睡眠障碍与不健康饮食行为的相互作用与临床启示

Clinical Implications and Interaction between Sleep Disorders and Unhealthy Dietary Behaviors

摘要: 睡眠障碍与不健康饮食行为是当代社会普遍存在的公共卫生问题，二者并非简单并存，而是可能通过神经内分泌、奖赏环路、认知情绪调节、代谢炎症反应、神经化学物质合成及肠道菌群等途径形成双向影响。这种影响能够增加肥胖、2型糖尿病、心血管疾病等慢性病的风险。睡眠障碍可增加高GI食物、超加工食品、夜间进食及情绪性进食等不健康饮食行为；不健康饮食又可能通过血糖波动、炎症水平升高、色氨酸–血清素–褪黑素通路受影响及肠道菌群紊乱，加重失眠、睡眠片段化和昼夜节律紊乱。本文在梳理机制的基础上，进一步结合失眠障碍、阻塞性睡眠呼吸暂停和昼夜节律睡眠–觉醒障碍的临床特征，总结其相关饮食行为表现与联合干预启示，以期为临床筛查、风险分层和个体化管理提供参考。

Abstract: Sleep disorders and unhealthy dietary behaviors are pervasive public health concerns in contemporary society. Far from merely coexisting, they exert bidirectional effects on each other via multiple pathways, including neuroendocrine regulation, reward circuits, cognitive and emotional modulation, metabolic and inflammatory responses, neurochemical synthesis, and gut microbiota. This reciprocal interaction elevates the risk of chronic diseases such as obesity, type 2 diabetes mellitus, and cardiovascular diseases. Sleep disorders can drive a range of unhealthy dietary behaviors, including increased consumption of high-glycemic index (high-GI) foods and ultra-processed foods, night eating, and emotional eating. In turn, unhealthy dietary patterns may worsen insomnia, sleep fragmentation, and circadian rhythm disruption by triggering blood glucose fluctuations, elevating inflammatory levels, impairing the tryptophan-serotonin-melatonin pathway, and inducing gut microbiota dysbiosis. Building on a systematic review of the underlying mechanisms, this paper further integrates the clinical features of insomnia disorder, obstructive sleep apnea, and circadian sleep-wake disorders. It summarizes the associated dietary behavioral manifestations and insights into combined interventions, aiming to provide references for clinical screening, risk stratification, and individualized patient management.