Orexin and sleep quality in anorexia nervosa: Clinical relevance and influence on treatment outcome.

Sarah Sauchelli, Susana Jiménez-Murcia, Isabel Sánchez, Nadine Riesco, Nuria Custal, Jose C Fernández-García, Lourdes Garrido-Sánchez, Francisco J Tinahones, Howard Steiger, Mimi Israel, Rosa M Baños, Cristina Botella, Rafael de la Torre, Jose M Fernández-Real, Francisco J Ortega, Gema Frühbeck, Roser Granero, Salome Tárrega, Ana B Crujeiras, Amaia Rodríguez, Xavier Estivill, Jacques S Beckmann, Felipe F Casanueva, Jose M Menchón, Fernando Fernández-Aranda

Journal: Psychoneuroendocrinology 2016;65():102-8

PMID: 26741881

Full Text on Elsevier Science View on PubMed

Abstract

BACKGROUND AND AIMS

Orexins/hypocretins are orexigenic peptides implicated in the regulation of feeding behavior and the sleep/wake cycle. Little is known about the functioning of these peptides in anorexia nervosa (AN). The aims of the current study were to evaluate the extent to which orexin-A might be linked to sleep and treatment outcome in AN.

METHOD

Fasting plasma orexin-A concentrations were measured in 48 females with AN at the start of a day hospital treatment and in 98 normal-eater/healthy-weight controls. The Pittsburgh Sleep Quality Index was administered at the beginning of the treatment as a measure of sleep quality. Other psychopathological variables were evaluated with the Symptom Checklist-Revised (SCL90R) and the Eating Disorder Inventory-2 (EDI). Patients were assessed at the start and end of treatment by means of commonly used diagnostic criteria and clinical questionnaires.

RESULTS

The AN patients presented more sleep disturbances and poorer overall sleep quality than did the healthy controls (p=.026) but there were no global differences between groups in plasma orexin-A concentrations (p=.071). In the AN sample, orexin-A concentrations were associated with greater sleep disturbances (|r|=.30), sleep inefficiency (|r|=.22) and poorer overall sleep (|r|=.22). Structural Equation Modeling (SEM) showed that both elevated orexin-A concentrations and inadequate sleep predicted poorer treatment outcome.

CONCLUSION

Plasma orexin-A concentrations contribute to poor sleep quality in AN, and both of these variables are associated with therapy response.

Address: Department of Psychiatry, University Hospital of Bellvitge-IDIBELL, Barcelona, Spain; CIBER Fisiopatología Obesidad y Nutrición (CIBERobn), Instituto Salud Carlos III, Madrid, Spain.; Department of Psychiatry, University Hospital of Bellvitge-IDIBELL, Barcelona, Spain; CIBER Fisiopatología Obesidad y Nutrición (CIBERobn), Instituto Salud Carlos III, Madrid, Spain; Department of Clinical Sciences, School of Medicine, University of Barcelona, Barcelona, Spain.; Department of Psychiatry, University Hospital of Bellvitge-IDIBELL, Barcelona, Spain.; CIBER Fisiopatología Obesidad y Nutrición (CIBERobn), Instituto Salud Carlos III, Madrid, Spain; Department of Diabetes, Endocrinology and Nutrition, Hospital Clínico Universitario Virgen de Victoria, Málaga, Spain.; Douglas University Institute in Mental Health & Psychiatry Department, McGill University, Montreal, Canada.; CIBER Fisiopatología Obesidad y Nutrición (CIBERobn), Instituto Salud Carlos III, Madrid, Spain; Department of Psychological, Personality, Evaluation and Treatment of the University of Valencia, Valencia, Spain.; CIBER Fisiopatología Obesidad y Nutrición (CIBERobn), Instituto Salud Carlos III, Madrid, Spain; Department of Basic Psychology, Clinic and Psychobiology of the University Jaume I, Castelló, Spain.; CIBER Fisiopatología Obesidad y Nutrición (CIBERobn), Instituto Salud Carlos III, Madrid, Spain; Integrated Pharmacology and Systems Neurosciences Research Group, Neuroscience Research Program Organization IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain; Department of Health and Experimental Sciences, Universitat Pompeu Fabra Barcelona, Spain.; CIBER Fisiopatología Obesidad y Nutrición (CIBERobn), Instituto Salud Carlos III, Madrid, Spain; Department of Diabetes, Endocrinology and Nutrition, Institu d'Investigació, Biomèdica de Girona (IdIBGi), Hospital Dr Josep Trueta, Girona, Spain.; CIBER Fisiopatología Obesidad y Nutrición (CIBERobn), Instituto Salud Carlos III, Madrid, Spain; Metabolic Research Laboratory, Clínica Universidad de Navarra, University of Navarra-IdiSNA, Pamplona, Spain.; CIBER Fisiopatología Obesidad y Nutrición (CIBERobn), Instituto Salud Carlos III, Madrid, Spain; Department of Psychobiology and Methodology, Autonomous University of Barcelona, Barcelona, Spain.; Department of Psychobiology and Methodology, Autonomous University of Barcelona, Barcelona, Spain.; CIBER Fisiopatología Obesidad y Nutrición (CIBERobn), Instituto Salud Carlos III, Madrid, Spain; Department of Medicine, Endocrinology Division, Santiago de Compostela University, Complejo Hospitalario Universitario, Santiago de Compostela, Spain.; Center for Genomic Regulation (CRG), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), ISCIII, Barcelona, Spain.; SIB Swiss Institute of Bioinformatics, Lausanne, Switzerland.; Department of Psychiatry, University Hospital of Bellvitge-IDIBELL, Barcelona, Spain; Department of Clinical Sciences, School of Medicine, University of Barcelona, Barcelona, Spain; CIBER Salud Mental (CIBERSAM), ISCIII, Barcelona, Spain.; Department of Psychiatry, University Hospital of Bellvitge-IDIBELL, Barcelona, Spain; CIBER Fisiopatología Obesidad y Nutrición (CIBERobn), Instituto Salud Carlos III, Madrid, Spain; Department of Clinical Sciences, School of Medicine, University of Barcelona, Barcelona, Spain. Electronic address: [email protected].

DOI: 10.1016/j.psyneuen.2015.12.014

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MeSH Terms: Adult, Anorexia Nervosa, Case-Control Studies, Feeding Behavior, Female, Humans, Orexins, Sleep, Sleep Wake Disorders, Treatment Outcome