Healthy eating reduces the risk of sleep apnea

In a recent study published in the journal NutrientsResearchers in the United States analyze the relationship between diet quality and various sleep outcomes in the Bogalusa Heart Study (BHS).

Study: Diet quality and sleep patterns in middle age: The Bogalusa heart study. Image credit: Prostock-studio/


Cardiovascular disease (CVD) is the leading cause of death in the United States, with one person dying of CVD every 34 seconds in this country. With approximately 122 million adults currently living with CVD in the United States, it is imperative to identify risk factors associated with the disease to reduce its incidence.

Some lifestyle-related risk factors, such as diet and sleep, can be modified to reduce CVD risks. In fact, a balanced diet has been shown to prevent the development of cardiovascular disease, while sleep apnea and insomnia have repeatedly been associated with an increased risk of cardiovascular disease. Studies have focused largely on the association between these activities and health outcomes; therefore, data on the interaction between nutrition and sleep is limited.

Short-term studies support the concept that diet and sleep are cyclical, as sleep affects next day food intake and diet affects sleep through metabolic pathways. In fact, high-quality diets are reportedly associated with better sleep outcomes.

However, many of these studies included non-diverse groups such as male or female only and Mediterranean diet followers only. Another common limitation of these studies is that many evaluated only one sleep parameter, such as sleep duration, with only one measure to determine diet quality.

About the study

In the present cross-sectional study, researchers investigate the association between diet quality and different sleep outcomes, such as sleep apnea, healthy sleep, and insomnia, in the BHS study cohort of black and white adults of both sexes. The researchers also determined whether the impacts varied by socioeconomic status, race, and gender.

The study cohort was made up of individuals who participated in the BHS study between 2013 and 2016 and completed sleep questionnaires and diet assessments. The Lower Mississippi Delta Nutrition Intervention Research Initiative (Delta NIRI) Food Frequency Questionnaire (FFQ) was used to assess diet. Over a six-month period, participants were given four one-day diet boosters.

The team matched Delta NIRI components to the United States Department of Agriculture (USDA) Food Patterns Equivalent Database (FPED) data published between 2015 and 2016. The Scientific Research Nutrient Database was used to estimate nutrient intake. The Healthy Eating Index (HEI) 2015, the Alternate Healthy Eating Index (AHEI) 2010 and the Alternate Mediterranean Dietary Pattern (aMed) were used to construct dietary patterns.

The Women’s Health Initiative Insomnia Rating Scale (WHIIRS) was used to assess insomnia, while the Berlin questionnaire was used for snoring and sleep apnea, and Healthy Sleep Model scores for overall sleep health. The International Physical Activity Questionnaire (IPAQ) was used to assess physical activity and total metabolic activity equivalent (MET) per week was determined. The Centers for Epidemiologic Studies Depression (CESD) scale assessed depressive symptoms.

Multivariate Poisson regression modeling was performed using generalized estimating equations (GEE) to estimate prevalence rate ratios (PRR). Models were adjusted for covariates such as age, gender, body mass index (BMI), race, exercise, education level, occupational status, caffeine consumption, depressive symptoms, bed partners, and frequent use of sleeping pills.

Data adjustments were also made for household size, census tract concentration index (ICE), pediatric individuals in households, census tract modified retail food environment index (mRFEI ), smoking habits, alcohol consumption and illicit drug use.

Study results

Of 1,298 individuals, 224 individuals with implausible caloric intake greater than 4,800 kcal/day, 43 individuals with a prior history of stroke or heart attack, 123 worked shifts, seven individuals with missing sleep or diet data, and 77 individuals with data on the missing covariates were excluded from the analysis. Consequently, the final sample cohort included 824 individuals.

The mean age of the participants was 48, 30% were black, 36% were male, approximately 30% had depression, and over 50% were obese. Among the participants, 44% had an increased risk of insomnia and sleep apnea, while sleep patterns were considered good in 23% of the participants.

An average score of 45 was obtained for AHEI-2010. The highest AHEI-2010 quintiles were more likely to be observed among older individuals, women, better educated individuals, non-smokers, alcoholic drinkers, and individuals who were not depressed.

Higher food quality, as determined using 2010 AHEI scores, correlated with a decreased sleep apnea risk score after adjustment. There was no significant relationship between HEI 2015, aMed, insomnia symptoms, or good sleep score.

AHEI-2010 and HEI-2015 were inversely related to a high risk of sleep apnea. Individuals in the fifth trimester of AHEI-2010 were 41% less likely to be at high risk for sleep apnea than those in the first trimester. Analysis of AHEI-2010 as a continuous variable showed that the correlation was significant, with a reduced prevalence of sleep apnea high score by 12% per 10-point increase in AHEI-2010.

A higher AHEI-2010 was related to being positive on the sleepiness component but not on the snoring component. In the unadjusted model, the researchers found a modest association between healthy sleep patterns and AHEI-2010.

The relationship between AHEI-2010 and sleep apnea risk was greater among women than among men. Notably, this relationship was also stronger among those with higher educational attainment.

Fruits, long-chain omega-3 fatty acids, sugary drinks, red and processed meats, and alcohol had significant inverse associations when comparing Q5 to Q1. Sensitivity analysis, which was performed by excluding BMI from the covariates, yielded similar results.


Higher food quality has been associated with reduced sleep apnea risk scores among low-income semi-rural populations in the southeastern United States, where health disparities are common. These results shed light on how diet quality affects sleep and, consequently, support the incorporation of high-quality food products into health care interventions that can improve the effectiveness of sleep therapies while simultaneously reducing the risk of developing CVD.

Magazine reference:

  • Potts, KS, Wallace, ME, Gustat, J., et al. (2023). Diet quality and sleep patterns in middle age: The Bogalusa heart study. Nutrients. doi:10.3390/nu15092078

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