Background: Physical inactivity and obesity are associated with short sleep duration and poor quality of sleep.

The aim was to explore the impact on sleep habits of a diet-induced weight loss followed by three weight maintenance strategies: Exercise training, GLP-1 receptor agonist (liraglutide), and the combination of both treatments.

Methods: Exploratory analyses from the randomized weight maintenance trial S-LITE (NCT 04122716). Participants with obesity (BMI 32-43 kg/m2) were included to 8 weeks on a very low-calorie diet (VLCD) of 800 kcal/day followed by 1-year of treatment with 1) exercise 150 min/week + placebo (EX), 2) liraglutide 3 mg/day (LIRA), 3) liraglutide 3 mg/day + exercise 150 min/week (LIRA + EX), or 4) placebo (PLA). Sleep duration and sleep efficiency (sleep time/time in bed * 100) were measured by 7-day wrist-worn accelerometry (GENEactiv) at inclusion, after weight loss at randomization, and after the intervention. Self-reported sleep quality was assessed by the validated Pittsburgh Sleep Questionnaire Index (PSQI) with higher scores denoting worse sleep.

Results: The VLCD resulted in a mean weight loss of 13.1 kg in 195 participants (64% women, mean (SD) age 42 (12) yrs) and improved sleep: Longer sleep duration (14.5 min/night, 95% CI: 6.9 to 22.2), higher sleep efficiency (2.1%, 1.2 to 3.0), and improved self-rated sleep quality (-0.76, -1.16 to -0.37). After one year, improvements in sleep quality were sustained only in the exercise groups despite all three intervention groups having maintained or further reduced body weight. Higher sleep efficiency was sustained in all four groups.

Conclusion: A large, rapid diet-induced weight loss exerts improvements in sleep duration and self-reported sleep quality; however, only weight maintenance including exercise sustains self-reported sleep quality for one year.


C. Janus: Research Support; Spouse/Partner; Mercodia, Novo Nordisk A/S. Research Support; Self; Novo Nordisk Foundation. Research Support; Spouse/Partner; Novo Nordisk Foundation. Speaker’s Bureau; Spouse/Partner; Merck Sharp & Dohme Corp. S. Jensen: None. J.R. Lundgren: None. C. Juhl: None. L.M. Olsen: None. B. Stallknecht: None. J.J. Holst: Advisory Panel; Self; AstraZeneca, Merck Sharp & Dohme Corp., Novo Nordisk A/S, Zealand Pharma A/S. Other Relationship; Spouse/Partner; Antag Therapeutics. S. Madsbad: Advisory Panel; Self; AstraZeneca, Boehringer Ingelheim Pharmaceuticals, Inc., Merck Sharp & Dohme Corp., Novo Nordisk A/S, Sanofi-Aventis. Research Support; Self; Boehringer Ingelheim International GmbH, Novo Nordisk A/S. Speaker’s Bureau; Self; AstraZeneca, Boehringer Ingelheim International GmbH, Novo Nordisk A/S. S.S. Torekov: Research Support; Self; Novo Nordisk Inc.


Novo Nordisk Foundation (NNF16OC0019968); Novo Nordisk Center for Metabolic Research; Helsefonden

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