Sleep, eating disorder symptoms, and daytime functioning

Abstract

Objective: To investigate the relationship between eating disorders, body mass index (BMI), sleep disorders, and daytime functioning.

Design: Survey.

Setting: The Netherlands.

Participants: N=574 Dutch young adults (18-35 years old).

Measurements: Participants completed a survey on eating and sleep habits including the Eating Disorder Screen for Primary care (ESP) and SLEEP-50 questionnaire subscales for sleep apnea, insomnia, circadian rhythm disorder (CRD), and daytime functioning. SLEEP-50 outcomes of participants who screened negative (≤2) and positive (>2) on the ESP were compared. In addition, SLEEP-50 scores of groups of participants with different ESP scores (0-4) and different BMI groups (ie, underweight, healthy weight, overweight, and obese) were compared using nonparametric statistics.

Results: Almost 12% (n=67) of participants screened positive for having an eating disorder. Relative to participants without eating disorders, participants who screened positive for eating disorders reported significantly higher scores on sleep apnea (3.7 versus 2.9, P=0.012), insomnia (7.7 versus 5.5, P<0.0001), CRD (2.9 versus 2.3, P=0.011), and impairment of daytime functioning (8.8 versus 5.8, P=0.0001). ESP scores were associated with insomnia (r=0.117, P=0.005), sleep apnea (r=0.118, P=0.004), sleep quality (r=-0.104, P=0.012), and daytime functioning (r=0.225, P<0.0001), but not with CRD (r=0.066, P=0.112). BMI correlated significantly with ESP scores (r=0.172, P<0.0001) and scores on sleep apnea (r=0.171, P<0.0001). When controlling for BMI, the partial correlation between ESP and sleep apnea remained significant (r=0.10, P=0.015).

Conclusion: Participants who score positive for eating disorders scored significantly higher on sleep disorder scales, and reported significantly more impairment of daytime functioning.

Keywords: apnea; circadian rhythm disorder; daytime functioning; eating disorders; insomnia; sleep disorders.

Figure 1

Relationship between SLEEP-50 scores and ESP scores. Notes: Mean (SD) SLEEP-50 scores are shown for groups of people with different ESP scores (0–4). An ESP score >2 is a positive screen for having eating disorders and warrants further investigation of the subject. Significant differences from the group with an ESP score of zero (P<0.05) are indicated by *. Abbreviations: ESP, Eating Disorder Screen for Primary Care; SD, standard deviation.