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

📖 Top 50% JournalSep 18, 2025Sleep science (Sao Paulo, Brazil)

How Sleep Quality and Excess Weight Are Linked Differently in Men and Women, Considering Lifestyle and Health Factors

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Abstract

Poor sleep quality and short sleep duration are associated with a 21% increase in odds of excess weight among female subjects.

In female participants, poor sleep quality and short sleep duration are linked to higher body mass index (BMI).
Chronic conditions, depression, and diet quality were identified as mediating factors for the impact of poor sleep quality on BMI in females.
Screen time before bed was a significant mediator for the relationship between short sleep duration and BMI, accounting for approximately 5% of the total effect.
No significant associations were observed between sleep quality, sleep duration, and BMI in male subjects.
The findings suggest important sex differences in the relationship between sleep and weight, indicating a need for targeted approaches.

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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/m. 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. 2

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.

Key numbers

21%

Increase in Odds of Excess Weight

Odds of excess weight ( > 24.9 kg/m) among female participants with .

20%

Mediation Effect of Chronic Conditions

Percentage of the total effect mediated by chronic conditions in female participants.

16%

Mediation Effect of Depression

Percentage of the total effect mediated by depression in female participants.

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