Psychological burden as the primary determinant of suicidal ideation in patients with temporomandibular disorders.

The three pillars of health are sometimes referred to as diet, exercise, and sleep with the dogma being that if you ignore one, the other two will suffer [, ]. People who are sleep deprived tend to limit daily activity and eat excessively, often non-nutritious foods [, ]. People who do not exercise do not sleep well and often gain weight, increasing their risk of obstructive sleep apnea (OSA) [–]. Some data support the notion that exercise itself may protect against sleep apnea independent of body weight []. These bidirectional relationships between poor sleep, weight gain, and insufficient exercise often compound each other and pose major challenges for patients and their healthcare providers. In this review, we explore current thinking regarding the links between sleep issues and obesity in adults with an emphasis on therapeutic interventions and unanswered questions. Obesity is defined as excess body fat, typically diagnosed by a body mass index (BMI) ≥ 30 kg/m (≥ 27.5 kg/m in Asian populations) [], and affects over 40% of US adults with disproportionately high prevalence among certain racial, ethnic, and socioeconomic subgroups (e.g., individuals reporting non-Hispanic Black race and those with low income) [, ]. Although widely used, BMI is an imperfect measure of excess adiposity and in individuals with BMI 30–40 kg/m should be interpreted in the context of additional anthropometric measures []. Given its high prevalence, obesity commonly coexists with sleep disorders and, as discussed below, frequently interacts with them (Fig. ). Mechanisms which are known to account for the bidirectional relationship between excess weight and sleep disruption