Recent Advances in Sleep and Circadian Characteristics in Eating Disorders: A Systematic Review of the Last Five Years (2020–2025)

Giulia Cera,1 Serena Scarpelli,1,2 Silvamaria Mastrocola,3 Margherita Boltri,3 Federico Brusa,4 Alberto Scalia,4 Maurizio Gorgoni,1,2 Carolina Lombardi,5,6 Leonardo Mendolicchio,4,* Luigi De Gennaro1,* 1Department of Psychology, Sapienza University of Rome, Rome, Italy; 2Body and Action Lab, I.R.C.C.S. Fondazione Santa Lucia, Rome, Italy; 3Department of Psychology, Università Cattolica Del Sacro Cuore, Milano, Italy; 4I.R.C.C.S. Istituto Auxologico Italiano, Experimental Laboratory for Metabolic Neurosciences Research, Piancavallo, VCO, Italy; 5Department of Cardiology, S. Luca Hospital, IRCCS, Istituto Auxologico Italiano, Milan, Italy; 6School of Medicine and Surgery, Università of Milano – Bicocca, Milan, Italy*These authors contributed equally to this workCorrespondence: Giulia Cera, Department of Psychology, Sapienza University of Rome, Rome, Italy, Email [email protected]: A high number of people affected by eating disorders also show severe sleep disturbances, as well as circadian rhythm disruptions. However, research is relatively limited, often yielding conflicting results, especially when comparing clinical populations to healthy controls. Few interventions currently integrate sleep and circadian considerations into ED treatment. This review aims to synthesize recent evidence on sleep and circadian alterations in EDs and to identify research and clinical priorities.Methods: A systematic research through four academic databases was conducted during September 2025, seeking studies on the theme published between 2020– 2025. Eligible articles were narratively synthesized to provide a comprehensive and recent overview of the state of the art. Quality appraisal tools were used according to the studies’ design.Results: Eleven studies met inclusion criteria. Sleep disturbances were most consistently reported in individuals with anorexia nervosa, including poor sleep quality. Evidence for bulimia nervosa and binge-eating disorder was limited and inconclusive, since only a study was included. Five case-control studies compared clinical populations to healthy controls and three studies assessed the effects of ED-focused treatments on sleep. Two studies evaluated a sleep-specific intervention, while one employed bright light therapy. Objective sleep measures were rarely employed.Conclusion: Sleep and circadian disturbances represent an underexplored but clinically relevant dimension of EDs. This review provides a systematically organized synthesis of recent evidence, clarifies diagnosis-specific patterns, and identifies methodological and intervention gaps. Integrating sleep and circadian considerations into assessment and treatment may enhance rehabilitation outcomes and inform the development of more effective, targeted interventions.Keywords: eating disorders, sleep, circadian rhythms, anorexia nervosa, bulimia nervosa, binge-eating disorder, chronotherapy, sleep-related interventions, eating-related interventions