The Effect of Behavioral Sleep Interventions on Measures of Obesity, Dietary Intake and Physical Activity in Adults With Poor Sleep Health: A Systematic Review, Meta-Analysis and Meta-Regression Analysis

Background: As poor sleep negatively impacts on adiposity, there is interest in examining whether improving sleep can improve adiposity markers. We reviewed studies aimed at improving sleep using (1) cognitive behavioral therapy for insomnia (CBT-I) and/or sleep hygiene and (2) sleep extension on adiposity markers, dietary intake, and physical activity. 

Methods: Literature searches were performed on MEDLINE, Embase, CINAHL, and Cochrane Library. We included studies featuring adults ≥ 18 years without OSA, a sleep intervention as well as preintervention and postintervention measures. 

Results: From a total of 27 studies, 25 were used in the meta-analyses. Using CBT-I and/or sleep hygiene in eight studies (n = 1384) led to significant BMI reductions averaging 0.64 kg/m ² (0.28, 1.01, p = 0.0006, I ² = 16%) but the reductions were not significant in five studies (n = 138) of sleep extension, 0.15 kg/m ² (−0.40, 0.11, p = 0.26). In obesity (n = 78, 3 studies) and in type 2 diabetes (n = 1121, 3 studies) BMI reductions averaged 1.53 (0.49, 2.56, p = 0.004, I ² = 0%) and 0.64 kg/m ² (0.37, 0.92, p < 0.00001, I ² = 0%), respectively. For body weight, using sleep interventions led to significant reductions in the obese (n = 72, 3 studies) and overweight ranges (n = 337, 6 studies), averaging 5.55 (4.13, 6.97, p < 0.00001, I ² = 0%) and 0.83 kg (0.32, 1.35, p = 0.002, I ² = 0%), respectively. Using sleep interventions reduced daily energy intake (n = 223, 5 studies) by 147.5 cal/day (5.74, 289.41, p = 0.04, I ² = 53%), but was higher in the obese/overweight range (n = 122, 3 studies) at 238.0 cal/day (138.86, 337.22, p < 0.00001, I ² = 0%); sugar consumption reduced (p = 0.05), and protein consumption increased (p = 0.001). There were no changes in physical activity or sedentary behavior levels. On quality assessment, 12 and 10 studies were of low and some concerns, respectively. 

Conclusion: Addressing poor sleep health through using sleep interventions has the potential to be integrated into obesity management programs, alongside current lifestyle strategies.

PROSPERO Identification Number: CRD42025644060.