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CC BY-NC-ND 4.0 · Sleep Sci 2025; 18(03): e307-e316
DOI: 10.1055/s-0045-1809062
Original Article

Sex Differences in the Association between Sleep Quality and Excess Weight: Exploring Lifestyle and Health-Related Mediators

Authors

  • Thauanny Heslley Lima dos Santos 

    1   Chronobiology, Nutrition, and Health Research Group, Faculty of Nutrition, Universidade Federal de Alagoas, Maceió, AL, Brazil

  • Júlia Souza de Melo 

    1   Chronobiology, Nutrition, and Health Research Group, Faculty of Nutrition, Universidade Federal de Alagoas, Maceió, AL, Brazil

  • Márcia de Oliveira Lima 

    1   Chronobiology, Nutrition, and Health Research Group, Faculty of Nutrition, Universidade Federal de Alagoas, Maceió, AL, Brazil

  • Risia Cristina Egito de Menezes 

    1   Chronobiology, Nutrition, and Health Research Group, Faculty of Nutrition, Universidade Federal de Alagoas, Maceió, AL, Brazil

  • Renan Serenini 

    2   Faculty of Economics, Sapienza Università di Roma, Roma, Lazio, Italy

  • Giovana Longo-Silva 

    1   Chronobiology, Nutrition, and Health Research Group, Faculty of Nutrition, Universidade Federal de Alagoas, Maceió, AL, Brazil

Funding Source The authors declare that the present study was supported by Fundação de Amparo à Pesquisa do Estado de Alagoas (FAPEAL; grant number: 60030.0000002539/2022).
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Abstract

Objective

To compare the associations between sleep quality and body mass index (BMI), as well as excess weight status, in male and female subjects, while exploring potential mediating factors, including lifestyle and health-related variables.

Materials and Methods

The present cross-sectional study analyzed data from 5,260 (29.7% male and 70.3% female) Brazilian adults collected through a virtual survey applied from 2023 to 2024. Sleep quality and duration were assessed using the Pittsburgh Sleep Quality Index (PSQI). The BMI was derived from self-reported weight and height, with excess weight defined as BMI > 24.9 kg/m2. Associations were explored using multiple linear and logistic regression models, marginal probabilities for being overweight, and restricted cubic splines. Potential mediating variables were identified through mediation analysis.

Results

Among the female subjects, poor sleep quality (β = 0.46; 95%CI: 0.15–0.77) and short sleep duration (β = 0.62; 95%CI: 0.27–0.97) were associated with higher BMI and 21% of increased odds of excess weight after adjusting for all covariates (age, depression, chronic conditions, level of schooling, marriage status, smoking, alcohol consumption, screen time before bed, physical activity, diet quality, and whether dinner is the largest meal of the day). The mediation analysis showed that chronic conditions (20%), depression (16%), and diet quality (14%) mediated the total effect of poor sleep quality on BMI in female participants. Screen time before bed was the only significant mediator for short sleep duration, accounting for ∼ 5% of the total effect. No significant associations were found in male subjects.

Conclusion

Our findings highlight sex differences in the relationship between sleep and BMI, emphasizing the need for sex-specific approaches to sleep and weight management, focusing on health and lifestyle improvements.

Keywords

body mass index - overweight - sleep - sleep quality - lifestyle

Data Visualization

Data described in the manuscript will be made available upon request pending approval.


Ethics Approval

The present study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Ethics in Research Committee of Universidade Federal de Alagoas (CAAE: 48689221.3.0000.5013).


Conflict of Interest

The authors have no relevant financial or non-financial interests to disclose.


Supplementary Material



Publication History

Received: 07 November 2024

Accepted: 07 March 2025

Article published online:
16 September 2025

© 2025. Brazilian Sleep Academy. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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