Obesity: Sleep Quality, Anxiety-Depression, and Quality of Life

Dr G. Neil Thomas, 
Regional Director, NIHR Research Design Service West Midlands 
 Deputy Director, Master of Public Heath Programme 
Reader in Epidemiology Department of Public Health, Epidemiology and Biostatistics
 School of Health and Population Sciences
 College of Medical and Dental Sciences The University of Birmingham
 Edgbaston, Birmingham, B15 2TTMedicalResearch.com Interview with:
Dr G. Neil Thomas, 
Regional Director,
NIHR Research Design Service West Midlands
Deputy Director, Master of Public Heath Programme 
Reader in Epidemiology
Department of Public Health, Epidemiology and Biostatistics
 School of Health and Population Sciences
 College of Medical and Dental Sciences The University of Birmingham
 Edgbaston, Birmingham, B15 2TT

MedicalResearch.com: What are the main findings of the study?

Dr. Thomas: This population of severely obese individuals (mean BMI 47kg/m2) from a regional specialist weight management service poor sleep quality (Pittsburgh Sleep Quality Index, PSQI) and daytime sleepiness (Epworth Sleepiness Scale) were strongly associated with poorer quality of life (Impact of Quality of Life-Lite (IWQOL-Lite)

MedicalResearch.com:

ere any of the findings unexpected?

Dr. Thomas: The levels of problems in these patients was very high; 3/4 (74.8%) were poor sleepers (PSQI≥5), 52% were anxious (HADS-anxiety subscore>7) and 43% were depressed (HADS-depression subscore>7) which are much higher than in the UK general population (15-35%, 33%, and 11%, respectively), yet there was a clear association between the sleep problems such as short sleep duration and the psychological disorders and with the quality of life. These associations remained significant even after adjusting for a range of potential confounders.

MedicalResearch.com: 
What should clinicians and patients take away from your report?

Dr. Thomas: Despite the very high levels of problems in these patients, those involved with their care usually do not ask about sleep problems and often pay little heed to the psychological issues underlying the obesity. The focus is often on treating the obesity and its consequences, such as diet and exercise interventions, rather than addressing its underlying cause, which may be psychological in nature, such as an unhappy marriage, job stresses etc.

This may also in part contribute to the difficulty in maintaining weight loss if the drivers of the increasing adiposity are not removed it is unlikely that long term weight loss will be successful.

MedicalResearch.com: What recommendations do you have for future research as a result of this study?

Dr. Thomas: There are issues of inferring causality in our study due to its cross-sectional nature in that the obesity may be leading to shorter sleep eg associated pains from joints, breathing disorders may disturb sleep leading to a shorter duration rather than the short sleep leading to increasing adiposity. Both approaches are possible, so we will need longitudinal data to help confirm the observations, those that have previously investigated this do support the contention that short sleep can contribute to the development of psychological conditions such as depression.  That said, there is clearly an important problem in these patients that needs addressing.

Citation:

Araghi MH; Jagielski A; Neira I; Brown A; Higgs S; Thomas GN; Taheri S. The complex associations among sleep quality, anxiety-depression, and quality of life in patients with extreme obesity. SLEEP 2013;36(12):1859-1865.

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