BRIEF REPORT Sleep Patterns Before and After Weight Restoration in Females with Anorexia Nervosa: A Longitudinal Controlled Study Marwan El Ghoch 1 * , Simona Calugi 1 , Jasmine Bernabè 1 , Massimo Pellegrini 2 , Chiara Milanese 3 , Elisa Chignola 1 & Riccardo Dalle Grave 1 1 Department of Eating and Weight Disorders, Villa Garda Hospital, Via Monte Baldo, Verona, Italy 2 Department of Diagnostic, Clinical and Public Health, University of Modena and Reggio Emilia, Italy 3 Department of Neurological and Movement Sciences, University of Verona, Italy Abstract Objective: To assess sleep patterns in female patients with anorexia nervosa before and after weight restoration. Methods: Sleep patterns were measured objectively using a Sense Wear Armband before and after weight restoration in 50 female pa- tients with anorexia nervosa, and in 25 healthy females. Results: At baseline, patients with anorexia nervosa exhibited lower total sleep time and sleep onset latency than controls, the former apparently associated with baseline BMI, duration of illness and age. However, after weight restoration, total sleep time and sleep onset latency were similar to controls, despite the persistence of longer periods of wake after sleep onset. Discussion: In patients with anorexia nervosa, total sleep time and sleep onset latency appears to be reduced. This sleep disturbance seems to be influenced by the duration and severity of malnutrition, and appears to normalize with weight restoration. Even though a discontinuous sleep pattern seems to persist, this finding should be discussed with patients. Copyright © 2016 John Wiley & Sons, Ltd and Eating Disorders Association. Received 9 March 2016; Revised 6 May 2016; Accepted 31 May 2016 Keywords sleep patterns; starvation; anorexia nervosa; sense wear armband *Correspondence Marwan El Ghoch, MD, Department of Eating and Weight Disorders, Villa Garda Hospital Via Monte Baldo, 89 I-37016 Garda (VR), Italy. Tel: +39-045-8103915; Fax: +39-045-8102884. Email: marwan1979@hotmail.com Names for PubMed indexing: El Ghoch, Calugi, Bernabè, Pellegrini, Milanese, Chignola, Dalle Grave Published online in Wiley Online Library (wileyonlinelibrary.com) DOI: 10.1002/erv.2461 Introduction Sufferers of anorexia nervosa restrict their energy intake relative to their requirements, causing them to become significantly underweight (American Psychiatric Association, 2013) and develop the characteristic symptoms of starvation (Dalle Grave, Pasqualoni & Marchesini, 2011). According to the Minnesota study on prolonged and severe dietary restriction in healthy volunteers, one of the commonly reported starvation symptoms was a reduced need for sleep (Keys, 1950). Accordingly, recent reports indicate, in both rodents and humans, that a long period of starvation is associated with increased vigilance and sleep loss (Penev, 2007). That being said, findings on sleep patterns in patients with anorexia nervosa have thus far been contradictory. Indeed, while some studies have detected sleep disturbances (i.e. reductions in total sleep time, slow wave sleep, rapid eye movement sleep, and sleep efficiency, and increases in awakenings and wakefulness after sleep onset and Stage 1 sleep) in underweight individuals with respect to healthy controls (Benca, Obermeyer, Thisted, & Gillin, 1992; Delvenne, Kerkhofs, Appelboom-Fondu, Lucas, & Mendlewicz, 1992; Lacey, Crisp, Kalucy, Hartmann, & Chien, 1976; Levy, Dixon, & Schmidt, 1987; Nobili et al., 1999; Walsh, Goetz, Roose, Fingeroth, & Glassman, 1985), others have found no significant difference in sleep patterns (Latzer, Tzischinsky, & Epstein, 2001; C. Lauer, Zulley, Krieg, Riemann, & Berger, 1988; C. J. Lauer, Krieg, Riemann, Zulley, & Berger, 1990). Nevertheless, such conflicting observations are likely ascribable to methodolog- ical factors such as differences in sample size, gender, age, eating disorder features and the presence/absence of other co-morbidities (Della Marca et al., 2004; Nobili et al., 1999), as well as the approach used to assess sleep patterns (i.e. subjective vs. objective) (Kim et al., 2010; Pieters, Theys, Vandereycken, Leroy, & Peuskens, 2004; Sauchelli et al., 2015). Similarly, the few studies to assess changes in sleep patterns in anorexia nervosa patients before and after weight restoration have relied on small samples, which may explain their inconsistent findings, that is, no or only small improvements (Crisp, Stonehill, & Fenton, 1970; Lacey et al., 1976; Lacey, Crisp, Kalucy, Hartmann, & Chien, 1975; C. J. Lauer & Krieg, 1992; Pieters et al., 2004). 1 Eur. Eat. Disorders Rev. (2016)© 2016 John Wiley & Sons, Ltd and Eating Disorders Association.