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RESEARCH PRODUCT

Orexin and sleep quality in anorexia nervosa: Clinical relevance and influence on treatment outcome

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Background and aims Orexins/hypocretins are orexigenic peptides implicated in the regulation of feeding behavior and the sleep/wake cycle. Little is known about the functioning of these peptides in anorexia nervosa (AN). The aims of the current study were to evaluate the extent to which orexin-A might be linked to sleep and treatment outcome in AN. Method Fasting plasma orexin-A concentrations were measured in 48 females with AN at the start of a day hospital treatment and in 98 normal-eater/healthy-weight controls. The Pittsburgh Sleep Quality Index was administered at the beginning of the treatment as a measure of sleep quality. Other psychopathological variables were evaluated with the Symptom Checklist-Revised (SCL90R) and the Eating Disorder Inventory-2 (EDI). Patients were assessed at the start and end of treatment by means of commonly used diagnostic criteria and clinical questionnaires. Results The AN patients presented more sleep disturbances and poorer overall sleep quality than did the healthy controls (p = .026) but there were no global differences between groups in plasma orexin-A concentrations (p = .071). In the AN sample, orexin-A concentrations were associated with greater sleep disturbances (|r| = .30), sleep inefficiency (|r| = .22) and poorer overall sleep (|r| = .22). Structural Equation Modeling (SEM) showed that both elevated orexin-A concentrations and inadequate sleep predicted poorer treatment outcome. Conclusion Plasma orexin-A concentrations contribute to poor sleep quality in AN, and both of these variables are associated with therapy response. This manuscript was partially supported by grants from Insti- tuto Salud Carlos III (FIS PI14/290 and CIBERobn) and Fondo Europeo de Desarrollo Regional (FEDER) a way to build Europe, but also AGAUR de la Generalitat de Catalunya (2014SGR1672) and PROMOSAM (PSI2014-56303-REDT), Spain. CIBEROBN, CIBERSMA and CIBERESP are all initiatives of ISCIII. Sarah Sauchelli is recipient of a pre-doctoral Grant (2013–17) by IDIBELL. José C. Fernández- García is recipient of a research contract from Servicio Andaluz de Salud (SAS) (B-0033-2014). The funders had no role in the study design, data collection and analysis, decision to publish, or prepa- ration of the manuscript.