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      Evening Chronotype Is Associated with Changes in Eating Behavior, More Sleep Apnea, and Increased Stress Hormones in Short Sleeping Obese Individuals

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          Abstract

          Background

          Short sleep duration and decreased sleep quality are emerging risk factors for obesity and its associated morbidities. Chronotype, an attribute that reflects individual preferences in the timing of sleep and other behaviors, is a continuum from morningness to eveningness. The importance of chronotype in relation to obesity is mostly unknown. Evening types tend to have unhealthy eating habits and suffer from psychological problems more frequently than Morning types, thus we hypothesized that eveningness may affect health parameters in a cohort of obese individuals reporting sleeping less than 6.5 hours per night.

          Methodology and Principal Findings

          Baseline data from obese (BMI: 38.5±6.4 kg/m 2) and short sleeping (5.8±0.8 h/night by actigraphy) participants ( n = 119) of the Sleep Extension Study were analyzed ( www.ClinicalTrials.gov, identifier NCT00261898). Assessments included the Horne and Ostberg Morningness-Eveningness questionnaire, a three-day dietary intake diary, a 14-day sleep diary, 14 days of actigraphy, and measurements of sleep apnea. Twenty-four hour urinary free cortisol, 24 h urinary norepinephrine and epinephrine levels, morning plasma ACTH and serum cortisol, fasting glucose and insulin, and lipid parameters were determined. Eveningness was associated with eating later in the day on both working and non-working days. Progression towards eveningness was associated with an increase in BMI, resting heart rate, food portion size, and a decrease in the number of eating occasions and HDL-cholesterol. Evening types had overtly higher 24 h urinary epinephrine and morning plasma ACTH levels, and higher morning resting heart rate than Morning types. In addition, Evening types more often had sleep apnea, independent of BMI or neck circumference.

          Conclusions

          Eveningness was associated with eating later and a tendency towards fewer and larger meals and lower HDL-cholesterol levels. In addition, Evening types had more sleep apnea and higher stress hormones. Thus, eveningness in obese, chronically sleep-deprived individuals compounds the cardiovascular risk associated with obesity.

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          Most cited references32

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          Exposure to room light before bedtime suppresses melatonin onset and shortens melatonin duration in humans.

          Jamie M. Zeitzer, Andrew D. A. C. Smith, Joshua Gooley … (2011)
          Millions of individuals habitually expose themselves to room light in the hours before bedtime, yet the effects of this behavior on melatonin signaling are not well recognized. We tested the hypothesis that exposure to room light in the late evening suppresses the onset of melatonin synthesis and shortens the duration of melatonin production. In a retrospective analysis, we compared daily melatonin profiles in individuals living in room light (<200 lux) vs. dim light (<3 lux). Healthy volunteers (n = 116, 18-30 yr) were recruited from the general population to participate in one of two studies. Participants lived in a General Clinical Research Center for at least five consecutive days. Individuals were exposed to room light or dim light in the 8 h preceding bedtime. Melatonin duration, onset and offset, suppression, and phase angle of entrainment were determined. Compared with dim light, exposure to room light before bedtime suppressed melatonin, resulting in a later melatonin onset in 99.0% of individuals and shortening melatonin duration by about 90 min. Also, exposure to room light during the usual hours of sleep suppressed melatonin by greater than 50% in most (85%) trials. These findings indicate that room light exerts a profound suppressive effect on melatonin levels and shortens the body's internal representation of night duration. Hence, chronically exposing oneself to electrical lighting in the late evening disrupts melatonin signaling and could therefore potentially impact sleep, thermoregulation, blood pressure, and glucose homeostasis.
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            Actigraphy validation with insomnia.

            David Murray, James P Soeffing, James Donaldson … (2006)
            Actigraphy, a method of inferring sleep from the presence or absence of wrist movement, has been well validated against polysomnography in trials with people without insomnia. However, the small amount of literature on validation with insomniacs has revealed an actigraphy bias toward overscoring sleep. The current validation trial with insomniacs used the largest number of subjects to date in such research and attracted participants with diverse demographic characteristics. People with insomnia slept 1 night in the laboratory while simultaneously being monitored by polysomnography, actigraphy (high-sensitivity algorithm of the Mini Mitter AW64 Actiwatch), and morning sleep diary. Sleep disorders center. Participants were 57 volunteers from the community, 26 men and 31 women, ranging in age from 21 to 87 years. All participants satisfied conservative criteria for insomnia. The sample included subjects with primary insomnia, subjects with comorbid insomnia, and hypnotic users with current insomnia complaints. N/A. Actigraphy was successfully validated on 4 measures of sleep pattern--number of awakenings, wake time after sleep onset, total sleep time, and sleep efficiency percentage--based on nonsignificant mean differences and significant correlation between actigraphy and polysomnography. Sleep-onset latency with actigraphy was not significantly different from polysomnography but was weakly correlated with polysomnography. Hypnotic use contributed to actigraphic overscoring of sleep. Actigraphy proved to be a satisfactory objective measure of sleep on 4 of 5 sleep parameters, but these results are specific to this particular instrument using this particular algorithm and should not be construed as a blanket endorsement of actigraphy for measuring insomnia.
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              Validation of Horne and Ostberg morningness-eveningness questionnaire in a middle-aged population of French workers.

              Jean-François Chastang, Bernard Bioulac, Jacques Taillard … (2004)
              As suggested by the authors, the Horne and Ostberg morning/evening questionnaire (MEQ) has never been adapted to evaluate a nonstudent population. The purpose of this study was to validate this MEQ in a sample of middle-aged workers by modifying only the cutoffs. It was administered in 566 non-shift-workers aged 51.2 to 3.2 years who presented no sleep disorders. According to the Home and Ostberg classification, the sample consisted of 62.1% morning type, 36.6% neither type, and 2.2% evening type. Multiple correspondence analysis, which determines the principal components, was performed on all MEQ items. Then an ascending hierarchical classification was applied to determine 3 clusters from these principal components. On the basis of these 3 clusters, new cutoffs were determined: evening types were considered as scoring under 53 and morning types above 64, thus giving 28.1% morning type, 51.7% neither type, and 20.2% evening type. As an external validation, eveningness was associated with later bedtime and waking-up time (more pronounced at the weekend), greater need for sleep, larger daily sleep debt, greater morning sleepiness, and ease of returning to sleep in the early morning. A positive correlation between age and morningness was again found. This study confirms that "owls" are not rare in a middle-aged sample. We conclude that this adapted MEQ could be useful when investigating age-related changes in sleep.
              Article 0 comments Cited 90 times – based on 0 reviews     Review now
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                Author and article information

                Contributors
                Namni Goel: Role: Editor
                Journal
                Journal ID (nlm-ta): PLoS One
                Journal ID (iso-abbrev): PLoS ONE
                Journal ID (publisher-id): plos
                Journal ID (pmc): plosone
                Title: PLoS ONE
                Publisher: Public Library of Science (San Francisco, USA )
                ISSN (Electronic): 1932-6203
                Publication date Collection: 2013
                Publication date (Electronic): 6 March 2013
                Volume: 8
                Issue: 3
                Electronic Location Identifier: e56519
                Affiliations
                [1 ]Clinical Center, National Institutes of Health, Bethesda, Maryland, United States of America
                [2 ]Intramural Research Program, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland, United States of America
                [3 ]Section on Pediatric Diabetes and Metabolism, National Institutes of Health, Bethesda, Maryland, United States of America
                [4 ]Section on Neuroendocrinology of Obesity, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland, United States of America
                [5 ]Department of Laboratory Medicine, Clinical Center, National Institutes of Health, Bethesda, Maryland, United States of America
                University of Pennsylvania School of Medicine, United States of America
                Author notes

                Competing Interests: The authors have declared that no competing interests exist.

                Conceived and designed the experiments: KIR G. Csako G. Cizza. Performed the experiments: EAL MSM ABC G. Cizza. Analyzed the data: EAL XZ KIR MSM ABC LdJ G. Csako G. Cizza. Wrote the paper: EAL KIR MSM LdJ G. Csako G. Cizza.

                Article
                Publisher ID: PONE-D-12-29177
                DOI: 10.1371/journal.pone.0056519
                PMC ID: 3590198
                PubMed ID: 23483886
                SO-VID: 54f7dbf6-669f-446d-9466-4bfeefddfe27
                Copyright statement: Copyright @ 2013
                License:

                This is an open-access article, free of all copyright, and may be freely reproduced, distributed, transmitted, modified, built upon, or otherwise used by anyone for any lawful purpose. The work is made available under the Creative Commons CC0 public domain dedication.

                History
                Date received : 22 September 2012
                Date accepted : 12 January 2013
                Page count
                Pages: 10
                Funding
                This study was supported by the National Institutes of Health, Intramural Research Program, National Institute of Diabetes and Digestive and Kidney Diseases. EAL received scholarships from Fulbright, VSBfonds and the Leiden University Fund. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. None of the authors had a conflict of interest.
                Categories
                Subject: Research Article
                Subject: Medicine
                Subject: Anatomy and Physiology
                Subject: Neurological System
                Subject: Peripheral Nervous System
                Subject: Physiological Processes
                Subject: Chronobiology
                Subject: Homeostasis
                Subject: Sleep
                Subject: Integrative Physiology
                Subject: Cardiovascular
                Subject: Hemodynamics
                Subject: Clinical Research Design
                Subject: Cohort Studies
                Subject: Epidemiology
                Subject: Modeling
                Subject: Complementary and Alternative Medicine
                Subject: Endocrinology
                Subject: Endocrine Physiology
                Subject: Neuroendocrinology
                Subject: Global Health
                Subject: Nutrition
                Subject: Obesity
                Subject: Public Health
                Subject: Behavioral and Social Aspects of Health
                Subject: Environmental Health
                Subject: Preventive Medicine
                Subject: Social and Behavioral Sciences
                Subject: Anthropology
                Subject: Anthropometry

                ScienceOpen disciplines: Uncategorized
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                ScienceOpen disciplines: Uncategorized

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