Sleep Extension: A Novel Intervention for Weight Loss in Young Adults

项目摘要 尽管人们广泛努力实施旨在限制能量摄入和增加热量的生活方式干预措施， 体育活动、减肥成功率有限，肥胖症流行率继续上升。因此， 迫切需要开发新的策略来预防肥胖和相关的心脏代谢风险。短睡眠 持续时间是一种非常普遍的行为，并且与年轻人的肥胖风险密切相关。 实验室证据表明，睡眠时间短可能会增加肥胖的风险，主要是通过 觅食行为和暴饮暴食。我们最近证明，短期睡眠延长在真实的- 习惯性短睡眠的年轻人的生活环境会显著减少能量摄入， 可能是一个有效的策略，以改善减肥结果的生活方式干预与热量限制饮食。 据我们所知，没有先前的减肥干预试验专门检查延长睡眠的影响 持续时间对年轻人的减肥效果的影响。因此，我们提出一项随机临床试验，以确定 是否可以通过增加干预成分来改善生活方式干预的减肥结果， 延长习惯性睡眠时间短的超重年轻人的睡眠时间。超重的年轻人 习惯性睡眠<6.5小时的人将被随机分为两组，一组单独进行生活方式干预（饮食和活动 咨询）或生活方式加睡眠干预（饮食、活动和睡眠咨询）。所有参与者将 接受技术支持的强化生活方式干预，通过每两周一次的远程指导来减肥， 6个月（干预）。被分配到生活方式加睡眠干预的参与者也将接受个性化的 睡眠咨询，以延长睡眠时间，在我们以前的工作证明是成功的，和量身定制的反馈。 受试者将继续其分配的干预措施，为期6个月，不频繁联系 （维护）。睡眠将通过加速度计进行客观评估。参与者将自我监测他们的饮食 （将所有饮食摄入量记录到定制的智能手机应用程序中），身体活动（通过加速度计）和自我称重 每天都在无线范围内。我们的具体目标是确定生活方式加上睡眠干预是否会产生 更大的体重减轻（Aim1）和客观评估的更大减少（使用双标记水/能量） 平衡法）能量摄入（Aim2），与单独的生活方式干预相比。我们将比较 两组之间6个月时体重（主要结局）和能量摄入（次要结局）的变化。我们 将收集更多的行为，生物和心理社会因素的数据，以探讨其影响， 干预反应并产生新的见解。12个月时的体重变化（维持期结束）将是 探索性结果。如果有效，这项试验的数据将有力地支持将睡眠干预纳入 行为减肥计划，并提供所需的证据基础，以指导量身定制的行为改变 在睡眠不足的年轻人中预防肥胖和相关心脏代谢风险的策略

PROJECT SUMMARY Despite widespread efforts to implement lifestyle interventions aimed at restricting energy intake and increasing physical activity, weight loss success has been limited and obesity prevalence continues to rise. Thus, there is a critical need to develop novel strategies to prevent obesity and related cardiometabolic risks. Short sleep duration is a highly prevalent behavior and is strongly associated with obesity risk among young adults. Experimental laboratory evidence indicates that short sleep duration may increase obesity risk primarily through food-seeking behavior and overeating. We have recently demonstrated that short-term sleep extension in real- life settings in young adults with habitual short sleep reduces energy intake by a significant amount, and thus might be a potent strategy to improve weight loss outcomes in lifestyle interventions with calorie-restricting diets. To our knowledge, no prior weight loss intervention trial specifically examined the effects of extending sleep duration on weight loss outcomes in young adults. We, thus, propose a randomized clinical trial to determine whether weight loss outcomes in lifestyle interventions can be improved by adding an intervention component to extend sleep duration in overweight young adults with habitual short sleep duration. Overweight young adults who habitually sleep <6.5 hours will be randomized to either a lifestyle intervention alone (diet and activity counseling) or a lifestyle plus sleep intervention (diet, activity, and sleep counseling). All participants will receive a technology-supported intensive lifestyle intervention for weight loss with biweekly remote coaching for 6 months (Intervention). Participants assigned to lifestyle plus sleep intervention will also receive individualized sleep counseling to extend sleep duration, proven successful in our prior work, and tailored feedback. Participants will continue their assigned intervention for an additional 6 months without frequent contact (Maintenance). Sleep will be objectively assessed by accelerometry. Participants will self-monitor their diet (record all dietary intake into a custom smartphone app), physical activity (by accelerometry), and self-weigh daily on a wireless scale. Our specific aims are to determine whether lifestyle plus sleep intervention produces a greater weight loss (Aim1) and a greater reduction in objectively assessed (using doubly labeled water/energy balance method) energy intake (Aim2), as compared with lifestyle intervention alone. We will compare the change in weight (primary outcome) and energy intake (secondary outcome) at 6 months between groups. We will collect additional data on behavioral, biological, and psychosocial factors to explore their effects on intervention responses and generate novel insights. Weight change at 12 months (end maintenance) will be an exploratory outcome. If effective, data from this trial would strongly support incorporating sleep interventions into behavioral weight loss programs and provide the evidence base needed to guide tailored behavior change strategies for preventing obesity and related cardiometabolic risk in young adults with insufficient sleep duration.