JAMA INTERN MED｜在现实生活中，延长睡眠时间对超重成年人客观评估的

　　JAMA INTERN MEDEarly Recent, Feb 07, 202210.1001/jamainternmed.2021.8098本文由“天纳”临床学术信息人工智能系统自动翻译What is the effect of sleep extension on objectively assessed energy intake in adults with overweight in their usual home environment?在正常的家庭环境中，延长睡眠时间对超重成年人客观评估的能量摄入有什么影响？In this randomized clinical trial of 80 adults with overweight and habitual sleep less than 6.5 hours per night, those randomized to a 2-week sleep extension intervention significantly reduced their daily energy intake by approximately 270 kcal compared with the control group. Total energy expenditure did not significantly differ between the sleep extension and control groups, resulting in a negative energy balance with sleep extension.在这项随机临床试验中，80名超重且每晚习惯性睡眠少于6.5小时的成年人，与对照组相比，随机接受2周睡眠延长干预的人的每日能量摄入显著减少约270千卡。在延长睡眠时间组和对照组之间，总能量消耗没有显著差异，导致延长睡眠时间组的能量负平衡。The findings suggest that improving and maintaining adequate sleep duration could reduce weight and be a viable intervention for obesity prevention and weight loss programs.研究结果表明，改善和保持充足的睡眠时间可以减轻体重，是预防肥胖和减肥计划的可行干预措施。Short sleep duration has been recognized as a risk factor for obesity. Whether extending sleep duration may mitigate this risk remains unknown.睡眠时间短被认为是肥胖的危险因素。延长睡眠时间是否可以减轻这种风险仍不得而知。To determine the effects of a sleep extension intervention on objectively assessed energy intake, energy expenditure, and body weight in real-life settings among adults with overweight who habitually curtailed their sleep duration.在现实生活中，在习惯性缩短睡眠时间的超重成年人中，确定延长睡眠干预对客观评估的能量摄入、能量消耗和体重的影响。This single-center, randomized clinical trial was conducted from November 1, 2014, to October 30, 2020. Participants were adults aged 21 to 40 years with a body mass index (calculated as weight in kilograms divided by height in meters squared) between 25.0 and 29.9 and had habitual sleep duration of less than 6.5 hours per night. Data were analyzed according to the intention-to-treat principle.这项单中心随机临床试验于2014年11月1日至2020年10月30日进行。参与者为21至40岁的成年人，体重指数（以千克为单位的体重除以以米为单位的身高平方）在25.0至29.9之间，每晚习惯性睡眠时间少于6.5小时。根据意向治疗原则对数据进行分析。After a 2-week habitual sleep period at baseline, participants were randomized to either an individualized sleep hygiene counseling session that was intended to extend their bedtime to 8.5 hours (sleep extension group) or to continue their habitual sleep (control group). All participants were instructed to continue daily routine activities at home without any prescribed diet or physical activity.在基线检查时经过2周的习惯性睡眠期后，参与者被随机分为两组，一组是个体化的睡眠卫生咨询课程，旨在将他们的就寝时间延长至8.5小时（睡眠延长组），另一组是继续他们的习惯性睡眠（对照组）。所有参与者都被要求在家继续日常活动，不需要任何规定的饮食或体育活动。The primary outcome was change in energy intake from baseline, which was objectively assessed as the sum of total energy expenditure and change in body energy stores. Total energy expenditure was measured by the doubly labeled water method. Change in body energy stores was computed using regression of daily home weights and body composition changes from dual-energy x-ray absorptiometry. Sleep duration was monitored by actigraphy. Changes from baseline were compared between the 2 groups using intention-to-treat analysis.主要结果是从基线检查时的能量摄入变化，这被客观地评估为总能量消耗和身体能量储存变化的总和。总能量消耗采用双标记水法测量。利用双能x射线吸收仪对每日家庭体重和身体成分变化的回归计算身体能量储备的变化。通过活动描记术监测睡眠时间。使用意向治疗分析比较两组之间基线检查时的变化。Data from 80 randomized participants (mean [SD] age, 29.8 [5.1] years; 41 men [51.3%]) were analyzed. Sleep duration was increased by?approximately 1.2 hours per night (95% CI, 1.0 to 1.4 hours; P?<?.001) in the sleep extension group vs the control group. The sleep extension group had a significant decrease in energy intake compared with the control group (?270 kcal/d; 95% CI, ?393 to ?147 kcal/d; P?<?.001). The change in sleep duration was inversely correlated with the change in energy intake (r?=??0.41; 95% CI, ?0.59 to ?0.20; P?<?.001). No significant treatment effect in total energy expenditure was found, resulting in weight reduction in the sleep extension group vs the control group.对80名随机参与者（平均[SD]年龄29.8[5.1]岁；41名男性[51.3%]）的数据进行了分析。睡眠时间增加了?每晚约1.2小时（95%可信区间，1.0至1.4小时；P?<?.001）在睡眠延长组与对照组中。与对照组相比，延长睡眠时间组的能量摄入显著减少(?270千卡/日；95%可信区间，?393到?147千卡/日；P?<?.001). 睡眠时间的变化与能量摄入的变化呈负相关（r?=??0.41; 95%可信区间，?0.59至?0.20; P?<?.001). 在总能量消耗方面没有发现显著的治疗效果，导致睡眠延长组与对照组相比体重减轻。This trial found that sleep extension reduced energy intake and resulted in a negative energy balance in real-life settings among adults with overweight who habitually curtailed their sleep duration. Improving and maintaining healthy sleep duration over longer periods could be part of obesity prevention and weight loss programs.这项试验发现，在习惯性缩短睡眠时间的超重成年人中，延长睡眠时间会减少能量摄入，并在现实生活中导致能量负平衡。改善和保持较长时间的健康睡眠时间可能是肥胖预防和减肥计划的一部分。ClinicalTrials.gov Identifier: NCT02253368临床试验。政府识别码：NCT02253368Obesity is a major public health concern.1 The obesity epidemic appears to coincide with a pattern of sleeping less that has been observed in society over the past several decades. For example, one-third of the US population reported not getting the recommended 7 to 9 hours of sleep per night.2-4 Substantial evidence suggests that sleeping less than 7 hours per night on a regular basis is associated with adverse health consequences.5 Particularly, insufficient sleep duration has been increasingly recognized as an important risk factor for obesity.6,7 Prospective epidemiologic studies suggest that short sleep duration is an important risk factor for weight gain.8-10 However, it remains unknown whether extending sleep duration can be an effective strategy for preventing or reversing obesity. Although sleep hygiene education is encouraged by obesity experts,11 most health professionals and patients do not implement obtaining adequate sleep duration as part of the strategies to combat the obesity epidemic.12肥胖是一个主要的公共卫生问题。1肥胖流行似乎与过去几十年在社会上观察到的睡眠不足模式相吻合。例如，三分之一的美国人口报告称每晚睡眠时间达不到建议的7到9小时。2-4大量证据表明，每晚睡眠少于7小时与不良健康后果有关。5尤其是，睡眠时间不足已越来越被认为是肥胖的一个重要风险因素。6,7前瞻性流行病学研究表明，睡眠时间短是体重增加的一个重要风险因素。8-10然而，延长睡眠时间是否是预防或逆转肥胖的有效策略尚不清楚。尽管肥胖专家鼓励进行睡眠卫生教育，但大多数健康专业人员和患者并未将获得充足睡眠时间作为对抗肥胖流行病的策略的一部分。12At the population level, the association between energy flux and body weight implicates that increased energy intake is the main factor in higher body weights in modern society.13 According to dynamic prediction models, a sustained increase in energy intake of even 100 kcal/d would result in a weight gain of about 4.5 kg over 3 years.14,15 Factors that underlie the observed persistent increase in energy intake and mean weight gain at the population level need to be better understood. One such factor is insufficient sleep duration. Short-term experimental laboratory studies have found that sleep restriction in healthy individuals is associated with an increased mean energy intake of about 250 to 350 kcal/d with minimal to no change in energy expenditure.16-19 However, these laboratory studies do not represent real life. The magnitude of sleep restriction was extreme in most cases, and energy intake was ascertained from a single or a few meals. In a real-life setting in which participants continue their normal daily activities, multiple interacting factors (eg, social interactions and free-living physical activity) can influence energy intake or expenditure and weight.在人口水平上，能量流量和体重之间的关联表明，在现代社会，增加能量摄入是导致体重增加的主要因素。13根据动态预测模型，即使能量摄入持续增加100 kcal/d，也会导致3年内体重增加约4.5 kg。14,15需要更好地理解在人群水平上观察到的能量摄入和平均体重增加持续增加的基础因素。其中一个因素是睡眠时间不足。短期实验性实验室研究发现，健康人的睡眠限制与平均能量摄入增加（约250至350 kcal/d）有关，而能量消耗变化最小或没有变化。16-19然而，这些实验室研究并不代表现实生活。在大多数情况下，睡眠限制的程度是极端的，能量摄入是通过一顿或几顿饭确定的。在参与者继续正常日常活动的现实生活环境中，多种相互作用的因素（例如，社交互动和自由生活的体育活动）可能会影响能量摄入或消耗以及体重。To date, it remains unknown whether and to what extent an intervention that is intended to increase sleep duration in a real-life setting affects energy balance and body weight. We conducted a randomized clinical trial (RCT) to determine the effects of a sleep extension intervention on objectively assessed energy intake, energy expenditure, and body weight in real-life settings among adults with overweight who habitually curtailed their sleep duration.到目前为止，在现实生活中增加睡眠时间的干预是否以及在多大程度上影响能量平衡和体重尚不清楚。我们进行了一项随机临床试验（RCT），以确定在现实生活中习惯性缩短睡眠时间的超重成年人中，睡眠延长干预对客观评估的能量摄入、能量消耗和体重的影响。This single-center, parallel-group RCT was conducted from November 1, 2014, to October 30, 2020. The protocol was approved by The University of Chicago Institutional Review Board, and participants provided written informed consent. The study protocol is available in Supplement 1. We followed the Consolidated Standards of Reporting Trials (CONSORT) reporting guideline.这项单中心平行分组随机对照试验于2014年11月1日至2020年10月30日进行。该协议得到了芝加哥大学机构审查委员会的批准，与会者提供了书面知情同意书。研究方案见附录1。我们遵循了综合报告试验标准（CONSORT）报告指南。Adult men and women aged 21 to 40 years with a body mass index (calculated as weight in kilograms divided by height in meters squared) between 25.0 and 29.9 and a mean habitual sleep duration of less than 6.5 hours per night were eligible. Individuals were required to have stable self-reported sleep habits for the past 6 months. They were recruited from the community and completed an initial online survey followed by a face-to-face interview. Race and ethnicity data were self-reported at this time and included the following race and ethnicity categories: Asian, Black or African American, Hispanic, and White. Those who met the inclusion criteria underwent laboratory screening (polysomnography, oral glucose tolerance test, and blood tests) to determine eligibility. Habitual sleep duration was confirmed by a 1-week screening wrist actigraphy at home. Those who had obstructive sleep apnea confirmed by laboratory polysomnography (apnea-hypopnea index >5), insomnia or history of any other sleep disorder, or night shift and rotating shift work (current or in the past 2 years) were excluded. Detailed eligibility criteria are provided in the eMethods in Supplement 2.年龄在21岁至40岁之间、体重指数（按体重（千克）除以身高（米）的平方计算）在25.0至29.9之间、每晚平均习惯性睡眠时间少于6.5小时的成年男女符合条件。在过去的6个月里，受试者需要有稳定的自我报告睡眠习惯。他们是从社区招募的，完成了最初的在线调查，然后进行了面对面的采访。种族和民族数据在当时是自我报告的，包括以下种族和民族类别：亚裔、黑人或非裔美国人、西班牙裔和白人。符合纳入标准的患者接受实验室筛查（多导睡眠图、口服葡萄糖耐量试验和血液测试）以确定其资格。习惯性睡眠持续时间通过在家中进行为期1周的腕部活动描记术筛查得到确认。经实验室多导睡眠描记术（呼吸暂停低通气指数>5）、失眠或任何其他睡眠障碍史、夜班和轮班工作（当前或过去2年）确诊的阻塞性睡眠呼吸暂停患者被排除在外。补充2中的方法提供了详细的资格标准。After a 2-week habitual sleep period at baseline, participants were randomized to either 2-week sleep extension (sleep extension group) or 2-week continued habitual sleep (control group) (Figure 1). Participants continued their daily routine activities at home without any prescribed diet or physical activity.在基线检查时习惯性睡眠2周后，参与者被随机分为2周睡眠延长组（睡眠延长组）或2周持续习惯性睡眠组（对照组）（图1）。参与者在家里继续日常活动，没有任何规定的饮食或体育活动。To blind participants to the sleep extension intervention, we described the study in the recruitment materials as follows: “we will collect information about sleep habits and metabolism.” The sleep extension group was blinded to randomization until after the 2-week baseline assessments, and the control group was blinded until the end of the 4-week study. This approach allowed us to capture habitual sleep-wake patterns without influencing participants' usual behavior or creating selection bias with only participants interested in improving sleep habits. After study completion, all participants were provided with information about the health benefits of optimal sleep duration. Block randomization, stratified by sex, was performed using computer-generated random numbers. Before the trial, randomization assignments were prepared by a biostatistician (K.W.) using opaque, sealed, and numbered envelopes and were given to the research coordinator (E.K.).为了让参与者对睡眠延长干预视而不见，我们在招募材料中描述了这项研究：“我们将收集有关睡眠习惯和新陈代谢的信息。”睡眠延长组在2周基线评估后才被随机分组，而对照组在4周研究结束后才被随机分组。这种方法使我们能够捕捉到习惯性的睡眠-觉醒模式，而不会影响参与者的日常行为，也不会造成选择偏差，只有参与者对改善睡眠习惯感兴趣。研究完成后，向所有参与者提供了最佳睡眠时间对健康有益的信息。采用计算机生成的随机数进行按性别分层的块随机分组。试验前，由生物统计学家（K.W.）使用不透明、密封和编号的信封准备随机分配，并交给研究协调员（E.K.）。Sleep-wake patterns were continuously monitored at home by wrist actigraphy throughout the 4-week study. Participants were asked to wear an accelerometer (motion)-based monitor (Actiwatch Spectrum Plus; Philips) and to press a built-in event marker button when they went to bed to sleep each night and when they got out of bed each morning. Sleep was automatically scored (Actiware, version 6.0.9; Philips) using validated algorithms as the sum of all epochs that were scored as sleep during the total time spent in bed.20,21在为期4周的研究中，在家中通过腕关节活动描记术持续监测睡眠-觉醒模式。参与者被要求佩戴基于加速度计（运动）的监视器（Actiwatch Spectrum Plus；飞利浦），并在每晚睡觉和起床时按下内置的事件标记按钮。睡眠被自动评分（Actiware，6.0.9版；飞利浦），使用经过验证的算法作为在床上总时间内被评分为睡眠的所有时期的总和。20、21During the 2-week baseline, all participants were instructed to continue their habitual sleep patterns at home. On the morning of day 15, participants met with study investigators (E.T. and E.K.) in the research center. Those who were randomized to the sleep extension group received individualized sleep hygiene counseling through a structured interview (E.T.) (eMethods in Supplement 2).22 At the end of the interview, participants were provided with individualized recommendations to follow at home for 2 weeks, with the aim of extending their bedtime duration to 8.5 hours. On day 22, participants returned for a brief follow-up visit. Actigraphy data from the first intervention week were reviewed, and further sleep counseling was provided as needed.在为期两周的基线测试中，所有参与者都被要求在家继续他们的习惯性睡眠模式。第15天上午，参与者在研究中心会见了研究调查人员（E.T.和E.K.）。那些被随机分配到睡眠延长组的人通过结构化访谈（E.T.）接受了个性化的睡眠卫生咨询（E.T.）（补充2中的方法）。22在访谈结束时，向参与者提供了个性化建议，让他们在家里遵循2周，目的是将他们的就寝时间延长到8.5小时。第22天，参与者返回进行短暂的随访。回顾了第一个干预周的活动描记术数据，并根据需要提供了进一步的睡眠咨询。To minimize any imbalance in contact with the investigators between the 2 groups, we asked participants in the control group to meet with the study investigators on days 15 and 22. Actigraphy data of these participants were downloaded, but the participants did not receive any specific sleep recommendations and were instructed to continue their daily routine and habitual sleep behaviors until the end of the study.为了尽量减少两组之间与研究人员接触的不平衡，我们要求对照组的参与者在第15天和第22天与研究人员会面。这些参与者的活动描记术数据被下载，但参与者没有收到任何具体的睡眠建议，并被指示在研究结束前继续他们的日常常规和习惯性睡眠行为。For each 2-week period, the energy intake was calculated from the sum of total energy expenditure and change in body energy stores using the principle of energy balance.14,23,24 Total energy expenditure was measured by the doubly labeled water method.25-29 For each 2-week period, the change in body energy stores was computed from the regression (slope, grams per day) of daily home weights and change in body composition (ie, fat mass and fat-free mass) using dual-energy x-ray absorptiometry. Participants were provided a cellular-enabled weight scale (BodyTrace; BodyTrace Inc) and instructed to take their nude weights twice every morning after awakening before eating or drinking. Weight values were hidden from the participants to minimize potential influence on behavior. Changes in body composition were converted to changes in energy stores using 9.5 kcal/g as the energy coefficient of fat mass and 1.0 kcal/g as the energy coefficient of fat-free mass.30 Resting metabolic rate was measured by indirect calorimetry for 30 minutes after fasting and for 4 hours after eating a standardized breakfast. Thermic effect of the meal was calculated, which was previously described elsewhere.31 Activity energy expenditure was calculated by subtracting the resting metabolic rate and thermic effect of the meal from the total energy expenditure.31,32 Additional details are provided in the eMethods in Supplement 2.对于每两周的时间段，能量摄入是根据总能量消耗和身体能量储备的变化之和，利用能量平衡原理计算得出的。14,23,24用双标记水法测量总能量消耗。25-29每两周，身体能量储备的变化是通过使用双能x射线吸收仪对每日家庭体重和身体成分（即脂肪质量和无脂肪质量）变化的回归（斜率，每天克数）来计算的。研究人员向参与者提供了一个支持细胞功能的体重秤（BodyTrace；BodyTrace Inc.），并指示他们每天早上醒来后在进食或饮水前测量裸体体重两次。对参与者隐藏体重值，以尽量减少对行为的潜在影响。用9.5 kcal/g作为脂肪质量的能量系数，1.0 kcal/g作为无脂肪质量的能量系数，将身体成分的变化转化为能量储存的变化。在禁食后30分钟和吃标准早餐后4小时内，通过间接量热法测量静息代谢率。这顿饭的热效应是经过计算的，之前在其他地方也有描述。31活动能量消耗的计算方法是从总能量消耗中减去静息代谢率和膳食的热效应。31,32补充2的方法中提供了更多细节。The primary outcome was change in energy intake from baseline. A total final sample size of 80 participants (40 per group) was originally planned and provided 80% power to detect a true difference in energy intake between groups of 207 kcal/d using a 2-sided α?=?.05 significance threshold (trial protocol in Supplement 1). An intention-to-treat analysis was conducted in Stata, version 16 (StataCorp LLC) using 2-tailed tests with statistical significance set at P?<?.05. Categorical data are presented as counts and percentages. Continuous data are presented as means and SDs. Linear mixed-effects models were fit to determine the treatment differences between the groups.33 Models included the randomization group, 2-week baseline period (period 1) vs 2-week intervention (period 2) and their interaction, and random effects for each participant. The treatment effect (95% CI) was estimated by the treatment group and period interaction, which is equivalent to testing the difference in change from baseline (period 2 minus period 1) in the sleep extension group vs the control group. To confirm the robustness of primary findings, we fit additional models using the analysis of covariance approach with the period 2 value as the dependent variable, treatment group as the independent variable, and period 1 value as covariates.主要结果是与基线相比能量摄入的变化。最初计划的最终总样本量为80名参与者（每组40名），并提供80%的功率，以便使用双面α法检测207 kcal/d组之间能量摄入的真实差异?=?.05显著性阈值（补充1中的试验方案）。在Stata第16版（StataCorp LLC）中进行了意向治疗分析，采用双尾检验，统计显著性设为P?<?.05.分类数据以计数和百分比表示。连续数据以平均值和SDs表示。线性混合效应模型适用于确定两组之间的治疗差异。33个模型包括随机分组、2周基线期（第1期）与2周干预期（第2期）及其相互作用，以及每个参与者的随机效应。治疗效果（95%置信区间）由治疗组和周期相互作用进行评估，这相当于测试延长睡眠组与对照组相比基线（周期2减去周期1）的变化差异。为了确认主要发现的稳健性，我们使用协方差分析方法拟合附加模型，以周期2值为因变量，治疗组为自变量，周期1值为协变量。In secondary analyses, mixed models that adjusted for sex or menstrual cycle were also fit; these covariates were chosen because of the known influence of menstrual cycle on short-term changes in weight. A Pearson correlation coefficient was calculated to assess the relationships between the changes from baseline in sleep duration and the changes from baseline in energy intake. No adjustments were made to P values or CIs for multiple comparisons. Baseline characteristics of participants with complete data were compared with those of participants with incomplete data using unpaired, 2-tailed t tests and Fisher exact tests. No imputation for missing values was performed.在二次分析中，根据性别或月经周期调整的混合模型也适用；选择这些协变量是因为已知月经周期对体重短期变化的影响。计算皮尔逊相关系数，以评估睡眠持续时间与能量摄入的基线变化之间的关系。多次比较时，未对P值或CI进行调整。使用非配对、双尾t检验和Fisher精确检验，比较数据完整参与者和数据不完整参与者的基线特征。未对缺失值进行插补。Of the 210 adults who provided consent and were assessed for eligibility, 81 were randomized (41 to the control group and 40 to the sleep extension group) initially (Figure 1). One participant in the control group revealed adhering to a weight loss regimen and thus did not meet the study inclusion criteria and was deemed ineligible after randomization.34 The 80 participants had a mean (SD) age of 29.8 (5.1) years and consisted of 41 men (51.3%) and 39 women (48.7%). Baseline characteristics of participants were similar between randomization groups (Table 1). None of the participants were using any antihypertensive or lipid-lowering agents or any prescription medication that can affect sleep or metabolism.在210名提供同意书并接受资格评估的成年人中，有81人最初被随机分组（41人进入对照组，40人进入睡眠延长组）（图1）。对照组的一名参与者显示坚持减肥方案，因此不符合研究纳入标准，随机分组后被视为不合格。34 80名参与者的平均年龄（SD）为29.8（5.1）岁，由41名男性（51.3%）和39名女性（48.7%）组成。随机分组之间参与者的基线特征相似（表1）。所有参与者均未使用任何可能影响睡眠或新陈代谢的抗高血压或降脂药物或处方药。Figure 2 illustrates the mean nightly sleep duration by actigraphy in each group throughout the 4-week study. Participants in the sleep extension group had a significant increase from baseline in mean sleep duration by actigraphy compared with those in the control group (1.2 hours; 95% CI, 1.0-1.4 hours; P?<?.001). The findings were similar with regard to change in sleep duration when only participants' workdays (1.3 hours; 95% CI, 1.0-1.5 hours; P?<?.001) or free days (1.1 hours; 95% CI, 0.7-1.5 hours; P?<?.001) were considered (eTable 1 in Supplement 2). No difference was found in change in sleep efficiency (percentage of time spent asleep during time in bed) between the 2 groups (–0.6 hours; 95% CI, –2.1 to 1.0 hours; P?=?.48), confirming the success of the intervention (eTable 2 in Supplement 2).图2显示了在为期4周的研究中，各组的平均夜间睡眠时间。与对照组相比，睡眠延长组参与者的平均睡眠时间（1.2小时；95%可信区间，1.0-1.4小时；P?<?.001). 研究结果表明，当参与者的工作日只有1.3小时（95%可信区间为1.0-1.5小时；P?<?.001）或自由日（1.1小时；95%CI，0.7-1.5小时；P?<?.001）进行了考虑（补充2中的表1）。两组之间的睡眠效率变化（卧床期间睡眠时间的百分比）没有差异（–0.6小时；95%可信区间，–2.1至1.0小时；P?=?.48），确认干预成功（补充2表2）。Energy intake was statistically significantly decreased in the sleep extension group compared with the control group (?270.4 kcal/d; 95% CI, ?393.4 to ?147.4 kcal/d; P?<?.001). Figure 3A through D illustrates the changes from baseline in energy intake and the changes from baseline in sleep duration in individual participants. There was a significant increase in energy intake from baseline in the control group (114.9 kcal/d; 95% CI, 29.6 to 200.2 kcal/d) and a significant decrease in energy intake from baseline in the sleep extension group (?155.5 kcal/d; 95% CI, ?244.1 to ?66.9 kcal/d) (Table 2). Considering all participants, the change in sleep duration was inversely correlated with the change in energy intake (r?=??0.41; 95% CI, ?0.59 to ?0.20; P?<?.001) (Figure 3E). Each 1-hour increase in sleep duration was associated with a decrease in energy intake of approximately 162 kcal/d (?162.3 kcal/d; 95% CI, ?246.8 to ?77.7 kcal/d; P?<?.001).与对照组相比，睡眠延长组的能量摄入在统计学上显著降低(?270.4千卡/日；95%可信区间，?393.4至?147.4千卡/日；P?<?.001). 图3A至图D显示了个体参与者能量摄入和睡眠时间的基线变化。对照组的能量摄入较基线显著增加（114.9千卡/天；95%可信区间，29.6至200.2千卡/天），而延长睡眠组的能量摄入较基线显著减少(?155.5千卡/日；95%可信区间，?244.1至?66.9千卡/日（表2）。考虑到所有参与者，睡眠时间的变化与能量摄入的变化呈负相关（r?=??0.41; 95%可信区间，?0.59至?0.20; P?<?.001）（图3E）。睡眠时间每增加1小时，能量摄入就会减少约162千卡/天(?162.3千卡/日；95%可信区间，?246.8至?77.7千卡/日；P?<?.001).No statistically significant treatment effect was found in total energy expenditure or other measures of energy expenditure (Table 2). Participants in the sleep extension group had a statistically significant reduction in weight compared with those in the control group (?0.87 kg; 95% CI, ?1.39 to ?0.35 kg; P?=?.001). There was weight gain from baseline in the control group (0.39 kg; 95% CI, 0.02 to 0.76 kg) and weight reduction from baseline in the sleep extension group (?0.48 kg; 95% CI, ?0.85 to ?0.11 kg) (Table 2).在总能量消耗或其他能量消耗指标中未发现具有统计学意义的治疗效果（表2）。与对照组相比，睡眠延长组的参与者体重在统计学上显著减轻(?0.87公斤；95%可信区间，?1.39至?0.35公斤；P?=?.001). 对照组与基线检查时相比体重增加（0.39千克；95%可信区间，0.02至0.76千克），而睡眠延长组与基线检查时相比体重减轻(?0.48公斤；95%可信区间，?0.85至?0.11千克（表2）。The findings on energy intake, energy expenditure, and weight were similar after adjustment for the effects of sex or menstrual cycle. No statistically significant differences in baseline characteristics were found between the 75 participants (93.8%) who had complete data on energy intake (primary outcome) vs participants with missing data on energy intake. The proportion of participants with complete data on energy intake was not significantly different between the sleep extension and control groups (90.0% vs 97.5%; P?=?.36). When all reported outcomes were considered, no significant differences (except for depressive symptoms) in baseline characteristics were found between participants with complete data and participants with incomplete or missing data (eTable 3 in Supplement 2). The proportion of participants with complete data on all reported outcomes was similar between the sleep extension and control groups (82.5% vs 85.0%; P?>?.99).在考虑了性别或月经周期的影响后，关于能量摄入、能量消耗和体重的研究结果是相似的。在能量摄入（主要结果）数据完整的75名参与者（93.8%）与能量摄入数据缺失的参与者之间，未发现基线特征的统计显著差异。在延长睡眠时间组和对照组之间，拥有完整能量摄入数据的参与者比例没有显著差异（90.0%比97.5%；P?=?.36). 当考虑所有报告的结果时，数据完整的参与者和数据不完整或缺失的参与者之间的基线特征没有显著差异（抑郁症状除外）（补充2表3）。在睡眠延长组和对照组之间，拥有所有报告结果完整数据的参与者比例相似（82.5%比85.0%；P?>?.99).In this RCT of adults with overweight who habitually curtailed their sleep duration, sleep extension reduced energy intake and resulted in a negative energy balance (ie, energy intake that is less than energy expenditure) in real-life settings. To our knowledge, this study provides the first evidence of the beneficial effects of extending sleep to a healthy duration on objectively assessed energy intake and body weight in participants who continued to live in their home environment. Modest lifestyle changes in energy intake or expenditure are increasingly promoted as viable interventions to reverse obesity.在这项随机对照试验中，超重成年人习惯性缩短睡眠时间，延长睡眠时间会减少能量摄入，并在现实生活中导致能量负平衡（即能量摄入低于能量消耗）。据我们所知，这项研究首次证明，在继续生活在家庭环境中的参与者中，延长健康睡眠时间对客观评估的能量摄入和体重有好处。在能量摄入或消耗方面适度的生活方式改变越来越多地被提倡为扭转肥胖的可行干预措施。According to the Hall dynamic prediction model, a decrease in energy intake of approximately 270 kcal/d, which we observed after short-term sleep extension, would predict an approximately 12-kg weight loss over 3 years if the effects were sustained over a long term.14,15 However, this study cannot infer how long healthy sleep habits may be sustained. Nevertheless, these modeling predictions on weight change suggest that continued adequate sleep duration and beneficial effect on energy intake could translate into clinically meaningful weight loss and help reverse or prevent obesity. Thus, the findings of this study may have important public health implications for weight management and policy recommendations.根据霍尔动态预测模型，我们在短期睡眠延长后观察到的能量摄入减少约270 kcal/d，如果这种影响在长期内持续，将预测3年内体重减轻约12 kg。14,15然而，这项研究无法推断健康的睡眠习惯可以维持多久。然而，这些关于体重变化的模型预测表明，持续充足的睡眠时间和对能量摄入的有益影响可以转化为具有临床意义的体重减轻，并有助于逆转或预防肥胖。因此，这项研究的结果可能对体重管理和政策建议具有重要的公共卫生意义。全文超过5万字符微信字数限制无法显示全文扫描左侧二维码查看全文?JAMA INTERN MEDEarly Recent, Feb 07, 202210.1001/jamainternmed.2021.8098