The Role of Circadian Rhythms and Sleep in Anorexia Nervosa

Wilcox, Hannah; Paz, Valentina; Saxena, Richa; Winkelman, John W.; Garfield, Victoria; Dashti, Hassan S.

doi:10.1001/jamanetworkopen.2023.50358

Cited by 4 publications

References 62 publications

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Taking Steps Toward a Consensus on Night Eating Syndrome Diagnostic Criteria

Weissman,

Martin‐Wagar,

Attaway

et al. 2024

Intl J Eating Disorders

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BackgroundNight eating syndrome (NES) is included in the Diagnostic and Statistical Manual for Mental Disorders, 5th edition, as an example of “Other Specified Feeding or Eating Disorders” with minimal guidance about how to define and operationalize NES. The literature suggests that research practices vary widely, making it difficult to draw conclusions about the public health burden of, effective interventions for, or policy implications relevant to NES. This Forum article seeks to illustrate the lack of definitional agreement to underscore the need for a consensus about NES diagnostic criteria, and to propose steps toward closing knowledge gaps and achieving consensus.MethodWe searched PubMed and PsycINFO titles and abstracts, using “NES” as the search term, for research articles published in English between January 1, 2013 to August 12, 2024 with sample sizes of NES > 10 and ages 18 or older. Eligible articles were coded for NES definitions and assessment method used to diagnose participants with NES and for information about comorbidity of NES and any other eating disorder (ED).ResultsSeventy‐three articles met inclusion criteria. Most commonly, NES was diagnosed using a diagnostic criteria set (35/73) or a symptom score threshold (34/73); among the former, only eight studies employed DSM‐5 NES criteria. Thirteen studies, varying widely in methodology, examined comorbidity with other EDs, most commonly binge‐eating disorder where comorbidity was high.ConclusionHeterogeneity of definitions and assessment impede progress in the study of NES. We propose strategies for developing a consensus definition and addressing research gaps.

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Taking Steps Toward a Consensus on Night Eating Syndrome Diagnostic Criteria

Weissman,

Martin‐Wagar,

Attaway

et al. 2024

Intl J Eating Disorders

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Sleep disturbances in anorexia nervosa

Burger,

Bos,

Maas

et al. 2024

Euro Eating Disorders Rev

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IntroductionSleep 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.MethodsA 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.ResultsOut 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.ConclusionSleep 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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An Evolutionary Perspective on the Genetics of Anorexia Nervosa

Breton

Kaufmann

2023

Preprint

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Anorexia nervosa (AN) is a serious psychiatric disorder that typically emerges around adolescence and predominantly affects girls and women. Recent progress has been made in identifying biological correlates of this debilitating disorder, but more research is needed to pinpoint the specific mechanisms that lead to the development and maintenance of AN. There is a known phenotypic link between AN and growth as well as sexual maturation, yet the genetic overlap between these phenotypes has never been investigated in detail. One may hypothesize that shared factors between AN, energy metabolism and reproductive functions may have been under recent evolutionary selection. Here, we characterize the genetic overlap between AN, BMI and age at menarche, and took an evolutionary perspective, aiming to reveal potential evolutionary factors that may help explain the origin of AN in recent human evolution. We obtained publicly available GWAS summary statistics of AN, BMI and age at menarche and studied the polygenic overlap between them. We found 22 loci overlapping between AN and BMI, and 9 loci between AN and age at menarche, with twelve of these not previously associated with AN. Next, we used Neandertal Selective Sweep scores to explore potential positive evolutionary selection for loci associated with the three phenotypes, or overlapping between them. We found evidence that gene variants associated with AN may have been under particular evolutionary dynamic. The circadian cycle seemed to be highly relevant to the studied genetic overlaps and prone to recent evolutionary selection, offering a promising avenue for future research into chronobiology. Taken together, our findings contribute to the understanding of the genetic underpinning of AN. Ultimately, better knowledge of the biological origins of AN may help to target specific biological processes and facilitate early intervention in individuals who are most at risk.

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The Role of Circadian Rhythms and Sleep in Anorexia Nervosa

Cited by 4 publications

References 62 publications

Taking Steps Toward a Consensus on Night Eating Syndrome Diagnostic Criteria

Taking Steps Toward a Consensus on Night Eating Syndrome Diagnostic Criteria

Sleep disturbances in anorexia nervosa

An Evolutionary Perspective on the Genetics of Anorexia Nervosa

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