Skip to main content

Association of adherence to the Mediterranean diet and physical activity habits with the presence of insomnia in patients with obstructive sleep apnea

Abstract

Purpose

Insomnia and obstructive sleep apnea (OSA) are among the most prevalent sleep disorders and frequently co-occur, defining the sleep apnea-insomnia syndrome. However, data exploring associations between insomnia and lifestyle habits in patients with OSA are lacking. Therefore, the aim of the present study was to investigate potential associations between insomnia presence and individual lifestyle parameters in patients with mild/moderate-to-severe OSA evaluated by attended polysomnography.

Methods

These are secondary analyses, using data from a cross-sectional study among 269 Greek patients with OSA. Clinical, anthropometric, socioeconomic, and lifestyle data were collected for all participants. Insomnia presence was evaluated through the validated psychometric instrument “Athens Insomnia Scale” (AIS). Adherence to the Mediterranean diet was estimated with the MedDietScale index and physical activity habits were assessed through a validated questionnaire. Backward stepwise multiple logistic regression analysis was used to estimate the association between lifestyle habits (i.e., adherence to the Mediterranean diet and physical activity) and the likelihood of having insomnia, while adjusting for potential confounders.

Results

Of 269 patients newly diagnosed with OSA (aged 21–70 years; 73% men), 146 (54%) were categorized as having insomnia. In multivariable models, higher adherence to the Mediterranean diet and engagement in physical activity for ≥ 30 min/day were both associated with a lower likelihood of having insomnia (odds ratio (95% confidence intervals): 0.40 (0.18–0.91) and 0.49 (0.28–0.86), respectively).

Conclusions

Results add to the limited data on the role of lifestyle in insomnia and should be further explored both in epidemiological and clinical studies.

This is a preview of subscription content, access via your institution.

Fig. 1

Data availability

The data is available on request from the corresponding author.

References

  1. Schutte-Rodin S, Broch L, Buysse D, Dorsey C, Sateia M (2008) Clinical guideline for the evaluation and management of chronic insomnia in adults. J Clin Sleep Med 4(5):487–504

    Article  PubMed  PubMed Central  Google Scholar 

  2. Benjafield AV, Ayas NT, Eastwood PR, Heinzer R, Ip MSM, Morrell MJ, Nunez CM, Patel SR, Penzel T, Pepin JL, Peppard PE, Sinha S, Tufik S, Valentine K, Malhotra A (2019) Estimation of the global prevalence and burden of obstructive sleep apnoea: a literature-based analysis. Lancet Respir Med 7(8):687–698. https://doi.org/10.1016/S2213-2600(19)30198-5

    Article  PubMed  PubMed Central  Google Scholar 

  3. American Academy of Sleep Medicine (2014) International Classification of Sleep Disorders, 3rd ed. Darien, IL

  4. Ong JC, Crawford MR (2013) Insomnia and obstructive sleep apnea. Sleep Med Clin 8(3):389–398. https://doi.org/10.1016/j.jsmc.2013.04.004

    Article  PubMed  PubMed Central  Google Scholar 

  5. Cho YW, Kim KT, Moon HJ, Korostyshevskiy VR, Motamedi GK, Yang KI (2018) Comorbid insomnia with obstructive sleep apnea: clinical characteristics and risk factors. J Clin Sleep Med 14(3):409–417. https://doi.org/10.5664/jcsm.6988

    Article  PubMed  PubMed Central  Google Scholar 

  6. Luyster FS, Buysse DJ, Strollo PJ Jr (2010) Comorbid insomnia and obstructive sleep apnea: challenges for clinical practice and research. J Clin Sleep Med 6(2):196–204

    Article  PubMed  PubMed Central  Google Scholar 

  7. Javaheri S, Redline S (2017) Insomnia and risk of cardiovascular disease. Chest 152(2):435–444. https://doi.org/10.1016/j.chest.2017.01.026

    Article  PubMed  PubMed Central  Google Scholar 

  8. Badran M, Yassin BA, Fox N, Laher I, Ayas N (2015) Epidemiology of sleep disturbances and cardiovascular consequences. Can J Cardiol 31(7):873–879. https://doi.org/10.1016/j.cjca.2015.03.011

    Article  PubMed  Google Scholar 

  9. Janson C, Lindberg E, Gislason T, Elmasry A, Boman G (2001) Insomnia in men-a 10-year prospective population based study. Sleep 24(4):425–430

    CAS  Article  PubMed  Google Scholar 

  10. Morgan K (2003) Daytime activity and risk factors for late-life insomnia. J Sleep Res 12(3):231–238

    Article  PubMed  Google Scholar 

  11. Passos GS, Poyares D, Santana MG, Garbuio SA, Tufik S, Mello MT (2010) Effect of acute physical exercise on patients with chronic primary insomnia. J Clin Sleep Med 6(3):270–275

    Article  PubMed  PubMed Central  Google Scholar 

  12. Tan X, Alen M, Cheng SM, Mikkola TM, Tenhunen J, Lyytikainen A, Wiklund P, Cong F, Saarinen A, Tarkka I, Partinen M, Cheng S (2015) Associations of disordered sleep with body fat distribution, physical activity and diet among overweight middle-aged men. J Sleep Res 24(4):414–424. https://doi.org/10.1111/jsr.12283

    Article  PubMed  Google Scholar 

  13. Grandner MA, Jackson N, Gerstner JR, Knutson KL (2014) Sleep symptoms associated with intake of specific dietary nutrients. J Sleep Res 23(1):22–34. https://doi.org/10.1111/jsr.12084

    Article  PubMed  Google Scholar 

  14. Katagiri R, Asakura K, Kobayashi S, Suga H, Sasaki S (2014) Low intake of vegetables, high intake of confectionary, and unhealthy eating habits are associated with poor sleep quality among middle-aged female Japanese workers. J Occup Health 56(5):359–368

    Article  PubMed  Google Scholar 

  15. Tanaka E, Yatsuya H, Uemura M, Murata C, Otsuka R, Toyoshima H, Tamakoshi K, Sasaki S, Kawaguchi L, Aoyama A (2013) Associations of protein, fat, and carbohydrate intakes with insomnia symptoms among middle-aged Japanese workers. J Epidemiol 23(2):132–138

    Article  PubMed  Google Scholar 

  16. Hu FB (2002) Dietary pattern analysis: a new direction in nutritional epidemiology. Curr Opin Lipidol 13(1):3–9

    CAS  Article  PubMed  Google Scholar 

  17. Dinu M, Pagliai G, Casini A, Sofi F (2018) Mediterranean diet and multiple health outcomes: an umbrella review of meta-analyses of observational studies and randomised trials. Eur J Clin Nutr 72(1):30–43. https://doi.org/10.1038/ejcn.2017.58

    CAS  Article  PubMed  Google Scholar 

  18. Campanini MZ, Guallar-Castillon P, Rodriguez-Artalejo F, Lopez-Garcia E (2017) Mediterranean diet and changes in sleep duration and indicators of sleep quality in older adults. Sleep 40(3). https://doi.org/10.1093/sleep/zsw083

  19. Jaussent I, Dauvilliers Y, Ancelin ML, Dartigues JF, Tavernier B, Touchon J, Ritchie K, Besset A (2011) Insomnia symptoms in older adults: associated factors and gender differences. Am J Geriatr Psychiatry 19(1):88–97. https://doi.org/10.1097/JGP.0b013e3181e049b6

    Article  PubMed  PubMed Central  Google Scholar 

  20. Castro-Diehl C, Wood AC, Redline S, Reid M, Johnson DA, Maras JE, Jacobs DR Jr, Shea S, Crawford A, St-Onge MP (2018) Mediterranean diet pattern and sleep duration and insomnia symptoms in the Multi-Ethnic Study of Atherosclerosis. Sleep 41(11). https://doi.org/10.1093/sleep/zsy158

  21. Kechribari I, Kontogianni MD, Georgoulis M, Lamprou K, Mourati I, Vagiakis E, Yiannakouris N (2020) Associations between red meat intake and sleep parameters in patients with obstructive sleep apnea. J Acad Nutr Diet 120(6):1042–1053. https://doi.org/10.1016/j.jand.2019.10.016

    Article  PubMed  Google Scholar 

  22. Berry RB, Gamaldo CE, Harding SM, Brooks R, Lloyd RM, Vaughn BV, Marcus CL (2015) AASM scoring manual version 2.2 updates: new chapters for scoring infant sleep staging and home sleep apnea testing. J Clin Sleep Med 11(11):1253–1254. https://doi.org/10.5664/jcsm.5176

    Article  PubMed  PubMed Central  Google Scholar 

  23. Soldatos CR, Dikeos DG, Paparrigopoulos TJ (2003) The diagnostic validity of the Athens Insomnia Scale. J Psychosom Res 55(3):263–267

    Article  PubMed  Google Scholar 

  24. Wallace DM, Wohlgemuth WK (2019) Predictors of Insomnia Severity Index profiles in United States veterans with obstructive sleep apnea. J Clin Sleep Med 15(12):1827–1837. https://doi.org/10.5664/jcsm.8094

    Article  PubMed  PubMed Central  Google Scholar 

  25. Bountziouka V, Bathrellou E, Giotopoulou A, Katsagoni C, Bonou M, Vallianou N, Barbetseas J, Avgerinos PC, Panagiotakos DB (2012) Development, repeatability and validity regarding energy and macronutrient intake of a semi-quantitative food frequency questionnaire: methodological considerations. Nutr Metab Cardiovasc Dis 22(8):659–667. https://doi.org/10.1016/j.numecd.2010.10.015

    CAS  Article  PubMed  Google Scholar 

  26. Trichopoulou A, Costacou T, Bamia C, Trichopoulos D (2003) Adherence to a Mediterranean diet and survival in a Greek population. N Engl J Med 348(26):2599–2608. https://doi.org/10.1056/NEJMoa025039

    Article  PubMed  Google Scholar 

  27. Papathanasiou G, Georgoudis G, Georgakopoulos D, Katsouras C, Kalfakakou V, Evangelou A (2010) Criterion-related validity of the short International Physical Activity Questionnaire against exercise capacity in young adults. Eur J Cardiovasc Prev Rehabil 17(4):380–386. https://doi.org/10.1097/HJR.0b013e328333ede6

    Article  PubMed  Google Scholar 

  28. World Health Organization (2010) Global recommendations on physical activity for health. WHO Guidelines Approved by the Guidelines Review Committee, Geneva

  29. St-Onge MP, Mikic A, Pietrolungo CE (2016) Effects of diet on sleep quality. Adv Nutr 7(5):938–949. https://doi.org/10.3945/an.116.012336

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  30. Yu C, Shi Z, Lv J, Guo Y, Bian Z, Du H, Chen Y, Tao R, Huang Y, Chen J, Chen Z, Li L (2017) Dietary patterns and insomnia symptoms in Chinese adults: the China Kadoorie Biobank. Nutrients 9(3). https://doi.org/10.3390/nu9030232

  31. Estruch R (2010) Anti-inflammatory effects of the Mediterranean diet: the experience of the PREDIMED study. Proc Nutr Soc 69(3):333–340. https://doi.org/10.1017/S0029665110001539

    CAS  Article  PubMed  Google Scholar 

  32. Clark IA, Vissel B (2014) Inflammation-sleep interface in brain disease: TNF, insulin, orexin. J Neuroinflammation 11:51. https://doi.org/10.1186/1742-2094-11-51

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  33. Peuhkuri K, Sihvola N, Korpela R (2012) Diet promotes sleep duration and quality. Nutr Res 32(5):309–319. https://doi.org/10.1016/j.nutres.2012.03.009

    CAS  Article  PubMed  Google Scholar 

  34. Auld F, Maschauer EL, Morrison I, Skene DJ, Riha RL (2017) Evidence for the efficacy of melatonin in the treatment of primary adult sleep disorders. Sleep Med Rev 34:10–22. https://doi.org/10.1016/j.smrv.2016.06.005

    Article  PubMed  Google Scholar 

  35. Haario P, Rahkonen O, Laaksonen M, Lahelma E, Lallukka T (2013) Bidirectional associations between insomnia symptoms and unhealthy behaviours. J Sleep Res 22(1):89–95. https://doi.org/10.1111/j.1365-2869.2012.01043.x

    Article  PubMed  Google Scholar 

  36. Hartescu I, Morgan K (2019) Regular physical activity and insomnia: an international perspective. J Sleep Res 28(2):e12745. https://doi.org/10.1111/jsr.12745

    Article  PubMed  Google Scholar 

  37. Gonzalez-Sanchez J, Recio-Rodriguez JI, Gomez-Marcos MA, Patino-Alonso MC, Agudo-Conde C, Garcia-Ortiz L (2019) Relationship between the presence of insomnia and walking physical activity and diet quality: a cross-sectional study in a sample of Spanish adults. Med Clin (Barc) 152(9):339–345. https://doi.org/10.1016/j.medcli.2018.06.029

    Article  Google Scholar 

  38. Passos GS, Poyares DL, Santana MG, Tufik S, Mello MT (2012) Is exercise an alternative treatment for chronic insomnia? Clinics (Sao Paulo) 67(6):653–660. https://doi.org/10.6061/clinics/2012(06)17

    Article  Google Scholar 

  39. Youngstedt SD (2005) Effects of exercise on sleep. Clin Sports Med 24(2):355–365, xi. https://doi.org/10.1016/j.csm.2004.12.003

    Article  PubMed  Google Scholar 

  40. Morgan WP (1985) Affective beneficence of vigorous physical activity. Med Sci Sports Exerc 17(1):94–100

    CAS  Article  PubMed  Google Scholar 

  41. Nehlsen-Cannarella SL, Nieman DC, Balk-Lamberton AJ, Markoff PA, Chritton DB, Gusewitch G, Lee JW (1991) The effects of moderate exercise training on immune response. Med Sci Sports Exerc 23(1):64–70

    CAS  Article  PubMed  Google Scholar 

  42. Irwin MR, Piber D (2018) Insomnia and inflammation: a two hit model of depression risk and prevention. World Psychiatry 17(3):359–361. https://doi.org/10.1002/wps.20556

    Article  PubMed  PubMed Central  Google Scholar 

  43. Georgoulis M, Yiannakouris N, Kechribari I, Lamprou K, Perraki E, Vagiakis E, Kontogianni MD (2020) The effectiveness of a weight-loss Mediterranean diet/lifestyle intervention in the management of obstructive sleep apnea: Results of the “MIMOSA” randomized clinical trial. Clin Nutr 40:850–859. https://doi.org/10.1016/j.clnu.2020.08.037

    Article  PubMed  Google Scholar 

  44. Vgontzas AN (2008) Does obesity play a major role in the pathogenesis of sleep apnoea and its associated manifestations via inflammation, visceral adiposity, and insulin resistance? Arch Physiol Biochem 114(4):211–223. https://doi.org/10.1080/13813450802364627

    CAS  Article  PubMed  Google Scholar 

  45. Hargens TA, Kaleth AS, Edwards ES, Butner KL (2013) Association between sleep disorders, obesity, and exercise: a review. Nat Sci Sleep 5:27–35. https://doi.org/10.2147/NSS.S34838

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgements

The authors would like to thank the staff of the Centre of Sleep Disorders of “Evangelismos” Hospital for their valuable help in data collection.

Funding

This work was partially supported by a grant from the Hellenic Atherosclerosis Society.

Author information

Authors and Affiliations

Authors

Contributions

NY, MDK, and EV conceived the study’s research hypothesis. NY and MDK designed the study. IK, MG, and KL were involved in participant recruitment and assessments. IK analyzed the data and drafted the manuscript. EC supervised the statistical analysis. MDK and NY critically revised the manuscript. NY had the primary responsibility for the final content. All authors read and approved the final manuscript.

Corresponding authors

Correspondence to Ioanna Kechribari or Nikos Yiannakouris.

Ethics declarations

Ethics approval

This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Ethics Committee of Evangelismos Hospital and by the Bioethics Committee of Harokopio University.

Consent to participate

Informed consent was obtained from all individual participants included in the study.

Conflict of interest

The authors declare no competing interests.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Kechribari, I., Kontogianni, M.D., Georgoulis, M. et al. Association of adherence to the Mediterranean diet and physical activity habits with the presence of insomnia in patients with obstructive sleep apnea. Sleep Breath 26, 89–97 (2022). https://doi.org/10.1007/s11325-021-02351-x

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11325-021-02351-x

Keywords

  • Comorbid insomnia and obstructive sleep apnea
  • Mediterranean diet
  • Physical activity