Sleep disturbances in anorexia nervosa

IF 3.4 2区心理学 Q1 PSYCHIATRY European Eating Disorders Review Pub Date : 2024-10-23 DOI:10.1002/erv.3148

Pia Burger, Rosita W. Bos, Joyce Maas, Mladena Simeunovic-Ostojic, Reinoud J. B. J. Gemke

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Abstract

Introduction

Sleep is crucial for physical and psychological health, and disturbances are closely linked to psychiatric disorders, making their management essential for improving treatment outcomes and preventing relapse. Although sleep disturbances are implicated in psychopathology of eating disorders, its role in anorexia nervosa (AN) remains unclear. This review aimed to characterise sleep in AN.

Methods

A systematic search was conducted in four scientific databases, including papers from inception to 25 May 2024. A machine learning algorithm (ASReview) was utilised to screen titles and abstracts for eligibility. Sleep quantity, architecture, and quality were investigated. Meta-analyses were conducted to investigate the difference between patients with AN and healthy controls (HC) in total sleep time (TST), wake after sleep onset (WASO), sleep onset latency (SOL), sleep efficiency, Sleep Stage 1, 2, slow wave sleep, rapid eye movement (REM) sleep and REM latency. Certainty of evidence was assessed using the GRADE approach.

Results

Out of 67 potentially eligible papers, 31 were included in this review, with 15 in the meta-analyses. Statistically significant average mean differences were found for TST (−32.1 min [95% CI: −50.9, −13.4]), WASO (19.0 min [95% CI: −2.4, 40.3]), and sleep efficiency (−4.4% [95% CI: −7.9, −0.9]). Additionally, Sleep stage 1 was significantly increased (2.4% [95%-CI: 0.05, 4.7]), while REM sleep was reduced (−2.1% [95%-CI: −4.2, −0.02]). Subgroup analysis showed that TST and WASO did not improve significantly after weight restoration.

Conclusion

Sleep in patients with AN is impaired, with lower TST and sleep efficiency, higher WASO, more time in stage 1 sleep, and less in REM. Weight restoration alone may not improve sleep. While more research is needed, substantial accompanying sleep disturbances in AN justifies addressing these in current treatment practice, also because of the chronic character of AN and importance of sleep for long term (mental) health.

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神经性厌食症患者的睡眠障碍。

简介睡眠对身心健康至关重要，而睡眠障碍与精神疾病密切相关，因此睡眠管理对改善治疗效果和防止复发至关重要。尽管睡眠障碍与进食障碍的精神病理学有关，但其在神经性厌食症（AN）中的作用仍不明确。本综述旨在描述神经性厌食症患者的睡眠特征：方法：在四个科学数据库中进行了系统检索，包括从开始到2024年5月25日的论文。利用机器学习算法（ASReview）筛选符合条件的标题和摘要。对睡眠的数量、结构和质量进行了调查。进行了元分析，以研究AN患者和健康对照组（HC）在总睡眠时间（TST）、睡眠开始后唤醒（WASO）、睡眠开始潜伏期（SOL）、睡眠效率、睡眠阶段1、2、慢波睡眠、快速眼动（REM）睡眠和REM潜伏期方面的差异。采用 GRADE 方法对证据的确定性进行了评估：在 67 篇可能符合条件的论文中，31 篇被纳入本综述，15 篇被纳入荟萃分析。研究发现，TST（-32.1 分钟 [95% CI：-50.9, -13.4]）、WASO（19.0 分钟 [95% CI：-2.4, 40.3]）和睡眠效率（-4.4% [95% CI：-7.9, -0.9]）的平均值差异具有统计学意义。此外，睡眠 1 期显著增加（2.4% [95%-CI: 0.05, 4.7]），而快速动眼期睡眠减少（-2.1% [95%-CI: -4.2, -0.02]）。亚组分析显示，体重恢复后，TST和WASO没有明显改善：结论：AN 患者的睡眠受到影响，TST 和睡眠效率较低，WASO 较高，第一阶段睡眠时间较长，快速动眼期睡眠时间较短。单靠恢复体重可能无法改善睡眠。虽然还需要进行更多的研究，但 AN 患者伴随的大量睡眠障碍证明在目前的治疗实践中解决这些问题是合理的，这也是因为 AN 具有慢性特征，而且睡眠对长期（心理）健康非常重要。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

European Eating Disorders Review PSYCHOLOGY, CLINICAL-

CiteScore

8.90

自引率

7.50%

发文量

期刊介绍： European Eating Disorders Review publishes authoritative and accessible articles, from all over the world, which review or report original research that has implications for the treatment and care of people with eating disorders, and articles which report innovations and experience in the clinical management of eating disorders. The journal focuses on implications for best practice in diagnosis and treatment. The journal also provides a forum for discussion of the causes and prevention of eating disorders, and related health policy. The aims of the journal are to offer a channel of communication between researchers, practitioners, administrators and policymakers who need to report and understand developments in the field of eating disorders.