The Role Of Sleep In Weight Loss Maintenance After Bariatric Surgery In Adult Females

PURPOSE: Bariatric surgery is the most effective treatment for obesity, yet many individuals experience substantial weight regain following surgery. Poor sleep is a risk factor for primary weight gain, but its role in weight loss maintenance after surgery remains largely unknown. The purpose of this cross-sectional analysis is to examine the relationship between polysomnography- (PSG) and actigraphy-derived sleep variables with weight regain (lowest weight following surgery to current weight; %WR) in a pilot sample of female adults who underwent bariatric surgery. METHODS: Sixteen female adults (age: 54.8 ± 9.7 y; body mass index (BMI): 36.0 ± 8.9 kg/m2; body fat: 45.5 ± 8.5%) who underwent bariatric surgery >1 year ago completed a 7-day study protocol. Actigraphy-derived sleep efficiency and sleep duration were calculated using the Cole-Kripke algorithm. Self-reported sleep quality (Karolinska Sleep Diary) was averaged over the 7 days. On one night, sleep was captured via in-home PSG and analyzed for duration, efficiency, and architecture (i.e., stage N2, N3, rapid eye movement (REM) sleep), and sleep-disordered breathing (i.e., apnea-hypopnea index (AHI), snoring). Participants self-reported highest lifetime weight and lowest weight since surgery, and current body weight and body composition were measured in-laboratory via Bod Pod. %WR was calculated as current weight - lowest weight after surgery. Linear regression models assessed relationships between actigraphy- and PSG-derived sleep variables with %WR. Covariates included age, total weight loss after surgery (highest lifetime weight - lowest weight post-surgery; kg) and time since surgery (months). RESULTS: %WR post-surgery was 10.5 ± 10.4%. While not statistically significant, large effects were noted for an inverse relationship between REM sleep duration with %WR (Β = -0.17, 95%CI [-0.4, 0.04], p = 0.10; adjusted R2 = 0.72). There were no other significant associations between sleep variables with %WR (p > 0.05). CONCLUSIONS: In this pilot sample, sleep variables were not associated with %WR post-bariatric surgery. However, there is some preliminary evidence that greater amounts of REM sleep, which plays a pivotal role in mood regulation and executive function, may be associated with better weight loss maintenance after bariatric surgery.