Night Eating Syndrome and Its Association with Sleep Quality and Body Mass Index Among University Students
Night Eating Syndrome and Its Association
with Sleep Quality and Body Mass Index
Among University Students
by
Lojeen aladeem
Nada alghamdi
Dareen faisal
Ghadah ibrahim
01 JANUARY 2023
HAFRAL-BATIEN
CLINCAL NUTRITION DEPARMENT
Night Eating Syndrome and Its Association with Sleep Quality and Body Mass Index Among University Students
Acknowledgment
we take this occasion to thank God ,almighty for blessing us with his grace and taking our endeavor
to a successful culmination .
we extend our sincere and heartfelt thanks to our esteemed guide , and we also take this opportunity
to express a deep sense of gratitude to our doctor course
Dr. Yasmine Bashir , Dr. Lamya Aljamie , Dr. Alhanouf Alghamdi ,Dr. Manal Alhawsawi
,Dr.Farouk Almutairi and Dr. Mohammad Algeldah Alqahtani , for cordial support ,valuable
suggestions and guidance .
Many thanks for all Members of clinical nutrition sciences Department who cooperate with us in
this study .
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Night Eating Syndrome and Its Association with Sleep Quality and Body Mass Index Among University Students
Index
contents..................................................................................................................................................................................... page
Abstract .............................................................................................................................................................................................. 3
Introduction...................................................................................................................................................................................... 3
Review of literature………………………………………………………………………………..10
1-1 Factors affecting sleep……………………………………………………………………10
1-2 Consequences of poor sleep ………………………………………………………..13
1-3 Prevalence of unhealthy sleep among adult ……………………………………………..15
1-4 Sleep and college student ………………………………………………………….…17
1-5 Prevalence of obesity in university student……………………………………………..18
1-6 Night eating syndrome………………………………………………………………….18
Methodology………………………………………………………………………………...19
1-1study design, sample size and subjects…………………………………………………...19
1-2 Data collection……………………………………………………………………….…20
Results…………………………………………………………………………………………...21
Discussions ……………………………………………………………………………………….23
Conclusion ………………………………………………………………………………………..28
Table ............................................................................................................................................. page
table1 ................................................................................................................................................................................................ 19
table2 ............................................................................................................................................................................................... 21
table3……………………………………………………………………………………………..…22
table4…………………………………………………………………………………………….…23
Figure…………………………………………………………………………………………….page
Figure1…………………………………………………………………………………………… 23
Abstract
2
Night Eating Syndrome and Its Association with Sleep Quality and Body Mass Index Among University Students
A disturbed eating pattern known as night eating syndrome (NES) is characterized by hyperphagia at
night and is frequently accompanied by sleep disturbances. The purpose of this study is to ascertain
the prevalence of NES and its relationship to body mass index (BMI) and sleep quality among
students at the University of Hafr Albaten. This cross-sectional study included 30 students from Hafr
Albaten University in total. BMI, NES, and sleep quality were all determined using questionnaires
and interviews that were administered. Seven self-rated questions in total were used to gauge the
prevalence of NES throughout the previous month. While seven self-rated questions were used to
gauge the quality of sleep, the results were added to produce the overall score. Results indicated that
3% of participants
Introduction
In recent years, disordered eating behaviours have been drawing attention progressively and
becoming a global concern due to their steady growing trends over the years (1). Night eating
syndrome was first described in 1955 by Stunkard, Grace, and Wolff, among a group of individuals
with obesity seeking weight loss treatment. They reported that those with the syndrome consumed a
large majority of their caloric intake (25% or more) at a time when individuals without obesity would
not be eating. In addition, the patients experienced insomnia and morning anorexia. Tremendous
efforts were carried out to define night eating syndrome (NES).. Is a serial of problematic behaviours
such as morning anorexia, evening hyperphagia (25% of total energy intake after 7 pm) and sleep
disturbances. another definition of NES was describing NES as a “delay in the circadian pattern of
food intake”, in which reduction of energy intake happened in the first half of the day and followed
by a great increment of energy intake in the second half of the day. Night eating syndrome or
nocturnal eating syndrome, is a proposed eating disorder that is characterized by extremely elevated
appetite (hyperphagia) in the evening and/or night eating and associated with insomnia and morning
anorexia and awakening from sleep to eat .two core diagnostic criteria were proposed to facilitate the
process of detecting NES (2), in which an individual was required to fulfil at least one of the criteria
to be identified as having NES. One of the criteria is the flow of the food consumption in the evening
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Night Eating Syndrome and Its Association with Sleep Quality and Body Mass Index Among University Students
and night, a condition at which 25% or more food intake occurs after the evening meals and from
awakening nocturnal ingestions for at least twice a week. Besides, the individual is aware of the
nocturnal ingestions and experiences distress or impairment in functioning for at least three months.
Asides from the two core diagnostic criteria, another five descriptors were recommended to aid in the
diagnosis of NES, in which three of the descriptors must be fulfilled.
These descriptors include (i) a lack of desire to eat in the morning or breakfast is omitted on at least
four mornings per week, (ii) a strong urge to eat between dinner and sleep onset and/ or during the
night, (iii) presence of sleep onset and/ or sleep maintenance insomnia at least four nights per week,
(iv) a belief that one must eat in order to initiate or return to sleep, and (v) frequent depressed mood
or worsening of mood in the evening (3). It is a problem warrants further investigation as consuming
most of the day food during night will definitely put stress on digestive system at a time when a
person should be resting. A person with a disease can be of normal weight or overweight not all
persons with night eating syndrome are overweight or obese, but more studies show that the syndrome
is more frequently found in obese populations. Most study proved that there is a strong relationship
with BMI in these study the patients with night-eating syndrome reported that they experienced
symptoms during times of weight gain and life stress. Since this time, the definition of night eating
syndrome has varied. For example, in later years, Stunkard’s definition was expanded to include
nocturnal ingestions. Night eating syndrome has a strong relationship with sleep disturbances, and it
could affect the sleep quality of the people with NES syndrome. Studies have found that patients
with night eating syndrome have difficulties initiating and maintaining sleep. Agents of sleep
disturbances in individuals with night eating syndrome may include nocturnal ingestions and
insomnia. This study was conducted for seeking and estimating the relationship between NES,BMI
and sleep quality by several methods.
The body weight is invariably influenced by many factors like, genes, prenatal and early life
influences; diet patters, physical activities and sleep. The most commonly used measure of weight
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Night Eating Syndrome and Its Association with Sleep Quality and Body Mass Index Among University Students
status today is the body mass index, or BMI. It uses a simple calculation based on the ratio of
someone’s height and weight (BMI = kg/m2 ). Decades of research have shown that BMI provides a
good estimate of “fatness” and also correlates well with important health outcomes like heart disease,
diabetes, cancer, and overall mortality. So it’s a useful tool for clinicians to screen the persons at risk
of the aforesaid diseases because of having too much weight for their height.
A circadian rhythm is any biological process seen in all living beings that displays an endogenous,
entrainable oscillation of about 24 hours. These rhythms are driven by a circadian clock and rhythms
have been widely observed in plants, animals, fungi and cyanobacteria. The term circadian comes
from the Latin circa, meaning "around" (or "approximately") and diem or dies, meaning "day". 5 A
good night’s sleep is one of the keys to good health - and may also be a key to maintaining a healthy
weight. There is mounting evidence that people who get too little sleep have a higher risk of weight
gain and obesity than people who get seven to eight hours of sleep a night. Lack of sleep could be the
prime suspect causing the obesity epidemic. Obesity was identified as a disease thirty years ago when,
the World Health Organization (WHO) listed obesity as a disease condition in its International
Classification of Diseases in 1979. Analysis of mortality trends suggests that large increases in NCDs
have occurred in developing countries, particularly those in rapid transition (e.g. Brazil, China and
India.) (The epidemic of rapid nutrition transition and its adverse health consequences in the Asian
region are now beginning to get noticed. These include insulin resistance, type II diabetes,
hypertension, coronary artery disease, hyperlipidemia, metabolic syndrome (Syndrome X), stroke
and certain cancers. Mortality from cardiovascular disease is expected to rise by about 60%, and
overtake deaths from infectious diseases by 2015-2020. The prevalence of type II diabetes has
increased by 40% in Chennai between 1988 and 1994 (Murray and Lopez, 1994). It is predicted that
the prevalence of type II diabetes will rise from 4% to 5.4% by 2025, and the proportional rise will
be greatest in developing countries (48%), especially India (59%). India will have more people with
diabetes (57 million), than any other country, with the greatest numbers in the 45-64 years age group.
The economic and health consequences of obesity epidemic can spell disaster for the nation unless
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Night Eating Syndrome and Its Association with Sleep Quality and Body Mass Index Among University Students
immediate remedial measures are instituted The complex range of factors that interact to determine
the nature and course of obesity epidemic needs to be understood in order to adopt preventive
strategies to help developing societies like India deal with this burgeoning problem (IAP, 2004).(4)
Healthy eating is believed to play a crucial role in the prevention of obesity, cardiovascular
(Richardson, 2000) disease, cancer, diabetes, and osteoporosis (McKevith, 2004; Renner, Hermes, &
Stracke, 1998; Steinmetz & Potter, 1996). Although there are many efforts to promote healthy eating
in individuals, studies suggest that 4 individuals, especially adolescents, fail to adhere to healthy
eating practice (Johnson & Hackett, 1977; Reynolds et al., 1999; Sjoberg et al., 2003). These
behaviours are of concern because eating behaviour established in adolescence is likely to affect not
only the health of an adolescent but also health and well-being in adulthood (Videon & Manning,
2003). Many studies report a relatively weak correlation between nutrition knowledge and dietary
behaviours in adolescents. Some studies even revealed no relationship between adolescent knowledge
about healthy diets and their actual behaviours (Baranowski, Cullen, & Baranowski, 1999). Thus,
other alternative influences must account for adolescent eating behaviours. Influences on adolescent
eating behaviours have been explored and categorized into many different perspectives (Ogden,
2003). Altogether, these influences may be categorized in two broad categories, which are individual
and environmental influences. Individual influences consist of individual cognitions and
characteristics that influence eating behaviour such as attitude, beliefs, self-efficacy, meal pattern,
and lifestyle (Story, Neumark-Sztainer, & French, 2002). Environmental influences are represented
by the adolescent‟s social environment such as family and peers as well as physical environment such
as availability of such foods (Berg et al., 2002; Videon & Manning, 2003). Of all these influences,
investigators play attention to the cognitive factors partly because they have been shown to affect
behaviour (Conner & Norman, 1998) and partly because they are influences which are potentially
modifiable (Povey et al., 2000). Poor eating habits are an important public health issue that has large
health and economic implications. Poor nutrition and obesity are among the most important health
issues facing society today, not only in terms of health, but also health care expenses (Goel, 2006,
6
Night Eating Syndrome and Its Association with Sleep Quality and Body Mass Index Among University Students
Rashad & Grossman, 2004). There are a variety of predictors of obesity including genetics, physical
activity, and food consumption (Goel, 2006). There are other outcomes of food choice and nutrition
that also have an independent effect on health including some types of cancer, cardiovascular disease,
and diabetes (Nicklas et al., 2001). For these reasons, food selection is an important consumer
behaviour with many longterm consequences to the individual in the form of health and longevity
and to society in the form of health costs. There has been a dramatic increase in the number of young
adults with unhealthy eating habits over the past twenty years. The prevalence of unhealthy eating
habits has increased in all socio economic classes in the last two decades and as a result, there is
growing recognition on the part of professionals, parents and educators for an intervention
programme to deal with unhealthy eating habits (Adolfsson et al., 2002). Over the last ten years there
has been an increase in the number of adolescents who are preoccupied with weight and therefore
populations can be at great risk for developing 6 unhealthy eating habits (Collins, 1991; Graham,
1998; Hill, Oliver & Rogers, 1992). As a consequence of unhealthy eating habits we are seeing very
significant increases in chronic disease morbidity in many countries at an earlier age (Catford, 2003;
Hartley, 1998).(5)
Sleep is an essential part of wellness, and if you've been missing out on a few hours a night just to
get more work done (or enjoy more of the day when you've finished working hard), you could be
putting yourself at risk and reducing the quality of your work. To be the best you must rest.
Unfortunately, in today's fast-paced culture, that can be easier said than done. Your brain is
continuous at work while you are awake or sleeping. Your brain clears out the waste when you sleep.
It is very helpful in reenergizing the body cells and helps in unifying information you have acquired
in entire day. Information is sort away to store as memories while sleeping only. Your brain cannot
accomplish needed tasks if you don't get good sufficient sleep. You enter in a state known as "Sleep
Deprivation" if less sleep becomes your pattern. As the name suggests, deprivation of sleep is a
condition where the individual is not getting the required amount of sleep. Deficiency of sleep is a
much vast concept. This occurs if you are experiencing one or more of the following conditions such
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Night Eating Syndrome and Its Association with Sleep Quality and Body Mass Index Among University Students
as you are experiencing a disorder of sleep that causes poor sleep quality, keeps you away from
getting adequate sleep, not getting adequate time to sleep, you sleep during wrong or odd hours of
the day (means body's natural clock is not in sync). Those shift workers try to sleep in day time mostly
get up fewer than seven to nine hours, due to the alerting signals receiving from 13 circadian system.
One or more of these can lead to chronic sleep deprivation (National heart, lung, and Blood Institute,
2018). Usually, it is known that adults need approximately 7-9 hours of sleep per day, however, each
person's wakeup and falling asleep time may vary. According to scientists, there can be certain
inherent differences in the terms of when they sleep and wake up optimally. Chrono type is a natural
pattern. Genetics partially decide if you are a lark (morning person) or a night owl (an evening
person). In order to adjust and check a specific schedule of shift that suits you the best, you must
know your natural tendency. For instance, if you always prefer to wake up early and feel energetic in
the morning, then a morning shift might be the most suitable one for you. If you prefer to stay awake
at night and have a sensation of productiveness during evening hours, then an evening or night shift
might be the best according to you. This happens because your circadian rhythm keeps you attentive
during these hours. There are a number of people who neither fall in both categories; they tend to be
in the middle. In this case, you must try varied hours of a shift to check the best timing for you.
Certain individuals experience more difficulty in schedule changes and their internal clock takes more
effort for adjustment, and even a few alterations in sleep might be more difficult to cope up for them.
The following individuals must think about securing their time of sleeping if they tend to work during
rotating or night shifts (Pacheco, 2021).(6)
Several studies have looked into the relationship between sleep quality and how a person feels when
they first wake up and throughout the day (Argyropoulos, Hicks, & Nash, 2003). The findings reveal
that sleep quality is linked to waking ease, exhaustion, sensation of balance and coordination clarity,
how one feels rested, restored, and refreshed, as well as waking mood and bodily feelings. Fatigue
was associated with poorer quality of sleep during the day, while attentiveness was linked to higher
sleep quality. External factors such as gender, scholastic accomplishment, academic background,
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Night Eating Syndrome and Its Association with Sleep Quality and Body Mass Index Among University Students
health status, socio-economic status, and the individual's degree of stress, according to Saygili,
Akinci, Arikan, and Dereli (2011), affect sleep quality. Mayda, Kasap, Yildirim, Yilmaz, Derdiyok
and Ertan (2012) have also found that medical students may have sleep problems due to the fact that
their training programme requires time and effort. Because of this issue, there may be various
physical, social, psychological issues for students who can not sleep enough.(7)
The escalating worldwide prevalence of obesity has drawn attention to the association between ‘nonnormative’ eating patterns, weight gain and obesity. Night eating syndrome (NES) is such a condition,
observed most frequently among groups of overweight and obese individuals. First characterized by
Stunkard et al. 1 in 1955, awareness of NES as a behavioral entity has only emerged in the last decade.
Individuals with NES are characterized by a time-delayed pattern of eating relative to sleep, where
most food is consumed late in the day and into the evening and night.2 Features of the syndrome have
generally included morning anorexia, evening hyperphagia and insomnia,3–10 and more recent
research criteria have stipulated the consumption of nocturnal snacks, where individuals wake from
sleep to eat.11–15 Individuals with NES, who report nocturnal snacking may constitute a group with
more severe symptoms than those who do not wake to eat.16 At present, NES is not formally listed
as an eating or sleep disorder, and no agreed diagnostic criteria exist. NES prevalence estimates are
low in community samples (range: 0.4–1.6%),5,17,18 but markedly higher among groups of obese
persons seeking medical or surgical weight loss (range: 6–64%).19 Despite this, only one crosssectional study has shown a positive relationship between NES and body mass index (BMI).(8)
Bariatric surgery candidates. Consecutive, eligible persons accepted into the bariatric surgery
program at The Centre for Bariatric Surgery, The Avenue Hospital, Melbourne, Australia. Two
hundred and thirty of 240 subjects agreed to participate and were provided with a survey pack and
consent form. Of these, 180 completed surveys and consent forms were returned, a response rate of
78%. Weight loss support group respondents. This sample provided data from obese persons who
were not seeking bariatric surgery. Subjects were recruited from ‘Take Off Weight Naturally’
(TOWN), a weight loss company that consists of over 130 support groups within Victoria. Research
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Night Eating Syndrome and Its Association with Sleep Quality and Body Mass Index Among University Students
flyers were disseminated throughout the groups and interested individuals were asked to contact the
research center to arrange for the survey pack to be sent out. In total, 158 survey packs were
distributed, and 93 completed surveys were returned, which represents a response rate of 59%. Names
and contact phone numbers were volunteered by 71% of respondents. General community
respondents. Subjects were randomly recruited through flyers placed on notice boards in the general
community, flyers on notice boards in two large metropolitan hospitals, and through survey
distribution at a large Australian university. Flyers invited any interested individuals, who were not
actively seeking weight loss to contact the research centre to arrange for the survey pack to be sent
out. Of 260 distributed packs, 158 completed surveys were received; a response rate of 61%. Names
and contact phone numbers were volunteered by 72% of respondents.
Review of literature:
Factors affecting sleep:
Across all animal species, sleep is a maintained state of awareness whose exact function is yet
unknown but which is crucial to health and wellbeing. According to epidemiological data, sleep
duration has likely decreased in both children and adults over the past 50 years, while rates of
overweight and obesity have risen at the same period. Both cross-sectionally and longitudinally,
insufficient sleep and other aspects of poor sleep have been linked to obesity. These findings point
to a possible causal link between insufficient sleep and higher rates of weight gain, which may be
due to sleep's impacts on food intake or physical activity. However, as obesity causes a number of
co-morbidities, such as sleep apnea, which can disturb sleep, there is also a possibility of reverse
causation.(9). Bailey and colleagues (2014) found that the standard deviation of bedtime was
significantly associated with BMI when using objective measures over a seven day period. Both
studies found that higher variability in sleep measures were associated with increased BMIs, though
these relations were not consistent across gender. In addition, both of these studies analyzed sleep
duration, however, sleep duration was either less strongly associated with BMI (Bailey et al., 2014)
or no longer a statistically significant predictor (Roane et al., 2015) when sleep IIV was included in
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Night Eating Syndrome and Its Association with Sleep Quality and Body Mass Index Among University Students
analyses.(36) results of such assessments in Andhra University (2004) have indicated a steady rise
in the incidence of overweight and obesity over the years and during the latter half of the Twentieth
century it showed signs of reaching pandemic proportions as indicated by the reports of several
workers all over the world.
Also in population-based research show a large U-shaped non-linear correlation between the amount
of time spent sleeping each night and body mass index (BMI). 13,14 Individuals who get less sleep
than 6 hours per night are more likely to be fat than those who get 7-8 hours per night.(10) also sleep
deprivation has other side effect according to research done in University of Chicago to identify
sleep deprivation and its effect in neuroendocrine function have demonstrated that, in healthy
persons sleep deprivation affects the neuroendocrine regulation of hunger .(11) regarding to student
sleep schedule a study conduct in Virginia Commonwealth University to describe sleeping habits
and factors that are associated with poor sleep in a large group of college students found that more
over 60% of students were classified as poor sleepers, and these students reported noticeably more
issues with their physical and mental health than did excellent sleepers. overwhelming majority of
students claimed that academic and emotional stress affected their ability to sleep. (12) In study
aimed to explore the relationship between food insecurity, sleep quality, and mental and physical
health among college students using a multi-campus approach found that college students have high
incident of poor sleep quality and quantity in addition to high incident of food insecurity (13)
Additionally, a person's food has a significant impact on the quality and amount of their sleep in
addition to how they feel physically and mentally.(14)
Sleep is affected by several factors. Amongst all, employment has remarkable positive effects on
mental health in general, and on the other hand, unemployment increases the risk of insomnia
(Vander Noordt et al., 2014)(17) Mental health is found to be the other factor that affects sleep
disruptions on staff (Sarah et al., 2013). Unemployment is the major cause of poor mental health
conditions which was both a cause and a risk factor. As a result, individual with poor mental health
does not work properly due to a lack of sleep. Hence unemployment and pre-existing mental health
11
Night Eating Syndrome and Its Association with Sleep Quality and Body Mass Index Among University Students
problems are the main causal factors for sleeplessness. The findings for men indicated that the impact
of unemployment on subsequent mental health was less than the effect of mental health on the
subsequent risk of unemployment.(18) Electronic gadgets were also found to be the other important
factor in sleep disruptions. Deborah, (2013) conducted a study in the United States on wireless handheld devices used by youth who have sleep disorders. It was found that devices such as laptops,
smartphones, and tablets emit between 30 and 50 lux, which is around half the illumination of a
normal room light resulting in sleep disturbance. Blue light is the most concerning of these short
wavelengths because it causes the body to produce less melatonin, which is released only when there
is dark and helps control and induce sleep. People control sleep and encourage it. Furthermore, it
was also concluded from the study that Sleeplessness triggers attention loss, memory loss, and
alertness (19). Baik and Ma (2012) study showed that enuresis (involuntary urination) was also
found to be the one factor of sleep disorder. The other factor found were gender, age, duration of
disease, etc.
Cheng et al. (2008) conducted a study on 1,113 Taiwanese women of age 43 to 57 years residing on
the island of Kinsmen. They aimed to study the relationship between sleep disturbances and the
menopause status of women. The results revealed that sleep problems were mostly found in the
postmenopausal group and least in premenopausal women. Menopausal status was found with the
help of menstrual history and was found that 46% of middle-aged women feel dissatisfied with their
sleep. (22) Querstret and Cropley (2012) investigated the role of sleep quality in work related
rumination and fatigue. It was discovered that work-related affective worrying is more harmful to
an individual's capacity and ability than problem solving pondering. Hence, the type of work-related
ruminations is important in determining sleep quality (20).
Akerstedt and Gillberg (1981) lay emphasis on the shift work which is common these days in the
industrialized societies (>20%), however, it also offers working at nights which can attract adverse
problems related to sleep, the performance of sleep, physiological and subjectiveness of sleepiness,
risk of accidents, and even other health-related issues such as diverse types of cancer and even
12
Night Eating Syndrome and Its Association with Sleep Quality and Body Mass Index Among University Students
cardiovascular diseases. The cause of the following clash is the demand for the job and work, the
circadian physiology of the day-oriented lifestyle, and falling asleep at the wrong timing
biologically. There are various other factors which negatively affect the work shift accident risk and
sleepiness which comprises of diagnosis of disorder related to shift work such as in the case of those
shift workers who are suffering from performance and sleepiness issues at the time of biological
insomnia and night at the time of day biologically and longer shifts (more than 12 hours). There can
be a few measures which can be used to pacify the adverse effects of shift work on sleeping problems
such as daytime insomnia and sleepiness during nighttime, however, at the current moment, there is
possibly no way to eradicate the adverse effects of shift work on human cognition and physiology.
(39)
Lallukka et al. (2012) conducted a study on “Sociodemographic and socioeconomic differences in
sleep duration and insomnia-related symptoms in Finnish adults”. The results revealed that 70% of
Finnish individuals slept 7–8 hours each day on average. Women (14%) were more likely than males
(11%) to experience frequent insomnia-related symptoms (10 percent). The symptoms related to
Insomnia were associated with being unmarried, childless, having an inadequate education, having
a low income, being jobless, disabled, and retired person. Short and extended sleep duration were
linked by similar causes. There are several risk factors for insomnia related to the research (29).
Consequences of poor sleep
Sleep disturbances have a wide range of health consequences, including an increased chance of
drowsy driving-related automobile accidents, as well as an increased risk of a range of chronic
disease states, including high blood pressure, diabetes mellitus, obesity, cardiovascular disease,
depression, and even cancer, as well as several that serve to raise mortality risk (Colten and Altevogt
2006) (23). Untreated sleep disorders have become increasingly recognized in recent years, and
clinicians will undoubtedly require improved knowledge in the realm of sleep disorders to adopt
initiatives to strengthen the recognition, diagnosis, and treatment of some of the most prevalent sleep
13
Night Eating Syndrome and Its Association with Sleep Quality and Body Mass Index Among University Students
problems, particularly because untreated sleep disorders can have a negative impact on health (Walia
and Mehra, 2016; Colten and Altevogt 2006) (24).
Parish (2009) revealed that sleep irregularities are related to medical problems. Patients who have
fewer hours of sleep in comparison to healthy individuals who have health problems like lung
disease, asthma, gastroesophageal reflux have more causes of disrupted sleep. It raises the sensation
of pain, lungdisease leading to insomnia, sleep apnea, restless leg syndrome, periodic limb
movement disorder, or Fibromyalgia. Patients with cancer or undertaking cancer treatment
experience sleep disruptions, which affect their quality of life and energy levels during the day (21)
"Lack of sleep or disturbed sleep affects the percentage of both Rapid Eye Movement (REM) and
non-REM sleep," Hamid (2016) found in their study. The importance of REM sleep in re-energizing
the brain and body muscles cannot be overstated. If this is insufficient, the individual's thoughts and
attention may be impacted the next day. This can cause brain alterations over time, resulting in
memory loss, irritation, anxiety, and even depression." On World Sleep Day, scientists warn that
"frequent lack of sleep or disrupted sleep might lead to mental health problems."(28)
Sleep and psychotic-like experiences (PLE), such as magical or persecutory ideas, have strong links
as investigated by Goder et al. (2021). They found that in comparison to healthy controls, patients
with insomnia had significantly higher rates of magical and delusional thought. In comparison with
the control group, sleep apnea patients had a higher rate of paranoid delusions beliefs. Magical ideas
in insomnia patients were observed to be extremely inversely related to the number of sleep spindles.
Delusional beliefs were inversely associated with rapid eye movement (REM) sleep in a subgroup
of insomnia patients who did not take antidepressants (25).
Prevalence of unhealthy sleep among adult
Sleep quality as a construct used in research has a subjective connotation, and so, its interpretation
may vary from person to person. However, one study comparing what sleep quality means to people
with and without insomnia found that, in defining sleep quality, both groups gave importance to the
14
Night Eating Syndrome and Its Association with Sleep Quality and Body Mass Index Among University Students
number of times they awoke at night, to the tiredness experienced after a night’s sleep as also during
the day, and to the extent they felt refreshed when they woke up (Harvey, Stinson, Whitaker,
Moskovitz, & Virk, 2008).
The concept of sleep quality considered in the present study is a multidimensional one as
conceptualized by Daniel Buysse and colleagues (Buysse, Reynolds, Monk, Berman, & Kupfer The
scientific study of sleep duration by psychologists can be said to have begun in the latter part of the
19th century with the experiments of G. T. W. Patrick and J. A. Gilbert assessing the outcome of the
loss of sleep in human subjects, the results of which were published in the journal, ‘Psychological
Review’ in 1896 (Fuchs & Burgdorf, 2008). However, it is literature from the 1970s to the present
time that yields most descriptions of the sleep duration studies done from a psychological standpoint
.The studies that follow illustrate the relation of sleep quality to emotion, cognition, and personality,
and throw light upon the sleep quality of college students with reference to academic performance,
physical health, mood and personality.(39)
Moreover sleep has been studied extensively with regard to children, adolescents and older adults
but not as much in the case of the younger adults, that is, the college-going population (Lemma et
al., Sadeh, Dahl, Shahar, & Rosenblat-Stein, 2009 A turn-of-the-century study reflecting the sleep
patterns on American college campuses,reported that a vast majority, that is, 73% of students, at
least occasionally suffered sleep problems (Buboltz, Brown, & Soper, 2001). More women than men
complained about some of the difficulties. The difficulties common among the students were: taking
the greater part of an hour in falling asleep, difficulty falling asleep more than thrice per week,
extremely early awakening, and morning tiredness. Comparing these results with those of a normal
adult population, college students were seen to have poorer sleep quality. A large-scale research on
1125 American college students in the age range of 17 to 24 years was undertaken to study their
sleep patterns, to understand the behavioural outcome of sleeping poorly, and also to identify the
physical, emotional, and psychosocial predictors, if any, of the same (Lund, Reider, Whiting, &
Prichard, 2010)(39).Furthermore US Department of Transportation (2011) conducted a survey on
15
Night Eating Syndrome and Its Association with Sleep Quality and Body Mass Index Among University Students
the prevalence of unhealthy/sleep behaviors among US adults and suggested that about 74,571 adults
from 12 states around 35.3% reported less than 7 hours in a day,48% noted snoring,37.9% reported
involuntary go to sleep during day time at least once in a month, and 4.7% noted falling asleep while
driving in a month which is responsible for accidents.
A global cross-sectional survey was conducted on International Sleep Well Day (March 21), 2002
by Soldatos et al. (2005) using a standardized questionnaire and was done in 10 countries under the
guidance of local survey managers. In addition, the Athens Epworth Sleepiness Scale (ESS) and the
Insomnia Scale (AIS) were used to evaluate sleepiness. Adults from ten nations representing several
continents with distinct lifestyle differences were enrolled in the study. 35,327 surveys were
gathered. In total, 24% of the participants said they didn't get enough sleep. 31.6 percent of
individuals experienced 'insomnia,' while another 17.5 percent had 'sub-threshold insomnia,'
according to self-assessments using the AIS. 11.6 percent of participants were judged to be very
drowsy' or 'dangerously sleepy' during the day, according to ESS results. Even though there seem to
be significant global variations in the prevalence of insomnia, its symptoms, and its management,
around one out of every four people believes they do not sleep well. Furthermore, self reported sleep
issues in the general population may be underestimated. Overall, there is a need for better detection
and care of sleep disorders, as well as increased awareness of the importance of disturbed sleep(16)
Insomnia is a widespread sign of depression. In contrast, it is a major risk for the onset of a depressive
episode (Baglioni et al., 2011)(30). Riemann et al. (2020) researched Sleep, insomnia, and
depression. They define Insomnia as “prolonged sleep latency, difficulty maintaining sleep, and
early morning waking up”. It is now recognized as a transdiagnostic clinical sign for a variety of
mental disorders, more notably depression (26). Revathy (2017) discovered that the number of Sleep
Apnea cases in India has increased in the last two to three years (pauses in breathing or facile
breathing during sleep). The most typical symptoms of sleep apnea, according to him, include loud
and persistent snoring, frequent nighttime urination, morning headaches, inability to concentrate,
feeling irritated, depressed, or having mood swings. They also found that "Obese persons, as well as
16
Night Eating Syndrome and Its Association with Sleep Quality and Body Mass Index Among University Students
those with stressful professions and irregular hours, are more likely to suffer from sleep difficulties,"
he added (27).
India is a sleep-deprived society and is therefore sleep and its disorders are becoming incredibly
valuable. Sleep is inextricably linked to various hormonal and metabolic processes in the body, and
it is essential for maintaining metabolic homeostasis. Sleep deprivation, sleep-disordered breathing,
and circadian misalignment is thought to affect metabolic dysregulation via a variety of pathways
that include sympathetic overstimulation, hormonal imbalance, and subclinical inflammation
(Sharma and Kavuru, 2010) (31) .
Sleep and college student
Research suggests that college students shift their sleep timing later from weekday to weekends in
college, indicating low sleep consistency. On average, college students reported one hour and 15
minutes delay in sleep timing from weekdays to weekends (Lund, Reider, Whiting, & Prichard,
2010). Referencing the Patel and colleagues study (2014) above, an hour difference between
weekday and weekend sleep has been associated with heightened obesity odds. In addition to
weekday and weekend differences, large fluctuations in sleep are seen from day to day in college.
(32) Wake time variability increases during the transition from high school to college when
measuring sleep across the weekday (Doane, Gress-Smith, & Breitenstein, 2015)(33).
Specifically, sleep timing from day to day shifts approximately 60 to 90 minutes for wake time and
bedtime and sleep duration in college (Whiting & Murdock, 2016). Only two studies have examined
consistent sleep timing in relation to body weight among a sample of college students(34). Roane
and colleagues (2015) collected daily diary data over a nine-week period averaged the difference
scores in sleep duration over a range of four-day windows(35).
Prevalence of obesity in university student
In study done by Supa Pengpid & Karl Peltzer (2013) a cross-sectional survey assessed
anthropometric measurements and a self-administered questionnaire among a sample of randomly
selected university students. The sample included 800 university students from non health (mainly
17
Night Eating Syndrome and Its Association with Sleep Quality and Body Mass Index Among University Students
sciences) courses Gitam University in India. The students were 541 (67.6%) males and 259 (32.4%)
females in the age range of 17–20 years .
They found that 37.5% were overweight or obese, 26.8% overweight (≥23–27.4 BMI) and 10.7%
obese (≥27.5 kg/m2), 11.7% underweight (<18.5 kg/m2) and 16.4% central obesity (WC ≥90 cm for
men and ≥80 cm for women). In multivariate analysis among men lack of non-organised religious
activity ,lower dietary risk knowledge , tobacco use , and suffering from depression were associated
with overweight/obesity, and younger age , lives away from parents or guardians ,, healthy dietary
practices , and 9 or more hours sleep duration were associated with central obesity. In bivariate
analysis among women, lack of social support, lower dietary risk knowledge, tobacco use, and 9 or
more hours sleep duration were associated with overweight/obesity and lives away from parents or
guardians and abstinence from alcohol associated with central obesity. (38). Etiology of obesity can
be the outcome of a number of disturbances leading to an excessive accumulation of fat in the body
when energy intake exceeds energy expenditure. This imbalance may be due to increased energy
intake or decreased expenditure of energy or both together (37).
Night eating syndrome
Night eating syndrome (NES) was first described by Stunkard et al in (1955) a more formal
definition of NES was then improvised as “morning anorexia, evening hyperphagia, and insomnia”.
Later in 2010, Allison et al. then described NES as a “delay in the circadian timing of food intake.
(40) This psychological disease characterized by sleep disordered and overeats during the night-time
(between the evening meal and sleeping time) at least twice a week and also characterized by
consumption of at least 25% of the total daily caloric intake after the evening meal and before
sleeping or at least two episodes of nocturnal eating per week .(15)NES was defined as a common
eating behavior among obese people. However, further research revealed that NES also affects nonobese people, who tend to be younger than obese people with NES. As a result, it has been suggested
that NES may cause future weight gain, which might account for the contradictory results on
associations between NES and body mass. (41)
18
Night Eating Syndrome and Its Association with Sleep Quality and Body Mass Index Among University Students
Methodology:
Study design, sample size and subjects
A cross-sectional study was conducted among the students at university in January 2023. The
sample of this study was conducted by stratified data with 10 students having overweight, and 10
students having normal weight, thus 10 students having underweight, according to their BMI.
Participations were invited to participate by interviewing and using google forum . The inclusion
criteria in the study were undergraduate students aged above 18 years and different weight
pattern , and the exclusion criteria were those who are pregnant, or who above 25, or taking
any medications, and having serious medical diseases.
Data Collection
All data collection was performed through interviewing with questionnaire the data collected
including anthropometric data NES and sleep quality the questionnaire consists of 18 questions .. The
aim was to conduct the survey with 30 students from university of Hafr albatin on 9/1/2023.
Part A: Sociodemographic data
Socio-demographic data including 4 questions. The name and participants were required to selfreport their body weight measured in kilograms (kg) and height measured in meters (m). The body
mass index (BMI) of each participant was calculated and categorized based on the World Health
Organization (WHO) guidelines-Asia-Pacific classification of BMI (World Health Organization,
2004).
Table 1: Classification of BMI
Underweight
BMI <18.5
Normal weight
18.5<BMI<24.9
Over obese
25<BMI<29.9
obese
Class1 30<BMI<34.9
Class2 35<BMI<39.9
Class3 40<BMI<44.9
Superobese
19
BMI>50
Night Eating Syndrome and Its Association with Sleep Quality and Body Mass Index Among University Students
Part B: Night Eating Syndrome criteria
A total of 7 self-rated questions in total to evaluate NES prevalence based on the past one month.
Questions included were seeking for feelings of hunger before bed time, eating large amounts of food
before bedtime, the strong appetite during the night, losing appetite in the morning, eating more
calories after dinner time, waking up to eat.
Based on the hierarchical scores obtained from the number of symptoms shown, all participants were
categorised into three different groups: mild NES, moderate NES, full NES.
Part C: Sleep Quality criteria
Questions are used to evaluate the sleeping pattern and quality of each participant based on the past
one month period. A total of 7 self-rated questions were asked and scores obtained were summed to
yield the global score. By answering the questionnaire, the questions included were seeking for
difficulty to get up in the morning, having nightmares most days, difficulty to sleep early, using or
taking pills to help sleeping. According to the total score obtained, the sleeping quality of the
participants was evaluated into two categories: Poor sleep quality and good sleep quality.
Results
A total of 30 enrolled university hafer Al-baten participated in this study with mean age 18 ± 24. The
mean BMI for the studied population was 22.85 (± 5.73) with range 19.8 of the total respondent
population, 10 were classified as overweight ≥ 25. And 10 of normal weight with 18.5 ≤ BMI ≤ 24.9,
And 10 of underweight with BMI ˂ 18.5, The prevalence of good sleep quality among university
student was 56.7%. Table 2 shows the level of severity on NES compared by different type of obese,
overweighted student had the highest rate of mild NES about 26.7% and normal weight student had
the lowest rates of mild NES with 10%, in contrast there is only one student had full NES with
underweight. However, this association represented a significant relation (B= 1.63, p= 0.000)
20
Night Eating Syndrome and Its Association with Sleep Quality and Body Mass Index Among University Students
Table 2: The severity of NES among 3 different types of obese (overweight, normal weights,
underweight among university students.
NES
Mild NES
Moderate
total
P-value
*P<0.05
Full NES
NES
Underweight
Normal weight
count
7
2
1
10
Total%
23.3%
6.7%
3.3%
33.3%
3
7
0
10
10%
23.3%
8
2
26.7%
6.7%
18
11
1
30
60%
36.7%
3.3%
100%
count
Total%
Overweight
count
33.3%
0
10
33.3%
Total%
Total
count
Total%
Table 2 demonstrate the association between NES and sleep quality, it reveals that the student who
had mild NES was the highest rate of student who have good sleep quality by 43.3% of the total, and
the student who had moderate NES were found to have poor sleep quality, this association is
statistically significant based on regression analysis (B= 1.94, P=0.000)
Table 3: Level of NES and its association with sleep quality among university students.
Sleep quality
21
Total
P-value
Night Eating Syndrome and Its Association with Sleep Quality and Body Mass Index Among University Students
Poor sleep Good sleep
quality
NES
mild NES
Count 5
quality
13
18
16.7%
43.3
60%
8
3
11
26.7%
10%
36.7%
0
1
1
0%
3.3%
3.3%
13
17
30
43.3%
56.7%
100%
*P<0.05
Total%
Moderate NES
Count
Total%
Full NES
Count
Total%
We found that NES level was lower with increasing BMI (p = 0.000), Figure 1 reveals the prevalence
of NES among university students, we found that 60% of the total sample had mild NES, while 3.3%
had Full NES. Table 4 demonstrate the association between Level of obese and their sleep quality, it
reveals that sleep quality among student who had normal weight was 1:1 (good/poor sleep quality),
however we found that there is no relation between them, BMI not effected on student quality of
sleep, since we have P>0.05.
22
Night Eating Syndrome and Its Association with Sleep Quality and Body Mass Index Among University Students
PREVELANCE OF
NES
3%
mild NES
moderate
NES
37%
60%
full NES
Figure 1: pie chart reveals the prevalence of NES among student university.
Table 4: association between type of obese and sleep quality among university students.
sleep quality
Good
sleep
quality
quality
Total
Count underweight
6
4
10
%
20%
13.3%
33.3%
Count normal weight
5
%
16.6%
16.6%
33.3%
Count overweight
6
4
10
%
20%
13.3%
33.3%
Count Total
17
13
%
56.7%
43.3%
BMI
23
sleep Poor
5
10
Night Eating Syndrome and Its Association with Sleep Quality and Body Mass Index Among University Students
Discussions :
Prevalence of NES among the University Students
In this study, 3% of the students were found to be engaged with NES. The findings of this
study were disturbing in comparison to previous study. The prevalence of NES found in this study
was higher than the results reported in University of Nottingham Malaysia (2017) (1.2%)
discovered among university students was significantly lower than our finding as well. the prevalence
discovered in this study was higher than that discovered in other studies demonstrates that Hafer
Albatin University does have a higher incidence of NES. This could be a result of the various
geographic regions, dispersion of ethnic groups, cultures, and personal habits. Meanwhile, College
students' lifestyles and eating habits differ from those of the broader public, and they frequently rely
on quick and convenient meals.(42) Also most of the university students experience high levels of
academic stress that lead to lower well-being, anxiety, depression, changes in appetite, sleeping
difficulty, and poorer academic performance. an extensive body of literature has shown that stress
may have two separate effects on a person's health. First, stress can operate directly on physiological
systems. Second, stress can affect eating habits and other health-related behaviors.
Because NES is so common among college students, the university has to take this problem seriously
and take precautions like raising awareness by sending emails to all students to prevent night eating
syndrome. The university's health department should also offer some solutions for dealing with the
NES issue. It is advisable to reduce the opening hours of late-night eateries and convenience stores
at night.(43)
The Association Between Night Eating Syndrome and Sleep Quality
University students typically experience shorter sleep durations and lower-quality sleep.(44) In this
study, almost half of the students (43.3%) were poor sleepers .and (56.7%) were good sleep
quality. comparing to previous study done in Jilin University the prevalence of sleep quality were
24
Night Eating Syndrome and Its Association with Sleep Quality and Body Mass Index Among University Students
(69.0%) and (31.0%) with good and poor sleep quality, respectively. (2020). The prevalence of poor
sleep quality in this study was higher than the previous studies. The significant incidence of poor
sleep quality seen among these two university students might be due to the variation in stress levels.
(45). The degree of stress was thought to be positively related to sleep quality (p = 0.001; α = 0.05).
Students are with poor sleep quality 4.7 times more likely to have higher stress than students who
have a good sleep quality.(46) meantime another study by Lan Wang and Peng Qin (2016) suggested
that the year of study psychological distress, eating habits, economic issues, depression and anxiety
were the risk factors for students' poor sleep quality.(47) Cameron A. Brick (2010) too found poorer
global sleep quality was related to several sleep hygiene and lifestyle behaviors.(48)
Poor sleep quality which includes insomnia (defined as difficulties falling asleep and/or staying
asleep) and obstructive sleep apnoea (49) According to the results of our study, students who had
poor sleep had a higher likelihood of engaging in NES. This result is consistent with earlier research
by Mahdieh Abbasalizad Farhangi (2019) where adolescents with night eating syndrome had poor
sleep quality scores (50). According to Akdevelioglu, Y., Sahin, T. O., & Yesildemir, O. (2020). The
night eating syndrome rates of participants with poor sleep quality (7.6%) were significantly higher
than in those with good sleep quality (0.5%) (p<0.001). There was a positive correlation between
night eating syndrome and all sub-components of sleep quality (p<0.05)(51). This correlation
between NES and poor sleep quality may be related to the lower sleep duration and because of the
nocturnal ingestion with the NES group (52). A study by Yahia et al. (2017) In our research we found
that, among the college students, the NES group was associated with poor sleep quality and
shorter sleep duration. According to Canuto et al. (2013), NES associated with sleep or altered
circadian timing and may contribute to metabolic dysfunction . Importantly, there are bi-directional
links between metabolic dysfunction and several of these sleep issues, especially in the cases of OSA,
obesity, and T2D.(53)
25
Night Eating Syndrome and Its Association with Sleep Quality and Body Mass Index Among University Students
The Association between Night Eating Syndrome and Body Mass Index
Eleven studies examined the association between NES and BMI. Five of these reported that there was
a significant relationship between NES and BMI (54, 55,56,57,58 ), five showed no significant
relationship(59,60,61,62,63) and one produced mixed findings [64]. In our result we found that there
is no an association between NES and weight gain and obesity . The prevalence of NES was 3.3%
in underweight induvial while in normal weight and overweight prevalence of NES was 0%.
Conforming to Heidi M. Marshall (2004) the NEQ results of the 21 obese night eaters who underwent
in-person interviews and the 40 obese internet participants showed no differences. When compared
to the replies of the 40 non-obese participants.(65).As reported by (, Harb et al.,& Moizé et al., )(2012)
there was shown to be a slight positive association between the frequency of night eating and body
mass. Notably, this association was mitigated by age, and among younger people, there was no
association between night eating and BMI.(66)
Conversely the prevalence of night eaters was also shown to be rising in the NHANES III health and
nutrition survey. Depending on the initial reason of NES behavior and the age at which it first
manifested, obesity may either be the cause or the result of NES.
The variation in NES prevalence observed might be explained by the use of various questionnaires
in the NES assessment. Additionally, given that the study by Dzulkafli et al. (2020) only included
female university students, the definition of gender may have been a factor.(67)
The Association between Sleep Quality and Body Mass Index
In this study sleep quality and BMI have no association . nearly 1:1 among 3 types of obese . This
finding was in line with the study by Zhou Yan, Huang (2012) found there was no discernible change
in individuals' sleep duration across various BMI classifications. (68) according to classification
criteria (of underweight, normal weight, overweight, and obesity) we found the total majority of poor
sleeping quality among students, it shows the normal weight students has a higher percentage than
overweight students with (16.6%, 13.3% respectively)
26
Night Eating Syndrome and Its Association with Sleep Quality and Body Mass Index Among University Students
Contradictorily, a study by Sung Keun Park&Ju (2018) Young Jung found that short sleep duration
and poor sleep quality was more positively associated with obesity across BMI than underweight
suggesting that individuals with short sleep duration are more likely to be obese. These finding was
seen in both men and women, however there was a little variation by sex subgroups. The male
subgroup, however, had a significant association of poor sleep quality with only severe obesity,
demonstrating an unexpected inverse relationship with obesity, in contrast to the female subgroup,
which showed a significant association between poor sleep quality and obesity and severe obesity.
Short sleep duration was substantially connected with underweight as well as overweight and obesity
. (69) Short sleep duration was substantially connected with underweight as well as overweight and
obesity in American adults and Norwegian adolescents, according to epidemic research conducted in
Western nations. (70)
Conclusion:
Poor sleep quality was found to be positively correlated with NES, while NES was found to be
unrelated to the prevalence of overweight and obesity. Additionally, students should begin to become
aware of NES and take responsibility for their eating and drinking habits. Students should speak with
a nutritionist or dietitian for some specific interventions and methods to help them combat NES if
this eating behavior is severe.
27
Night Eating Syndrome and Its Association with Sleep Quality and Body Mass Index Among University Students
References
1.
Ahmad, M., Wolberg, A., & Kahwaji, C. I. (2022). Biochemistry, Electron Transport Chain.[Updated 2021 Sep
8]. StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing.
2.
Gallant, A. R., Lundgren, J., & Drapeau, V. (2012). The night‐eating syndrome and obesity. Obesity
reviews, 13(6), 528-536.
3.
Yahia, N., Brown, C., Potter, S., Szymanski, H., Smith, K., Pringle, L., ... & Geliebter, A. (2017).
Night eating syndrome and its association with weight status, physical activity, eating habits, smoking
status, and sleep patterns among college students. Eating and Weight Disorders-Studies on Anorexia,
Bulimia and Obesity, 22, 421-433
4. Colles, S. L., Dixon, J. B., & O'Brien, P. E. (2007). Night eating syndrome and nocturnal snacking:
association with obesity, binge eating and psychological distress. International journal of obesity,
31(11), 1722-1730.
5. Borregaard, M. K., & Rahbek, C. (2010). Causality of the relationship between geographic
distribution and species abundance. The Quarterly review of biology, 85(1), 3-25.
6. Quan, S. F., & Gersh, B. J. (2004). Cardiovascular consequences of sleep-disordered breathing: past,
present and future: report of a workshop from the National Center on Sleep Disorders Research and
the National Heart, Lung, and Blood Institute. Circulation, 109(8), 951-957.
7. Argyropoulos, S. V., Hicks, J. A., Nash, J. R., Bell, C. J., Rich, A. S., Nutt, D. J., & Wilson, S. J.
(2003). Correlation of subjective and objective sleep measurements at different stages of the
treatment of depression. Psychiatry research, 120(2), 179-190.
8. Marshall, H. M., Allison, K. C., O'Reardon, J. P., Birketvedt, G., & Stunkard, A. J. (2004). Night
eating syndrome among nonobese persons. International Journal of Eating Disorders, 35(2), 217-222.
9. Ogilvie, R. P., & Patel, S. R. (2017). The epidemiology of sleep and obesity. Sleep health, 3(5), 383388.
10.Vargas, P. A., Flores, M., & Robles, E. (2014). Sleep quality and body mass index in college students:
the role of sleep disturbances. Journal of American college health, 62(8), 534-541.
11.Van Cauter, E., Holmbäck, U., Knutson, K., Leproult, R., Miller, A., Nedeltcheva, A., ... & Spiegel,
K. (2007). Impact of sleep and sleep loss on neuroendocrine and metabolic function. Hormone
Research in Paediatrics, 67(Suppl. 1), 2-9.
12.Lund, H. G., Reider, B. D., Whiting, A. B., & Prichard, J. R. (2010). Sleep patterns and predictors of
disturbed sleep in a large population of college students. Journal of adolescent health, 46(2), 124132.
13.Hagedorn, R. L., Olfert, M. D., MacNell, L., Houghtaling, B., Hood, L. B., Roskos, M. R. S., ... &
Fontenot, M. C. (2021). College student sleep quality and mental and physical health are associated
with food insecurity in a multi-campus study. Public Health Nutrition, 24(13), 4305-4312
14.Hur, S., Oh, B., Kim, H., & Kwon, O. (2021). Associations of diet quality and sleep quality with
obesity. Nutrients, 13(9), 3181.
15.O’Reardon, J. P., Peshek, A., & Allison, K. C. (2005). Night eating syndrome. CNS drugs, 19(12),
997-1008.
16.Soldatos, C. R., Allaert, F. A., Ohta, T., & Dikeos, D. G. (2005). How do individuals sleep around
the world? Results from a single-day survey in ten countries. Sleep medicine, 6(1), 5-13.
17.van der Noordt, M., IJzelenberg, H., Droomers, M., & Proper, K. I. (2014). Health effects of
employment: a systematic review of prospective studies. Occupational and environmental medicine,
71(10), 730-736.
18.Sarah Larkins, M. B. B. S., & Gupta, T. S. (2013). Recruitment and retention of general practitioners
in rural Canada and Australia: a review of the literature. Canadian Journal of Rural Medicine, 18(1),
13.
19.Paulo, S., Francisco, B., Charlotte, D., Laura, G., & Deborah, N. (2013). OECD reviews of evaluation
and assessment in education teacher evaluation in Chile 2013. OECD Publishing.
28
Night Eating Syndrome and Its Association with Sleep Quality and Body Mass Index Among University Students
20.Querstret, D., & Cropley, M. (2012). Exploring the relationship between work-related rumination,
sleep quality, and work-related fatigue. Journal of occupational health psychology, 17(3), 341.
21.Kathiresan, S., Willer, C. J., Peloso, G. M., Demissie, S., Musunuru, K., Schadt, E. E., ... & Cupples,
L. A. (2009). Common variants at 30 loci contribute to polygenic dyslipidemia. Nature genetics,
41(1), 56-65.
22.Cheng, Q. (2008). Non-linear theory and power-law models for information integration and mineral
resources quantitative assessments. Mathematical Geosciences, 40, 503-532.
23.Altevogt, B. M., & Colten, H. R. (Eds.). (2006). Sleep disorders and sleep deprivation: an unmet
public health problem.
24.Walia, H. K., & Mehra, R. (2016). Overview of common sleep disorders and intersection with
dermatologic conditions. International journal of molecular sciences, 17(5), 654.
25.Boaretto, E., Hernandez, M., Goder-Goldberger, M., Aldeias, V., Regev, L., Caracuta, V., ... &
Barzilai, O. (2021). The absolute chronology of Boker Tachtit (Israel) and implications for the Middle
to Upper Paleolithic transition in the Levant. Proceedings of the National Academy of Sciences,
118(25), e2014657118.
26.Riemann D, Krone LB, Wulff K, Nissen C. Sleep, insomnia, and
depression.Neuropsychopharmacology. 2020 Jan;45(1):74-89.
27.A. Srinivasulu, S. Mohan, H. T, S. P and R. Y, "Apnea Event Detection Using Machine Learning
Technique for the Clinical Diagnosis of Sleep Apnea Syndrome," 2021 3rd International Conference
on Signal Processing and Communication (ICPSC), Coimbatore, India, 2021, pp.
28.Kumari, V., Antonova, E., Wright, B., Hamid, A., Hernandez, E. M., Schmechtig, A., & Ettinger, U.
(2017). The mindful eye: Smooth pursuit and saccadic eye movements in meditators and nonmeditators. Consciousness and cognition, 48, 66-75.
29.Lahelma, E., Laaksonen, M., Lallukka, T., Martikainen, P., Pietiläinen, O., Saastamoinen, P., ... &
Rahkonen, O. (2012). Working conditions as risk factors for disability retirement: a longitudinal
register linkage study. BMC public health, 12, 1-10.
30.Baglioni, C., Battagliese, G., Feige, B., Spiegelhalder, K., Nissen, C., Voderholzer, U., ... & Riemann,
D. (2011). Insomnia as a predictor of depression: a meta-analytic evaluation of longitudinal
epidemiological studies. Journal of affective disorders, 135(1-3), 10-19.
31.Sharma, S., & Kavuru, M. (2010). Sleep and metabolism: an overview. International journal of
endocrinology, 2010.
32.Lund, H. G., Reider, B. D., Whiting, A. B., & Prichard, J. R. (2010). Sleep patterns and predictors of
disturbed sleep in a large population of college students. Journal of adolescent health, 46(2), 124132.
33.Doane, L. D., Gress-Smith, J. L., & Breitenstein, R. S. (2015). Multi-method assessments of sleep
over the transition to college and the associations with depression and anxiety symptoms. Journal of
youth and adolescence, 44, 389-404.
34.Whiting, W. L., & Murdock, K. K. (2016). Emerging adults’ sleep patterns and attentional capture:
the pivotal role of consistency. Cognitive processing, 17, 155-162.
35.Roane, B. M., Van Reen, E., Hart, C. N., Wing, R., & Carskadon, M. A. (2015). Estimating sleep
from multisensory armband measurements: validity and reliability in teens. Journal of sleep research,
24(6), 714-721.
36.Berner, L. A., Keast, D. R., Bailey, R. L., & Dwyer, J. T. (2014). Fortified foods are major
contributors to nutrient intakes in diets of US children and adolescents. Journal of the Academy of
Nutrition and Dietetics, 114(7), 1009-1022.
37.Jordan, H. A., & Levitz, L. S. (1975). A behavioural approach to the problem of obesity. Obesity: Its
pathogenesis and management, 155-191. Jordan, H. A., & Levitz, L. S. (1975). A behavioural
approach to the problem of obesity. Obesity: Its pathogenesis and management, 155-191.
38.Peltzer, K., Pengpid, S., Samuels, T. A., Özcan, N. K., Mantilla, C., Rahamefy, O. H., ... &
Gasparishvili, A. (2014). Prevalence of overweight/obesity and its associated factors among
university students from 22 countries. International journal of environmental research and public
health, 11(7), 7425-7441
29
Night Eating Syndrome and Its Association with Sleep Quality and Body Mass Index Among University Students
39.Pengpid,
S., & Peltzer, K. (2014). Prevalence of overweight/obesity and central obesity and its
associated factors among a sample of university students in India. Obesity research & clinical
practice, 8(6), e558-e570.Stephan, Y., Sutin, A. R., Bayard, S., Križan, Z., & Terracciano, A. (2018).
Personality and sleep quality: Evidence from four prospective studies. Health Psychology, 37(3),
271.
40.Meule, A., Allison, K. C., Brähler, E., & de Zwaan, M. (2014). The association between night eating
and body mass depends on age. Eating behaviors, 15(4), 683- 685.
41.Lundgren, J. D., Allison, K. C., O'Reardon, J. P., & Stunkard, A. J. (2008). A descriptive study of
non-obese persons with night eating syndrome and a weight-matched comparison group. Eating
Behaviors, 9(3), 343-351.
42.Choi, J. (2020). Impact of stress levels on eating behaviors among college students. Nutrients, 12(5),
1241.
43.Caso, D., Miriam, C., Rosa, F., & Mark, C. (2020). Unhealthy eating and academic stress: The
moderating effect of eating style and BMI. Health psychology open, 7(2), 2055102920975274.
44.Vail-Smith, K., Felts, W. M., & Becker, C. (2009). Relationship between sleep quality and health
risk behaviors in undergraduate college students. College Student Journal, 43(3), 924-930.
45.Li, Y., Bai, W., Zhu, B., Duan, R., Yu, X., Xu, W., ... & Kou, C. (2020). Prevalence and correlates
of poor sleep quality among college students: a cross-sectional survey. Health and quality of life
outcomes, 18(1), 1-11.
46.Herawati, K., & Gayatri, D. (2019). The correlation between sleep quality and levels of stress among
students in Universitas Indonesia. Enfermeria clinica, 29, 357-361.
47.Wang, L., Qin, P., Zhao, Y., Duan, S., Zhang, Q., Liu, Y., ... & Sun, J. (2016). Prevalence and risk
factors of poor sleep quality among Inner Mongolia Medical University students: A cross-sectional
survey. Psychiatry Research, 244, 243-248.
48.Brick, C. A., Seely, D. L., & Palermo, T. M. (2010). Association between sleep hygiene and sleep
quality in medical students. Behavioral sleep medicine, 8(2), 113-121.
49.Scott, A. J., Webb, T. L., Martyn-St James, M., Rowse, G., & Weich, S. (2021). Improving sleep
quality leads to better mental health: A meta-analysis of randomised controlled trials. Sleep Medicine
Reviews, 60, 101556.
50.Farhangi, M. A. (2019). Night eating syndrome and its relationship with emotional eating, sleep
quality and nutritional status among adolescents’ boys. Community mental health journal, 55, 14111418.
51.Akdevelioglu, Y., Sahin, T. O., & Yesildemir, O. (2020). Sleep quality and its relationship with night
eating syndrome, the risk of diabetes, and nutritional status among university students. ProgNutr,
22(1), 304-15.
52.Nolan, L. J., & Geliebter, A. (2019). Factor structure of the Night Eating Diagnostic Questionnaire
(NEDQ) and an evaluation of the diagnostic criteria of the night eating syndrome. Journal of eating
disorders, 7, 1-10.
53.Depner, C. M., Stothard, E. R., & Wright, K. P. (2014). Metabolic consequences of sleep and
circadian disorders. Current diabetes reports, 14(7), 1-9.
54.Gallant A, Drapeau V, Allison KC, Tremblay A, Lambert M, O’Loughlin J, et al. Night eating
behavior and metabolic heath in mothers and fathers enrolled in the QUALITY cohort study. Eat
Behav. 2014;15(2):186–91.
55.Meule A, Allison KC, Brähler E, de Zwaan M. The association between night eating and body mass
depends on age. Eat Behav. 2014;15(4):683–5. This study examined whether BMI was associated
with NES
56.Panczyk M, Kielan A,Czerw A, et al. Risk assessment of night-eating syndrome occurrence in women
in Poland, considering the obesity factor in particular. Neuropsychiatr Dis Treat. 2018;14:1521–6.
57.Yeh SSS, Brown RF. Disordered eating partly mediates the relationship between poor sleep quality
and high body mass index. Eat Behav. 2014;15(2):291–7.
58.Aloi M, Rania M, de Fazio P, Vinai P, Tagliabue A, Allison KCSGC. Validation of the Italian version
of the Night Eating Questionnaire (I-NEQ). J Psychopathol. 2017;23:137–44
30
Night Eating Syndrome and Its Association with Sleep Quality and Body Mass Index Among University Students
A, Lundgren J, O’Loughlin J, Allison K, Tremblay A, Henderson M, et al. Night-eating
symptoms and 2-year weight change in parents enrolled in the QUALITY cohort. Int J Obes.
2015;39(7):1161–5. This study looked at the ability for NEQ scores to predict change in BMI
60.He J, Ji F, Zhang X, Fan X. Psychometric properties and gender invariance of the simplified Chinese
version of Night Eating Questionnaire in a large sample of mainland Chinese college students. Eat
Weight Disord. 2019;24:57–66.
61.Hood MM, Reutrakul S, Crowley SJ. Night eating in patients with type 2 diabetes. Associations with
glycemic control, eating patterns, sleep, and mood. Appetite. 2014;79:91–6. This study examined the
relationship between BMI and scores on the NEQ in a sample of adults with Type 2 diabetes, finding
a non-significant correlation.
62.Kim OS, Kim MS, Lee JE, Jung H. Night-eating syndrome and the severity of self-reported
depressive symptoms from the Korea nurses’ health study: analysis of propensity score matching and
ordinal regression. Public Health. 2016;141:80–7.
63.Nolan LJ, Geliebter A. Validation of the Night Eating Diagnostic Questionnaire (NEDQ) and its
relationship with depression, sleep quality, “food addiction”, and body mass index. Appetite.
2017;111:86–95.
64.Bruzas, M. B., & Allison, K. C. (2019). A review of the relationship between night eating syndrome
and body mass index. Current obesity reports, 8, 145-155.
65.Marshall, H. M., Allison, K. C., O'Reardon, J. P., Birketvedt, G., & Stunkard, A. J. (2004). Night
eating syndrome among nonobese persons. International Journal of Eating Disorders, 35(2), 217-222.
66.Meule, A., Allison, K. C., Brähler, E., & de Zwaan, M. (2014). The association between night eating
and body mass depends on age. Eating behaviors, 15(4), 683-685.
67.Kwan, Y. Q., Lee, S. S., & Cheng, S. H. (2021). Night eating syndrome and its association with sleep
quality and body mass index among university students during the COVID-19. Malaysian Journal of
Social Sciences and Humanities (MJSSH), 6(8), 371-383.
68.Yan, Z., Chang-Quan, H., Zhen-Chan, L., & Bi-Rong, D. (2012). Association between sleep quality
and body mass index among Chinese nonagenarians/centenarians. Age, 34, 527-537.
69.Park, S. K., Jung, J. Y., Oh, C. M., McIntyre, R. S., & Lee, J. H. (2018). Association between sleep
duration, quality and body mass index in the Korean population. Journal of Clinical Sleep Medicine,
14(8), 1353-1360.
70.Krueger, P. M., & Friedman, E. M. (2009). Sleep duration in the United States: a cross-sectional
population-based study. American journal of epidemiology, 169(9), 1052-1063.
59.Gallant
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