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The contribution of sleep to anorexia nervosa severity

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Abstract

Purpose

Anorexia nervosa (AN) is associated with poor sleep and altered circadian rhythms. Evidence is unclear as to whether these features relate to ongoing psychiatric symptoms of AN, or are merely concomitant with low weight. In this study, we sought to evaluate subjective sleep quality and sleep–wake preferences in a sample of individuals with lifetime AN. Furthermore, we aimed to examine whether sleep quality would significantly predict AN symptom severity, after accounting for demographic features and negative emotions (depression, anxiety and stress).

Methods

Adults with a lifetime diagnosis of AN (n = 96) or no lifetime psychiatric diagnoses (NC; n = 246) completed an online survey assessing demographics, sleep quality, circadian sleep–wake preferences, eating disorder symptoms, and negative emotions.

Results

AN participants reported significantly poorer sleep quality overall, including increased sleep disturbances, use of sleep medications, and daytime dysfunction, as compared to NC participants. Groups did not differ significantly in circadian sleep–wake preferences. Regression analysis showed that among AN participants, sleep quality and negative emotions significantly predicted AN symptom severity, while sex and body mass index (BMI) did not.

Conclusion

The findings demonstrate that poor sleep quality was associated with more severe symptoms of AN, even when accounting for negative emotions and BMI. Future research should investigate causal interactions between sleep quality and AN symptom severity longitudinally and across different recovery stages.

Level of evidence

Level III—Cohort and case–control analytic studies.

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Data availability

The data that support the findings of this study are available from the corresponding author upon reasonable request.

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Acknowledgements

AP and WLT are supported by National Health and Medical Research Council of Australia (NHMRC) Project Grants (CIA-GNT1159953, CIA-GNT1161609, respectively). The authors would also like to thank all the participants who took the time to participate in this study.

Funding

This research did not receive any specific funding.

Author information

Authors and Affiliations

  1. Centre for Mental Health, Faculty of Health, Arts and Design, AMDC907, Swinburne University of Technology, John St, Hawthorn, VIC, 3122, Australia

    Amy Malcolm, Wei Lin Toh, Kaitlyn Crocker & Andrea Phillipou

  2. Department of Mental Health, St Vincent’s Hospital, Melbourne, Australia

    Andrea Phillipou

  3. Department of Psychiatry, The University of Melbourne, Melbourne, Australia

    Andrea Phillipou

  4. Department of Mental Health, Austin Health, Melbourne, Australia

    Andrea Phillipou

Authors
  1. Amy Malcolm
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  2. Wei Lin Toh
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  3. Kaitlyn Crocker
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  4. Andrea Phillipou
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Corresponding author

Correspondence to Amy Malcolm.

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Conflict of interest

All authors have no conflicts to declare.

Ethical approval

Ethical approval for the project was granted by the Swinburne University of Technology Human Research Ethics Committee and all study protocols abided by the Declaration of Helsinki, as revised in 2008.

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

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Malcolm, A., Toh, W.L., Crocker, K. et al. The contribution of sleep to anorexia nervosa severity. Eat Weight Disord 27, 1563–1568 (2022). https://doi.org/10.1007/s40519-021-01286-2

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  • DOI: https://doi.org/10.1007/s40519-021-01286-2

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