Professional Documents
Culture Documents
James E. Gangwisch, PhD1; Dolores Malaspina, MD, MPH2; Bernadette Boden-Albala, Dr.PH3; Steven B. Heymsfield, MD4
1
Mailman School of Public Health, Department of Epidemiology; 2Department of Psychiatry, Division of Clinical Neurobiology; 3Department of Neurol-
ogy and Department of Sociomedical Sciences; 4Obesity Research Center, St. Luke’s-Roosevelt Hospital Center; Columbia University, College of Physi-
cians and Surgeons, New York, NY
Study Objectives: Sleep deprivation has been hypothesized to contribute be obese than subjects with sleep durations of 7 hours. Sleep durations
toward obesity by decreasing leptin, increasing ghrelin, and compromising over 7 hours were not consistently associated with either an increased
insulin sensitivity. This study examines cross-sectional and longitudinal or decreased likelihood of obesity in the cross-sectional and longitudinal
data from a large United States sample to determine whether sleep dura- results. Each additional hour of sleep at baseline was negatively associ-
tion is associated with obesity and weight gain. ated with change in body mass index over the follow-up period, but this
Design: Longitudinal analyses of the 1982-1984, 1987, and 1992 NHANES association was small and statistically insignificant.
Average BMI
28
4 hours, 5 hours, and 6 hours of sleep per night at baseline had the
27 1982/1984
first, second, and third highest average BMI, respectively, of the
sleep-duration categories in 1982-1984, 1987, and 1992. 26 1987
Table 3 and Figure 2 show the results for the logistic regression 25 1992
analyses, in which the dependent variable was dichotomized 24
night and was adjusted for the potential confounding variables. In Figure 1—Average BMI by the number of hours of sleep reported per
Table 3, we can see that women who slept less than 7 hours per night at baseline in 1982-1984. (BMI is calculated as the weight in kg
night were progressively more likely to be obese as their sleep divided by height in meters squared.)
durations decreased. Men who slept 6 or fewer hours per night
4.5
n = 3,682
4
Table 1—Relationship Between the Number of Hours of Sleep per OR & 95% CI - 1982 to 1984
3.5
Night and Obesity Status* by Age Group at Baseline (1982-1984)
3
2.5
Age, y Average Lean Overweight Obese X 2
2
Sleep (P value)
1.5
Per Night, h
32-49 (n = 3682) 1
(P < .0001) 0
5 72 (4) 76 (6) 57 (8) 4.5
6 349 (20) 286 (24) 175 (24) 4
n = 3,355
(P = .4486) 1.5
SLEEP, Vol. 28, No. 10, 2005 1292 Inadequate Sleep as a Risk Factor for Obesity—Gangwisch et al
Table 2—Characteristics of Subjects Between the Ages of 32 and 49
55
Years by Obesity Status* at Baseline (1982-1984)
Differences in BMI
Depression, CES-D 22 **
**
< 16 1,501 (85) 981 (84) 590 (80) 8.08 11 **
**
(P = .0176) **
00
≥ 16 272 (15) 191 (16) 147 (20)
-1
Physical Activity, score -1
Differences in BMI
& 95% CI - 1987
Highest Level of Education 22 **
** **
**
< High- 334 (19) 276 (24) 237 (32) 62.41
Differences in BMI
& 95% CI - 1992
Caucasian 1,580 (89) 995 (85) 554 (75) 79.33 33
(P < .0001) **
**
22
Non- 193 (11) 177 (15) 183 (25) **
**
11
Caucasian **
00
Consumption of Alcohol, drinks/d
0 482 (27) 342 (29) 305 (41) 53.93 -1
-1
(P < .0001) -2
-2
>0<2 1124 (63) 707 (60) 382 (52) -3
-3 22 to
to 44 55 66 77 88 99 =>
=> 10
10
≥2 167 (9) 123 (10) 50 (7) Average
Average Sleep S leep Duration in
Duration inHours
Hourat at
Baseline in 1982-1984
Baseline in 1982-1984
Cigarette Smoker
Figure 3—Differences in average BMI by sleep duration at baseline
Yes 706 (40) 390 (33) 232 (31) 21.51
for subjects between the ages of 32 and 49 adjusted for depression,
(P < .0001)
physical activity, education, ethnicity, alcohol consumption, cigarette
No 1067(60) 782 (67) 505 (69)
smoking, gender, waking during the night, daytime sleepiness, and
Sex
age.
Female 1374(77) 626 (53) 516 (70) 190.32
(BMI is calculated as the weight in kg divided by height in meters
(P < .0001)
squared.) ** p < .01, * p < .05
Male 399 (23) 546 (47) 221 (30)
Waking during the night and men who slept 9 hours per night were more likely to be obese,
Never 437 (25) 327 (28) 221 (30) 23.30
while men who slept 8 hours per night and women who slept 9
(P = .0030)
Rarely 653 (37) 394 (34) 217 (29)
hours per night were not more likely to be obese. In Figure 2, in
Sometimes 450 (25) 280 (24) 171 (23) which the data for both sexes are pooled, subjects with 8- and 9-
Often 149 (8) 104 (9) 77 (10) hour sleep durations did not differ significantly from those with
Almost 84 (5) 67 (6) 51 (7) 7-hour sleep durations.
Always In the results from the cross-sectional analyses shown in Figure
Daytime Sleepiness 2, subjects between the ages of 32 and 49 years who reported
Never 615 (35) 420 (36) 232 (31) 19.32 getting 2 to 4, 5, and 6 hours of sleep per night were 235% (OR =
(P = .0132) 2.35, 95% CI 1.36-4.05), 60% (OR = 1.60, 95% CI 1.12-2.29), and
Rarely 613 (35) 364 (31) 224 (30)
27% (OR = 1.27, 95% CI 1.01-1.60) more likely to be obese after
Sometimes 401 (23) 272 (23) 200 (27)
Often 88 (5) 80 (6) 38 (5)
adjusting for the potential confounding variables than subjects
Almost 33 (2) 48 (4) 32 (4) who reported getting 7 hours of sleep per night, respectively.
Always Subjects who reported getting 4 or fewer hours of sleep per night
Total 1696 (100) 1276 (100) 710 (100) at baseline continued to be significantly more likely than those
Sample who reported getting 7 hours per night to be obese at the times
of the 1987 and 1992 follow-up studies. The likelihood of being
*Lean is defined as a body mass index (BMI) ≤ 25 kg/m2, over- obese for subjects who reported getting more than 7 hours of sleep
weight as > 25 kg/m2 but < 30 kg/m2, and obese as ≥ 30 kg/m2. (BMI per night was not significantly different than for subjects who
is calculated as weight in kg divided by height in meters squared.)
reported getting 7 hours per night in either the cross-sectional
Data are presented as number (%).
CES-D refers to the Center for Epidemiologic Studies Depression
or longitudinal results. All of the logistic regression models,
Scale. both before and after the inclusion of the potential confounding
SLEEP, Vol. 28, No. 10, 2005 1293 Inadequate Sleep as a Risk Factor for Obesity—Gangwisch et al
2
Table 4—Self-Report of Weight Change Over the Past 6 Months by
n = 3,208 Sleeping Problems Compared With 1 Year Ago
1.5
Change in BMI & 95% CI
1
Sleeping problems Weight now X2 (P value)
0.5 now compared compared with 6
0 with 1 year ago months ago
-0.5 At least About At least
-1
10 lb less the same 10 lb more
Much less 31 (7) 79 (3) 25 (5) 83.12
-1.5
Somewhat less 20 (4) 92 (3) 17 (3) (P < .0001)
-2
2 to 4 5 6 7 8 9 => 10 About the same 339 (74) 2,297 (85) 365 (74)
Average Sleep Duration in Hours at Baseline in 1982-1984 Somewhat 48 (10) 181 (7) 55 (11)
Figure 4—Change in BMI and 95% confidence intervals between more
baseline (1982-1984) and 1992 for subjects between the ages of 32 Much more 22 (5) 55 (2) 34 (7)
and 49 by sleep duration adjusted for depression, physical activity,
education, ethnicity, alcohol consumption, cigarette smoking, gender, Data are presented as number (%).
SLEEP, Vol. 28, No. 10, 2005 1295 Inadequate Sleep as a Risk Factor for Obesity—Gangwisch et al
found, though, in previous studies between self-reported sleep 12. Locard E, Mamelle N, Billette A, Miginiac M, Munoz F, Rey S.
durations and those obtained through actigraphic monitoring.28,29 Risk factors of obesity in a five year old population. Parental versus
Other limitations include possible bias arising from loss to fol- environmental factors. Int J Obesity 1992;16:721-9.
low-up, missing data on baseline risk variables, and missing data 13. Gupta NK, Mueller WH, Chan W, Meininger JC. Is obesity
associated with poor sleep quality in adolescents? Am J Hum Biol
at follow-up.
2002;14:762-8.
If metabolic changes resulting from sleep deprivation contrib- 14. Vioque J, Torres A, Quiles J. Time spent watching television, sleep
ute toward weight gain, then interventions designed to increase the duration and obesity in adults living in Valencia, Spain. Int J Obesity
amount and quality of sleep could potentially augment the most 2002;24:1683-8.
common clinical interventions of increasing physical activity and 15. Kripke DF, Garfinkel L, Wingard DL, Klauber MR, Marler MR.
improving nutrition. These interventions could include educating Mortality associated with sleep duration and insomnia. Arch Gen
patients about healthier sleep-hygiene practices and helping them Psychiatry 2002;59:131-6.
to modify maladaptive sleep habits. 16. Hasler G, Buysse, DJ, Klaghofer R, et al. The association between
The results from this study suggest that sleep deprivation could short sleep duration and obesity in young adults: a 13-year prospec-
tive study. Sleep 2004;27:661-6.
play a significant role in the etiology of obesity in some individu-
17. U.S. Department of Health and Human Services, National Center
als. Further research is needed to further explicate the biologic for Health Statistics. National Health and Nutrition Examination
SLEEP, Vol. 28, No. 10, 2005 1296 Inadequate Sleep as a Risk Factor for Obesity—Gangwisch et al