Sleep Health in Bulimia Nervosa: A Systematic Review

Research on sleep in bulimia nervosa (BN) is methodologically varied and yields inconsistent findings. This review synthesised BN-sleep studies and examined whether comorbid mood disorders contribute to sleep disturbance.

PsycINFO, Medline (Ovid), and Scopus were searched for English or French quantitative studies comparing sleep health variables between individuals with diagnosed BN and healthy controls. Extracted data included study design, sample characteristics, sleep and BN measures, and key findings. Methodological quality was evaluated using a validated risk-of-bias tool.

Of 1233 titles/abstracts and 39 full texts screened, 11 studies met inclusion criteria. Some studies using subjective measures reported greater sleep disturbance in individuals with BN, including poorer sleep quality, difficulty initiating or maintaining sleep, and increased daytime sleepiness, with moderate to large effect sizes (|d| = 0.60-1.43). Objective findings were mixed: one actigraphy study reported later sleep onset and wake times in BN, while findings for sleep efficiency and rapid eye movement (REM) sleep parameters were inconsistent, and most polysomnography (PSG) variables showed no reliable group differences despite some large effect sizes (range: |d| = 0.72-1.69). Sleep disturbances were reported in some BN samples with and without comorbid mood disorders, although the specific contribution of mood pathology remains unclear. Studies were generally small, cross-sectional, and dated.

Some studies suggest elevated subjective sleep disturbances in individuals with BN, but findings remain heterogeneous and are limited by methodological variability and small sample sizes. Future studies are needed to better characterise sleep health in individuals with BN.

The systematic review was registered with the International Prospective Register of Systematic Reviews (CRD42022354504).