Sleep-disordered breathing subtypes and future diet quality in the Multi-Ethnic Study of Atherosclerosis

Authors: POTTS, KAITLIN - Brigham & Women'S Hospital; CASTRO-DIEHL, CECILIA - Brigham & Women'S Hospital; HUANG, TIANYI - National Institute On Aging (NIA, NIH); WOOD, ALEXIS - Children'S Nutrition Research Center (CNRC); ROTTER, JEROME - Harbor-Ucla Medical Center; RICH, STEPHEN - University Of Virginia; SOFER, TAMAR - Harvard School Of Public Health; REDLINE, SUSAN - Harvard Medical School; WANG, HEMING - Brigham & Women'S Hospital

Submitted to: Sleep Health
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 8/13/2025
Publication Date: 10/1/2025
Citation: Potts, K.S., Castro-Diehl, C., Huang, T., Wood, A.C., Rotter, J.I., Rich, S.S., Sofer, T., Redline, S., Wang, H. 2025. Sleep-disordered breathing subtypes and future diet quality in the Multi-Ethnic Study of Atherosclerosis. Sleep Health. https://doi.org/10.1016/j.sleh.2025.08.003.
DOI: https://doi.org/10.1016/j.sleh.2025.08.003

Interpretive Summary: Cardiometabolic diseases such as heart disease and diabetes are major causes of illness and death, and both poor sleep and poor diet are important risk factors. This study explored whether sleep-disordered breathing (SDB)—a condition that includes frequent snoring or diagnosed sleep apnea—affects diet quality over time. Data from more than 3,200 US revealed that people with SDB were more likely to have poorer diet quality at follow-up compared to those without SDB, even after accounting for their baseline diet and other lifestyle factors. The decline in diet quality was observed in both people with and without daytime sleepiness, though it was slightly greater in those who experienced sleepiness. These findings suggest that SDB may have long-term impacts on eating habits, which could worsen cardiometabolic health. For stakeholders, this research provides valuable evidence that addressing sleep disorders may improve dietary outcomes and reduce the burden of cardiometabolic disease at the population level.

Technical Abstract: Sleep-disordered breathing (SDB) and diet quality impact cardiometabolic disease, but few studies have examined if SDB influences diet quality. This study estimated the association between SDB subtypes (with and without sleepiness) and future diet quality in the Multi-Ethnic Study of Atherosclerosis. Probable SDB was characterized by self-reported physician-diagnosed sleep apnea (PDSA) or habitual snoring and subtyped by presence or absence of sleepiness. A food frequency questionnaire measured diet 1.6 years before, and 7.8 years after SDB assessment. Diet quality was measured with the Alternate Healthy Eating Index-2010 (AHEI). Mean differences in AHEI at follow-up by SDB subtypes were estimated with multivariable linear regression adjusting for baseline AHEI, demographic, and lifestyle factors. Among 3294 participants (mean age 62 years, 51% women), 29.5% had SDB. When grouped by sleepiness, 20.6% had SDB without, and 8.9% had SDB with, sleepiness. Adjusting for baseline diet and potential confounders, those with SDB had lower follow-up AHEI scores compared with unaffected individuals (mean AHEI difference [95% CI]: -1.02 [-1.69, -0.35]). Upon stratifying by sleepiness, both groups had lower AHEI scores at follow-up compared with unaffected individuals, and the difference was greater for those with sleepiness (mean score difference [95% CI]: -0.8 [-1.56, -0.04], without sleepiness; -1.52 [-2.59, -0.45], with sleepiness). The difference between those with and without sleepiness was not statistically significant. In a multi-ethnic cohort, SDB was associated with lower diet quality after 7.8 years and this association was larger among participants with SDB with sleepiness.