbohydrate (HPLC) or low-protein, high-carbohydrate (LPHC) followed by 24-h free living assessments. Sleep was measured by ambulatory polysomnography pre-post-intervention. Melatonin levels were assessed on the third night of each session on eight-point salivary sampling. Physical activity was monitored by accelerometry. On day 4, participants reported their 24-h ad-libitum dietary intake. LPHC resulted in better sleep quality and increased secretion of melatonin compared to HPLC. A significant difference was noted in sleep efficiency (p < 0.05) between the two sessions. This was mainly explained by a difference in sleep onset latency (p < 0.01) which was decreased during LPHC (PRE: 15.8 ± 7.8 min, POST: 11.4 ± 4.5 min, p < 0.001). Differences were also noted in sleep staging including time spent on REM (p < 0.05) and N1 (p < 0.05). More importantly, REM latency (PRE: 97.2 ± 19.9 min, POST 112.0 ± 20.7 min, p < 0.001) and cortical arousals (PRE: 7.2 ± 3.9 event/h, POST 8.5 ± 3.3 event/h) increased in response to HPLC diet but not LPHC. On day 4, 24-h ad-libitum energy intake was higher following HPLC compared to LPHC (+64 kcal, p < 0.05) and explained by increased snacking behavior (p < 0.01) especially from carbohydrates (p < 0.05). Increased carbohydrates intake was associated with increased cortical arousals.

Nutritional Elements in Sleep

Sleep comprises one-third of our day and plays an integral role in human health and well-being. Many factors influence sleep, with nutrition being a key element that impacts various sleep parameters. Meal-timing through strategies like chrono-nutrition leads to positive sleep outcomes. In addition, consuming a high-protein diet with essential amino acids, low-glycemic-index foods, and certain fruits rich in antioxidants can all contribute to better sleep quality. Other facets of nutrition that can affect sleep outcomes include weight loss and limiting certain nutritional elements such as caffeine, nicotine, and alcohol. In this article, we will shed some light on how some of these factors can play a vital role in sleep quality.

Sleep-disordered breathing, sleep apnea, and other obesity-related sleep disorders: An Obesity Medicine Association (OMA) Clinical Practice Statement (CPS) 2022

Background

This Obesity Medicine Association (OMA) Clinical Practice Statement (CPS) provides clinicians an overview of sleep-disordered breathing, (e.g., sleep-related hypopnea, apnea), and other obesity-related sleep disorders.

Methods

The scientific support for this CPS is based upon published citations, clinical perspectives of OMA authors, and peer review by the Obesity Medicine Association leadership.

Results

Obesity contributes to sleep-disordered breathing, with the most prevalent manifestation being obstructive sleep apnea. Obesity is also associated with other sleep disorders such as insomnia, primary snoring, and restless legs syndrome. This CPS outlines the evaluation, diagnosis, and treatment of sleep apnea and other sleep disorders, as well as the clinical implications of altered circadian system.

Conclusions

This Obesity Medicine Association (OMA) Clinical Practice Statement (CPS) on "Sleep-Disordered Breathing, Sleep Apnea, and Other Obesity-Related Sleep Disorders" is one of a series of OMA CPSs designed to assist clinicians in the care of patients with the disease of obesity.

Sleep Duration and Visceral Adipose Tissue: Linear and Nonlinear Mendelian Randomization Analyses

CONTEXT

Increasing evidence suggests that sleep is important for fat metabolism. However, the causal relationship between sleep duration and visceral adipose tissue (VAT) needs to be further clarified.

OBJECTIVE

This study investigated the linear and nonlinear causal association between sleep duration and VAT.

METHODS

This study used one-sample and two-sample Mendelian randomization MR). Single-nucleotide polymorphisms (SNPs) associated with sleep duration at genome-wide significance were obtained from published genome-wide association studies. We also recalculated the correlation between each SNP and sleep duration in the UK Biobank. The associations of SNPs with predicted VAT (396 858 participants) were conducted in the UK Biobank.

RESULTS

A total of 396 858 eligible participants (54.10% females, 57 ± 8 years old) were included in the study. The participants slept 7.17 ± 1.04 hours and stored 1.25 ± 0.88 kg of VAT on average. Genetically predicted sleep duration was significantly associated with VAT. For each 1-hour increase in genetically predicted sleep duration, the reduction in predicted VAT mass was 0.11 kg (P = 8.18E-16) in total, 0.17 kg (P = 3.30E-11) in men and 0.07 kg (P = 1.94E-06) in women. Nonlinear MR analyses demonstrated nonlinearity (L-shaped associations) between genetically predicted sleep duration and VAT in all participants, men, and women. Complementary analyses provided confirmative evidence of the adverse effects of genetically predicted short sleep duration on the increased VAT. In contrast, no clear evidence on the causal effect of genetically predicted long sleep duration on VAT mass was found.

CONCLUSION

The causal association of sleep duration with VAT was L-type. Our findings support that short sleep duration is a risk factor for increasing VAT, thus reinforcing the probability that increasing sleep duration may decrease VAT.

Do Sleep Disorders and Western Diet Influence Psoriasis? A Scoping Review

Western diet may trigger sleep disorders and vice versa, but their single and mutual effects on systemic inflammatory diseases (i.e., psoriasis) are far from being fully elucidated. At the same time, psoriatic patients display a great burden of sleep disorders and dysmetabolisms related to an unhealthy lifestyle (i.e., diet). These patients are also affected by a chronic disorder deeply modulated by environmental factors (i.e., sleep and diet) capable to influence drug-response and disease progression. Thus, we aimed to summarize the evidence in the literature that may highlight a potential link among psoriasis–diet–sleep in order to further promote a multidisciplinary approach to psoriatic patients in the scientific community.

Shift Work and Obesity Risk-Are There Sex Differences?

PURPOSE OF REVIEW

Shift work is prevalent among the working population and is linked to an array of adverse health outcomes. This review summarizes current evidence on the relation between shift work and risk of obesity, with a particular emphasis on potential sex differences.

RECENT FINDINGS

Observational data strongly point towards an association between shift work and heightened risk of prevalent and incident obesity, and particularly abdominal obesity. Circadian misalignment and unhealthy lifestyle behaviors are the primary culprits mediating such association. As it pertains to sex differences in the impact of shift work on obesity, few studies have examined this aspect, and findings are conflicting. Shift work is an important risk factor for obesity, with likely multiple biological and behavioral mediators. However, whether there is a sex-dependent vulnerability to the obesogenic effects of shift work is unclear. This area presents opportunities for future research.

Sleep problems in pain patients entering tertiary pain care: the role of pain-related anxiety, medication use, self-reported diseases, and sleep disorders

ABSTRACT

Chronic pain and sleep problems frequently co-occur. Pain itself disturbs sleep, but other factors may also contribute to sleep problems in pain patients. This cross-sectional study of 473 patients (69.9% female, mean age 47 years) entering tertiary pain management compared normally sleeping pain patients with those having recurring sleep problems to determine the relationship between pain and sleep. Groups were compared for pain and pain aetiology, pain-related anxiety, childhood adversities, use of sleep and pain medications, self-reported diseases, and sleep disorders. Furthermore, the association of pain-related anxiety (cognitive anxiety, escape/avoidance, fear, and physiological anxiety) with more disturbing sleep problems was investigated in the whole cohort. The main results were that those with sleep problems more often reported multiple health conditions than those sleeping normally (depression 31.6% vs 5.0%; angina pectoris 6.5% vs 0.0%; asthma 19.6% vs 1.7%; low back problems 55.1% vs 23.3%; joint disease other than rheumatoid arthritis 32.3% vs 18.3%). Accumulations of 5 or more childhood adversities were more often present in those with sleep problems. Restless legs symptoms were more common in those with sleep problems than those sleeping normally (33.2% vs 11.7%). Patients having sleep problems reported more use of sleep and pain medications than those sleeping normally. Findings about pain-related anxiety suggest physiological reactions as significant factors for increased sleep disturbances. These factors need to be addressed in the management of the comorbidity of pain and sleep problems, and research to understand mechanisms in these is sorely needed.

The association between low-carbohydrate diet score and sleep duration among Iranian adults

Sleep disorders are linked to obesity, type 2 diabetes mellitus (T2DM) and cardiovascular disease (CVD). The evidence suggests that dietary carbohydrate content may be related to sleep duration. We designed a study to investigate the association between a low-carbohydrate diet (LCD) with long sleep duration (> 8 h) and short sleep duration (< 5 h). This cross-sectional analysis was conducted on data obtained from the recruitment phase of Yazd Health Study (YaHS) and the Taghzieh Mardom-e-YaZd (TAMYZ). The dietary intake was assessed using a validated food frequency questionnaire. The LCD score was calculated for each subject based on summing up assigned scores to deciles of percentages of energy from macronutrients. Sleep duration was assessed using a nocturnal sleep questionnaire. The association between LCD and sleep duration was evaluated using logistic regressions in crude and adjusted models. A total of 5929 subjects were entered into the analysis. Most of the participants were aged 20-29 years (24.8%), male (52.2%) and never smokers (87.7%). After adjusting for level of physical activity, age, sex, total energy, smoking status and body mass index in model III, a significant direct association was observed between LCD score with long sleep duration (OR 1.15; 95% CI1-1.32, P = 0.049) and short sleep duration (OR 1.29; 95% CI 1.02-1.62, P = 0.028). Higher LCD score is associated with higher chance of long sleep duration and short sleep duration. Regarding the nature of our study, cohort and clinical trial studies in future are required to reach a causal association and a definitive conclusion.

The relationship between dietary total antioxidant capacity, clinical parameters, and oxidative stress in fibromyalgia syndrome: A novel point of view

Objectives

This study aims to reveal the relationship between serum total antioxidant status (TAS), clinical parameters, and nutrition (dietary total antioxidant capacity [TAC]) in patients with fibromyalgia.

Patients and methods

This cross-sectional study was conducted with a total of 60 female participants (mean age: 44.7±9.7 years; range, 18 to 50 years) at Gaziler Physical Medicine and Rehabilitation Hospital between July 2020 and February 2021. Thirty female patients with fibromyalgia were compared with 30 age-, sex-, and body mass index-matched healthy individuals. The short-form McGill Pain Questionnaire, Fibromyalgia Impact Questionnaire (FIQ), and Pittsburg Sleep Quality Index were used. Total antioxidant status, total oxidant status (TOS), and oxidative stress index (OSI) were measured. Dietary TAC was calculated using the ferric reducing ability of plasma according to a food frequency questionnaire.

Results

Total antioxidant status showed no significant difference between groups (p=0.080). Total oxidant status and OSI were significantly higher in the patient group (p<0.001 and p=0.005, respectively). The mean dietary TAC was 16.5±6.5 in the patient group and 17.2±6.2 in the control group, and it was similar between groups (p=0.492). Pittsburg Sleep Quality Index global score was significantly higher in the patient group than in the control group (p<0.001). Dietary TAC showed a moderate positive correlation with serum TAS in both groups (r=0.373, p=0.042 for the patient group, and r=0.380, p=0.038 for the control group). In the patient group, TOS and OSI showed a moderate positive correlation with FIQ total scores (r=0.420, p=0.021 and r=0.450, p=0.013, respectively). The mean polyunsaturated fatty acid and omega-6 intake of the patient group was significantly lower than the control group (p=0.025 for both). Dietary antioxidant intake from vegetables (p=0.025), legumes/nuts (p=0.049), and meat (p<0.001) was significantly lower, whereas dietary antioxidant intake from cereal and potatoes was significantly higher in the patient group compared to the control group (p=0.028).

Conclusion

The results indicate that oxidative stress can be reduced by increasing dietary antioxidant intake in fibromyalgia.

Sleep Disturbance and Changes in Energy Intake and Body Composition During Weight Loss in the POUNDS Lost Trial

To examine associations between sleep disturbance and changes in weight and body composition and the mediating role of changes of appetite and food cravings in the Preventing Overweight Using Novel Dietary Strategies (POUNDS Lost) 2-year weight-loss diet intervention trial, this study included 810 overweight or obese individuals with baseline sleep disturbance assessment who were randomly assigned one of four diets varying in macronutrient composition. Changes in body weight and fat distribution were assessed by DEXA and computed tomography during the 2-year intervention. Participants were asked to provide sleep disturbance levels (no, slight, moderate, or great) at baseline and to recall their sleep disturbances since last visit at 6, 12, 18, and 24 months. Weight loss during the first 6 months was followed by 1.5 years of steady weight regain. Participants with greater sleep disturbance from baseline to 6 months showed significant losses of body weight (Ptrend <0.001) and waist circumference (Ptrend = 0.002) at 6 months, after multivariate adjustment. Compared with individuals without sleep disturbance at all from baseline to 6 months, those with slight, moderate, or great sleep disturbance showed an elevated risk of failure to lose weight (-5% or more loss) at 6 months, when the maximum weight loss was achieved, with an odds ratio of 1.24 (95% CI 0.87, 1.78), 1.27 (95% CI 0.75, 2.13), or 3.12 (95% CI 1.61, 6.03), respectively. In addition, we observed that the repeatedly measured levels of sleep disturbance over 2 years were inversely associated with the overall weight loss rate (weight changes per 6 months) (Ptrend <0.001). Further, sleep disturbances during weight loss from baseline to 6 months and weight regain from 6 months to 24 months were significantly predictive of total fat, total fat mass percent, and trunk fat percent changes during the 2 years. Our results also indicated that food cravings for carbohydrates/starches, fast food fats, and sweets; cravings, prospective consumption, hunger of appetite measurements; and dietary restraint, disinhibition, and hunger subscales measured at 6 months significantly mediated the effects of sleep disturbance on weight loss. In conclusion, our results suggested that more severe sleep disturbance during weight loss was associated with an elevated risk of failure to lose weight during the dietary intervention. Food cravings and eating behaviors may partly mediate these associations.

OBSTRUCTIVE SLEEP APNEA SYNDROME RISK IN PATIENTS WITH NON-ALCOHOLIC FATTY LIVER DISEASE IS ASSOCIATED WITH OBESITY AND PRESENCE OF NASH

BACKGROUND

Non-alcoholic fatty liver disease (NAFLD) is the most common form of liver disease and refers to a wide spectrum of histological abnormalities ranging from simple steatosis (HE) to non-alcoholic steatohepatitis (NASH), fibrosis, cirrhosis and hepatocellular carcinoma.

OBJECTIVE

To assess the risk of obstructive sleep apnea syndrome (OSAS) and relating it to demographic, biochemical and histological data in patients with non-alcoholic fatty liver disease.

METHODS

Cross-sectional cohort study in individuals with biopsy-proven NAFLD. Anthropometric and biochemical parameters, presence of metabolic syndrome and insulin resistance were evaluated. The Berlin Questionnaire (BQ) was applied to assess the risk of apnea and a food record was requested. Based on the BQ, participants were classified as high or low risk for OSAS. In the correlation of sleep apnea with the severity of NAFLD, presence of nonalcoholic steatohepatitis (NASH) and the degree of liver fibrosis were evaluated. Statistical analysis used the chi-square test, Student's t and bivariate logistic regression; values were expressed as mean ± standard deviation. This research project was approved by the Ethics Committee.

RESULTS

Regarding the parameters evaluated, significant differences were observed between the groups in terms of body mass index (BMI), waist and neck circumference. In the histological evaluation, patients classified as high risk were more likely to have fibrosis and NASH. In bivariate regression, the BMI, presence of fibrosis and steatohepatitis in the biopsy were independently associated with an elevated risk of the syndrome.

CONCLUSION

A high prevalence of risk for OSAS was observed in the studied group, with a higher risk being independently associated with BMI and presence of steatohepatitis, suggesting that it is a factor associated with the severity of the disease.

Adherence to the MIND dietary pattern and sleep quality, sleep related outcomes and mental health in male adults: a cross-sectional study

BACKGROUND

A large number of studies have investigated the association of the Mediterranean and DASH diets with psychological health as well as sleep related outcomes. However, only a few number of studies have examined the association of their newly proposed hybrid, Mediterranean-DASH Intervention for Neurodegenerative Delay (MIND) dietary pattern, with sleep quality and sleep related outcomes.

METHODS

This cross-sectional study was conducted on 400 male health professions (mean age 38.67 years). Dietary information was collected using a validated 168-item semi-quantitative food frequency questionnaire. The MIND score was computed based on major dietary components emphasized or minimized in this pattern. The higher the MIND score of a subject, the greater his adherence to the MIND pattern. Mental health was evaluated using the 21-item depression, anxiety, and stress scale (DASS-21). Pittsburgh Sleep Quality Index (PSQI) was used to assess sleep quality. Sleep-related outcomes (day-time sleepiness and insomnia) were also evaluated using standard questionnaires RESULTS: No significant associations were found between adherence to the MIND diet score and odds of stress, anxiety and depression either in the crude or multivariable-adjusted models (P > 0.05). Nevertheless, participants with the greatest adherence to the MIND diet had lower odds of poor sleep quality (OR for T3 vs. T1: 0.56 (95% CI: 0.34, 0.92), P-trend = 0.023). The results remained significant after full adjustment for confounding variables (P-trend = 0.042). Participants in the highest tertile of MIND diet had a 42% lower odds of daytime sleepiness in the crude and multivariable-adjusted model (P-trend < 0.05). Although no significant association was observed between adherence to the MIND diet and severity of insomnia in the crude model (P-trend = 0.055), the multivariable-adjusted model showed that the highest adherence to the MIND diet was associated with lower odds of insomnia (OR for T3 vs. T1: 0.54 (95% CI: 0.31, 0.93), P-trend = 0.031).

CONCLUSION

While no significant associations were found between adherence to the MIND diet and stress, anxiety and depression, greater adherence to the MIND diet were associated with lower odds of poor sleep quality and sleep-related outcomes.

The relationship between physical activity, BMI, circadian rhythm, and sleep with cognition in bipolar disorder

BACKGROUND

Cognitive deficits affect a significant proportion of patients with bipolar disorder (BD). Problems with sustained attention have been found independent of mood state and the causes are unclear. We aimed to investigate whether physical parameters such as activity levels, sleep, and body mass index (BMI) may be contributing factors.

METHODS

Forty-six patients with BD and 42 controls completed a battery of neuropsychological tests and wore a triaxial accelerometer for 21 days which collected information on physical activity, sleep, and circadian rhythm. Ex-Gaussian analyses were used to characterise reaction time distributions. We used hierarchical regression analyses to examine whether physical activity, BMI, circadian rhythm, and sleep predicted variance in the performance of cognitive tasks.

RESULTS

Neither physical activity, BMI, nor circadian rhythm predicted significant variance on any of the cognitive tasks. However, the presence of a sleep abnormality significantly predicted a higher intra-individual variability of the reaction time distributions on the Attention Network Task.

CONCLUSIONS

This study suggests that there is an association between sleep abnormalities and cognition in BD, with little or no relationship with physical activity, BMI, and circadian rhythm.

A Time to Rest, a Time to Dine: Sleep, Time-Restricted Eating, and Cardiometabolic Health

Cardiovascular disease (CVD) poses a serious health and economic burden worldwide. Modifiable lifestyle factors are a focus of research into reducing the burden of CVD, with diet as one of the most investigated factors. Specifically, the timing and regularity of food intake is an emerging research area, with approaches such as time-restricted eating (TRE) receiving much attention. TRE involves shortening the time available to eat across the day and is associated with improved CVD outcomes compared with longer eating windows. However, studies that have examined TRE have not considered the impact of sleep on CVD outcomes despite recent evidence showing that sleep duration can influence the timing and amount of food eaten. In this article, we argue that as TRE and sleep influence each other, and influence the same cardiometabolic parameters, experiencing inadequate sleep may attenuate any positive impact TRE has on CVD. We examine the relationship between TRE and CVD, with sleep as a potential mediator in this relationship, and propose a research agenda to investigate this relationship. This will provide necessary evidence to inform future interventions aimed at reducing the burden of CVD.

Lifestyle Adjustments in Long-COVID Management: Potential Benefits of Plant-Based Diets

Purpose of Review

The SARS-CoV-2-pandemic has caused mortality and morbidity at an unprecedented global scale. Many patients infected with SARS-CoV-2 continue to experience symptoms after the acute phase of infection and report fatigue, sleep difficulties, anxiety, and depression as well as arthralgia and muscle weakness. Summarized under the umbrella term “long-COVID,” these symptoms may last weeks to months and impose a substantial burden on affected individuals. Dietary approaches to tackle these complications have received comparably little attention. Although plant-based diets in particular were shown to exert benefits on underlying conditions linked to poor COVID-19 outcomes, their role with regard to COVID-19 sequelae is yet largely unknown. Thus, this review sought to investigate whether a plant-based diet could reduce the burden of long-COVID.

Recent Findings

The number of clinical trials investigating the role of plant-based nutrition in COVID-19 prevention and management is currently limited. Yet, there is evidence from pre-pandemic observational and clinical studies that a plant-based diet may be of general benefit with regard to several clinical conditions that can also be found in individuals with COVID-19. These include anxiety, depression, sleep disorders, and musculoskeletal pain. Adoption of a plant-based diet leads to a reduced intake in pro-inflammatory mediators and could be one accessible strategy to tackle long-COVID associated prolonged systemic inflammation.

Summary

Plant-based diets may be of general benefit with regard to some of the most commonly found COVID-19 sequelae. Additional trials investigating which plant-based eating patterns confer the greatest benefit in the battle against long-COVID are urgently warranted.

Disentangling the Relationship between Food Insecurity and Poor Sleep Health

The COVID-19 pandemic has created disruptions in global and national food supply chains. Along with an increase in the unemployment rate, this resulted in a rise in food insecurity at the community-level, threatening individual and family well-being. Food insecurity is associated with inadequate nutrient intakes, weight gain, and psychological distress, including anxiety and depressive symptoms, all of which are known to affect sleep. Yet, little is known about whether and how food insecurity is associated with sleep health, a critical but underrecognized health outcome. This paper reviews literature describing associations between food insecurity and sleep, summarizes key findings based on proposed mechanisms, and discusses directions for future research.

Changes in dietary inflammatory potential predict changes in sleep quality metrics, but not sleep duration

STUDY OBJECTIVES

Non-pharmacological sleep interventions may improve sleep profiles without the side-effects observed with many pharmacological sleep aids. The objective of this research was to examine the association between sleep and inflammation and to examine how changes in dietary inflammatory potential influence changes in sleep.

METHODS

The Inflammation Management Intervention Study (IMAGINE), which was a dietary intervention designed to lower inflammation, provided access to 24-h dietary recalls (24HR), objectively measured sleep using SensewearTM armbands, and a range of self-reported demographics, health histories, lifestyle behaviors, psychosocial metrics, anthropometric measurements, and inflammatory biomarkers. Dietary Inflammatory Index® (DII®) scores were calculated from three unannounced 24HR-derived estimated intakes of whole foods and micro and macronutrients over a 2-week period at baseline and post-intervention (i.e. month 3). Statistical analyses primarily utilized linear regression.

RESULTS

At baseline, for every 1-min increase in sleep onset latency, tumor necrosis factor-α increased by 0.015 pg/mL (±0.008, p = 0.05). Every one-percentage increase in sleep efficiency was associated with decreased C-reactive protein (CRP) of -0.088 mg/L (±0.032, p = 0.01). Every 1-min increase in wake-after-sleep-onset (WASO) increased both CRP and interleukin-6. Compared to participants with pro-inflammatory DII changes over 3 months, those with anti-inflammatory changes decreased WASO (0 vs. -25 min, respectively, p < 0.01) and improved sleep efficiency (-2.1% vs. +2.6%, respectively, p = 0.04).

CONCLUSIONS

Non-pharmacological treatments, such as anti-inflammatory diets, may improve sleep in some adults. Future research involving dietary treatments to improve sleep should not only focus on the general population, but also in those commonly experiencing co-morbid sleep complaints.

CLINICAL TRIAL INFORMATION

NCT02382458.

Association of adherence to the Mediterranean diet and physical activity habits with the presence of insomnia in patients with obstructive sleep apnea

PURPOSE

Insomnia and obstructive sleep apnea (OSA) are among the most prevalent sleep disorders and frequently co-occur, defining the sleep apnea-insomnia syndrome. However, data exploring associations between insomnia and lifestyle habits in patients with OSA are lacking. Therefore, the aim of the present study was to investigate potential associations between insomnia presence and individual lifestyle parameters in patients with mild/moderate-to-severe OSA evaluated by attended polysomnography.

METHODS

These are secondary analyses, using data from a cross-sectional study among 269 Greek patients with OSA. Clinical, anthropometric, socioeconomic, and lifestyle data were collected for all participants. Insomnia presence was evaluated through the validated psychometric instrument "Athens Insomnia Scale" (AIS). Adherence to the Mediterranean diet was estimated with the MedDietScale index and physical activity habits were assessed through a validated questionnaire. Backward stepwise multiple logistic regression analysis was used to estimate the association between lifestyle habits (i.e., adherence to the Mediterranean diet and physical activity) and the likelihood of having insomnia, while adjusting for potential confounders.

RESULTS

Of 269 patients newly diagnosed with OSA (aged 21-70 years; 73% men), 146 (54%) were categorized as having insomnia. In multivariable models, higher adherence to the Mediterranean diet and engagement in physical activity for ≥ 30 min/day were both associated with a lower likelihood of having insomnia (odds ratio (95% confidence intervals): 0.40 (0.18-0.91) and 0.49 (0.28-0.86), respectively).

CONCLUSIONS

Results add to the limited data on the role of lifestyle in insomnia and should be further explored both in epidemiological and clinical studies.

Short Sleep Duration and Its Association with Obesity and Other Metabolic Risk Factors in Kuwaiti Urban Adults

BACKGROUND

Efficient sleep duration and its quality are increasingly recognized as important contributors for maintaining normal body weight. However, lifestyle and social structure within the Arab-gulf region differ compared to those in the western world. This study was specifically conducted in Kuwait's population to investigate the link between sleep quality (SQ) and obesity in the absence of sleep apnea (SA) onset.

METHODS

SQ was measured by the Pittsburgh Sleep Quality Index (PQSI) in 984 participants, then verified in 60 individuals including 20 lean (Body mass index/BMI: 18.5-24.9 kg/m²), 20 overweight (BMI: 25-29.9 kg/m²) and 20 obese (BMI: ≥30 kg/m²) through actigraph worn over the right-hip for 7 consecutive days to characterize their sleep-wake cycle, rest-activity, and physical activity. Blood samples were collected for metabolic markers.

RESULTS

59.6% of participants reported a PSQI score higher than 5, with 57.6% of the participants reporting less than 6 hours of sleep per day. The data show that both SQ and sleep duration are considered inadequate in comparison to the international SQ standards. We found a significant association between SQ and obesity independent of age and sex. Actigraph data further supported the independent association of sleep duration on BMI within the population (p < 0.001). Additionally, total sleep time (TST) was found to significantly correlate with several other metabolic factors including diastolic blood pressure, elevated resting heart rate (RHR), triglycerides, total cholesterol, homeostatic model assessment for insulin resistance (HOMA-IR), C-peptide, and C-Reactive Protein (CRP) secretion. Further multiple-regression analysis showed a significant independent association between blood pressure (p < 0.03), HOMA-IR (p < 0.04), and C-peptide (p < 0.3) and sleep duration.

CONCLUSION

These findings suggest that sleep deprivation and disturbance could be indirect factors involved in the development of not only obesity in Kuwait but also other metabolic syndromes such as type 2 diabetes.

Improving sleep disturbances in obesity by nutritional strategies: review of current evidence and practical guide

Over the past decades, there has been an increase in overweight and obesity worldwide rates in both in adult and children. In parallel, it has been reported a worsening of sleep duration and quality. Some studies have shown an association between obesity and sleep disturbances (SD) vice versa, subjects with obesity have a greater risk of SD. As well as SD influences diet, also food choices have been shown to influence various sleep-related variables, such as duration and quality. For this reason, nutrition could represent an important tool not only to lose weight but also to improve sleep in patients with obesity and sleep disturbances. Thus, the aim of this review is to provide an overview of the studies that assessed the association between obesity and SD and vice versa, highlighting possible nutritional advices as a tool to improve sleep in patients with obesity and sleep disturbances.

The role of exercise-induced peripheral factors in sleep regulation

BACKGROUND

Recurrently disrupted sleep is a widespread phenomenon in our society. This is worrisome as chronically impaired sleep increases the risk of numerous diseases that place a heavy burden on health services worldwide, including type 2 diabetes, obesity, depression, cardiovascular disease, and dementia. Therefore, strategies mitigating the current societal sleep crisis are needed.

SCOPE OF REVIEW

Observational and interventional studies have found that regular moderate to intensive exercise is associated with better subjective and objective sleep in humans, with and without pre-existing sleep disturbances. Here, we summarize recent findings from clinical studies in humans and animal experiments suggesting that molecules that are expressed, produced, and released by the skeletal muscle in response to exercise may contribute to the sleep-improving effects of exercise.

MAJOR CONCLUSIONS

Exercise-induced skeletal muscle recruitment increases blood concentrations of signaling molecules, such as the myokine brain-derived neurotrophic factor (BDNF), which has been shown to increase the depth of sleep in animals. As reviewed herein, BDNF and other muscle-induced factors are likely to contribute to the sleep-promoting effects of exercise. Despite progress in the field, however, several fundamental questions remain. For example, one central question concerns the optimal time window for exercise to promote sleep. It is also unknown whether the production of muscle-induced peripheral factors promoting sleep is altered by acute and chronic sleep disturbances, which has become increasingly common in the modern 24/7 lifestyle.

Does Sars-Cov-2 threaten our dreams? Effect of quarantine on sleep quality and body mass index

Background

COVID 19-related quarantine led to a sudden and radical lifestyle changes, in particular in eating habits. Objectives of the study were to investigate the effect of quarantine on sleep quality (SQ) and body mass index (BMI), and if change in SQ was related to working modalities.

Materials

We enrolled 121 adults (age 44.9 ± 13.3 years and 35.5% males). Anthropometric parameters, working modalities and physical activity were studied. Sleep quality was evaluated by the Pittsburgh Sleep Quality Index (PSQI) questionnaire. At baseline, the enrolled subjects were assessed in outpatient clinic and after 40 days of quarantine/lockdown by phone interview.

Results

Overall, 49.6% of the subjects were good sleepers (PSQI < 5) at the baseline and significantly decreased after quarantine (p < 0.001). In detail, sleep onset latency (p < 0.001), sleep efficiency (p = 0.03), sleep disturbances (p < 0.001), and daytime dysfunction (p < 0.001) significantly worsened. There was also a significant increase in BMI values in normal weight (p = 0.023), in subjects grade I (p = 0.027) and II obesity (p = 0.020). In all cohort, physical activity was significantly decreased (p = 0.004). However, analyzing the data according gender difference, males significantly decreased physical activity as well as females in which there was only a trend without reaching statistical significance (53.5% vs 25.6%; p = 0.015 and 50.0% vs 35.9%, p = 0.106; in males and females, respectively). In addition, smart working activity resulted in a significant worsening of SQ, particularly in males (p < 0.001).

Conclusions

Quarantine was associated to a worsening of SQ, particularly in males doing smart working, and to an increase in BMI values.

The implementation of a physical activity intervention in adults with Obstructive Sleep Apnoea over the age of 50 years: a feasibility uncontrolled clinical trial

Background

Obstructive Sleep Apnoea (OSA) is a risk factor for cardiovascular disease (CVD) and Type 2 diabetes (T2D). Observational studies suggested that OSA treatment might reduce CVD and T2D but RCTs failed to support these observations in part due to poor adherence to continuous positive airway pressure (CPAP). Physical activity (PA) has been shown to have favourable impact on CVD and the risk of T2D independent of its impact on weight and therefore might provide additional health gains to patients with OSA, whether or not adherent to CPAP.

Methods

The main aim of this study was to explore the feasibility of providing a 12-week PA intervention to adults aged over 50 with OSA. The secondary aim was to assess the impact of the PA intervention on OSA severity. Patients with moderate-severe OSA (apnoea hypopnea index (AHI) ≥ 15 events/hour (based on overnight ApneaLink™) were recruited in response to posters displayed in workplaces. A 12-week daily PA intervention was delivered in participant’s home setting and PA was monitored via text and validated by objective PA measures (GT3X accelerometers).

Results

The intervention was feasible as all 10 patients (8 males, mean (SD) age 57.3 (6.01)) completed the intervention and PA increased across the 12-weeks. The duration of PA increased from baseline (113.1 min (64.69) per week to study-end following the intervention (248.4 min (148.31) (p = 0.02). Perceived Exertion (RPE) (physical effort) increased significantly between baseline (M = 10.7 (1.94)) to end of intervention (M = 13.8, (1.56) (p < 0.001). The intervention had no significant impact on weight or composition. Following the intervention, there was a statistically non-significant a reduction in AHI from baseline to study end (22.3 (7.35) vs. 15.8 (7.48); p = 0.09).

Conclusion

It is feasible to deliver a PA intervention to adults aged over 50 with OSA. The intervention resulted in improved PA and AHI levels somewhat and seemingly independent of weight changes. Future trials need to examine whether PA can reduce the burden of OSA associated comorbidities.

Trial registration

CTN: ISRCTN11016312 Retrospectively Registered 21/07/20.

Sleep Quality in Obesity: Does Adherence to the Mediterranean Diet Matter?

Obesity and unhealthy eating habits have been associated with sleep disturbances (SD). The Mediterranean diet (MD) is a healthy nutritional pattern that has been reported to be associated with better health and sleep quality. Thus, the aim of the study was to investigate whether adherence to the MD is associated with sleep quality in a population of middle-aged Italian adults. This cross-sectional study included 172 middle-aged adults (71.5% females; 51.8 ± 15.7 years) that were consecutively enrolled in a campaign to prevent obesity called the OPERA (Obesity, Programs of Nutrition, Education, Research and Assessment of the best treatment) prevention project that was held in Naples on 11–13 October 2019. Anthropometric parameters, adherence to the MD and sleep quality were studied. Overall, 50.6% of the subjects were good sleepers (the Pittsburgh Sleep Quality Index (PSQI) < 5) while 49.4% were poor sleepers (PSQI ≥ 5). Our results demonstrated that good sleepers, when compared to poor sleepers (p < 0.001) had significantly higher adherence to the MD as assessed by PREDIMED (Prevención con Dieta Mediterránea) score, lower BMI (body mass index) and waist circumference (WC). The higher PSQI, the higher the BMI (p < 0.001) and WC values (p < 0.001), thus suggesting that poor sleep was more common in subjects with obesity. In addition, a negative correlation between PSQI and the PREDIMED score (p < 0.001) was found. to the intake of the cluster of foods enclosed in the MD, rather than the intake of the single food, predicted PSQI. By performing a receiver operator characteristic (ROC) curve analysis, we determined a cut-off value at a PREDIMED score < 9 as the threshold for screening poor sleepers. In conclusion, good sleepers had lower BMI and WC and higher adherence to the MD than poor sleepers. PSQI was positively associated to BMI and WC while it was negatively associated to adherence to the MD. The consumption of the MD dietary pattern rather than the intake of a single nutrient has a beneficial effect on sleep quality. Hence, the assessment of sleep should be taken into account in the management of obesity and promoting adherence to the MD could be a tool to improve SD.

A healthy dietary pattern may be associated with primary insomnia among Iranian adults: A case-control study

Objective: While it has been reported that both foods and nutrients for individuals are connected with sleep, there is no evidence regarding the association of dietary patterns, identified by factor analysis, with primary insomnia. The present study sought to evaluate the association between major dietary patterns and the chance of having primary insomnia. Methods: The present case-control study was performed using 444 people (111 cases and 333 control), aged 18 to 60 years, referred to Isfahan health centers. Dietary intake was assessed via a food frequency questionnaire in a case-control study in Isfahan, Iran. Principal component analysis was used to determine major dietary patterns. The presence of primary insomnia was measured via the insomnia severity index questionnaire, and the subjects were grouped as healthy or insomniac. Results: Three major dietary patterns were recognized, and named; Western, Iranian Traditional and Healthy, respectively. The cumulative percentage of variance explained by three dietary patterns was 48.2%. Those in second (OR = 0.30; 95%CI: 0.2-0.46) and third (OR = 0.22; 95%CI: 0.15-0.35) tertiles of healthy dietary pattern were less likely suffer with insomnia. This association remained significant only in the highest tertile after adjusting potential confounders (OR = 0.45; 95%CI: 0.32-0.95). We found no significant association between greater adherence to Western or Iranian traditional dietary patterns and primary insomnia. Conclusions: The findings showed that although no statistically significant association was observed between both Western and Iranian traditional dietary patterns with primary insomnia, people with greater adherence to the healthy dietary pattern are less likely to have primary insomnia.

Measures of Poor Sleep Quality Are Associated With Higher Energy Intake and Poor Diet Quality in a Diverse Sample of Women From the Go Red for Women Strategically Focused Research Network

Background

Poor sleep increases cardiovascular disease risk, and diet likely contributes to this relationship. However, there are limited epidemiological data on the relationship between measures of sleep quality and habitual dietary patterns. This study examined these associations in a diverse sample of women.

Methods and Results

Baseline data from 495 participants in the AHA Go Red for Women prospective cohort study (age: 20–76 years; 61% racial/ethnic minority) were examined. Sleep quality and sleep‐onset latency were measured using the Pittsburgh Sleep Quality Index (PSQI) and insomnia using the Insomnia Severity Index. The validated Block Brief Food Frequency Questionnaire was used to assess diet quantity and quality. Linear regression models adjusted for confounding variables tested relationships between sleep and diet variables. Results showed that higher PSQI scores, indicative of poorer sleep quality, were associated with lower unsaturated fat intake (β=−0.14, P<0.05) and higher food weight (β=14.9, P=0.02) and added sugars consumed (β=0.44, P=0.04). Women with sleep‐onset latency >60 minutes had higher intakes of food by weight (β=235.2, P<0.01) and energy (β=426, P<0.01), and lower intakes of whole grains (β=−0.37, P=0.01) than women with sleep‐onset latency ≤15 minutes. Greater insomnia severity was associated with higher food weight (β=9.4, P=0.02) and energy (β=17, P=0.01) consumed and lower total (β=−0.15, P=0.01) and unsaturated fat intakes (β=−0.11, P<0.01).

Conclusions

Poor sleep quality was associated with greater food intake and lower‐quality diet, which can increase cardiovascular disease risk. Future studies should test whether promoting sleep quality could augment efforts to improve cardiometabolic health in women.

High glycemic index and glycemic load diets as risk factors for insomnia: analyses from the Women's Health Initiative

BACKGROUND

Previous studies have shown mixed results on the association between carbohydrate intake and insomnia. However, any influence that refined carbohydrates have on risk of insomnia is likely commensurate with their relative contribution to the overall diet, so studies are needed that measure overall dietary glycemic index (GI), glycemic load, and intakes of specific types of carbohydrates.

OBJECTIVE

We hypothesized that higher GI and glycemic load would be associated with greater odds of insomnia prevalence and incidence.

METHODS

This was a prospective cohort study with postmenopausal women who participated in the Women's Health Initiative Observational Study, investigating the relations of GI, glycemic load, other carbohydrate measures (added sugars, starch, total carbohydrate), dietary fiber, and specific carbohydrate-containing foods (whole grains, nonwhole/refined grains, nonjuice fruits, vegetables, dairy products) with odds of insomnia at baseline (between 1994 and 1998; n = 77,860) and after 3 y of follow-up (between 1997 and 2001; n = 53,069).

RESULTS

In cross-sectional and longitudinal analyses, higher dietary GI was associated with increasing odds of prevalent (fifth compared with first quintile OR: 1.11; CI: 1.05, 1.16; P-trend = 0.0014) and incident (fifth compared with first quintile OR: 1.16; CI: 1.08, 1.25; P-trend < 0.0001) insomnia in fully adjusted models. Higher intakes of dietary added sugars, starch, and nonwhole/refined grains were each associated with higher odds of incident insomnia. By contrast, higher nonjuice fruit and vegetable intakes were significantly associated with lower odds of incident insomnia. Also, higher intakes of dietary fiber, whole grains, nonjuice fruit, and vegetables were significantly associated with lower odds of prevalent insomnia.

CONCLUSIONS

The results suggest that high-GI diets could be a risk factor for insomnia in postmenopausal women. Substitution of high-GI foods with minimally processed, whole, fiber-rich carbohydrates should be evaluated as potential treatments of, and primary preventive measures for, insomnia in postmenopausal women.

Dietary fatty acids promote sleep through a taste-independent mechanism

Consumption of foods that are high in fat contribute to obesity and metabolism-related disorders. Dietary lipids are comprised of triglycerides and fatty acids, and the highly palatable taste of dietary fatty acids promotes food consumption, activates reward centers in mammals and underlies hedonic feeding. Despite the central role of dietary fats in the regulation of food intake and the etiology of metabolic diseases, little is known about how fat consumption regulates sleep. The fruit fly, Drosophila melanogaster, provides a powerful model system for the study of sleep and metabolic traits, and flies potently regulate sleep in accordance with food availability. To investigate the effects of dietary fats on sleep regulation, we have supplemented fatty acids into the diet of Drosophila and measured their effects on sleep and activity. We found that flies fed a diet of hexanoic acid, a medium-chain fatty acid that is a by-product of yeast fermentation, slept more than flies starved on an agar diet. To assess whether dietary fatty acids regulate sleep through the taste system, we assessed sleep in flies with a mutation in the hexanoic acid receptor Ionotropic receptor 56D, which is required for fatty acid taste perception. We found that these flies also sleep more than agar-fed flies when fed a hexanoic acid diet, suggesting the sleep promoting effect of hexanoic acid is not dependent on sensory perception. Taken together, these findings provide a platform to investigate the molecular and neural basis for fatty acid-dependent modulation of sleep.

Association between Macronutrient Intake and Excessive Daytime Sleepiness: An Iso-Caloric Substitution Analysis from the North West Adelaide Health Study

Epidemiological evidence on the association between macronutrient intake and excessive daytime sleepiness (EDS) is scarce. Using data from the North West Adelaide Health Study, we aimed to determine the association between iso-caloric substitution of macronutrients and EDS. Data from 1997 adults aged ≥ 24 years were analyzed. Daytime sleepiness was measured using the Epworth Sleepiness Scale, a score ≥ 11 was considered EDS. Dietary intake data were collected using a food frequency questionnaire. We determined absolute and relative energy intake based on consumption of saturated and unsaturated fats, protein, and carbohydrate. Odds ratios (ORs) were used to determine the associations using log-binomial logistic regression with and without iso-caloric substitution methods, and models were adjusted for confounders. The prevalence of EDS in the sample was 10.6%. After adjusting for potential confounders, substituting 5% energy intake from protein with an equal amount of saturated fat (OR = 1.57; 95% CI: 1.00–2.45) and carbohydrate (OR = 1.23; 95% CI: 0.92–1.65) increased the odds of EDS. When carbohydrate was substituted with saturated fat (OR = 1.27; 95% CI: 0.93–1.59), the odds of EDS were increased. The odds of EDS were lower when saturated fat was substituted with unsaturated fat (OR = 0.74; 95% CI: 0.51–1.06), protein (OR = 0.63; 95% CI: 0.41–0.99) or carbohydrate (OR = 0.79; 95% CI: 0.57–1.08). While these results were consistent over different iso-caloric substitution methods, inconsistent results were found with standard regression. While substitution of fat and carbohydrate with protein was inversely associated with EDS, substitution of protein with fat and carbohydrate was positively associated with EDS. Randomized trials are needed to confirm if dietary interventions can be used to improve daytime alertness in those with EDS.

Undiagnosed Obstructive Sleep Apnea and Physical Activity in Older Manual Workers

Cardiovascular disease is a negative health outcome of obstructive sleep apnea (OSA). Risk factors associated with OSA development include low physical activity (PA), high body mass index (BMI), and increasing age (>50 years), and weight loss is usually recommended as treatment. This cross-sectional study examined the association between PA, BMI, and OSA severity in manual workers. Fifty-five participants (23 females and 32 males; mean age 55.2 years), were examined for OSA and completed a PA and anthropometric assessment. On average, OSA severity was mild, PA levels were moderate, and 32% of the sample was classified as obese. PA was negatively associated with OSA severity, but BMI strongly independently predicted OSA severity, with no evidence of mediation. As both PA and BMI were significantly associated with OSA in older manual workers, increasing PA should also be a focus of treatment for OSA.

The Associations between Dietary Patterns and Short Sleep Duration in Polish Adults (LifeStyle Study)

Short sleep duration appears to put adults at risk of excessive energy intake and obesity; less is known specifically about how sleep quantity relates to dietary patterns. Therefore, the aim of this study was to assess the associations of dietary patterns (DPs) with short sleep duration. The data were collected in November 2016 through a cross-sectional quantitative survey among 972 Polish adults with both normal weight and excessive weight. Principal components analysis (PCA) was conducted to derive DPs. Logistic regression analysis was used to verify associations between short sleep duration (independent variable) and DPs (dependent variables). Five DPs ('Fast foods & sweets'-FF&S; 'Meat & meat products'-M&MP; 'Fruit & vegetable'-F&V; 'Wholemeal food'-WF; and 'Fruit & vegetable juices'-F&VJ) were identified. Adults whose diet was based both on fruit and vegetables (OR 0.62, 95% CI: 0.44⁻0.88; p < 0.01) and on fast food and sweets (OR 0.63, 95% CI: 0.44⁻0.99; p < 0.01) were less likely to be short sleepers on weekdays. On weekdays short sleep duration was associated with smaller odds of FF&S both for men (OR 0.58, 95% CI: 0.33⁻0.97; p < 0.05) and for women (OR 0.61, 95% CI: 0.38⁻0.98; p < 0.05), and with smaller odds of F&V (OR 0.34, 95% CI: 0.20⁻0.58; p < 0.001) for men. Short sleep duration on weekend days was associated with a smaller odds of F&VJ (OR 0.56, 95% CI: 0.30⁻0.96; p < 0.05- only in crude model) and higher odds of F&V (OR 1.70, 95% CI: 1.02⁻3.11; p < 0.05) for women, and with a smaller odds of FF&S (OR 0.37, 95% CI: 0.17⁻0.79; p < 0.05) for men. The number of significant associations between dietary patterns and sleep duration was higher among people with normal weight and overweight compared to those with BMI ≥ 30. We found that both short sleep duration on weekdays and weekend days was associated with some dietary patterns including both healthy and unhealthy DPs. Gender significantly differed these relationships in groups with normal and excessive weight. Findings of the study confirmed the potential effectiveness of combined use of sleep duration and dietary patterns in the development of recommendations for prevention of obesity. Future studies are called for to evaluate these links using dietary patterns identified according to food intake.

Understanding the Positive Associations of Sleep, Physical Activity, Fruit and Vegetable Intake as Predictors of Quality of Life and Subjective Health Across Age Groups: A Theory Based, Cross-Sectional Web-Based Study

Background: Due to the increase in unhealthy lifestyles and associated health risks, the promotion of healthy lifestyles to improve the prevention of non-communicable diseases is imperative. Thus, research aiming to identify strategies to modify health behaviors has been encouraged. Little is known about addressing multiple health behaviors across age groups (i.e., young, middle-aged, and older adults) and the underlying mechanisms. The theoretical framework of this study is Compensatory Carry-Over Action Model which postulates that different health behaviors (i.e., physical activity and fruit and vegetable intake) are interrelated, and they are driven by underlying mechanisms (more details in the main text). Additionally, restful sleep as one of the main indicators of good sleep quality has been suggested as a mechanism that relates to other health behaviors and well-being, and should therefore also be investigated within this study. The present study aims to identify the interrelations of restful sleep, physical activity, fruit and vegetable intake, and their associations with sleep quality as well as overall quality of life and subjective health in different age groups.

Methods: A web-based cross-sectional study was conducted in Germany and the Netherlands. 790 participants aged 20–85 years filled in the web-based baseline questionnaire about their restful sleep, physical activity, fruit and vegetable intake, sleep quality, quality of life, and subjective health. Descriptive analysis, multivariate analysis of covariance, path analysis, and multi-group analysis were conducted.

Results: Restful sleep, physical activity, and fruit and vegetable intake were associated with increased sleep quality, which in turn was associated with increased overall quality of life and subjective health. The path analysis model fitted the data well, and there were age-group differences regarding multiple health behaviors and sleep quality, quality of life, and subjective health. Compared to young and older adults, middle-aged adults showed poorest sleep quality and overall quality of life and subjective health, which were associated with less engagement in multiple health behaviors.

Conclusion: A better understanding of age-group differences in clustering of health behaviors may set the stage for designing effective customized age-specific interventions to improve health and well-being in general and clinical settings.

Trial Registration: A clinical trial registration was conducted with ClinicalTrials.gov (NCT01909349) https://clinicaltrials.gov/ct2/show/NCT01909349.

What You Eat Could Affect Your Sleep: Dietary Findings in Patients With Newly Diagnosed Obstructive Sleep Apnea

Rationale. We hypothesized that certain dietary components such as increased fat intake are associated with severity of obstructive sleep apnea (OSA). Methods. A total of 104 patients, diagnosed with OSA completed a validated dietary survey. The apnea-hypopnea index (AHI) was used to measure the severity of OSA. Subjects were divided using body mass index (BMI) into obese and overweight categories. Regression analysis was performed to predict severity of OSA from gender, BMI, age, % energy from fat, and the individual dietary components of the survey. Results. Overweight subjects who ate a diet high in fat (>35% of their total diet) had twice the severity of sleep apnea (AHI 18.2 ± 10.1 vs 36.6 ± 27.5; P = .001). There was a strong trend (P = .056) in OSA severity between subjects eating processed meats "often" (AHI 42.5 ± 30.7) versus those eating "rarely/never" (AHI 28.9 ± 22.7). Eating greater than 2 servings of dairy daily was associated with worsening severity of OSA (AHI 26.2 ± 15.6 vs 39.7 ± 31; P = .04]. Conclusions. Dietary components such as fat intake and processed meats were associated with increased risk of OSA severity. In addition, 2 servings of dairy foods were associated with a decreased severity of OSA at presentation.

Insomnia symptoms and sleep duration and their combined effects in relation to associations with obesity and central obesity

OBJECTIVE

Previous studies have shown that both sleep duration and insomnia have an impact on obesity and central obesity. However, studies of the joint effects of these sleep disorders are still sparse.

METHODS

The present study utilized data from the Swedish EpiHealth cohort study. Participants (45-78 y) were asked to fill out an internet-based questionnaire. Body mass index (BMI) and central obesity (calculated from waist circumference) were based on measured data.

RESULTS

A total of 18,823 participants (mean age = 60 ys) were included in this study. The reported prevalence of short (<6 h/night) and long (>9 h/night) sleep duration was 8% and 4% respectively, and insomnia symptoms was 19%. Of the study population, 16% were obese (BMI ≥ 30 kg/m²) and 40% had central obesity. There was a U-shaped association between sleep duration and obesity and central obesity, and significant associations between insomnia symptoms and obesity. When stratifying sleep duration by concurrent insomnia symptoms, there were associations (odds ratios, (95% confidence intervals)) between the combination of both short (1.48, (1.22-1.80)) and long sleep duration (1.77 (1.00-3.16)) with insomnia symptoms and obesity and central obesity (1.36 (1.16-1.61) and 2.44 (1.41-3.24) respectively). However, there was no significant association between insomnia symptoms and obesity or central obesity in participants with normal sleep duration. For central obesity there was an association with long sleep duration regardless of insomnia symptoms, while the association with short sleep duration was significant only if insomnia symptoms were present.

CONCLUSIONS

Both short and long sleep duration, as well as insomnia symptoms, are associated with obesity and central obesity. There is an important joint effect of sleep duration and insomnia symptoms and there is no association between insomnia symptoms and obesity, as long as a normal sleeping time can be attained. This indicates that sleep duration rather than insomnia symptoms per se is of importance for the relationship between sleep and obesity.

Sleep and Obesity

Rising global prevalence and incidence of obesity lead to increased cardiovascular-renal complications and cancers. Epidemiological studies reported a worldwide trend towards suboptimal sleep duration and poor sleep quality in parallel with this obesity epidemic. From rodents and human models, it is highly plausible that abnormalities in sleep, both quantity and quality, impact negatively on energy metabolism. While excess dietary intake and physical inactivity are the known drivers of the obesity epidemic, promotion of healthy sleep habits has emerged as a new target to combat obesity. In this light, present review focuses on the existing literature examining the relationship between sleep physiology and energy homeostasis. Notably, sleep dysregulation perturbs the metabolic milieu via alterations in hormones such as leptin and ghrelin, eating behavior, neuroendocrine and autonomic nervous systems. In addition, shift work and trans-meridian air travel may exert a negative influence on the hypothalamic-pituitary-adrenal axis and trigger circadian misalignment, leading to impaired glucose tolerance and increased fat accumulation. Amassing evidence has also suggested that uncoupling of the circadian clock can increase the risk of adverse metabolic health. Given the importance of sleep in maintaining energy homeostasis and that it is potentially modifiable, promoting good sleep hygiene may create new avenues for obesity prevention and treatment.

Association between Erythrocyte Membrane Phospholipid Fatty Acids and Sleep Disturbance in Chinese Children and Adolescents

The relationship between circulating fatty acid (FA) composition and childhood sleep disturbance remains largely unclear. We aimed to investigate the association of erythrocyte membrane FA composition with prevalence of sleep disturbance in Chinese children and adolescents. A cross-sectional survey was conducted among 2337 school-aged children and adolescents who completed a clinical assessment in Beijing, China. Presence of sleep disturbance was self-reported or parent-reported by questionnaires. Erythrocyte FAs were measured by gas chromatography, and desaturase activities were estimated by FA ratios. Multivariable-adjusted odds ratios (ORs) and 95% confidence intervals (CIs) for sleep disturbance across FA quartiles were calculated by a logistical regression model. We found higher proportions of erythrocyte phospholipid 24:0, 24:1n-9, and lower proportions of total n-3 polyunsaturated FA (PUFA), 22:5n-3 and 22:6n-3 in participants with sleep disturbance compared with those without. In the logistical regression models, significant inverse associations were found for total n-3 PUFA, 22:5n-3 and 22:6n-3, the highest versus lowest quartile ORs and 95% CIs were 0.57 (0.40, 0.82), 0.67 (0.47, 0.97) and 0.69 (0.49, 0.96), respectively. For per 1 SD difference of proportion, OR and 95% CI of prevalence of sleep disturbance was 0.91 (0.86, 0.97) for total n-3 PUFA, 0.90 (0.82, 0.98) for 22:5n-3, and 0.92 (0.86, 0.99) for 22:6n-3, respectively. No significant association was found for saturated fatty acids, monounsaturated fatty acids, n-6 polyunsaturated fatty acids or FA ratios. The present study suggested that erythrocyte n-3 PUFAs, especially 22:5n-3 and 22:6n-3, are inversely associated with prevalence of sleep disturbance in Chinese children and adolescents.