Highlights
- •Obesity and sleep disturbances are linked by a bi-directional causal-effect relation.
- •Sleep disturbances increase the risk of obesity and metabolic syndrome.
- •Obesity is a risk factor for several sleep disorders (such as Obstructive Sleep Apnea).
- •It is mandatory to investigate possible sleep disorders in obese patients.
Abstract
Obesity and sleep disturbances are common conditions in modern societies and accumulating
evidence support a close bidirectional causal relationship between these two conditions.
Indeed, from one side sleep loss seems to affect energy intake and expenditure through
its direct effects on hormone-mediated sensations of satiety and hunger and through
the influence on hedonic and psychological aspects of food consumption. Sleep deprived
patients have been shown to experiment excessive daytime sleepiness, fatigue, and
tiredness that, in a vicious circle, enhances physical inactivity and weight gain.
On the other side, obesity is a well-known risk factor for several sleep disorders.
This narrative review will discuss the main pathophysiological mechanisms that link
sleep loss to obesity and metabolic syndrome with particular attention to the three
most common sleep disorders (insomnia, obstructive sleep apnoea syndrome, restless
leg syndrome).
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References
- Obesity collaborators (2017) health effects of overweight and obesity in 195 countries over 25 years.N Engl J Med. 2015; 377: 13-27https://doi.org/10.1056/nejmoa1614362
- Prevalence of sleep disturbances: sleep disordered breathing, short sleep duration, and non-restorative sleep.Respir Investig. 2019; 57: 227-237https://doi.org/10.1016/j.resinv.2019.01.008
- Chronic sleep deprivation and seasonality: implications for the obesity epidemic.J Endocrinol Invest. 2011; 34: 793-800https://doi.org/10.3275/7808
- Examining the pathways linking chronic sleep restriction to obesity.J Obes. 2010; (2010)https://doi.org/10.1155/2010/821710
- Obesity, sleep apnea, and hypertension.Hypertension. 2003; 42: 1067-1074
- Restless legs syndrome and poor sleep quality in obese children and adolescents.J Clin Res Pediatr Endocrinol. 2018; 10: 131-138https://doi.org/10.4274/jcrpe.5165
- Night shift work, short sleep and obesity.Diabetol Metab Syndr. 2020; 12: 13https://doi.org/10.1186/s13098-020-0524-9
- Short sleep duration and cardiometabolic risk: from pathophysiology to clinical evidence.Nat Rev Cardiol. 2019; 16: 213-224https://doi.org/10.1038/s41569-018-0109-6
- Obesity: global epidemiology and pathogenesis.Nat Rev Endocrinol. 2019; 15: 288-298https://doi.org/10.1038/s41574-019-0176-8
- Sleep duration and the heart: I sleep, therefore I beat.J. Am. Coll. Cardiol. 2019; 74: 1315-1316
- The AASM manual for the scoring of sleep and associated events: rules, terminology and technical specifications.American Academy of Sleep Medicine, Darien, IL2020 (version 2.6, www.aasmnet.org2020)
- Recommended amount of sleep for a healthy adult: a joint consensus statement of the American Academy of Sleep Medicine and Sleep Research Society.J Clin Sleep Med. 2015; 11: 931-952
- Prevalence of healthy sleep duration among adults — United States, 2014.MMWR Morb Mortal Wkly Rep. 2016; 65: 137-141https://doi.org/10.15585/mmwr.mm6506a1
- Problems associated with short sleep: bridging the gap between laboratory and epidemiological studies.Sleep Med Rev. 2010; 14: 239-247https://doi.org/10.1016/j.smrv.2009.08.001
- Sleep deprivation and activation of morning levels of cellular and genomic markers of inflammation.Arch Intern Med. 2006; 166: 1756-1762https://doi.org/10.1001/archinte.166.16.1756
- Effect of acute sleep deprivation on vascular function in healthy subjects.J Appl Physiol. 2010; 108: 68-75https://doi.org/10.1152/japplphysiol.00851.2009
- National Sleep Foundation's updated sleep duration recommendations: final report.Sleep Heal. 2015; 1: 233-243https://doi.org/10.1016/j.sleh.2015.10.004
- Effect of shift work on body mass index: results of a study performed in 319 glucose-tolerant men working in a Southern Italian industry.Int J Obes Relat Metab Disord J Int Assoc Study Obes. 2003; 27: 1353-1358https://doi.org/10.1038/sj.ijo.0802419
- Metabolic syndrome and shift work: a systematic review.Sleep Med Rev. 2013; 17: 425-431https://doi.org/10.1016/j.smrv.2012.10.004
- One night on-call: sleep deprivation affects cardiac autonomic control and inflammation in physicians.Eur J Intern Med. 2013; 24: 664-670https://doi.org/10.1016/j.ejim.2013.03.011
- Is sleep duration related to obesity? A critical review of the epidemiological evidence.Sleep Med Rev. 2008; 12: 289-298https://doi.org/10.1016/j.smrv.2008.03.001
- Sleep, sleep deprivation, autonomic nervous system and cardiovascular diseases.Neurosci Biobehav Rev. 2017; 74: 321-329https://doi.org/10.1016/j.neubiorev.2016.07.004
- Vascular response to 1 week of sleep restriction in healthy subjects. A metabolic response?.Int J Cardiol. 2015; 190: 246-255https://doi.org/10.1016/j.ijcard.2015.04.119
- Roles of gender, age, race/ethnicity, and residential socioeconomics in obstructive sleep apnea syndromes.Curr Opin Pulm Med. 2012; 18: 568-573https://doi.org/10.1097/MCP.0b013e328358be05
- Longitudinal study of moderate weight change and sleep-disordered breathing.JAMA. 2000; 284: 3015-3021https://doi.org/10.1001/jama.284.23.3015
- A controlled study of sleep related disordered breathing in obese children.Arch Dis Child. 2003; 88: 1043-1047https://doi.org/10.1136/adc.88.12.1043
- Primary Aldosteronism and obstructive sleep apnea: casual association or pathophysiological link?.Horm Metab Res = Horm und Stoffwechselforsch = Horm Metab. 2020; 52: 366-372https://doi.org/10.1055/a-1133-7255
- Abnormal vasoactive hormones and 24-hour blood pressure in obstructive sleep apnea.Am J Hypertens. 2003; 16: 274-280https://doi.org/10.1016/s0895-7061(02)03267-3
- The renin-angiotensin system in obesity hypertension.J Renin Angiotensin Aldosterone Syst. 2001; 2: S114-S119https://doi.org/10.1177/14703203010020012001
- Sleep and obesity: a focus on animal models.Neurosci Biobehav Rev. 2012; 36: 1015-1029https://doi.org/10.1016/j.neubiorev.2012.01.001
- The effects of leptin on REM sleep and slow wave delta in rats are reversed by food deprivation.J Sleep Res. 1999; 8: 197-203https://doi.org/10.1046/j.1365-2869.1999.00158.x
- The sleep disorder canine narcolepsy is caused by a mutation in the hypocretin (orexin) receptor 2 gene.Cell. 1999; 98: 365-376https://doi.org/10.1016/s0092-8674(00)81965-0
- Enhanced orexin receptor-2 signaling prevents diet-induced obesity and improves leptin sensitivity.Cell Metab. 2009; 9: 64-76https://doi.org/10.1016/j.cmet.2008.10.010
- Beneficial effects of regular exercise on sleep in old F344 rats.Neurobiol Aging. 2006; 27: 1859-1869https://doi.org/10.1016/j.neurobiolaging.2005.10.009
- The effects of partial sleep deprivation on energy balance: a systematic review and meta-analysis.Eur J Clin Nutr. 2017; 71: 614-624https://doi.org/10.1038/ejcn.2016.201
- Effects of recombinant leptin therapy in a child with congenital leptin deficiency.N Engl J Med. 1999; 341: 879-884https://doi.org/10.1056/NEJM199909163411204
- Sleep deprivation selectively upregulates an amygdala-hypothalamic circuit involved in food reward.J Neurosci. 2019; 39: 888-899https://doi.org/10.1523/JNEUROSCI.0250-18.2018
- Adult obstructive sleep apnoea.Lancet (London, England). 2014; 383: 736-747https://doi.org/10.1016/S0140-6736(13)60734-5
- Risk factors for obstructive sleep apnea in adults.JAMA. 2004; 291: 2013-2016https://doi.org/10.1001/jama.291.16.2013
- Obstructive sleep apnoea.Lancet (London, England). 2002; 360: 237-245https://doi.org/10.1016/S0140-6736(02)09464-3
- Visceral fat accumulation as an important risk factor for obstructive sleep apnoea syndrome in obese subjects.J Intern Med. 1997; 241: 11-18https://doi.org/10.1046/j.1365-2796.1997.63889000.x
- Obesity and obstructive sleep apnea: pathogenic mechanisms and therapeutic approaches.Proc. Am. Thorac. Soc. 2008; 5: 185-192
- Relationship between body mass index, age and upper airway measurements in snorers and sleep apnoea patients.Eur Respir J. 1996; 9: 1801-1809https://doi.org/10.1183/09031936.96.09091801
- Obesity and upper airway control during sleep.J Appl Physiol. 2010; 108: 430-435https://doi.org/10.1152/japplphysiol.00919.2009
- Obesity and obstructive sleep apnoea: mechanisms for increased collapsibility of the passive pharyngeal airway.Respirology. 2012; 17: 32-42https://doi.org/10.1111/j.1440-1843.2011.02093.x
- Role of leptin in obstructive sleep apnea.Ann Am Thorac Soc. 2017; 14: 1607-1621https://doi.org/10.1513/AnnalsATS.201702-181FR
- Effects of sleep restriction on metabolism-related parameters in healthy adults: a comprehensive review and meta-analysis of randomized controlled trials.Sleep Med Rev. 2019; 45: 18-30https://doi.org/10.1016/j.smrv.2019.02.002
- Obstructive sleep apnea is independently associated with insulin resistance.Am J Respir Crit Care Med. 2002; 165: 670-676https://doi.org/10.1164/ajrccm.165.5.2103001
- Effects of obstructive sleep apnea on circulating ICAM-1, IL-8, and MCP-1.J Appl Physiol. 2003; 94: 179-184https://doi.org/10.1152/japplphysiol.00177.2002
- Obstructive sleep apnoea and its therapy influence high-density lipoprotein cholesterol serum levels.Eur Respir J. 2006; 27: 121-127https://doi.org/10.1183/09031936.06.00131304
- Effectiveness of primary care–relevant treatments for obesity in adults: a systematic evidence review for the U.S. Preventive Services Task Force.Ann Intern Med. 2011; 155: 434https://doi.org/10.7326/0003-4819-155-7-201110040-00006
- Effectiveness of lifestyle interventions on obstructive sleep apnea (OSA): systematic review and meta-analysis.Sleep. 2013; 36: 1553-1562
- Surgical vs conventional therapy for weight loss treatment of obstructive sleep apnea: a randomized controlled trial.JAMA. 2012; 308: 1142-1149https://doi.org/10.1001/2012.jama.11580
- Treatment of adult obstructive sleep apnea with positive airway pressure: an American academy of sleep medicine systematic review, meta-analysis, and GRADE assessment.J. Clin. Sleep Med. 2019; 15: 301-334
- Effects of continuous positive airway pressure on fatigue and sleepiness in patients with obstructive sleep apnea: data from a randomized controlled trial.Sleep. 2011; 34: 121-126https://doi.org/10.1093/sleep/34.1.121
- European guideline for the diagnosis and treatment of insomnia.J Sleep Res. 2017; 26: 675-700https://doi.org/10.1111/jsr.12594
- Meta-analysis of short sleep duration and obesity in children and adults.Sleep. 2008; 31: 619-626https://doi.org/10.1093/sleep/31.5.619
- Sleep duration and obesity among adults: a meta-analysis of prospective studies.Sleep Med. 2014; 15: 1456-1462https://doi.org/10.1016/j.sleep.2014.07.018
- A meta-analysis of associations between obesity and insomnia diagnosis and symptoms.Sleep Med Rev. 2018; 40: 170-182https://doi.org/10.1016/j.smrv.2017.12.004
- Risk factors for incident chronic insomnia: a general population prospective study.Sleep Med. 2012; 13: 346-353https://doi.org/10.1016/j.sleep.2011.10.033
- The effects of sleep extension on cardiometabolic risk factors: a systematic review.J Sleep Res. 2019; 28: e12865https://doi.org/10.1111/jsr.12865
- Prevalence and correlates of restless legs syndrome: results from the 2005 National Sleep Foundation Poll.Chest. 2006; 129: 76-80https://doi.org/10.1378/chest.129.1.76
- Restless legs syndrome/Willis-Ekbom disease diagnostic criteria: updated International Restless Legs Syndrome Study Group (IRLSSG) consensus criteria–history, rationale, description, and significance.Sleep Med. 2014; 15: 860-873https://doi.org/10.1016/j.sleep.2014.03.025
- The association between obesity and restless legs syndrome: a systemic review and meta-analysis of observational studies.J Affect Disord. 2018; 235: 384-391https://doi.org/10.1016/j.jad.2018.04.042
- Prospective study of obesity, hypertension, high cholesterol, and risk of restless legs syndrome.Mov Disord. 2014; 29: 1044-1052https://doi.org/10.1002/mds.25860
- Restless legs syndrome: diagnostic criteria, special considerations, and epidemiology. A report from the restless legs syndrome diagnosis and epidemiology workshop at the National Institutes of Health.Sleep Med. 2003; 4: 101-119https://doi.org/10.1016/s1389-9457(03)00010-8
- Brain dopamine and obesity.Lancet (London, England). 2001; 357: 354-357https://doi.org/10.1016/s0140-6736(00)03643-6
- Restless legs syndrome and conditions associated with metabolic dysregulation, sympathoadrenal dysfunction, and cardiovascular disease risk: a systematic review.Sleep Med Rev. 2012; 16: 309-339https://doi.org/10.1016/j.smrv.2011.04.001
- Influence of obesity surgery on restless leg syndrome.J Coll Physicians Surg Pak. 2019; 29: 309-312https://doi.org/10.29271/jcpsp.2019.04.309
- Diseases in patients coming to a sleep center with symptoms related to restless legs syndrome.PLoS One. 2013; 8: e71499https://doi.org/10.1371/journal.pone.0071499
- Polysomnographic and health-related quality of life correlates of restless legs syndrome in the Sleep Heart Health Study.Sleep. 2009; 32: 772-778https://doi.org/10.1093/sleep/32.6.772
- Sleep apnea in patients reporting insomnia or restless legs symptoms.Acta Neurol Scand. 2016; 133: 61-67https://doi.org/10.1111/ane.12439
- The urge to move and breathe - the impact of obstructive sleep apnea syndrome treatment in patients with previously diagnosed, clinically significant restless legs syndrome.Sleep Med. 2017; 38: 17-20https://doi.org/10.1016/j.sleep.2017.06.023
- International classification of sleep disorders-third edition highlights and modifications.Chest. 2014; 146: 1387-1394https://doi.org/10.1378/chest.14-0970
- The treatment of restless legs syndrome and periodic limb movement disorder in adults–an update for 2012: practice parameters with an evidence-based systematic review and meta-analyses: an American Academy of Sleep Medicine Clinical Practice Guideline.Sleep. 2012; 35: 1039-1062https://doi.org/10.5665/sleep.1988
- Prevalence of restless legs syndrome and periodic limb movement disorder in the general population.J Psychosom Res. 2002; 53: 547-554https://doi.org/10.1016/s0022-3999(02)00443-9
- Prevalence and associated risk factors of periodic limb movement in sleep in two German population-based studies.Sleep. 2019; 42https://doi.org/10.1093/sleep/zsy237
Publications Office of the European Union (2017) Sixth European Working Conditions Survey – Overview report (2017 update). Luxembourg.
- Incidence of metabolic syndrome among night-shift healthcare workers.Occup Environ Med. 2010; 67: 54-57https://doi.org/10.1136/oem.2009.046797
- Is shift work associated with a higher risk of overweight or obesity? A systematic review of observational studies with meta-analysis.Int J Epidemiol. 2018; 47: 1956-1971https://doi.org/10.1093/ije/dyy079
- Association between shift work and obesity among nurses: A systematic review and meta-analysis.Int J Nurs Stud. 2020; 112103757https://doi.org/10.1016/j.ijnurstu.2020.103757
- Overweight and obesity in shift workers: associated dietary and lifestyle factors.Eur J Public Health. 2020; 30: 579-584https://doi.org/10.1093/eurpub/ckaa084
- Association between work schedules and motivation for lifestyle change in workers with overweight or obesity: a cross-sectional study in Japan.BMJ Open. 2020; 10e033000https://doi.org/10.1136/bmjopen-2019-033000
- Efficacy of a workplace-based weight loss program for overweight male shift workers: the Workplace POWER (Preventing Obesity Without Eating like a Rabbit) randomized controlled trial.Prev Med (Baltim). 2011; 52: 317-325https://doi.org/10.1016/j.ypmed.2011.01.031
- Independent feeding and metabolic actions of orexins in mice.Biochem Biophys Res Commun. 1998; 253: 241-245https://doi.org/10.1006/bbrc.1998.9750
Article info
Publication history
Published online: May 14, 2021
Accepted:
April 15,
2021
Received in revised form:
April 12,
2021
Received:
December 16,
2020
Identification
Copyright
© 2021 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.
