Associação entre potencial inflamatório da dieta, horário de comer e padrão de sono em pacientes com síndrome da apneia obstrutiva do sono

Abstract

Background: In the last years, there has been an increase in the number of individuals with sleep disorders related to obesity, such as obstructive sleep apnea (OSA). It is well described in the literature that sleep interruptions caused by sleep disorders may result in diseases due to the chronic inflammation, which could be aggravated for the dietary pattern of the individual. However, scientific literature lacks studies that evaluated the impact of dietary pattern, such as the inflammatory potencial of diet and meal timing, in OSA. Objectives: To analyze the associations between the inflammatory potential of diet, meal timing and sleep parameters, as well as to analyze the efficacy of the diet inflammatory index (DII) at predicting sleep pattern. Methods: Patients aged 18–60 years old and with no previous sleep disorders were included in the study. The individuals selected were evaluated for antrophometric measures, blood pressure, food and sleep patterns, and physical activity. The food intake was obtained by a food frequency questionnaire and the nutrients data were used to calculate DII. The DII values were organized in quintiles and the individuals were classified as late and early eaters for multiple comparisons. The sleep parameters were evaluated by objective (polysomnography) and subjective (questionnaires) methods. Results: DII was efficient at predicting apnea severity (p=0.048) and daytime sleepiness (p=0.015) in age stratification, and REM latency in obese sleep apnea individuals (p=0.026). No significant associations were found between DII and the majority of sleep parameters, such as total sleep time (p=0.991), sleep efficiency (p=0.989), sleep latency (p=0.910), REM latency (p=0.889), N1 (p=0.916), N2 (p=0.972), N3 (p=0.281), R sleep stage (p=0.916), and apnea severity (p=0.916). DII was only associated with daytime sleepiness, once patients with more pro-inflammatory diet (quintile 4) showed more subjective sleepiness than the group with more anti-inflammatory diet (quintile 1) (Exp(B)= 0.470, CI= 0.222-0.994, p=0.048). Regarding meal timing, dinner timing was associated with sleep latency (β=0.130, p=0.022), apnea-hypopnea index (AHI) (β=1.284, p=0.033), and poor sleep quality (β=1.140, p=0.015). Breakfast timing was associated with wakefulness after sleep onset (WASO) (β=3.567, p=0.003), N1 (β=0.130, p<0.001), and R sleep (β= -1.189, p=0.001). Lunch timing also was associated with N1 sleep (β=0.095, p=0.025), sleep latency (β=0.293, p=0.001), and daytime sleepiness (β=1.267, p=0.009). Compared to early eaters, late eaters presented lower duration of R sleep and greater values of sleep latency, WASO, N1 sleep, and AHI, beyond increased risk of poor sleep quality and daytime sleepiness (p<0.005). Conclusion: Poor dietary pattern, such as diets with higher inflammatory potential and late meal timing, was associated with worse sleep pattern and apnea severity.