behaviour Teresa Arora BSc (Hons) MSc PhD CPsychol AFBPsS Zayed - PowerPoint PPT Presentation

The association between sleep and feeding behaviour Teresa Arora BSc (Hons) MSc PhD CPsychol AFBPsS Zayed University Abu Dhabi Email: Teresa.Arora@zu.ac.ae

Global prevalence of obesity Consequences & causes of obesity Introduction to sleep Overview Scientific evidence linking sleep and obesity Mechanisms Scientific evidence surrounding sleep and feeding Summary

https://ourworldindata.org/obesity

Consequences of obesity • Individual & family • Psychological • Physiological • Societal • Employers • Healthcare systems • What are the causes ?

Energy Balance Equation Causes Energy Energy Intake Expenditure “It’s Easy” Medications and Surgery - consequences

Energy Balance Equation Energy Energy Intake Expenditure “It’s Easy” Medications and Surgery WHERE DOES SLEEP FIT IN TO THIS?

Energy Balance Equation SLEEP Energy Energy Intake Expenditure “It’s Easy” Medications and Surgery WHERE DOES SLEEP FIT IN TO THIS?

Is sleep really important? ➢ One third (adulthood); half (childhood) ➢ Behaviour - all species/organisms ➢ Cannot resist urge to sleep ➢ Complex physiological process ➢ Why do we need it?

The 90-minute Sleep Cycle 1 : wake-sleep, rolling eyes (alpha waves) REM Stage1 2 : light sleep, easily woken (20-25 mins) (5-10 mins) 3 : deep sleep (SWS), muscles relax, breathing slows, confused if woken (delta waves) REM : brain activity, dreaming, Stage 3 Stage 2 paralysis, faster breathing, (45 mins) (15 mins) higher BP

Obesity Trends Among U.S. Adults 1990 1995 2005 No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

Is Is it ju just a coincidence?

Consequences of sleep deprivation

Where’s the evidence? • 1992 first study to link sleep-obesity • More than 500 published articles in 2011 • Currently >800 published studies • Cross-sectional evidence • Longitudinal evidence • Experimental evidence • Systematic reviews and meta-analyses • Objective and subjective measures

Early longitudinal evidence (children) 1.6 * p<0.01 * 1.4 1.2 ref 1 re 0.8 Odds ratio 0.6 0.4 0.2 0 <10.5 10.5-10.9 11-11.9 >12 Sleep duration (hours) Reilly JJ, Armstrong J, Dorosty AR et al. Early life risk factors for obesity in childhood: cohort study. BMJ 2005; 330 :1357.

Sleep-obesity • Midlands Adolescent Schools Sleep Education Study (MASSES) • Aged 11-18 years, n=624 • Weekday sleep duration (hours) was negatively associated with body mass index

Sleep, BMI and mortality Kripke et al (2002)

Meta-analysis of sleep-obesity (adults) Cappuccio et al. (2008)

Meta-analysis of sleep-obesity (children) Cappuccio et al. (2008)

Sle leep duratio ion is is a predic ictor of f in incid ident dia iabetes • Meta analysis – Shan et al (2015) • Prospective studies only • Pubmed & EMBASE • 10 articles included • 482,502 participants • 18,443 incident cases (3.8%) • Follow up period 2.5 – 16 years (median 7.5y)

The relationship between sleep duration and risk of type 2 diabetes Pooled RR= 1.09 (1.04-1.15) for each 1-h <7h Pooled RR=1.14 (1.03-1.26) for each 1h >7h If you sleep too much or not enough then you increase your risk of developing diabetes Zhilei Shan et al. Diabetes Care 2015;38:529-537

What are the mechanisms? • Evidence for sleep-obesity link • Prospective studies show consistent sleep impairment causes weight gain • How does this happen?

Appetite regulating hormones Hypothalamus Food Intake & Energy Ghrelin Metabolism Leptin Pituitary Ghrelin Adipose Ghrelin Tissue Leptin is positively correlated with adipose tissue and signals satiety Stomach Obese patients are leptin resistant - eat more Ghrelin indicates hunger To maintain energy balance, leptin should be high and ghrelin should be low

All employees (aged 30-60 years) Polysomnography: of four state agencies in south central 1. Total sleep time (TST) Wisconsin sent mailed survey 2. Sleep efficiency Stratified random sample 3. Wake after sleep onset (n= 2,917) (WASO) Questionnaire: Overnight sleep study protocol (n= 1,488, 51% response rate) Usual sleep Serum: Morning fasted blood sample added to Hormones protocol in 1995 (n= 1,024) and metabolites Sleep Diary: 1. Average nightly sleep Sleep diary added to 2. Average nightly sleep plus naps protocol in 1995 (n=721) Sample Data Collected Taheri S , Lin L, Austin D, Young T, Mignot E. Short Sleep Duration Is Associated with Reduced Leptin, Elevated Ghrelin, and Increased Body Mass Index. PLoS Med. 2004;1(3):e62.

Results from Wisconsin Sleep Cohort Study

Spiegel, K. et. al. Ann Intern Med 2004;141:846-850

Pil ilot data on chronic sle leep reduction/extension • Randomised to 30/60 minute condition (n=5) • 4 weeks baseline • 4 weeks sleep restriction • 4 weeks ‘wash out’ • 4 weeks sleep extension • Food intake measured

Cake consumption Difference in cake consumption across 3 time-points 140 120 100 80 Visit 3 Grams Visit 4 60 Visit 6 40 20 0 1001 1004 1006 1002 1005 Volunteer

Experimental evidence – sle leep and feeding • Randomised study • Habitual sleep duration (8 nights) vs 2/3 habitual sleep duration (8 nights) • SR group consumed +566 kcal/day (p=0.011) • Sleep restriction not compensated with increased energy expenditure, p=0.62 • How much weight could be gained with +566 kcal/day accountable for sleeping less? Calvin et al Effects of Experimental Sleep Restriction on Caloric Intake and Activity Energy Expenditure. Chest (2013)

100 kcals is:

100 kcals is: 1 chocolate biscuit ½ cup of milk 25g cheddar cheese 1 scoop of ice cream

100 kcals more than your body requires each day will result in: 100 kcals is: 1 chocolate biscuit ½ cup of milk 25g cheddar cheese 1 scoop of ice cream

100 kcals more than your body requires each day will result in: 5kg (11.5lbs) weight gain per year 25kg (4 stone) weight gain over 5 100kcals is: years 1 chocolate biscuit ½ cup of milk 25g cheddar cheese 1 scoop of ice cream

Reduced Tiredness Activity Low Leptin • Hunger • Food Selection Sleep OBESITY High Ghrelin • Energy Loss Expenditure Other Hormones Increased Opportunity Energy Dense to Eat Food Intake

Epworth Sleepiness Scale • Use the following scale to choose the most appropriate number for each situation: • 0 = no chance of dozing; 1 = slight chance of dozing; 2 = moderate chance of dozing; 3 = high chance of dozing • • SITUATION - CHANCE OF DOZING • 1. Sitting and reading • 2. Watching TV • 3. Sitting inactive in a public place (e.g. a theatre, or a meeting) • 4. As a passenger in a car for an hour without a break • 5. Lying down to rest in the afternoon when circumstances permit • 6. Sitting and talking to someone • 7. Sitting quietly after a lunch • 8. In a car, while stopped for a few minutes in traffic

Sleep hygiene education • Avoid eating large or spicy meals late at night • Avoid intense exercise 2-3 h before bed • Avoid caffeine after midday • Bath vs shower • Limit bed for sleeping only • Bedroom temperature • No electronics in bedroom • Consistent bedtime routine • Consistent sleep-wake timings • Lighting in bedroom (dark room) • Lavender scent • Avoid conflict, alcohol & smoking before bedtime • Keep notepad next to bed • Keep a sleep diary • Daytime light exposure

Summary ry • Global obesity is becoming more prevalent • Old view focuses on energy balance equation • Sleep is a third factor which needs to be assessed and addressed • Sleep is unequivocally linked to obesity and type 2 diabetes • Sleep impacts feeding behaviour resulting in excessive energy intake • Sleep also alters appetite regulating hormones • Patients should be asked about their sleep • Telling someone to sleep more is easier for them vs dieting and exercise • Sleep hygiene education can be given as a minimum to help • Sleep is your super power