Ann Intern Med. 2026 Jul 7. doi: 10.7326/ANNALS-25-01660. Online ahead of print.
ABSTRACT
BACKGROUND: Insufficient sleep is associated with obesity. However, the causal effect on weight status of chronic, mildly insufficient sleep and its potential variability by gender and menopausal status remain unknown.
OBJECTIVE: To explore the effect of 6 weeks of sleep restriction (SR) of 1.5 hours per night on energy balance and body weight regulation.
DESIGN: Pooled analysis of 2 randomized crossover trials. (ClinicalTrials.gov: NCT02960776 and NCT02835261).
SETTING: Outpatient intervention with inpatient and outpatient assessments.
PARTICIPANTS: Adults (n = 95) aged 20 years or older at elevated cardiometabolic risk with habitual sleep of 7 or more hours per night.
INTERVENTION: Six weeks of sustained adequate sleep (AS) and SR of 1.5 hours per night separated by a multiweek washout.
MEASUREMENTS: Outcome measures included adiposity (assessed using magnetic resonance imaging), body weight, waist circumference, and energy balance behaviors and biomarkers.
RESULTS: Sleep duration was reduced by 78.4 minutes (95% CI, -83.5 to -73.3 minutes) per night with SR versus AS. Body weight (0.45 kg [CI, 0.33 to 0.57 kg]), waist circumference (0.52 cm [CI, 0.25 to 0.79 cm]), and whole-body volume (0.56 L [CI, 0.19 to 0.93 L]) were increased with SR relative to AS. Leptin levels were elevated with SR versus AS (2.03 ng/mL [CI, 0.38 to 3.68 ng/mL]). Sedentary time was increased by 17.2 minutes (CI, 11.7 to 22.7 minutes) per day with SR versus AS.
LIMITATIONS: The intervention duration may have been too short to identify changes in body composition, power to evaluate individual differences was limited, and effect sizes were modest.
CONCLUSION: Prolonged exposure to moderately short sleep may lead to weight gain, suggesting that weight management and cardiometabolic disease prevention programs should consider incorporating sleep strategies to promote AS.
PRIMARY FUNDING SOURCE: National Institutes of Health and American Heart Association.
PMID:42407080 | DOI:10.7326/ANNALS-25-01660