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The quality and duration of sleep are related to hedonic hunger: a cross-sectional study in university students

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Abstract

There is a relationship between extreme sleep duration and increased food intake. Some studies have reported that there was no change in the homeostatic aspects of energy balance, despite the increased nutrient intake, and in this case, the hedonic aspects may be effective. The purpose of this study was to examine the associations of hedonic hunger with sleep quality and duration among university students. This cross-sectional study was carried out on university students. An online questionnaire was applied in the study, in which 1144 participants were included. The Pittsburgh Sleep Quality Index (PSQI) was used to assess sleep quality and duration, and the Power of Food Scale (PFS) and Palatable Eating Motives Scale (PEMS) for detecting hedonic hunger states. Multiple linear regression analysis was performed to evaluate the relationship between sleep quality and duration and hedonic hunger by modelling. Total PFS and PEMS scores were positively associated with PSQI scores after controlling for all possible confounding factors [β (95%CI) = 0.04 (0.03–0.05), p < 0.05; 0.06 (0.05–0.07), p < 0.05, respectively). The relationship between the subdimensions of the PFS, PEMS and PSQI remained statistically significant, except for food availability (PFS) and social motive (PEMS).After fully adjusting, the odds of having a high PEMS score increased in individuals with short or long sleep duration, but not PFS score [OR (95%CI) = 1.40 (1.09–1.83), p = 0.012; 0.98 (0.70–1.21), p = 0.878, respectively]. While a positive relationship was found between increased hedonic hunger and poor sleep quality, an inverse relationship was observed between ideal sleep duration and hedonic hunger. The findings suggest that improving sleep quality and duration can help reduce hedonic hunger, which increases the tendency to unhealthy and delicious foods and plays a role in weight gain.
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Sleep and Biological Rhythms (2021) 19:163–172
https://doi.org/10.1007/s41105-020-00303-8
ORIGINAL ARTICLE
The quality andduration ofsleep are related tohedonic hunger:
across‑sectional study inuniversity students
MuratAçik1 · AyşeNurSongürBozdağ1· FundaPınarÇakiroğlu1
Received: 19 June 2020 / Accepted: 24 December 2020 / Published online: 16 January 2021
© Japanese Society of Sleep Research 2021
Abstract
There is a relationship between extreme sleep duration and increased food intake. Some studies have reported that there was
no change in the homeostatic aspects of energy balance, despite the increased nutrient intake, and in this case, the hedonic
aspects may be effective. The purpose of this study was to examine the associations of hedonic hunger with sleep quality and
duration among university students. This cross-sectional study was carried out on university students. An online question-
naire was applied in the study, in which 1144 participants were included. The Pittsburgh Sleep Quality Index (PSQI) was
used to assess sleep quality and duration, and the Power of Food Scale (PFS) and Palatable Eating Motives Scale (PEMS)
for detecting hedonic hunger states. Multiple linear regression analysis was performed to evaluate the relationship between
sleep quality and duration and hedonic hunger by modelling. Total PFS and PEMS scores were positively associated with
PSQI scores after controlling for all possible confounding factors [β (95%CI) = 0.04 (0.03–0.05), p < 0.05; 0.06 (0.05–0.07),
p < 0.05, respectively). The relationship between the subdimensions of the PFS, PEMS and PSQI remained statistically
significant, except for food availability (PFS) and social motive (PEMS).After fully adjusting, the odds of having a high
PEMS score increased in individuals with short or long sleep duration, but not PFS score [OR (95%CI) = 1.40 (1.09–1.83),
p = 0.012; 0.98 (0.70–1.21), p = 0.878, respectively]. While a positive relationship was found between increased hedonic
hunger and poor sleep quality, an inverse relationship was observed between ideal sleep duration and hedonic hunger. The
findings suggest that improving sleep quality and duration can help reduce hedonic hunger, which increases the tendency to
unhealthy and delicious foods and plays a role in weight gain.
Keywords Sleep quality· Hedonic hunger· Sleep duration· Appetite· University students
Introduction
Sleep is a rapidly reversible recurring state of inactivity
associated with diminished responsiveness to the external
environment [1]. Short and long sleep duration have been
suggested to be risk factors for chronic diseases [2]. Pro-
spective cohort studies especially point out that extremes of
sleep duration (short and long) are associated with adverse
health outcomes, including increased risk of obesity and
non-communicable disease (i.e. diabetes and cardiovascular
diseases etc.) [3, 4]. Moreover, there is much growing evi-
dence investigating the relationship between sleep quality or
time and obesity, including extensive meta-analysis reports
in recent years [57].
Epidemiologic studies have demonstrated connections
between sleep duration and diet. Sleep deprivation can
modify nutritional habits [8], and adequate sleep is posi-
tively associated with health-related behaviour, such as the
adoption of healthy eating habits. Recent studies observed
a U-shaped association between sleep duration and eating
behaviours and dietary quality among women; women with
short or long sleep duration were more likely to eat dur-
ing unconventional hours and replace meals with snacks
than women with adequate sleep duration. Decreasing or
increasing sleep duration decays the control of homeostatic,
increasing food intake (especially, intake of foods rich in fat
and carbohydrates) [9, 10]. The underlying mechanism is
that short sleep duration is associated with decreased leptin
or increased ghrelin levels [11, 12]. However, Calvin etal.
[13] did not detect any change in the leptin and ghrelin levels
* Murat Açik
acikm@ankara.edu.tr
1 Faculty ofHealth Sciences, Department ofNutrition
andDietetics, Ankara University, Tepebaşi Neighborhood,
Fatih Street, Keçiören, Ankara, Turkey
164 Sleep and Biological Rhythms (2021) 19:163–172
1 3
of individuals with short sleep duration, and they observed
an increase in the food intake of these participants. In recent
systematic and meta-analysis reports, it was suggested that
the hedonic system, which increases in short sleep duration,
seems to play a crucial role in food intake, and increased
food intake was observed in cases where the homeostatic
control did not change [14]. This may be attributed to het-
erogeneity in the study designs, but other researchers suggest
that these results are due to increased hedonic system activ-
ity that may contribute to increased food intake independent
of hormonal change [13, 15]. On the other hand, it is known
that there is a negative relationship between prolonged sleep
time and gut hormone glucagon-like peptide 1, which pro-
vides satiety due to long sleep duration, although there are
not many studies on weight gain or food intake. Moreover,
it activates sedentary behaviours in individuals with long
sleep duration and as a result it plays a role in appetite regu-
lation, energy expenditure and body composition, due to the
decrease in leptin, the anorexigenic adipokine [16].
Hedonic eating is satisfied by the intake of highly palat-
able foods, which are typically made tasty by their higher
fat, sugar, and salt contents and hence also tend to be dense
in calories [17]. However, it is difficult to evaluate hedonic
hunger in those with eating behaviour disorders and under-
weight individuals. Individuals, are underweight and have
eating behaviour disorders such as anorexia nervosa, have
low body weight and a significant negative energy balance.
Therefore, they may have higher or lower hedonic hunger
scores [18]. It was demonstrated that the effects of substance
abuse on the limbic system are similar to the effects of the
consumption of delicious foods (especially high fat and/or
sugar) on the limbic system [18]. Neuroimaging studies sup-
port the evidence that some individuals may be obese due
to a disorder in their dopaminergic pathways [19, 20]. It
was suggested, in experimental studies, that the activation
of neurons in the limbic system of participants, responsible
for the reward, increased after short-term sleep manipula-
tion. Thus, the increase in food intake associated with sleep
duration seems to be mainly driven by hedonic and nonhor-
monal factors [21, 22]. However, this view only is limited to
short-term intervention studies. Therefore, epidemiological
studies are also needed to confirm such a relationship in the
large population.
To the best of our knowledge, there are no studies in the
literature that examine the effect of sleep duration or quality
on hedonic hunger. However, a few studies have explored
the possible influence of eating behaviour constructs, as an
independent and strong predictor of weight gain, short sleep
duration and weight status. Chaput etal. [23] have inves-
tigated the relationship between sleep duration or quality
and eating behaviour. In a 6-year longitudinal study, they
observed that short sleep with a high disinhibition eating
behaviour trait had a greater increase in body weight. In a
recent study, Blumfield etal. [24] examined if eating behav-
iour mediates the relationship between sleep and body mass
index (BMI) in a large sample of American adults. It was
found that disinhibited eating behaviour mediated the rela-
tionship between sleep quality and weight status. Results
of this research suggest that improving sleep quality may
benefit weight loss by helping to reduce an individual’s sus-
ceptibility to overeating. In both studies, the relationship
between sleep duration or quality and three-factor eating
attitude-behaviour was examined. Although eating behav-
iour is an independent and powerful marker of weight gain
in adults, it cannot provide detailed information about the
hedonic hunger status and psychological effects in various
delicious food environments. Since both sleep and hedonic
hunger are two important factors in weight management,
it is important to explain the relationship between them.
In addition, when such studies are conducted in university
students, who are considered a high-risk group in terms of
sleep behaviours and eating habits, more effective strategies
can be developed in the struggle against obesity and adop-
tion of healthy life habits in young people. To this end, we
conducted a study to see if hedonic hunger is associated with
sleep quality and to what extent hedonic hunger is related to
sleep quality, depending on factors that can affect it.
Materials andmethods
Participants
Data were obtained from a cross-sectional study that was
conducted in a convenience sample of students studying at
six universities in Ankara. In the research, an online ques-
tionnaire was used as a data collection tool. This online
questionnaire was shared on the social media accounts of
universities in Ankara province and reached the participants
during October 2020. Four weeks following the students
invitations, a convenient sample of 1250 participants was
reached, allowing the survey to be closed. Informed consent
was obtained prior to beginning the online survey. Partici-
pants who provided exclusion criteria (i.e. the presence of
any major disease, nutrition and dietetic or sports science
students and underweight individuals (BMI < 18.5kg/m2))
were excluded (n = 106) to give a total sample size of 1144
adults.
Participants were full-time students, aged 18–28years,
and enrolled at six universities. Eligibility criteria for this
study included the following: BMI 18.5kg/m2; not a
nutrition major or sports science major graduate or student;
depression, anxiety, or other psychiatric disorders; cancer;
history of obstructive sleep apnoea; free from health condi-
tions that could interfere with diet and exercise changes;
taking part in another study; and not pregnant or lactating.
165Sleep and Biological Rhythms (2021) 19:163–172
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Questionnaires
An online, self-administered questionnaire was used to
obtain data about demographic and personal characteris-
tics, physical activity level, sleep time-quality and hedonic
hunger. These five constructs were assessed using previously
validated questionnaires, and the final questionnaire required
approximately 25min to complete.
Demographic andpersonal characteristics
Participants were asked to report their gender, age, smok-
ing status, alcohol consumption, disease status, height and
weight. The BMI was calculated as weight (kg) divided by
height squared (m2).
Physical activity
The International Physical Activity Questionnaire (IPAQ)
was developed by Craig etal. [25] to determine the physi-
cal activity levels of participants aged 15–65years. This
questionnaire provides information about the time spent
sitting, walking, and in moderate to vigorous activities. In
order to evaluate all activities, it is taken as a criteria that
each activity is performed for at least 10min at a time. Data
collected with the IPAQ can be reported as a continuous
measure of total physical activity and reported in metabolic
equivalent of task (MET) minutes. In calculating the score
related to physical activity, the weekly duration (minutes)
of each activity and the metabolic equivalent (MET) energy
values created for the IPAQ are multiplied [25]. The Turk-
ish validity and reliability study of the IPAQ was done by
Öztürk [26].
Sleep assessment
Sleep quality was measured with the Pittsburgh Sleep Qual-
ity Index (PSQI), which was used as a subjective measure
of sleep quality and disturbances of the patient’s sleep. The
PSQI is a 19-item self-reported questionnaire grouped into
seven score components (subjective sleep quality, sleep
latency, sleep duration, habitual sleep efficiency, sleep dis-
turbances, use of sleeping medication and daytime dysfunc-
tion). In addition, five questions of the PSQI are answered
by the individual’s sleep partner, if applicable. However,
these questions are not included in the scoring. The PSQI
questions consist of a 4-point Likert structure and are scored
ranging from “0” to “3”. The PSQI yields a score from 0
(good quality) to 21 (poor quality). If the total score of the
PSQI is > 5, it indicates poor sleep quality. Those with a
score 5 were classified as good sleepers [27]. The ques-
tionnaire was validated previously for use in Turkey and
achieved a Cronbach’s alpha of 0.80 for 114 individuals [28].
Hedonic Hunger
Power offood scale
The Power of Food Scale (PFS) assesses the psychological
impact of living in food-abundant environments. It measures
appetite for, rather than consumption of, palatable foods at
three levels of food proximity (food available, food present,
and food tasted) [29]. The questionnaire originally started
with 21 items, but it was decreased to 15 items after the
validity and reliability analyses in a Turkish population. The
validity and reliability study of the survey carried out on 363
university students was conducted by Hayzaran etal., and
a Cronbach’s alpha of 0.85 for the Turkish population was
observed [30]. The current PFS consists of 15 items rated
on a 5-point Likert scale, with an aggregate score and three
subscales: (1) food available, but not present (e.g. ‘‘I seem
to have food on my mind a lot’’); (2) food present, but not
tasted (e.g. ‘‘If I see or smell a food I like, I get a power-
ful urge to have some’’); and (3) food tasted, but not eaten
(e.g. ‘‘When I eat delicious food, I focus a lot on how good
it tastes’’). It means that when the individual’s scale score
increases, the influence of the PFS (hedonic hunger) on the
individual increases [29].
Palatable eating motives scale
The Palatable Eating Motives Scale (PEMS) scale, devel-
oped by Burgess etal. and composed of 20 items, was
reduced to 19 items after validity and reliability analyses
were performed [31]. The PEMS scale was developed to
identify the reasons why individuals consume delicious food
and drink. The scale includes four subfactors: social, cop-
ing, reward enhancement, and conformity motives. Social
motives include questions about consuming palatable foods
or beverages for social reasons (e.g. consumption to enjoy a
party, eating behaviour shown to socialize more with friends,
etc.). Coping motive includes items related to the consump-
tion of palatable foods or beverages to deal with negative
feelings (such as anxiety, eating behaviour in a sad situa-
tion, depression, or eating behaviour related to frustration
and anger). Reward enhancement motive involves ques-
tions about consuming palatable foods or drinks to enhance
positive experiences, emotions or inherent satisfying traits
that are not related to social situations (e.g. eating behav-
iour towards foods that give pleasure or make the individual
happy when consumed). Conformity motive involves ques-
tions about the consumption of palatable foods in response
to external pressures (e.g. conformity to social environments
with friends and eating behaviour shown to avoid being
excluded) [31]. Responses can range from 1 (Never/Almost
Never) to 5 (Almost Always/Always) and are scored as the
mean response for each motive. The validity and reliability
166 Sleep and Biological Rhythms (2021) 19:163–172
1 3
study of the survey carried out on 363 university students
was conducted by Hayzaran etal. [30]. The reliability coef-
ficient of the PEMS (Cronbach’s alpha) has been calculated
as 0.88, with the four subscales of the PEMS approved in
confirmatory factor analysis changes between 0.75 and 0.89
[30].
Statistical analysis
We calculated the mean ± standard deviation values for
continuous variables and the frequency (percentage) val-
ues for nominal variables. We used independent t tests to
compare continuous variables and Pearson’s Chi squared
test to compare categorical data between groups by gender.
After the necessary criteria were provided, linear regression
analyses were performed to calculate the β-coefficient of
the association between BMI and hedonic hunger status by
gender. We also calculated crude values of the linear regres-
sion relationship between hedonic hunger and sleep quality.
After the confounding factors “age, BMI and smoking” were
included in the model, multiple linear regression was used to
determine the association between hedonic hunger and sleep
quality. As emphasized in the introduction, long and short
sleep duration share similar physiological characteristics.
Therefore, short and longed sleep duration groups (< 7h/d
or > 9h/d, respectively) were combined and logistic regres-
sion analysis was used to determine the effect on hedonic
hunger compared to ideal sleep duration (7–9h/d). The other
main reason for combining groups is that the number of indi-
viduals with long sleep duration (n = 52) is quite low. Then,
we created multiple logistic regression analyses to assess the
relationship between the PFS and PEMS scores and good/
short or long sleep duration and to determine whether the
odds of good/short or long sleep duration were associated
with hedonic hunger by gender. Moreover, model 1 was
adjusted for age and BMI. Model 2 additionally adjusted
for physical activity and smoking. A p < 0.05 was considered
statistically significant. All statistical analyses were calcu-
lated using the Statistical Package for the Social Sciences
(SPSS) version 21 for Windows (SPSS Inc., Chicago, IL).
Results
Descriptive statistics are presented in Table1. In all,
25.3% of the 1144 participants in the study were male and
74.7% were female. The mean age of the participants was
22.0 ± 2.7years, and the mean BMI was 24.6 ± 3.6kg/m2
(male: 25.6 ± 3.4 kg/m2, female: 24.2 ± 3.6 kg/m2). The
majority (57.5%) of the participants were normal, 34.7%
were overweight and 7.8% were obese. Females were more
likely to be younger (p = 0.003) and have a lower BMI
(p < 0.001), smoking (p < 0.001), alcohol consumption
and physical activity score (p < 0.001) compared to males
(Table1). While the average sleep quality scores of the
participants were 6.1 ± 2.6, the sleep quality was worse
in females (6.3 ± 2.6) compared to males (5.8 ± 2.7)
(p < 0.001). However, there was no significant difference
between females and males in sleep duration (6.9 ± 1.4h
for females and 6.9 ± 1.4h for males; p = 0.748) and time
in bed (p = 0.253).
Table1 also lists the mean scores for females and males
on the PFS and the PEMS subscales. The scores of PFS
and its subscales were found to be higher in women than
men (p < 0.001). The coping motive (PEMS subscale) scores
were significantly higher in females, while the conformity
motive (PEMS subscale) scores were significantly higher in
males (p < 0.05).
We showed the association of the PEMS and PFS aggre-
gated and their subscales scores with BMI in the female
and male groups using linear regression (Table2). For the
total group, high PFS aggregated score [β (95%CI) = 0.07
(0.06–0.09), p < 0.001], “food available” [β (95%CI) = 0.18
(0.15–0.22), p < 0.001), “food present” [β (95%CI) = 0.22
(0.17–0.27), p < 0.001] and “food tasted” [β (95%CI) = 0.14
(0.10–018), p < 0.001] scores were independently associated
with high BMI, and explained 9.4% of food available, 7.2%
of food present and 4.1% of food tasted. This association
remained significant in both groups when classified accord-
ing to gender. In the total group, PEMS scores were posi-
tively associated with BMI [β (95%CI) = 0.05 (0.04–0.07),
p < 0.001] and explained 4.6% of its. Moreover, there was
a significant relationship between poorer sleep quality and
higher “coping motive and reward motive” (PEMS sub-
scales), but not “social motive” or “conformity motive”.
While positive linear trends for only “social motive” scores
with BMI did not remain statistically significant in the
female group and for both “social motive” and “conformity
motive” in the male group.
After modelling was performed with age, BMI, smok-
ing and physical activity, which were thought to affect
the PFS and PEMS subscales, multiple linear regres-
sion analysis was conducted to determine the effect of
hedonic hunger on sleep quality (Table3). The PFS total
scores were positively associated with the PSQI scores
after being fully adjusted [β (95%CI) = 0.04 (0.03–0.05),
p < 0.05] and coefficient of determination was found to
be 20.0%. Moreover, “food present” and “food tasted”
scores were positively associated with the PSQI score after
adjusting for age, BMI, smoking and physical activity [β
(95% CI) = 0.15 (0.10–0.17), p < 0.05 for food present;
β (95% CI) = 0.14 (0.10–0.16), p < 0.05 for food tasted].
The PEMS scores were positively associated with the
PSQI scores after controlling for all possible confound-
ing factors [β (95%CI) = 0.06 (0.05–0.07), p < 0.05] and
explained 25.6% of PEMS scores. “Coping”, “reward”
167Sleep and Biological Rhythms (2021) 19:163–172
1 3
and “conformity” motives were positively associated with
the PSQI scores in the crude and fully adjusted models.
Variables with significant correlation between the PFS
or PEMS subscales and the PSQI in total participants
remained significant in both groups according to gender.
In males, higher current PFS scores were associated with
Table 1 General characteristics,
sleep attitudes and hedonic
hunger states of the university
students by gender
BMI Body Mass Index; MET: Metabolic Equivalent of Task; PEMS Palatable Eating Motives Scale; PFS
Power of Food Scale; PSQI Pittsburgh Sleep Quality Index
Numeric variables are presented as mean ± standard deviation (except for physical activity). Nominal vari-
ables are shown as percentage (frequency); p values were derived by independent t test and Pearson’s Chi
squared, respectively
a Data are presented as median (25 and 75th quartile) values; p values were derived by Mann Whitney U
test
b Defined by the Pittsburgh Sleep Quality Index (PSQI). A global PSQI score > 5 indicates poor sleep qual-
ity
*p < 0.01; **p < 0.001
Characteristics Total (n = 1144) Females (n = 778) Males (n = 366) p value
Age 22.0 ± 2.7 21.8 ± 2.5 22.4 ± 3.1 0.003*
Smoking status, n (%)
Never 833 (72.8) 626 (80.5) 207 (56.6)
Former 97 (8.5) 55 (7.1) 42 (11.4) < 0.001**
Current 214 (18.7) 97 (12.4) 117 (32.0)
Alcohol consumption, % (n)
Non-drinker 1020 (89.2) 723 (92.9) 297 (81.1) < 0.001**
Yes 124 (10.8) 55 (7.1) 69 (18.9)
BMI (kg/m2)24.6 ± 3.6 24.2 ± 3.6 25.6 ± 3.4 < 0.001**
Normal 658 (57.5) 498 (64.0) 160 (43.7)
Overweight 397 (34.7) 223 (28.7) 174 (47.5) < 0.001**
Obese 89 (7.8) 57 (7.3) 32 (8.8)
Physical activity (MET-
mins)a (Median (25-75th)
742 (396–1386) 693 (330–1314) 1072 (532–2133) < 0.001**
Disease status, %(n)
No 981 (86.0) 641 (82.7) 340 (92.9)
Respiratory diseases 35 (3.1) 30 (3.9) 5 (1.4)
Endocrine diseases 27 (2.4) 25 (3.2) 2 (0.5)
Digestive diseases 24 (2.1) 21 (2.7) 3 (0.8)
Sleeping behaviour
Sleep qualityb6.1 ± 2.6 6.3 ± 2.6 5.8 ± 2.7 0.005*
Sleep quality ≤ 5 496 (43.4) 317 (40.7) 179 (48.9) 6.751
Sleep quality > 5 648 (56.6) 461 (59.3) 187 (51.1) 0.009*
Time in bed (clock time, h) 7.5 ± 1.5 7.5 ± 1.4 7.6 ± 1.6 0.253
Total sleep duration (h) 6.9 ± 1.4 6.9 ± 1.4 6.9 ± 1.4 0.748
Total sleep duration < 7h 474 (41.4) 313 (40.2) 161 (44.0) 1.448
Total sleep duration ≥ 7h 670 (58.6) 465 (59.8) 205 (56.0) 0.229
Hedonic hunger
Total PFS 47.9 ± 13.6 49.6 ± 13.3 44.5 ± 13.6 < 0.001**
Food available 17.5 ± 5.9 18.2 ± 5.9 16.1 ± 5.6 < 0.001**
Food present 14.0 ± 4.3 14.4 ± 4.2 12.9 ± 4.3 < 0.001**
Food tasted 17.0 ± 5.1 17.0 ± 4.9 15.4 ± 5.3 < 0.001**
Total PEMS 50.0 ± 13.7 50.3 ± 13.3 49.5 ± 14.4 0.362
Social motive 12.4 ± 4.3 12.4 ± 4.2 12.5 ± 4.3 0.954
Coping motive 13.3 ± 4.6 13.7 ± 4.6 12.5 ± 4.3 0.001*
Reward motive 14.0 ± 4.8 14.0 ± 4.8 13.8 ± 4.9 0.503
Conformity motive 9.6 ± 3.0 9.3 ± 2.8 10.0 ± 3.4 0.002*
168 Sleep and Biological Rhythms (2021) 19:163–172
1 3
worse sleep quality compared to females after adjustment
for confounders [β (95%CI) = 0.06, (0.04–0.08), p < 0.05
for males; β (95% CI) = 0.04, (0.02–0.05), p < 0.05 for
females], and coefficient of determinations were found
to be 22.2% and 20.8%, respectively. When classified by
gender, the PEMS and PSQI scores remained significant
after being fully adjusted in both groups. In both females
and males, there was a significant relationship between
poorer sleep quality and higher “food present and food
tasted” (PFS subscales), “coping motive, reward motive
Table 2 Linear regression analysis of the relationship between scores of PFS or PEMS subscales and BMI by gender
BMI Body Mass Index; PEMS Palatable Eating Motives Scale; PFS Power of Food Scale; SE Standard Error
Beta coefficient, standard error, 95% confidence interval, R squared and p value calculated from linear regression analysis
*p < 0.01; **p < 0.001
Total Female Male
βSE 95% CI R2βSE 95% CI R2βSE 95% CI R2
PFS
Food available 0.18 0.01 0.15–0.22 0.094** 0.20 0.02 0.16–0.24 0.113** 0.22 0.03 0.16–0.28 0.136**
Food present 0.22 0.02 0.17–0.27 0.072** 0.24 0.02 0.19–0.30 0.085** 0.27 0.03 0.19–0.34 0.118**
Food tasted 0.14 0.02 0.10–0.18 0.041** 0.15 0.02 0.10–0.20 0.045** 0.17 0.03 0.11–0.24 0.078**
PFS total 0.07 0.01 0.06–0.09 0.084** 0.08 0.01 0.06–0.10 0.098** 0.09 0.01 0.06–0.11 0.136**
PEMS
Social motive 0.03 0.02 −0.01–0.08 0.002 0.04 0.03 −0.01–0.10 0.003 0.03 0.04 -0.05–0.11 0.001
Coping motive 0.21 0.02 0.16–0.25 0.075** 0.25 0.02 0.20–0.30 0.107** 0.18 0.03 0.11–0.26 0.063**
Reward motive 0.16 0.02 0.12–0.20 0.047** 0.15 0.02 0.10–0.20 0.041** 0.19 0.03 0.12–0.26 0.074**
Conformity motive 0.11 0.05 0.01–0.21 0.009 0.13 0.04 0.04–0.22 0.011*0.07 0.05 -0.02–0.17 0.006
PEMS total 0.05 0.01 0.04–0.07 0.046** 0.06 0.01 0.04–0.08 0.053** 0.05 0.01 0.02–0.07 0.044**
Table 3 Multiple linear regression analysis of associations between scores of PFS or PEMS subscales and PSQI by gender
PEMS Palatable Eating Motives Scale; PFS Power of Food Scale; PSQI Pittsburgh Sleep Quality Index; SE Standart Error
Beta coefficient, standart error, 95% confidence interval, R squared and p value calculated from a multiple linear regression analysis
a All models adjusted for age, BMI, physical activity and smoking
*p < 0.05
Total Female Male
β SE 95% CI R2 β SE 95% CI R2 β SE 95% CI R2
PFS
Food available Crude 0.04 0.01 0.01–0.08 0.007 0.02 0.02 −0.13–0.05 0.002 0.03 0.01 0.01–0.13 0.021
Adjusteda0.06 0.01 0.03–0.14 0.010 0.04 0.01 0.01–0.10 0.005 0.05 0.02 0.02–0.17 0.035
Food present Crude 0.19 0.01 0.16–0.23 0.101*0.17 0.02 0.12–0.21 0.075*0.23 0.03 0.17–0.30 0.143*
Adjusted 0.15 0.01 0.10–0.17 0.196*0.10 0.02 0.06–0.14 0.203*0.18 0.03 0.12–0.24 0.220*
PFS total Crude 0.06 0.01 0.05–0.07 0.112*0.05 0.01 0.04–0.07 0.085*0.08 0.01 0.06–0.10 0.156*
Adjusted 0.04 0.01 0.03–0.05 0.200*0.04 0.01 0.02–0.05 0.208*0.06 0.01 0.04–0.08 0.222*
PEMS
Social motive Crude 0.06 0.02 −0.01–0.10 0.006 0.03 0.02 −0.01–0.08 0.003 0.07 0.02 0.01–0.16 0.012
Adjusted 0.05 0.01 0.01–0.08 0.012 0.03 0.02 −0.01–0.07 0.010 0.08 0.03 0.02–0.14 0.015
Coping motive Crude 0.25 0.01 0.22–0.28 0.194*0.24 0.01 0.21–0.28 0.194*0.25 0.03 0.20–0.31 0.182*
Adjusted 0.21 0.02 0.18–0.24 0.269*0.19 0.02 0.16–0.22 0.281*0.22 0.03 0.16–0.27 0.270*
Reward motive Crude 0.19 0.01 0.16–0.22 0.125*0.17 0.01 0.14–0.21 0.107*0.22 0.02 0.17–0.28 0.163*
Adjusted 0.16 0.02 0.13–0.18 0.221*0.14 0.02 0.10–0.17 0.247*0.19 0.03 0.13–0.24 0.246*
Conformity motive Crude 0.25 0.02 0.21–0.30 0.087*0.26 0.03 0.20–0.33 0.082*0.27 0.03 0.19–0.34 0.115*
Adjusted 0.22 0.03 0.18–0.27 0.210*0.22 0.03 0.16–0.28 0.234*0.26 0.04 0.18–0.33 0.248*
PEMS total Crude 0.08 0.01 0.06–0.08 0.166*0.07 0.01 0.06–0.09 0.151*0.08 0.01 0.06–0.10 0.194*
Adjusted 0.06 0.01 0.05–0.07 0.256*0.06 0.01 0.05–0.07 0.266*0.07 0.01 0.06–0.09 0.286*
169Sleep and Biological Rhythms (2021) 19:163–172
1 3
and conformity motive” (PEMS subscales), but not “food
available” and “social motive”.
Table4 shows the subgroup analysis of multiple logistic
regression between the hedonic hunger score and sleep dura-
tion according to gender. After adjusting for potential con-
founding factors (age and BMI) in model 2, the odds of hav-
ing a high PEMS score increased in individuals with short
or long sleep duration, but not the PFS score. According to
model 2, participants who slept for less than 7h or more
than 9h had 40% higher odds for increased PEMS scores
compared to those who slept for 7–9h (reference group).
Moreover, poor sleep duration was associated with a 1.79
higher odds ratio for a high PEMS score in the male group.
In the female group, inadequate sleep duration was posi-
tively associated with the PEMS score in the crude model
or model 1 (adjusting for age and BMI), but the association
was not significant in the fully adjusted models (model 2).
While there was no relationship between the PFS and sleep
duration in the female group, this association was found only
in the crude model of the male group (odds ratio (OR) (95%
CI) = 1.72 (1.09–2.72), p = 0.020).
Discussion
With a large sample of young people, this is the first
research to examine the relationship between sleep quality
and duration and hedonic hunger by potential confound-
ing. General results have shown that poor sleep quality
or inadequate sleep duration may be associated with high
hedonic hunger and most of its subdimensions.
As is known, the PFS and PEMS have been developed
to detect the factors affecting the hedonic hunger impulse.
In particular, the PFS is used to assess the psychologi-
cal effects of various delicious foods, while the PEMS
was developed to determine the reasons for consuming
delicious foods and drinks. In this study, hedonic hunger
scores were found statistically significant between women
and men, especially in the PFS and its subcomponent
scores. Since eating disorders are more common in women,
most of the studies on hedonic hunger have been in women
and sometimes in both genders. In the majority of stud-
ies, it was determined that women are more sensitive to
Table 4 Logistic regression
models for the association
between sleep duration and
PEMS and PFS score according
to gender
PEMS Palatable Eating Motives Scale; PFS Power of Food Scale
All OR’s and 95% CI’s with p value were given for those with short or long sleep duration compared to
other with good sleep
Model 1: adjusted for age and BMI. Model 2: additionally adjusted for smoking and physical activity
Short or long sleep duration was defined by less than 7h or over 9h
Good sleep duration for female and male group (n) = 422 and 186, respectively. Short or long sleep dura-
tion for female and male group (n) = 356 and 180, respectively
*p < 0.05; **p < 0.01; ***p < 0.001
Total pFemale pMale p
PFS
Crude
7–9h 1 [Reference] 1 [Reference] 1 [Reference]
< 7h or > 9h 1.18 (0.90–1.56) 0.249 1.16 (0.88–1.56) 0.196 1.72 (1.09–2.72) 0.020*
Model 1
7–9h 1 [Reference] 1 [Reference] 1 [Reference]
< 7h or > 9h 1.01 (0.75–1.35) 0.931 1.07 (0.81–1.39) 0.239 1.45 (0.90–2.36) 0.126
Model 2
7–9h 1 [Reference] 1 [Reference] 1 [Reference]
< 7h or > 9h 0.98 (0.70–1.21) 0.878 0.94 (0.75–1.15) 0.538 1.13 (0.68–1.91) 0.630
PEMS
Crude
7–9h 1 [Reference] 1 [Reference] 1 [Reference]
< 7h or > 9h 1.61 (1.27–2.03) < 0.001*** 1.39 (1.05–1.84) 0.023*2.21 (1.46–3.36) < 0.001***
Model 1
7–9h 1 [Reference] 1 [Reference] 1 [Reference]
< 7h or > 9h 1.47 (1.16–1.87) 0.001** 1.26 (1.02–1.68) 0.045*2.03 (1.33–3.12) 0.003**
Model 2
7–9h 1 [Reference] 1 [Reference] 1 [Reference]
< 7h or > 9h 1.40 (1.09–1.83) 0.012*1.20 (0.92–1.70) 0.148 1.79 (1.13–2.84) 0.006**
170 Sleep and Biological Rhythms (2021) 19:163–172
1 3
reward-related food intake than men [32, 33], but it was
reported in the other study that there was no such differ-
ence by gender [34]. In a review of molecular mechanisms
of hedonic hunger, it has been shown that oestrogen plays
a strong role in food motivation and reward processes and
affects the prefrontal cortex, which is an area known as
one of the hedonic reward areas [35]. In a recently pub-
lished study on Iranian adults, it was shown that the score
obtained from the PFS and all its subgroups is higher in
women compared to men [36]. The relationship between
hedonic starvation and BMI still remains controversial.
In some studies, obese individuals were more sensitive
to consuming food for pleasure [37, 38]. However, in the
studies in which the effect of hedonic fasting status on
BMI was examined in the general population, no relation-
ship could be established between the PFS score and BMI.
When the population of referenced studies is examined,
there are different countries (Canada and Japan) and target
groups (adult women and university students) [39, 40]. In
the study conducted by Lipsky etal. [41], food available
and food present scores were higher in overweight and
obese young individuals. In the study conducted on the
Turkish population, a significant relationship was found
between the scores of all subgroups of the PEMS and BMI
[42]. A positive correlation was shown between the PFS
score and BMI in both groups, but this relationship was
weaker in men in another study [36]. In our study, similar
findings were found in both groups. However, the effect of
potential factors that could affect the relationship between
BMI and hedonic hunger by gender was not included, so
this situation in the study may cause bias. In future studies,
there is a need to investigate the question of whether there
is a gender difference between hedonic hunger and BMI
and the underlying factors.
Considering the linear regression relationship between
hedonic hunger status and sleep quality in our study, a strong
relationship was found with other components other than
food available and social motive. The results of studies
investigating the relationship between sleep quality and eat-
ing behaviour strengthen our findings [23, 24]. For example,
a cross-sectional study examining the effect of eating behav-
iour on sleep quality revealed a linear relationship between
increased disinhibited eating behaviour and poor sleep qual-
ity in both men and women [24]. The relationship between
eating competence and quality of sleep, which examines the
positive psychosocial status of eating attitudes and behav-
iours, was investigated in university students, constituting
the high-risk group for bad eating habits. Finally, it was
determined that those who had a high eating competence
score had better overall sleep quality and fewer sleep-related
problems compared to the low-risk group [43]. Actually,
the scales, used in studies showing the relationship between
sleep quality and eating attitudes and behaviours, examine
the level of hunger and nutrition in response to social, envi-
ronmental, emotional and nutritional stimuli [24, 43, 44].
However, the appetizing aspects of the eating behaviour or
the underlying causes were not mentioned in these speci-
fied scales. Experimental research found that neuronal activ-
ity is associated with hedonic eating and activation of the
right anterior cingulate cortex, which is one of the hedonic
rewarding areas, increase in short sleepers via neuroimaging
[21, 22]. It is known that endocannabinoids, dopamine, and
opioids are associated with hedonic rewarding by affecting
the receptor system in the brain [45]. It is emphasized that
the levels of these receptor systems or neurotransmitters
increase due to insomnia, and thus increases motivation of
the stimulant and willingness, which examines the stimulat-
ing importance of foods and aspects associated with their
taste [46].
The PEMS score was found to be higher in individuals
who slept a short or long time compared to the ideal sleep
time, despite not as much as sleep quality. Especially after
full modelling, this relationship remained in men. In the
expanding reports, one of the most important views explain-
ing increased food intake (especially unhealthy snack foods)
due to impaired sleep time is hedonic rather than appetite-
related hormonal factors [47]. Interestingly, the participants
gained more than 1kg in weight when the sleep restraint
programme was applied for five nights in an experimental
study on healthy adults. In addition, participants took an
average of 550cal between 22:00 and 03:59, and the major-
ity of this energy was made up of carbohydrate and fat-rich
foods, increasing hedonic appetite [48]. In contrast to short
sleep time, studies examining the relationship between pro-
longed sleep time and eating behaviour and hedonic hunger
are limited. In the study conducted by Almoosawi etal. [47],
it was founded that individuals who slept for a long time
were associated with a lower healthy dietary pattern score.
In a recent meta-analysis review, it was emphasized that long
sleep duration was associated with risk of obesity in adults
[47]. There are several potential mechanisms linking diet
to prolonged sleep and metabolic impairment. Long sleep
time can initiate systemic inflammation, which reduces the
level of adipokines that provide satiety in adipocytes and
hunger hormones in the brain [16]. In addition, low lev-
els of satiety hormones are observed in individuals due to
decreased systemic insulin sensitivity and glucose utiliza-
tion [49]. As a result, long sleep duration can trigger the
development of obesity and hedonic hunger mechanisms.
In our research, it has been shown that hedonic dependence
is one of the most potential mechanisms that can underlie
this situation. However, this should be supported by clinical
and epidemiological studies. We thought that the reason for
a statistically stronger result in men compared with women
may be due to hormonal differences, which is the possible
underlying reason for a lower relation between sleep quality
171Sleep and Biological Rhythms (2021) 19:163–172
1 3
and hedonic appetite in women; the duration of sleep can
be affected by hormonal conditions or the menstrual cycle.
Due to this interaction, women may show a weaker relation-
ship between sleep duration and hedonic appetite. Especially
in this context, future research should examine the effect
of sleep duration and quality on human eating behaviour
or the hedonic hunger response and include topics such as
how hedonic appetite and sleep quality together mediate
the increase in BMI by controlling factors affecting hedonic
appetite, such as gender, age, physical activity, hormonal
status and menstrual cycle. In therapeutic interventions for
weight management, it will be beneficial to focus on sleep
quality and duration in reducing hedonic hunger.
Although this research determined the psychological
effects and causes of hedonic appetite and evaluated the
relationship between hedonic hunger status and sleep qual-
ity and duration, there are some limitations in this research.
The self-reported data were used to determine the sleep and
hedonic hunger conditions of the participants. Moreover,
the results obtained may not be generalized for all univer-
sity students, as students self-determined to participate in
the study, like online survey research. In the study, it was
not questioned whether the students worked at night or not,
and this may affect the results. While individuals who sleep
7–9h were considered as the reference group or good sleep
group, those with impaired sleep times were not categorized
as short (< 7h) or long sleep (> 9h) durations. Regression
analysis was very difficult to perform, as the number of
samples per group was low if categorized as short and long
sleep durations. While increased appetite, nutrient intake,
eating attitude, or hedonic status are often associated with
short sleep duration, this data is limited to individuals with
long sleep times [50, 51]. It is important to investigate the
effectiveness of nutrition in long-term sleepers, as in hedonic
hunger. Lastly, causality cannot be deduced from the find-
ings of the study due to the cross-sectional study design.
Thus, the findings show that there is a need for more longi-
tudinal and experimental research.
Conclusions
In conclusion, findings from this study found that individuals
who have lower hedonic hunger may have better overall sleep
quality compared with individuals who have higher hedonic
hunger. However, an inverse relationship was found between
a good sleep duration and hedonic hunger scores (especially
the PEMS score). The findings suggest that improving sleep
quality and duration can help reduce hedonic hunger, which
increases the tendency to unhealthy and delicious foods and
plays a role in weight gain. In addition, it is important to
reach the level of evidence by conducting both longitudinal
and experimental intervention studies for health promotion
and weight management in young people.
Acknowledgments This study was not supported by any institution or
organization. We would like to express our gratitude to Ankara Uni-
versity students for their help in data collection. I also make a present
of this article to my Hayal baby. So glad I have you, Hayal!
Author contributions MA and ANBS contributed in conception,
search, statistical analyses and manuscript drafting. MA, ANBS and
FPÇ contributed in data interpretation and design. All authors approved
the final version.
Compliance with ethical standards
Conflict of interest Authors declare that there is no conflict of interest.
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... True homeostatic hunger can only occur a few times a day as its primarily concerned with energy balance regulation of peripheral hormones (leptin and ghrelin) [12]. There may be a correlation between HH and body mass index (BMI) [13]. Studies have found that obese people may have higher HH. ...
... A recent study was conducted on sleep quality and HH among university students in Turkey using the tools Pittsburgh Sleep Quality Index (PSQI), Palatable Eating Motive Scale (PEMS), and Power of Food Scale (PFS). It was reported that poor sleep quality and duration may in uence high HH, which rises the tendency to overeat unhealthy food and plays a role in weight gain [13]. Recent study conducted on food consumption frequency and perceived stress scale (PSS) among female university students in UAE; has moderate stress and high consumption of fast foods and soft drinks [17]. ...
... Total PSQI global score (0-21) and seven sleep components scores (0-3) were used to express sleeping behavior as continuous variables. Additionally, HH scales were analyzed as continuous variables; subscales scores (1-5) and total PEMS score (4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20). The PSS was analyzed as a continuous variable (0-40) and as a categorical variable; low stress (0-13), moderate stress (14-26), and high perceived stress (27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40) to classify the stress level of the students. ...
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Objective The study aims to examine the relationship between sleep quality and stress levels in relation to hedonic hunger (HH) among university students in the United Arab Emirates (UAE) and the Kingdom of Bahrain (BH). Design: A cross-sectional study design was applied using a self-administered standardized and validated online questionnaire. Setting/Participants: A total of 565 students from both countries were recruited. Measurements: Palatable Eating Motives Scale (PEMS) and Power of Food Scale (PFS) were used to detect HH states, Pittsburgh Sleep Quality Index (PSQI) scale to assess sleep quality and sleep components, Perceived Stress Scale (PSS) to assess the stress levels, and International Physical Activity Questionnaire (IPAQ) to estimate physical activity levels among university students. Descriptive and analytical (simple, multiple linear, and logistic regressions) statistics were conducted to assess the relationships between sleep quality and perceived stress with hedonic hunger. Results A positive association was found between total PEMS and PFS scores with total PSQI score [β (95%Cl) = 0.14 (0.06 – 0.25), p=0.001; β (95%Cl) = 0.21 (0.45 – 1.04), p<0.001, respectively]. An increased likelihood of having poor sleep quality by 8% (OR= 1.08, p=0.02) and 43% (OR=1.43, p<0.001) for each one-unit increase of PEMS and PFS scores, respectively. A positive association was found between total PEMS and PFS scores with PSS score [β (95%Cl) =0.19 (0.26 – 0.63), p<0.001; β (95%Cl) =0.23 (1.04 – 2.22), p<0.001, respectively]. Conclusion Reduction in HH and low-stress levels may help in improving sleep quality among university students.
... Sleep can be used as a way to cope with hunger (e.g., regulating appetite hormones); however, going to bed hungry may interfere with the quality of sleep. Restricted caloric intake and hunger are associated with poor sleep quality in a sample of university students (Açik, Bozdağ, and Çakiroğlu 2021). Skipping meals is also associated with poor sleep quality and sleep disorders (Katagiri et al. 2014;Pot 2018). ...
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Limited observational studies have described the relationship between sleep duration and overall diet. The present study investigated the association between sleep duration on weekdays or social jetlag and empirically derived dietary patterns in a nationally representative sample of UK adults, aged 19–64 years old, participating in the 2008–2012 UK National Diet and Nutrition Survey Rolling Programme. Survey members completed between three to four days of dietary records. Sleep duration on weekdays was categorized into tertiles to reflect short, normal, and long sleep duration. Social jetlag was calculated as the difference between sleep duration on weekends and weekdays. The association between sleep duration/social jetlag and dietary patterns, derived by principal components analysis, was assessed by regressing diet on sleep, whilst accounting for the complex survey design and adjusting for relevant confounders. Survey members in the highest tertile of sleep duration had on average a 0.45 (95% Confidence Interval (CI) −0.78, −0.12) lower healthy dietary pattern score, compared to middle tertile (p = 0.007). There was an inverted u-shaped association between social jetlag and the healthy dietary pattern, such that when sleep on weekends exceeded weekday sleep by 1 h 45 min, scores for indicating a healthy dietary pattern declined (p = 0.005). In conclusion, long sleep duration on weekdays and an increased social jetlag are associated with a lower healthy dietary pattern score. Further research is required to address factors influencing dietary patterns in long sleepers.
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Introduction: The term 'hedonic hunger' refers to one's preoccupation with and desire to consume foods for the purposes of pleasure and in the absence of physical hunger. The Power of Food Scale (PFS) was developed as a quantitative measure of this construct in 2009. Since then, over 50 published studies have used the PFS to predict appetite-related outcomes including neural, cognitive, behavioural, anthropometric and clinical measures. Objective: This narrative review evaluates how closely the PFS captures the construct it was originally presumed to assess and to more clearly define hedonic hunger itself. Methods: The measure's relationship to four domains is reviewed and summarized: motivation to consume palatable foods; level of actual consumption of such foods; body mass; and subjective loss-of-control over one's eating behaviour. Findings are synthesized to generate a more accurate understanding of what the PFS measures and how it may relate to the broader definition of hedonic hunger. Results: Results suggest that the PFS is closely related to motivation to consume palatable foods and, in extreme cases, occurrence of loss-of-control eating episodes. PFS scores are not consistently predictive of amount of food consumed or body mass. Conclusions: Implications of these findings are discussed in the context of behavioural health, and avenues for further inquiry are identified.
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For the last two decades research has revealed an alarming association between short sleep duration and metabolic disorders. In tandem, the hormonal, behavioral, and genetic mechanisms underlying this relationship have been extensively investigated and reviewed. However, emerging evidence is revealing that excessive sleep duration has remarkably similar deleterious effects. Unfortunately, to date there has been little attention to what drives this connection. This narrative review therefore aims to summarize existing epidemiological findings, experimental work, and most importantly putative molecular and behavioral mechanisms connecting excessive sleep duration with both obesity and type 2 diabetes mellitus. It will also address recent findings suggesting a worrisome bidirectional effect such that metabolic disorders create a positive feedback loop which further perpetuates excessive sleep.
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In an obesity pandemic context, eating disorders (ED) have arisen as serious illnesses associated with severe disturbances and has a clear gender dependent bias. In this manuscript, we provide an overview of the oestrogen role in the homeostatic and hedonic control of food intake. We draw attention to the role of oestrogens in the various reward processes and their possible implication in the development of ED, a condition much more common in women. In here, we have summarized the most relevant studies conducted in animal models over the last few years. In particular, we want to emphasize on the importance of continuing thorough investigations in female animal models. We believe that understanding the molecular mechanisms that regulate gender differences in food intake may provide new potential targets for ED treatment.
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Background: Inadequate sleep independently influences eating habits and weight status. However, the relationship between these three factors has not been well quantified. The objective of this study was to examine if eating behavior (i.e. dietary restraint, disinhibition and hunger) mediates the relationship between sleep and body mass index (BMI) in a large sample of American adults. Method: Cross-sectional data from the Nathan Kline Institute Rockland sample were assessed (n = 602; 38.9 ± 14.5 years). Self-reported sleep and eating behavior were measured using the Pittsburgh Sleep Quality Index and Three Factor Eating Questionnaire, respectively. Path analysis was used to examine relationships amongst the construct, with mediation tested via bootstrapped confidence intervals. Results: Poorer sleep quality was associated with both greater hunger (P = 0.03) and higher disinhibited eating (overeating in the presence of palatable foods or other disinhibiting stimuli like emotional stress; P < 0.001) behaviors. Higher disinhibited eating behavior was also associated with higher BMI (P < 0.001). There was a significant indirect relationship between sleep quality and BMI via disinhibition (b [95% CI] = 0.13 [0.06, 0.21], P = 0.001). No significant effects were found when total sleep time or time in bed were replaced as predictors in the mediation model. Conclusion: Disinhibited eating behavior mediated the relationship between sleep quality and weight status in both males and females. This mediation was due to aspects of sleep quality other than duration. These results suggest that improving sleep quality may benefit weight loss by helping to reduce an individuals' susceptibility to overeating.