Relationship Among Macronutrients, Dietary Components, and Objective Sleep Variables Measured by Smartphone Apps: Real-World Cross-Sectional Study (Preprint)

BACKGROUND Few studies have explored the relationship between macronutrient intake and sleep outcomes using daily data from mobile apps. OBJECTIVE This cross-sectional study aimed to examine the associations between macronutrients, dietary components, and sleep parameters, considering their interdependencies. METHODS We analyzed data from 4825 users of the Pokémon Sleep and Asken smartphone apps, each used for at least 7 days to record objective sleep parameters and dietary components, respectively. Multivariable regression explored the associations between quartiles of macronutrients (protein; carbohydrate; and total fat, including saturated, monounsaturated, and polyunsaturated fats), dietary components (sodium, potassium, dietary fiber, and sodium-to-potassium ratio), and sleep variables (total sleep time [TST], sleep latency [SL], and percentage of wakefulness after sleep onset [%WASO]). The lowest intake group was the reference. Compositional data analysis accounted for macronutrient interdependencies. Models were adjusted for age, sex, and BMI. RESULTS Greater protein intake was associated with longer TST in the third (+0.17, 95% CI 0.09-0.26 h) and fourth (+0.18, 95% CI 0.09-0.27 h) quartiles. In contrast, greater fat intake was linked to shorter TST in the third (–0.11, 95% CI –0.20 to –0.27 h) and fourth (–0.16, 95% CI –0.25 to –0.07 h) quartiles. Greater carbohydrate intake was associated with shorter %WASO in the third (–0.82%, 95% CI –1.37% to –0.26%) and fourth (–0.57%, 95% CI –1.13% to –0.01%) quartiles, while greater fat intake was linked to longer %WASO in the fourth quartile (+0.62%, 95% CI 0.06%-1.18%). Dietary fiber intake correlated with longer TST and shorter SL. A greater sodium-to-potassium ratio was associated with shorter TST in the third (–0.11, 95% CI –0.20 to –0.02 h) and fourth (–0.19, 95% CI –0.28 to –0.10 h) quartiles; longer SL in the second (+1.03, 95% CI 0.08-1.98 min) and fourth (+1.50, 95% CI 0.53-2.47 min) quartiles; and longer %WASO in the fourth quartile (0.71%, 95% CI 0.15%-1.28%). Compositional data analysis, involving 6% changes in macronutrient proportions, showed that greater protein intake was associated with an elevated TST (+0.27, 95% CI 0.18-0.35 h), while greater monounsaturated fat intake was associated with a longer SL (+4.6, 95% CI 1.93-7.34 min) and a larger %WASO (+2.2%, 95% CI 0.63%-3.78%). In contrast, greater polyunsaturated fat intake was associated with a reduced TST (–0.22, 95% CI –0.39 to –0.05 h), a shorter SL (–4.7, 95% CI to 6.58 to –2.86 min), and a shorter %WASO (+2.0%, 95% CI –3.08% to –0.92%). CONCLUSIONS Greater protein and fiber intake were associated with longer TST, while greater fat intake and sodium-to-potassium ratios were linked to shorter TST and longer WASO. Increasing protein intake in place of other nutrients was associated with longer TST, while higher polyunsaturated fat intake improved SL and reduced WASO.