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Reutrakul S, McAnany JJ, Park JC, Chau FY, Danielson KK, Prasad B, Pannain S, Hanlon EC. Greater sleep variability is associated with higher systemic inflammation in type 2 diabetes. J Sleep Res 2024; 33:e13989. [PMID: 37414725 PMCID: PMC10770284 DOI: 10.1111/jsr.13989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Revised: 06/18/2023] [Accepted: 06/21/2023] [Indexed: 07/08/2023]
Abstract
Sleep irregularity and variability have been shown to be detrimental to cardiometabolic health. The present pilot study explored if higher day-to-day sleep irregularity and variability were associated with systemic inflammation, as assessed by high-sensitivity C-reactive protein, in type 2 diabetes. Thirty-five patients with type 2 diabetes (mean age 54.3 years, 54.3% female) who were not shift-workers participated. The presence of diabetic retinopathy was determined. The standard deviation of sleep duration and sleep midpoint across all recorded nights were used to quantify sleep variability and regularity, respectively, assessed by 14-day actigraphy. The presence and severity of sleep apnea were assessed using an overnight home monitor. Low-density lipoprotein, haemoglobin A1C and high-sensitivity C-reactive protein were collected. Multiple regression analysis using natural-log-transformed values was performed to establish an independent association between sleep variability and high-sensitivity C-reactive protein. Twenty-two (62.9%) patients had diabetic retinopathy. The median (interquartile range) of high-sensitivity C-reactive protein was 2.4 (1.4, 4.6) mg L-1. Higher sleep variability was significantly associated with higher high-sensitivity C-reactive protein (r = 0.342, p = 0.044), as was haemoglobin A1C (r = 0.431, p = 0.010) and low-density lipoprotein (r = 0.379, p = 0.025), but not sleep regularity, sleep apnea severity or diabetic retinopathy. Multiple regression analysis showed that higher sleep variability (B = 0.907, p = 0.038) and higher HbA1c (B = 1.519, p = 0.035), but not low-density lipoprotein, contributed to higher high-sensitivity C-reactive protein. In conclusion, higher sleep variability in patients with type 2 diabetes who were not shift-workers was independently associated with higher systemic inflammation, conferring increased cardiovascular risk. Whether sleep interventions to reduce sleep variability can reduce systemic inflammation and improve cardiometabolic health should be investigated.
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Affiliation(s)
- Sirimon Reutrakul
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of Illinois Chicago, Chicago, IL
| | - J. Jason McAnany
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, IL
| | - Jason C. Park
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, IL
| | - Felix Y. Chau
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, IL
| | - Kirstie K. Danielson
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of Illinois Chicago, Chicago, IL
| | - Bharati Prasad
- Division of Pulmonary, Critical Care, Sleep and Allergy, Department of Medicine, University of Illinois Chicago, Chicago, IL
- Jesse Brown Department of Veterans Affairs Hospital, Chicago, Illinois
| | - Silvana Pannain
- Section of Adult and Pediatric Endocrinology, Diabetes & Metabolism, Department of Medicine, University of Chicago, Chicago, IL
| | - Erin C. Hanlon
- Section of Adult and Pediatric Endocrinology, Diabetes & Metabolism, Department of Medicine, University of Chicago, Chicago, IL
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McNeil J, Berry NT, Dollar JM, Shriver LH, Keane SP, Shanahan L, Wideman L. Associations of actigraphy-assessed sleep variables with adiposity and serum cardiometabolic outcomes in emerging adults. J Sleep Res 2024; 33:e14068. [PMID: 37803814 PMCID: PMC10947974 DOI: 10.1111/jsr.14068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 08/11/2023] [Accepted: 09/28/2023] [Indexed: 10/08/2023]
Abstract
This study assessed associations of actigraphy-assessed sleep with adiposity and serum cardiometabolic outcomes in emerging adults, and whether sex and race modified these associations. Data on 147 emerging adults (age = 19.4 ± 1.3 years; body mass index = 26.4 ± 7.0 kg m-2 ; 59% female; 65% White) from RIGHT Track Health were used. Actigraphy-based sleep measures included sleep duration, sleep efficiency, sleep timing midpoint, day-to-day sleep duration and sleep timing midpoint variability. Combined sleep duration and sleep timing behaviours were also derived (early-bed/late-rise, early-bed/early-rise, late-bed/late-rise, late-bed/early-rise). Outcomes included body mass index and BodPod-assessed fat mass index, fasting serum leptin, C-reactive protein, and homeostatic model assessment-insulin resistance. Sleep duration was 5.4 h per night. We noted an inverse association between sleep duration and homeostatic model assessment-insulin resistance. The early-bed/early-rise group had greater body mass index, C-reactive protein and homeostatic model assessment-insulin resistance compared with the early-bed/late-rise group (referent). Sex modified associations of sleep efficiency with C-reactive protein; stratified results revealed positive association between sleep efficiency and C-reactive protein in males, but not females. Race modified associations of sleep duration with body mass index and leptin, and of sleep duration variability with C-reactive protein. Stratified analyses revealed inverse associations between sleep duration with body mass index and leptin in Black, multiracial/other race individuals only. Positive association between sleep duration variability and C-reactive protein was noted in White individuals only. Shorter sleep duration, particularly when combined with earlier sleep timing, is associated with greater adiposity and serum cardiometabolic outcomes. Additional studies are needed to assess individual- and contextual-level factors that may contribute to sex and race differences in sleep health and cardiometabolic risk in emerging adults.
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Affiliation(s)
- Jessica McNeil
- Department of Kinesiology, University of North Carolina at Greensboro, Greensboro, North Carolina, USA
| | - Nathaniel T. Berry
- Department of Kinesiology, University of North Carolina at Greensboro, Greensboro, North Carolina, USA
- Under Armour, Inc., Innovation, Baltimore, Maryland, USA
| | - Jessica M. Dollar
- Department of Kinesiology, University of North Carolina at Greensboro, Greensboro, North Carolina, USA
- Department of Psychology, University of North Carolina at Greensboro, Greensboro, North Carolina, USA
| | - Lenka H. Shriver
- Department of Nutrition, University of North Carolina at Greensboro, Greensboro, North Carolina, USA
| | - Susan P. Keane
- Department of Psychology, University of North Carolina at Greensboro, Greensboro, North Carolina, USA
| | - Lilly Shanahan
- Department of Psychology, University of Zurich, Zurich, Switzerland
- Jacobs Center for Productive Youth Development, University of Zurich, Zurich, Switzerland
| | - Laurie Wideman
- Department of Kinesiology, University of North Carolina at Greensboro, Greensboro, North Carolina, USA
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McNeil J, Berry NT, Dollar JM, Shriver LH, Keane SP, Shanahan L, Wideman L. Cross-sectional associations of actigraphy-assessed sleep with dietary outcomes in emerging adults. Eur J Clin Nutr 2024:10.1038/s41430-024-01417-9. [PMID: 38402354 DOI: 10.1038/s41430-024-01417-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 02/13/2024] [Accepted: 02/14/2024] [Indexed: 02/26/2024]
Abstract
BACKGROUND/OBJECTIVES Emerging adults (~18-28 years of age) have a high prevalence of poor sleeping habits and poor diet quality; however, little is known on whether these poor sleeping habits are associated with dietary outcomes in this age group. This study assessed associations between actigraphy-based sleep with energy intake (EI), overall diet quality, and measures of meal timing in emerging adults. SUBJECTS/METHODS Data on 135 emerging adults (age = 19.4 ± 1.3 years; body mass index (BMI) = 26.5 ± 6.9 kg/m2; 58% female; 65% White) from the RIGHT Track Health project were used. Measures included actigraphy-assessed sleep duration, sleep efficiency, sleep timing midpoint, day-to-day sleep duration and sleep timing midpoint variability and combined sleep duration and sleep timing behaviors (early-bed/late-rise, early-bed/early-rise, late-bed/late-rise, late-bed/early-rise); EI (three 24-h dietary recalls), diet quality (Healthy Eating Index 2015 total score) and meal timing outcomes (timing of first and last meal intake, total duration, and midpoint of the eating window). RESULTS Shorter sleep duration, later sleep timing midpoint and greater sleep efficiency, as well as combined late-bed/late-rise and late-bed/early-rise groups, were associated with lower diet quality. Greater sleep timing midpoint variability was associated with higher EI, and the late-bed/early-rise group had significantly delayed first meal timing. CONCLUSION In emerging adults, shorter sleep duration and later sleep timing are associated with lower overall diet quality, and greater sleep timing variability is associated with higher EI. Future research is needed to examine the role of sleep on diet quality and eating habits to identify potential targets for nutritional interventions in this age group.
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Affiliation(s)
- Jessica McNeil
- Department of Kinesiology, University of North Carolina at Greensboro, Greensboro, NC, USA.
| | - Nathaniel T Berry
- Department of Kinesiology, University of North Carolina at Greensboro, Greensboro, NC, USA
- Under Armour, Inc., Innovation, Baltimore, MD, USA
| | - Jessica M Dollar
- Department of Kinesiology, University of North Carolina at Greensboro, Greensboro, NC, USA
- Department of Psychology, University of North Carolina at Greensboro, Greensboro, NC, USA
| | - Lenka H Shriver
- Department of Nutrition, University of North Carolina at Greensboro, Greensboro, NC, USA
| | - Susan P Keane
- Department of Psychology, University of North Carolina at Greensboro, Greensboro, NC, USA
| | - Lilly Shanahan
- Department of Psychology, University of Zurich, Zurich, Switzerland
- Jacobs Center for Productive Youth Development, University of Zurich, Zurich, Switzerland
| | - Laurie Wideman
- Department of Kinesiology, University of North Carolina at Greensboro, Greensboro, NC, USA
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Wang M, Flexeder C, Harris CP, Thiering E, Koletzko S, Bauer CP, Schulte-Körne G, von Berg A, Berdel D, Heinrich J, Schulz H, Schikowski T, Peters A, Standl M. Accelerometry-assessed sleep clusters and cardiometabolic risk factors in adolescents. Obesity (Silver Spring) 2024; 32:200-213. [PMID: 37873587 DOI: 10.1002/oby.23918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 07/07/2023] [Accepted: 08/18/2023] [Indexed: 10/25/2023]
Abstract
OBJECTIVE This study aimed to identify sleep clusters based on objective multidimensional sleep characteristics and test their associations with adolescent cardiometabolic health. METHODS The authors included 1090 participants aged 14.3 to 16.4 years (mean = 15.2 years) who wore 7-day accelerometers during the 15-year follow-up of the German Infant Study on the influence of Nutrition Intervention PLUS environmental and genetic influences on allergy development (GINIplus) and the Influence of Lifestyle factors on the development of the Immune System and Allergies in East and West Germany (LISA) birth cohorts. K-means cluster analysis was performed across 12 sleep characteristics reflecting sleep quantity, quality, schedule, variability, and regularity. Cardiometabolic risk factors included fat mass index (FMI), blood pressure, triglycerides, high-density lipoprotein cholesterol, high-sensitivity C-reactive protein, and insulin resistance (n = 505). Linear and logistic regression models were examined. RESULTS Five sleep clusters were identified: good sleep (n = 337); delayed sleep phase (n = 244); sleep irregularity and variability (n = 108); fragmented sleep (n = 313); and prolonged sleep latency (n = 88). The "prolonged sleep latency" cluster was associated with increased sex-scaled FMI (β = 0.39, 95% CI: 0.15-0.62) compared with the "good sleep" cluster. The "sleep irregularity and variability" cluster was associated with increased odds of high triglycerides only in male individuals (odds ratio: 9.50, 95% CI: 3.22-28.07), but this finding was not confirmed in linear models. CONCLUSIONS The prolonged sleep latency cluster was associated with higher FMI in adolescents, whereas the sleep irregularity and variability cluster was specifically linked to elevated triglycerides (≥1.7 mmol/L) in male individuals.
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Affiliation(s)
- Mingming Wang
- Institute of Epidemiology, Helmholtz Zentrum München - German Research Center for Environmental Health, Neuherberg, Germany
- Institute for Medical Information Processing, Biometry and Epidemiology (IBE), Faculty of Medicine, LMU Munich, Pettenkofer School of Public Health, Munich, Germany
| | - Claudia Flexeder
- Institute of Epidemiology, Helmholtz Zentrum München - German Research Center for Environmental Health, Neuherberg, Germany
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Munich, Germany
| | - Carla P Harris
- Institute of Epidemiology, Helmholtz Zentrum München - German Research Center for Environmental Health, Neuherberg, Germany
- Department of Pediatrics, Dr. von Hauner Children's Hospital, LMU University Hospitals, Munich, Germany
| | - Elisabeth Thiering
- Institute of Epidemiology, Helmholtz Zentrum München - German Research Center for Environmental Health, Neuherberg, Germany
- Department of Pediatrics, Dr. von Hauner Children's Hospital, LMU University Hospitals, Munich, Germany
| | - Sibylle Koletzko
- Department of Pediatrics, Dr. von Hauner Children's Hospital, LMU University Hospitals, Munich, Germany
- Department of Pediatrics, Gastroenterology and Nutrition, School of Medicine Collegium Medicum, University of Warmia and Mazury, Olsztyn, Poland
| | | | - Gerd Schulte-Körne
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Hospital of the Ludwig-Maximilians-University (LMU) Munich, Munich, Germany
| | - Andrea von Berg
- Research Institute, Department of Pediatrics, Marien-Hospital Wesel, Wesel, Germany
| | - Dietrich Berdel
- Research Institute, Department of Pediatrics, Marien-Hospital Wesel, Wesel, Germany
| | - Joachim Heinrich
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Munich, Germany
- Allergy and Lung Health Unit, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Holger Schulz
- Institute of Epidemiology, Helmholtz Zentrum München - German Research Center for Environmental Health, Neuherberg, Germany
| | - Tamara Schikowski
- IUF-Leibniz Research Institute for Environmental Medicine, Düsseldorf, Germany
| | - Annette Peters
- Institute of Epidemiology, Helmholtz Zentrum München - German Research Center for Environmental Health, Neuherberg, Germany
- Chair of Epidemiology, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Marie Standl
- Institute of Epidemiology, Helmholtz Zentrum München - German Research Center for Environmental Health, Neuherberg, Germany
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Promsod O, Kositanurit W, Tabtieang T, Kulaputana O, Chirakalwasan N, Reutrakul S, Sahakitrungruang T. Impact of irregular sleep pattern, and sleep quality on glycaemic parameters and endothelial function in adolescents and young adults with type 1 diabetes. J Sleep Res 2023:e14110. [PMID: 38030221 DOI: 10.1111/jsr.14110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 11/01/2023] [Accepted: 11/08/2023] [Indexed: 12/01/2023]
Abstract
This study investigated the impact of comprehensive sleep patterns on glycaemic parameters and endothelial function in adolescents and young adults with type 1 diabetes (T1D). Thirty subjects with type 1 diabetes (aged 13-25) without chronic complications participated. For 1 week, glucose levels were monitored by real-time continuous glucose monitoring (CGM) and sleep was simultaneously assessed by actigraphy. Subjective sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI). Flow-mediated dilatation (FMD) measured endothelial function at the brachial artery. Insulin sensitivity was determined by calculated estimated glucose disposal rate (eGDR). Glycaemic control was assessed using haemoglobin A1C (HbA1C) levels. To address potential confounding by metabolic syndrome on the FMD results, three affected subjects were excluded from FMD correlation analyses. Participants with PSQI scores >5 had a lower %FMD compared with those with scores ≤5 (4.6 ± 3.7% vs. 7.6 ± 3.0%, p = 0.03). Multivariate analysis indicated that lower sleep efficiency and higher sleep duration variability were associated with higher HbA1C levels (β = -0.076, 95%CI [-0.145, -0.008], p = 0.029; β = 0.012, 95%CI [0.001, 0.023], p = 0.033). Irregular sleep timing and lower sleep efficiency were related to decreased insulin sensitivity (sleep midpoint irregularity β = -1.581, 95%CI [-2.661, -0.502], p = 0.004, and sleep efficiency β = 0.147, 95%CI [0.060, 0.235], p = 0.001). No significant associations were found between glycaemic parameters and FMD. Our study demonstrated that sleep irregularity in type 1 diabetes was associated with glycaemic control and insulin resistance, while poor subjective sleep quality was linked to endothelial dysfunction. Promoting healthy sleep habits, including consistent sleep timing could benefit metabolic and cardiovascular health in type 1 diabetes.
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Affiliation(s)
- Ornpisa Promsod
- Division of Pediatric Endocrinology, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Weerapat Kositanurit
- Department of Physiology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Tanat Tabtieang
- Department of Anatomy, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Onanong Kulaputana
- Department of Physiology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Naricha Chirakalwasan
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- Excellence Center for Sleep Disorders, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - Sirimon Reutrakul
- Division of Endocrinology, Department of Medicine, Ramathibodi Hospital, Bangkok, Thailand
- Division of Endocrinology, Diabetes, and Metabolism, University of Illinois Chicago, Chicago, Illinois, USA
| | - Taninee Sahakitrungruang
- Division of Pediatric Endocrinology, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
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Zuraikat FM, Jelic S, St-Onge MP. Wake up! It's time to recognize the importance of sleep in metabolic health. Obesity (Silver Spring) 2023; 31:1188-1191. [PMID: 37140407 PMCID: PMC10322183 DOI: 10.1002/oby.23776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 03/22/2023] [Indexed: 05/05/2023]
Affiliation(s)
- Faris M Zuraikat
- Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - Sanja Jelic
- Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - Marie-Pierre St-Onge
- Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
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