title: Orexin and sleep quality in anorexia nervosa: Clinical relevance and influence on treatment outcome.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  Plasma orexin-A concentrations contribute to poor sleep quality in AN, and both of these variables are associated with therapy response.
authors.affiliation: Department of Psychiatry, University Hospital of Bellvitge-IDIBELL, Barcelona, Spain; CIBER Fisiopatología Obesidad y Nutrición (CIBERobn), Instituto Salud Carlos III, Madrid, Spain.
authors.forename: Sarah
authors.initials: S
authors.lastname: Sauchelli
authors.affiliation: Department of Psychiatry, University Hospital of Bellvitge-IDIBELL, Barcelona, Spain; CIBER Fisiopatología Obesidad y Nutrición (CIBERobn), Instituto Salud Carlos III, Madrid, Spain; Department of Clinical Sciences, School of Medicine, University of Barcelona, Barcelona, Spain.
authors.forename: Susana
authors.initials: S
authors.lastname: Jiménez-Murcia
authors.affiliation: Department of Psychiatry, University Hospital of Bellvitge-IDIBELL, Barcelona, Spain.
authors.forename: Isabel
authors.initials: I
authors.lastname: Sánchez
authors.affiliation: Department of Psychiatry, University Hospital of Bellvitge-IDIBELL, Barcelona, Spain.
authors.forename: Nadine
authors.initials: N
authors.lastname: Riesco
authors.affiliation: Department of Psychiatry, University Hospital of Bellvitge-IDIBELL, Barcelona, Spain.
authors.forename: Nuria
authors.initials: N
authors.lastname: Custal
authors.affiliation: CIBER Fisiopatología Obesidad y Nutrición (CIBERobn), Instituto Salud Carlos III, Madrid, Spain; Department of Diabetes, Endocrinology and Nutrition, Hospital Clínico Universitario Virgen de Victoria, Málaga, Spain.
authors.forename: Jose C
authors.initials: JC
authors.lastname: Fernández-García
authors.affiliation: CIBER Fisiopatología Obesidad y Nutrición (CIBERobn), Instituto Salud Carlos III, Madrid, Spain; Department of Diabetes, Endocrinology and Nutrition, Hospital Clínico Universitario Virgen de Victoria, Málaga, Spain.
authors.forename: Lourdes
authors.initials: L
authors.lastname: Garrido-Sánchez
authors.affiliation: CIBER Fisiopatología Obesidad y Nutrición (CIBERobn), Instituto Salud Carlos III, Madrid, Spain; Department of Diabetes, Endocrinology and Nutrition, Hospital Clínico Universitario Virgen de Victoria, Málaga, Spain.
authors.forename: Francisco J
authors.initials: FJ
authors.lastname: Tinahones
authors.affiliation: Douglas University Institute in Mental Health & Psychiatry Department, McGill University, Montreal, Canada.
authors.forename: Howard
authors.initials: H
authors.lastname: Steiger
authors.affiliation: Douglas University Institute in Mental Health & Psychiatry Department, McGill University, Montreal, Canada.
authors.forename: Mimi
authors.initials: M
authors.lastname: Israel
authors.affiliation: CIBER Fisiopatología Obesidad y Nutrición (CIBERobn), Instituto Salud Carlos III, Madrid, Spain; Department of Psychological, Personality, Evaluation and Treatment of the University of Valencia, Valencia, Spain.
authors.forename: Rosa M
authors.initials: RM
authors.lastname: Baños
authors.affiliation: CIBER Fisiopatología Obesidad y Nutrición (CIBERobn), Instituto Salud Carlos III, Madrid, Spain; Department of Basic Psychology, Clinic and Psychobiology of the University Jaume I, Castelló, Spain.
authors.forename: Cristina
authors.initials: C
authors.lastname: Botella
authors.affiliation: CIBER Fisiopatología Obesidad y Nutrición (CIBERobn), Instituto Salud Carlos III, Madrid, Spain; Integrated Pharmacology and Systems Neurosciences Research Group, Neuroscience Research Program Organization IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain; Department of Health and Experimental Sciences, Universitat Pompeu Fabra Barcelona, Spain.
authors.forename: Rafael
authors.initials: R
authors.lastname: de la Torre
authors.affiliation: CIBER Fisiopatología Obesidad y Nutrición (CIBERobn), Instituto Salud Carlos III, Madrid, Spain; Department of Diabetes, Endocrinology and Nutrition, Institu d'Investigació, Biomèdica de Girona (IdIBGi), Hospital Dr Josep Trueta, Girona, Spain.
authors.forename: Jose M
authors.initials: JM
authors.lastname: Fernández-Real
authors.affiliation: CIBER Fisiopatología Obesidad y Nutrición (CIBERobn), Instituto Salud Carlos III, Madrid, Spain; Department of Diabetes, Endocrinology and Nutrition, Institu d'Investigació, Biomèdica de Girona (IdIBGi), Hospital Dr Josep Trueta, Girona, Spain.
authors.forename: Francisco J
authors.initials: FJ
authors.lastname: Ortega
authors.affiliation: CIBER Fisiopatología Obesidad y Nutrición (CIBERobn), Instituto Salud Carlos III, Madrid, Spain; Metabolic Research Laboratory, Clínica Universidad de Navarra, University of Navarra-IdiSNA, Pamplona, Spain.
authors.forename: Gema
authors.initials: G
authors.lastname: Frühbeck
authors.affiliation: CIBER Fisiopatología Obesidad y Nutrición (CIBERobn), Instituto Salud Carlos III, Madrid, Spain; Department of Psychobiology and Methodology, Autonomous University of Barcelona, Barcelona, Spain.
authors.forename: Roser
authors.initials: R
authors.lastname: Granero
authors.affiliation: Department of Psychobiology and Methodology, Autonomous University of Barcelona, Barcelona, Spain.
authors.forename: Salome
authors.initials: S
authors.lastname: Tárrega
authors.affiliation: CIBER Fisiopatología Obesidad y Nutrición (CIBERobn), Instituto Salud Carlos III, Madrid, Spain; Department of Medicine, Endocrinology Division, Santiago de Compostela University, Complejo Hospitalario Universitario, Santiago de Compostela, Spain.
authors.forename: Ana B
authors.initials: AB
authors.lastname: Crujeiras
authors.affiliation: CIBER Fisiopatología Obesidad y Nutrición (CIBERobn), Instituto Salud Carlos III, Madrid, Spain; Metabolic Research Laboratory, Clínica Universidad de Navarra, University of Navarra-IdiSNA, Pamplona, Spain.
authors.forename: Amaia
authors.initials: A
authors.lastname: Rodríguez
authors.affiliation: Center for Genomic Regulation (CRG), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), ISCIII, Barcelona, Spain.
authors.forename: Xavier
authors.initials: X
authors.lastname: Estivill
authors.affiliation: SIB Swiss Institute of Bioinformatics, Lausanne, Switzerland.
authors.forename: Jacques S
authors.initials: JS
authors.lastname: Beckmann
authors.affiliation: CIBER Fisiopatología Obesidad y Nutrición (CIBERobn), Instituto Salud Carlos III, Madrid, Spain; Department of Medicine, Endocrinology Division, Santiago de Compostela University, Complejo Hospitalario Universitario, Santiago de Compostela, Spain.
authors.forename: Felipe F
authors.initials: FF
authors.lastname: Casanueva
authors.affiliation: Department of Psychiatry, University Hospital of Bellvitge-IDIBELL, Barcelona, Spain; Department of Clinical Sciences, School of Medicine, University of Barcelona, Barcelona, Spain; CIBER Salud Mental (CIBERSAM), ISCIII, Barcelona, Spain.
authors.forename: Jose M
authors.initials: JM
authors.lastname: Menchón
authors.affiliation: Department of Psychiatry, University Hospital of Bellvitge-IDIBELL, Barcelona, Spain; CIBER Fisiopatología Obesidad y Nutrición (CIBERobn), Instituto Salud Carlos III, Madrid, Spain; Department of Clinical Sciences, School of Medicine, University of Barcelona, Barcelona, Spain. Electronic address: ffernandez@bellvitgehospital.cat.
authors.forename: Fernando
authors.initials: F
authors.lastname: Fernández-Aranda
mesh_terms: D000328:Adult; D000856:Anorexia Nervosa / Q000097:blood* / Q000503:physiopathology / Q000628:therapy; D016022:Case-Control Studies; D005247:Feeding Behavior / Q000502:physiology; D005260:Female; D006801:Humans; D000068797:Orexins / Q000097:blood*; D012890:Sleep / Q000502:physiology; D012893:Sleep Wake Disorders / Q000097:blood* / Q000503:physiopathology; D016896:Treatment Outcome
chemical_list: D000068797:Orexins
keywords: Anorexia nervosa; Orexin-A; Partial hospitalization; Sleep; Treatment outcome