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Gender Differences in the Relationship of Sleep Pattern and Body Composition in Healthy Adults

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Gender Differences in the Relationship of Sleep Pattern and Body Composition in Healthy Adults ORIGINAL ARTICLE Gender differences in the relationship of sleep pattern and body composition in healthy adults Diferenças do gênero na relação entre o padrão de sono e a composição corporal em adultos saudáveis Ioná Zalcman Zimberg1, Cibele Aparecida Crispim1,2, Rafael Marques Diniz1, Murilo Dattilo1, Bruno Gomes dos Reis1, Daniel Alves Cavagnolli1, Alexandre Paulino de Faria1, Sérgio Tufik1, Marco Túlio de Mello1 Abstract de composição corporal foram feitas na manhã seguinte, após 12 horas Objective: To investigate the gender differences in relationship be- de jejum. Protocolos validados foram usados para avaliar o sono (po- tween body composition and sleep pattern in healthy subjects. Meth- lissonografia) e antropometria (massa corporal, altura, dobras cutâneas ods: Fifty-two healthy volunteers (27 women) participated in this e circunferências corporais). Resultados: Correlação positiva entre study. Subjects underwent overnight polysomnography and measure- porcentagem de sono de ondas lentas e massa corporal magra (r=0,46; ments of body composition were taken in the following morning af- p=0,016) foram encontradas em mulheres. Em homens, desperta- ter a 12-hour fast. Validated protocols were used to evaluate sleep res durante o sono foram positivamente correlacionados com índices (polysomnography) and anthropometry (body mass, height, skinfolds como índice de massa corporal (r=0,62, p<0,01), massa gorda (kg) and body circumferences). Results: A positive correlation between (r=0,61, p<0,01), percentual de gordura (r=0,56, p<0.01), circunfe- percentage of slow-wave sleep and percentage of lean body mass rência de cintura (r=0,58, p<0.01), circunferência de quadril (r=0,45, (r=0.46, p=0.016) was found in women. In men, awakenings during p<0.01) e relação cintura-quadril (r=0,50, p=0,01). Índice de massa sleep were correlated positively with indices such as body mass in- corporal, percentual de gordura, circunferência de cintura e relação dex (r=0.62, p<0.01), fat mass (kg) (r=0.61, p<0.01), fat percentage cintura quadril foram correlacionadas com o índice de apneia e hipop- (r=0.56, p<0.01), waist circumference (r=0.58, p<0.01), hip circum- neia (r=0,40, p=0,0�; r=0,46, p<0,01; r=0,4�, p<0,01; e r=0,56, ference (r=0.45, p<0.01), and waist-to-hip ratio (r=0.50, p=0.01). p<0,01) em ambos os gêneros. Conclusões: Este estudo demonstrou Body mass index, body fat percentage, waist circumference, and waist- importantes associações estatísticas entre diferentes variáveis de sono to-hip ratio were correlated with apnea-hypopnea index (r=0.40, e características antropométricas em indivíduos saudáveis, sugerindo p=0.0�; r=0.46, p<0.01; r=0.4�, p<0.01; and r=0.56, p<0.01) in uma possível relação entre maior deposição de gordura e diminuição both genders. Conclusion: This study showed important statistical na qualidade de sono. Ademais, atesta-se que essas associações diferem associations between different sleep variables and anthropometric entre gêneros e incitam investigações mais aprofundadas. characteristics in healthy subjects, suggesting a possible relationship between greater body fat deposition and impairment of sleep quality. Palavras-chave: sono/fisiologia; transtornos do sono/diagnostico; In addition, it was noticed that these associations differ between gen- índice de massa corporal; composição corporal; distribuição da gor- ders and deserve further exploration. dura corporal; polissonografia; humanos; feminino. Keywords: sleep/physiology; sleep disorders/diagnosis; body mass INTRODUCTION index; body composition; body fat distribution; polysomnography; Sleep has been increasingly recognized for its contribution human; female. to physical and psychological health1. Moreover, sleep loss due to voluntary curtailment of time in bed has become a RESUMO hallmark of modern society2. Studies show that most people Objetivo: Investigar as diferenças de gênero na relação entre compo- sição corporal e padrão de sono em indivíduos saudáveis. Métodos: need between 7 and 8 hours of daily sleep, however, over less Cinquenta e dois voluntários saudáveis (27 mulheres) participaram do than 50 years, a reduction of sleep duration by 1.5 to 2 hours estudo. Os sujeitos foram submetidos à polissonografia e mensurações seems to have occurred2-4. Study carried out at Centro de Estudos em Psicobiologia e Exercício (CEPE), São Paulo (SP), Brazil. 1Departamento de Psicobiologia, Universidade Federal de São Paulo (UNIFESP), São Paulo (SP), Brazil. 2Universidade Federal de Uberlândia (UFU), Uberlândia (MG), Brazil. Financial support: AFIP, Sleep Institute, CEDIP/FAPESP (#��8/14�0�-�), CEPE, UNIFESP, FADA, CAPES and CEMSA. Conflict of interests: nothing to declare. Corresponding author: Marco Túlio de Mello � Rua Professor Francisco de Castro, �� � CEP 04020-050 � São Paulo (SP), Brazil � E-mail: [email protected] Received: February 2, 2011 � Accepted: July 2, 2011 Sleep Sci. 2011;4(2):�������44 40 Relationship between sleep pattern and body composition Several studies have observed an association between eters were recorded in one night of PSG in the laboratory. short sleep duration and increased body mass index (BMI) The PSG consisted of the simultaneous and continuous or increased risk for being overweight5-1�. Compared with registration of the electroencephalogram (C4-A1, C�-A2, sleeping 7 to 8 hours per night, Patel et al.14 found that O2-A1, and O1-A2), left and right electrooculogram, sub- sleeping less than 5 hours was associated with a BMI that mentonian and tibialis anterior muscles electromyography, was, on average, more than 2.5 kg/m2 in men and 1.8 kg/m2 electrocardiogram, nasal and oral airflow, thoracic cage and in women, after adjustments were made for multiple poten- abdominal respiratory motion, oxyhemoglobin saturation tially confounding variables. Moreover, measures of adipos- (SaO2), snoring and body positioning. All data were col- ity also have been associated with time of sleep, showing lected and stored using an EMBLA S7000® and recordings that short sleep duration is associated with higher body fat were taken in �0-second epochs. PSGs were scored by a percentage and waist circumference15-17. blinded, experienced sleep technician and staged according However few studies that examined the association be- to standard criteria21. Analyses included measures of total tween sleep quality and body composition in health indi- sleep time (TST), sleep efficiency, stages 1, 2,� (slow wave viduals are available in the literature17 as well as gender sleep � SWS), rapid eye movement (REM) sleep, REM differences in these variables18. In front of this, the aim of sleep latency, wake time after sleep onset (WASO), AHI, this study was to investigate whether sleep architecture is oxygen saturation and PLM. associated with body composition in healthy adults and if Arousals were defined according to guidelines of the this association is influenced by gender. Sleep Disorders Atlas Task Force of the American Sleep Dis- orders Association22, and respiratory events classified using METHODS criteria of the American Academy of Sleep Medicine1�. Epi- sodes of apnea were defined as complete cessation of airflow Participants and study design for 10 seconds or more, and hypopnea was scored if there Fifty-two non-obese, healthy volunteers (27 women), between was at least a 50% reduction in airflow for 10 seconds or a 1� and 45 years old (men: 27.�±6.0; women: 28.8±6.7), discernable decrement in airflow for 10 seconds in associa- were recruited from the community and from the medical tion with either an oxyhemoglobin desaturation of at least and technical staff and students of Universidade Federal de �% or an arousal. Apnea/hypopnea events were classified as São Paulo (UNIFESP) and Associação Fundo de Incentivo a obstructive, central or mixed according to the presence or Pesquisa (AFIP). All individuals were sedentary (according the absence of breathing efforts and the AHI was calculated to International Physical Activity Questionnaire � IPAQ), considering number of episodes of apnea and hypopnea per did not work in shift work, featured no abnormalities in a hour of sleep. clinical electrocardiogram at rest and under physical strain, and did not have any health problems according to medical Body composition evaluation evaluation. After clinical evaluation, all subjects underwent Measurements of body mass, height, skinfolds, and body overnight polysomnography (PSG). Subjects who presented circumferences were taken in the following morning of the values of apnea-hypoapnea index (AHI) >151�, and those PSG exam after a 12-hour fast. Height was measured with a who presented periodic leg movements (PLM) >520, assessed Sanny estadiometer (American Medical do Brasil Ltda., Bra- by means of PSG were excluded. Enrollment was voluntary zil) with a 0.1 cm precision. Body weight was measured to after being informed about the procedures and objectives of the nearest 0.1 kg using a Filizola scale (Star model, Filizola, the study. Brazil). Body mass (kg) divided by the square height (m²) The research was performed in Sleep Institute and Cen- was used to calculate BMI. tro de Estudos em Psicobiologia e Exercício/Associação Fundo de Three measurements of triceps, subscapular, midaxillary, Incentivo à Pesquisa (CEPE/AFIP) in 2007, situated in São chest, suprailiac, abdominal, and thigh skinfolds were taken Paulo city (SP), Brazil. It was approved by the Committee using a Lange skinfold caliper (Beta Technology Incorpo- of Ethics of Universidade Federal de São Paulo (#0018/08) rated, USA) with a 0.1 mm precision. The mean value was and the volunteers were informed about all the stages of used to estimate the body fat percentage according to Jack- the study and signed a written and informed consent be- son & Pollock2� and Jackson et al.24, equations for men and fore participation. women, respectively. A Sanny measuring tape (American Medical do Bra- Sleep evaluation sil Ltda., São Paulo) with a 10 mm precision was used to Volunteers arrived at the sleep laboratory at 21h�0 for measure the waist (WC) and hip (HP) circumferences.
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