Short sleep duration and obesity are common occurrence in today's society. An extensive literature from cross-sectional and longitudinal epidemiological studies shows a relationship between short sleep and prevalence of obesity and weight gain. However, causality cannot be inferred from such studies. Clinical intervention studies have examined whether reducing sleep in normal sleepers, typically sleeping 7-9 h/night, can affect energy intake, energy expenditure, and endocrine regulators of energy balance. The aim of this review is to evaluate studies that have assessed food intake, energy expenditure, and leptin and ghrelin levels after periods of restricted and normal sleep. Most studies support the notion that restricting sleep increases food intake, but the effects on energy expenditure are mixed. Differences in methodology and component of energy expenditure analyzed may account for the discrepancies. Studies examining the effects of sleep on leptin and ghrelin have provided confl icting results with increased, reduced, or unchanged leptin and ghrelin levels after restricted sleep compared to normal sleep. Energy balance of study participants and potential sex differences may account for the varied results. Studies should strive for constant energy balance and feeding schedules when assessing the role of sleep on hormonal profi le. Although studies suggest that restricting sleep may lead to weight gain via increased food intake, research is needed to examine the impact on energy expenditure and endocrine controls. Also, studies have been of short duration, and there is little knowledge on the reverse question: does increasing sleep duration in short sleepers lead to negative energy balance? keywords: Energy balance, energy expenditure, food intake, ghrelin, leptin Citation: St-Onge MP. The role of sleep duration in the regulation of energy balance: effects on energy intakes and expenditure. J Clin Sleep Med 2013;9(1):73-80.http://dx.doi.org/10.5664/jcsm.2348 T here is much epidemiological evidence supporting an association between self-reported short sleep duration and obesity. This has been the topic of several meta-analyses and systematic reviews.1-3 These studies show that the odds of obesity are increased in those who report sleeping short, generally < 7 h/night, compared to those who report sleeping a recommended amount of time, about 7-8 h/night. Since those reviews were published, additional support has been put forth from various population studies. [4][5][6][7][8][9] Although the literature is somewhat consistent, some studies do not show an association in specifi c population subgroups, such as the elderly.6,10 Nevertheless, it is generally agreed that there is a link between short sleep duration and obesity. However, whether this relationship is causal is debatable. The purpose of this review is to examine the literature to determine if alterations in sleep duration lead to changes in the energy balance equation: Energy intake = Energy output (weight stability). The focus will be on adult clinical...