CHAPTER 2

Review of Literature

This chapter of the paper presents the related literatures and studies vital
for the removal of vagueness surrounding the concepts central to the study. This
chapter also includes the synthesis of the study.

Review of Related Literature

With the present research focusing on the correlation between sleep
duration and the body mass index of the first year Management, Marketing
management, Legal management, and HRM students in CEU – Makati for
School Year 2018 – 2019, the researchers assessed the different major variables
as well as its sub-variables and indicators in order to obtain better
comprehension of the focus of the research. Moreover, these literatures are vital
for clarification of the variables.

Less Sleep Leads to More Pounds

When sleep deprivation is caused by high workloads, priorities are

focused on the eagerness to accomplish of the tasks that can disregard the need
of one’s health. Most researchers conclude that sleep is compromised to have
extended working hours (Shechter, et al., 2014). According to an article written at
Villanova University Student Life – Psychological Topics (n.d.) entitled Sleep
Deprivation, for a variety of reasons, college students can particularly considered
prone to sleep disturbances. The adjusting stage to college life can be very
stressful and have an impact on the student’s ability to sleep properly. The same
can be said for keeping up with the ongoing academic and social demands in
school. This observation is known to contribute to weight gain and eventually
obesity. Not only the hormone regulation becomes abnormal, the lifestyle choices
are also affected. Meal timing and eating habits change (Morgenthaler, 2013). As
people try to meet deadlines and become sleep deprived, they go for whatever is
going to be easy and make them feel better in the moment (Brues, 2011).
 Sleep Duration. According to Buysse et al. (1989), the proponents of the
Pittsburgh Sleep Quality Index (PSQI), sleep quality is an important clinical
construct for two major reasons. First, complaints about sleep quality are
common, most epidemiological surveys indicate that majority of the adult
population of frequent sleep quality disturbance; this includes difficulty falling
asleep as well as difficulty in maintaining sleep. Secondly, sleep quality can be
an important symptom of many sleep and medical disorders one of which is
relevant to the present study is obesity and/or overweightness. Although sleep
quality is a readily accepted clinical construct, sleep quality still represents a
complex phenomenon that is difficult to define and measure objectively.

Sleep duration, which is a quantitative aspect of sleep quality, is a part of

this component since the effects of short sleep duration and poor sleep quality
are indistinguishable unless given sophisticated instruments, equipments or tools
for laboratory study and manipulation of sleep occurrence. Sleep duration, per
se, indicates hours of actual sleep at night and not hours of being “in-bed”.

Body Mass Index (BMI). Body mass index will determine the body fat
based on the weight-to-height ratio of an individual and is mostly used to indicate
for overweightness (BMI ≥ 23).According to the research study of Taheri et al.
(2004), an increase in body mass index is related to the levels of the appetite
hormones within our body which are leptin and ghrelin. Based on the
researchers, a reduction in leptin causes the inability of the brain to suppress
continual food intake or hunger, and this reduction in leptin causes the ghrelin
levels within our body to increase as well, stimulating our brain to increase food
uptake since ghrelin induces hunger through appetite-stimulating signals sent to
our brain and this increased intake of food contributes to the increase in body
mass index of an individual. Moreover, in the case of insulin resistance, Kahn
and Flier’s (2000) literature involved the association of obesity and insulin
resistance. According to them, insulin resistance contributes to the development
of obesity through biological processes within our body, one of which is the
inability of the cells to utilize the glucose within our body and is thus, converted to
lipids or fats in adipose cells (fat cells) caused by the nature of insulin. Moreover,
these fats are not able to be utilized as an alternative for glucose since insulin
inhibits the breakdown of fats or inhibits lipolysis. These are literatures that basis
for the significant association between BMI and Sleep Duration. Furthermore,
BMI in this present study will only be indicated by calculation of self-reported data
of height and weight, not through direct measurements, thus, adding to the
limitations observed within this study.

Review of Related Studies

The following studies will provide a brief review, ideas, findings and claims
about the correlation between sleep duration and body mass index:

Hormones regulate appetite and hunger signals that are considered

chemical substances that act as a messengers in the body. Deficiency or
excessiveness in hormone production can make body functions such as weight
control be affected. Figure 1.1 confirms the link between the lack of sleep and
obesity. Studies showed that sleep deprived adults have decreased levels of
Leptin, a hormone that tells the brain there is no need for more food, and
increased levels of Gherlin, a hormone that triggers hunger. In result, sleep
deprived adults tend to eat more in response to their increased appetite and
hunger level. The eat “more” idea does not only pertains to the quantity of food.
The preference is also affected as the food desires of the sleep deprived
individuals are inclined more to contain high calories (Greer, et al., 2013).
According to Michael Brues, PhD (2011) in his The Sleep Doctor’s Diet Plan:
Lose Weight Through Better Sleep, the more sleep deprived a person will be, the
higher the level of stress hormone cortisol will triggers the body to eat. Sleep
deprivation can also make an individual feel uneasy and stressed that can make
one to demand comfort. The easiest way that the Serotin – a natural mood
stabilizer in the body can do to calm you down is to trigger you to eat high – fat
and high – carbohydrate foods that produce a neurochemical reaction. Sleep
deprived individuals have higher “pleasure – seeking” needs which is very
observable when they crave for too sweet or too salty foods such as pizza,
burger, and ice cream. Not only individuals who sleep less crave for more junk
foods, they also eat less food that is good for them as well.

Sleep Deprivation can also increase the feeling of tiredness and

exhaustion reducing energy expenditure. It is the amount of energy (or calories)
that a person needs to carry out a physical function such as breathing, circulating
blood, digesting food, or physical movement (Scott, 2016). To prevent weight
gain, energy intake or calorie intake must be balanced with energy expenditure.

These related factors conclude that individuals who lack sleep have lower
energy levels. They may experience fatigue and lack of motivation (Harrison,
2000) which can be essential in school. This makes it harder for sleep deprived
students to engage in physical activity as their desire to exercise lowers. This
effect further carries the chances of weight gain as sleep deprivation promotes
body inactivity. Sleep deprivation also found to be associated with different health
disorders like high blood pressure and diabetes (Knutson, 2008) that is close to
obesity.

Role of Leptin and Ghrelin in Increased Body Mass Index

The amount of sleep can affect levels of hormones in our body including
the ones that control our appetite. To put it briefly, sleep deprivation is correlated
with body weight increase. Taheri, Lin, Austin, Young and Mignot (2004)
conducted a research entitled “Short sleep duration is associated with reduced
leptin, elevated ghrelin, and increased body mass index”, to study the levels of
leptin and other appetite hormones linked to sleep duration. The researchers are
from Howard Hughes Medical Institute, Stanford University and Department of
Population Health Sciences, University of Wisconsin. Volunteers from the
Wisconsin Sleep Cohort Study, a population-based longitudinal study of sleep
disorders that has been going on in Wisconsin for over 15 years, are the
participants of the study. They underwent nocturnal polysomnography and
reported their sleep habits through questionnaires and sleep diaries. For
hormones, blood samples were taken to assess their leptin, ghrelin, insulin, and
glucose. Using multiple variable regressions, BMI and sleep duration were also
examined. Findings from this study show that people who had poor sleep
duration were averagely heavier or had increased weight. These people had
lower levels of leptin and higher levels of ghrelin. Leptin controls appetite and
ghrelin controls food intake. The combination of the two hormones for food intake
will likely increase one’s appetite. With these, the shorter the sleep means
increase in weight. In general, the study shows the association of short sleep
duration and reduced leptin, elevated ghrelin and increased body mass index.
This study will be considered vital to the current study as the researchers also
study the relationship between sleep duration and the body mass index of the
first year Management, Marketing management, Legal management, and HRM
students in CEU – Makati for School Year 2018 – 2019. This study also verifies
that there is a significant association between sleep duration and increased BMI.

Sleep Disturbances are Good Predictors of Obesity

According to the study of Vargas et al. (2014) entitled “Sleep Quality and
Body Mass Index in College Students: The Role of Sleep Disturbances”, which is
a study that is focused on the evaluation of the relationship between parameters
of sleep and BMI. The researchers of the study used evidences from numerous
studies that sleep fragmentation alters metabolic functions involved in appetite
control to verify that sleep disturbances, independent of sleep duration loss, is
associated with increased BMI (BMI ≥ 23). The study was conducted on 2014
among 515 participants between 18 and 34 years. Using univariate logistic
regression and multivariate logistic regression analyses, the study concluded that
sleep disturbances were the only significant predictors of overweight/obesity or
increased BMI (BMI ≥ 23). Moreover, their study showed that after controlling for
age and sex, it was found that they were not significantly associated with
overweight and/or obesity. These findings are consistent with the hypothesis that
sleep restrictions alter the circulating levels of metabolically relevant hormones
such as leptin and ghrelin, resulting in alterations of glucose homeostasis and
appetite regulation.
Synthesis

Poor sleep quality generally affects our body mass index through
hormonal changes which is altered by the said poor sleep quality. The studies
reviewed above mostly shows alterations in hormonal homeostasis resulting from
sleep deprivation or sleep disturbances, such hormonal changes include insulin
sensitivity, glucose tolerance, the levels of ghrelin and leptin within our body.
These means that sleep quality can contribute to weight gain directly through
adverse hormonal changes within our body. Furthermore, it has been found that
even when sleeping within normal range of sleep time, yet, encountering sleep
fragmentation, causes an individual to have adverse hormonal changes as well,
one of which is a decrease in insulin sensitivity which may cause insulin
resistance.

Moreover, sleep loss contributes largely to the increased production of

ghrelin, the appetite-stimulating hormone and decreased production of leptin, the
appetite-inhibiting hormone, thus, contributing or promoting weight gain and/or
obesity. These studies show that sleep quality has a significant association with
obesity or increased body mass index, however, it has limited the phenomenon
of sleep quality to its quantitative aspect which is mostly sleep duration.