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LeBlanc ES, Zhang S, Hedlin H, Clarke G, Smith N, Garcia L, Hale L, Hery CB, Liu S, Ochs-Balcom H, Phillips L, Shadyab AH, Stefanick M. Sleep Characteristics are Associated with Risk of Treated Diabetes Among Postmenopausal Women. Am J Med 2024; 137:331-340. [PMID: 38128859 PMCID: PMC11141584 DOI: 10.1016/j.amjmed.2023.12.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 11/17/2023] [Accepted: 12/09/2023] [Indexed: 12/23/2023]
Abstract
OBJECTIVE The purpose of this study was to determine whether sleep characteristics are associated with incidence of treated diabetes in postmenopausal individuals. METHODS Postmenopausal participants ages 50-79 years reported sleep duration, sleep-disordered breathing, or insomnia at baseline and again in a subsample 3 years later. The primary outcome was self-reported new diagnosis of diabetes treated with oral drugs or insulin at any time after baseline. Multivariable Cox proportional hazards models were used. RESULTS In 135,964 participants followed for 18.1 (± 6.3) years, there was a nonlinear association between sleep duration and risk of treated diabetes. Participants sleeping ≤5 hours at baseline had a 21% increased risk of diabetes compared with those sleeping 7 hours (adjusted hazard ratio [aHR] 1.21; 95% confidence interval [CI], 1.00-1.47). Those who slept for ≥9 hours had a nonsignificant 6% increased risk of diabetes compared with those sleeping 7 hours (aHR 1.06; 95% CI, 0.97-1.16). Participants whose sleep duration had decreased at 3 years had a 9% (aHR 1.09; 95% CI, 1.02-1.16) higher risk of diabetes than participants with unchanged sleep duration. Participants who reported increased sleep duration at 3 years had a risk of diabetes (HR 1.01; 95% CI, 0.95-1.08) similar to those with no sleep duration change. Participants at high risk of sleep-disordered breathing at baseline had a 31% higher risk of diabetes than those without (aHR 1.31; 95% CI, 1.26-1.37). No association was found between self-reported insomnia score and diabetes risk. CONCLUSIONS Sleep-disordered breathing and short or long sleep duration were associated with higher diabetes risk in a postmenopausal population.
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Affiliation(s)
- Erin S LeBlanc
- Kaiser Permanente Center for Health Research, Portland, Ore.
| | - Shiqi Zhang
- Quantitative Sciences Unit, Stanford University, Stanford, Calif
| | - Haley Hedlin
- Quantitative Sciences Unit, Stanford University, Stanford, Calif
| | - Greg Clarke
- Kaiser Permanente Center for Health Research, Portland, Ore
| | - Ning Smith
- Kaiser Permanente Center for Health Research, Portland, Ore
| | - Lorena Garcia
- University of California, Davis, School of Medicine, Calif
| | - Lauren Hale
- Professor of Family, Population and Preventive Medicine, Department of Family, Population and Preventive Medicine, Stony Brook University, Stony Brook, NY
| | - Chloe Beverly Hery
- Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, Ohio
| | - Simin Liu
- Department of Epidemiology and Center for Global Cardiometabolic Health, School of Public Health, Departments of Medicine and Surgery, the Warren Alpert School of Medicine, Brown University, Providence, RI
| | - Heather Ochs-Balcom
- Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo, The State University of New York
| | - Lawrence Phillips
- Atlanta VA Health Care System, Decatur, Ga; Division of Endocrinology and Metabolism, Department of Medicine, Emory University School of Medicine, Atlanta, Ga
| | - Aladdin H Shadyab
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla
| | - Marcia Stefanick
- Stanford University School of Medicine, Stanford University, Calif
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Lee HJ, Cho S, Lee SH, Kim SJ, Kim KM, Chu MK. Catch-up sleep on free days and body mass index: results from the seventh Korea National Health and Nutrition Examination Survey, 2016. J Clin Sleep Med 2024; 20:39-47. [PMID: 38163942 PMCID: PMC10758546 DOI: 10.5664/jcsm.10790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 08/18/2023] [Accepted: 08/18/2023] [Indexed: 01/03/2024]
Abstract
STUDY OBJECTIVES We aimed to identify the relationship between duration of categorized catch-up sleep on free days (CUS) and measured body mass index (BMI) in adults using the data from the seventh Korean National Health and Nutrition Examination Survey (KNHANES VII), 2016. METHODS CUS duration was classified as ≤ 0, > 0-1, > 1-2, and > 2 hours. Being overweight or obese was defined as having a BMI ≥ 25.0 kg/m2 or ≥ 30.0 kg/m2, respectively. RESULTS Of 6,382 participants aged 19-80 years in the KNHANES VII survey of 2016, 201 and 583 participants were excluded because of shift-working and insufficient data, respectively. Of 5,598 participants, CUS was observed in 2,274 (44.9%) participants, of which 3,324 (55.1%), 1,043 (19.4%), 724 (14.7%), and 507 (10.8%) had CUS of ≤ 0, > 0-1, > 1-2, and > 2 hours, respectively; the prevalence of obesity was 5.6%, 5.6%, 4.8%, and 6.1%, respectively. The association between BMI and CUS duration showed a significant negative association in the CUS ≤ 0 hours group (beta [95% confidence interval], -0.394 [-0.646, -0.143], P = .002); however, other CUS groups did not show any significant association with BMI (CUS > 0-1 hours: -0.196 [-1.258, 0.865], P = .716; CUS > 1-2 hours, -0.542 [-1.625, 0.541], P = .325; CUS > 2 hours, -0.113 [-0.459, 0.233], P = .519). CONCLUSIONS Our findings provide an understanding of the relationship between CUS and BMI and can serve as an instructive basis for the management of BMI. CITATION Lee HJ, Cho S, Lee SH, Kim SJ, Kim KM, Chu MK. Catch-up sleep on free days and body mass index: results from the seventh Korea National Health and Nutrition Examination Survey, 2016. J Clin Sleep Med. 2024;20(1):39-47.
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Affiliation(s)
- Hye Jeong Lee
- Department of Neurology, Chung-Ang University Gwangmyeong Hospital, Gwangmyeong, Gyeonggi-do, Korea
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
| | - Soomi Cho
- Department of Neurology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Sue Hyun Lee
- Department of Neurology, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, Gangwon-do, Korea
| | - Seung Jae Kim
- Department of Neurology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Kyung Min Kim
- Department of Neurology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Min Kyung Chu
- Department of Neurology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
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3
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Abstract
Epidemiologic studies have demonstrated that short sleep duration is associated with an increased risk of cardio-metabolic health outcomes including cardiovascular disease mortality, coronary heart disease, type 2 diabetes mellitus, hypertension, and metabolic syndrome. Experimental sleep restriction studies have sought to explain these findings. This review describes the main evidence of these associations and possible mechanisms explaining them. Whether sleep extension reverses these now widely acknowledged adverse health effects and the feasibility of implementing such strategies on a public health level is discussed.
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Affiliation(s)
- Roo Killick
- Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, University of Sydney, Sydney, Australia
| | - Lachlan Stranks
- Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, University of Sydney, Sydney, Australia; The University of Adelaide, Faculty of Health and Medical Sciences, Adelaide, Australia
| | - Camilla M Hoyos
- Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, University of Sydney, Sydney, Australia; The University of Sydney, Faculty of Science, School of Psychology and Brain and Mind Centre, Sydney, Australia.
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4
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Duan D, Kim LJ, Jun JC, Polotsky VY. Connecting insufficient sleep and insomnia with metabolic dysfunction. Ann N Y Acad Sci 2023; 1519:94-117. [PMID: 36373239 PMCID: PMC9839511 DOI: 10.1111/nyas.14926] [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] [Indexed: 11/16/2022]
Abstract
The global epidemic of obesity and type 2 diabetes parallels the rampant state of sleep deprivation in our society. Epidemiological studies consistently show an association between insufficient sleep and metabolic dysfunction. Mechanistically, sleep and circadian rhythm exert considerable influences on hormones involved in appetite regulation and energy metabolism. As such, data from experimental sleep deprivation in humans demonstrate that insufficient sleep induces a positive energy balance with resultant weight gain, due to increased energy intake that far exceeds the additional energy expenditure of nocturnal wakefulness, and adversely impacts glucose metabolism. Conversely, animal models have found that sleep loss-induced energy expenditure exceeds caloric intake resulting in net weight loss. However, animal models have significant limitations, which may diminish the clinical relevance of their metabolic findings. Clinically, insomnia disorder and insomnia symptoms are associated with adverse glucose outcomes, though it remains challenging to isolate the effects of insomnia on metabolic outcomes independent of comorbidities and insufficient sleep durations. Furthermore, both pharmacological and behavioral interventions for insomnia may have direct metabolic effects. The goal of this review is to establish an updated framework for the causal links between insufficient sleep and insomnia and risks for type 2 diabetes and obesity.
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Affiliation(s)
- Daisy Duan
- Division of Endocrinology, Diabetes, and Metabolism; Department of Medicine; Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Lenise J. Kim
- Division of Pulmonary and Critical Care; Department of Medicine; Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jonathan C. Jun
- Division of Pulmonary and Critical Care; Department of Medicine; Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Vsevolod Y. Polotsky
- Division of Pulmonary and Critical Care; Department of Medicine; Johns Hopkins University School of Medicine, Baltimore, Maryland
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5
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Van Cutsem J, Pattyn N. Primum non nocere; It's time to consider altitude training as the medical intervention it actually is! Front Psychol 2022; 13:1028294. [PMID: 36582343 PMCID: PMC9792969 DOI: 10.3389/fpsyg.2022.1028294] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 11/23/2022] [Indexed: 12/15/2022] Open
Abstract
Sleep is one of the most important aspects of recovery, and is known to be severely affected by hypoxia. The present position paper focuses on sleep as a strong moderator of the altitude training-response. Indeed, the response to altitude training is highly variable, it is not a fixed and classifiable trait, rather it is a state that is determined by multiple factors (e.g., iron status, altitude dose, pre-intervention hemoglobin mass, training load, and recovery). We present an overview of evidence showing that sleep, and more specifically the prolonged negative impact of altitude on the nocturnal breathing pattern, affecting mainly deep sleep and thus the core of physiological recovery during sleep, could play an important role in intra- and interindividual variability in the altitude training-associated responses in professional and recreational athletes. We conclude our paper with a set of suggested recommendations to customize the application of altitude training to the specific needs and vulnerabilities of each athlete (i.e., primum non nocere). Several factors have been identified (e.g., sex, polymorphisms in the TASK2/KCNK5, NOTCH4 and CAT genes and pre-term birth) to predict individual vulnerabilities to hypoxia-related sleep-disordered breathing. Currently, polysomnography should be the first choice to evaluate an individual's predisposition to a decrease in deep sleep related to hypoxia. Further interventions, both pharmacological and non-pharmacological, might alleviate the effects of nocturnal hypoxia in those athletes that show most vulnerable.
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Affiliation(s)
- Jeroen Van Cutsem
- Vital Signs and Performance Monitoring (VIPER) Research Unit, Royal Military Academy, Brussels, Belgium,Human Physiology and Sports Physiotherapy Research Group, Vrije Universiteit Brussel, Brussels, Belgium,*Correspondence: Jeroen Van Cutsem,
| | - Nathalie Pattyn
- Vital Signs and Performance Monitoring (VIPER) Research Unit, Royal Military Academy, Brussels, Belgium,Human Physiology and Sports Physiotherapy Research Group, Vrije Universiteit Brussel, Brussels, Belgium
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6
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Mild to Moderate Sleep Restriction Does Not Affect the Cortisol Awakening Response in Healthy Adult Males. Clocks Sleep 2022; 4:722-734. [PMID: 36547105 PMCID: PMC9776856 DOI: 10.3390/clockssleep4040054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 11/02/2022] [Accepted: 11/18/2022] [Indexed: 11/29/2022] Open
Abstract
The cortisol awakening response (CAR) is a distinct rise in cortisol that occurs upon awakening that is thought to contribute to arousal, energy boosting, and anticipation. There is some evidence to suggest that inadequate sleep may alter the CAR, but the relationship between sleep duration and CAR has not been systematically examined. Healthy males (n = 111; age: 23.0 ± 3.6 yrs) spent 10 consecutive days/nights in a sleep laboratory. After a baseline night (9 h time in bed), participants spent either 5 h (n = 19), 6 h (n = 23), 7 h (n = 16), 8 h (n = 27), or 9 h (n = 26) in bed for seven nights, followed by a 9 h recovery sleep. The saliva samples for cortisol assay were collected at 08:00 h, 08:30 h and 08:45 h at baseline, on experimental days 2 and 5 and on the recovery day. The primary dependent variables were the cortisol concentration at awakening (08:00 h) and the cortisol area under the curve (AUC). There was no effect of time in bed on either the cortisol concentration at awakening or cortisol AUC. In all the time in bed conditions, the cortisol AUC tended to be higher at baseline and lower on experimental day 5. Five consecutive nights of mild to moderate sleep restriction does not appear to affect the CAR in healthy male adults.
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7
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Abstract
Epidemiologic studies have demonstrated that short sleep duration is associated with an increased risk of cardio-metabolic health outcomes including cardiovascular disease mortality, coronary heart disease, type 2 diabetes mellitus, hypertension, and metabolic syndrome. Experimental sleep restriction studies have sought to explain these findings. This review describes the main evidence of these associations and possible mechanisms explaining them. Whether sleep extension reverses these now widely acknowledged adverse health effects and the feasibility of implementing such strategies on a public health level is discussed.
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Affiliation(s)
- Roo Killick
- Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, University of Sydney, Sydney, Australia
| | - Lachlan Stranks
- Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, University of Sydney, Sydney, Australia; The University of Adelaide, Faculty of Health and Medical Sciences, Adelaide, Australia
| | - Camilla M Hoyos
- Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, University of Sydney, Sydney, Australia; The University of Sydney, Faculty of Science, School of Psychology and Brain and Mind Centre, Sydney, Australia.
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8
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Effects of sleep manipulation on markers of insulin sensitivity: a systematic review and meta-analysis of randomized controlled trials. Sleep Med Rev 2022; 62:101594. [DOI: 10.1016/j.smrv.2022.101594] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 12/30/2021] [Accepted: 01/18/2022] [Indexed: 01/03/2023]
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9
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Yuan RK, Zitting KM, Duffy JF, Vujovic N, Wang W, Quan SF, Klerman EB, Scheer FAJL, Buxton OM, Williams JS, Czeisler CA. Chronic Sleep Restriction While Minimizing Circadian Disruption Does Not Adversely Affect Glucose Tolerance. Front Physiol 2021; 12:764737. [PMID: 34744800 PMCID: PMC8564292 DOI: 10.3389/fphys.2021.764737] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 09/24/2021] [Indexed: 11/24/2022] Open
Abstract
Insufficient sleep, which has been shown to adversely affect metabolism, is generally associated with prolonged exposure to artificial light at night, a known circadian disruptor. There is growing evidence suggesting that circadian disruption adversely affects metabolism, yet few studies have attempted to evaluate the adverse metabolic effects of insufficient sleep while controlling for circadian disruption. We assessed postprandial glucose and insulin responses to a standard breakfast meal in healthy adults (n = 9) who underwent 3 weeks of chronic sleep restriction (CSR) in a 37-day inpatient study while minimizing circadian disruption by maintaining the same duration of light exposure each study day. We compared these results to findings from an earlier inpatient study which used a forced desynchrony (FD) protocol to assess the influence of 3 weeks of CSR combined with recurrent circadian disruption (RCD) on glycemic control in healthy adults (n = 21). CSR combined with RCD resulted in significantly elevated postprandial plasma glucose levels (p < 0.0001), while CSR with minimized circadian disruption had no adverse glycemic effects after 3 weeks of exposure (EXP). These results suggest that one mechanism by which sleep restriction impacts metabolism may be via concurrent circadian disruption.
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Affiliation(s)
- Robin K Yuan
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, Boston, MA, United States.,Division of Sleep Medicine, Harvard Medical School, Boston, MA, United States
| | - Kirsi-Marja Zitting
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, Boston, MA, United States.,Division of Sleep Medicine, Harvard Medical School, Boston, MA, United States
| | - Jeanne F Duffy
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, Boston, MA, United States.,Division of Sleep Medicine, Harvard Medical School, Boston, MA, United States
| | - Nina Vujovic
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, Boston, MA, United States.,Division of Sleep Medicine, Harvard Medical School, Boston, MA, United States
| | - Wei Wang
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, Boston, MA, United States.,Division of Sleep Medicine, Harvard Medical School, Boston, MA, United States
| | - Stuart F Quan
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, Boston, MA, United States.,Division of Sleep Medicine, Harvard Medical School, Boston, MA, United States
| | - Elizabeth B Klerman
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, Boston, MA, United States.,Division of Sleep Medicine, Harvard Medical School, Boston, MA, United States
| | - Frank A J L Scheer
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, Boston, MA, United States.,Division of Sleep Medicine, Harvard Medical School, Boston, MA, United States
| | - Orfeu M Buxton
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, Boston, MA, United States.,Division of Sleep Medicine, Harvard Medical School, Boston, MA, United States.,Department of Biobehavioral Health, Pennsylvania State University, University Park, PA, United States
| | - Jonathan S Williams
- Division of Endocrinology, Diabetes, and Hypertension, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, United States
| | - Charles A Czeisler
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, Boston, MA, United States.,Division of Sleep Medicine, Harvard Medical School, Boston, MA, United States
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10
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García-Aviles JE, Méndez-Hernández R, Guzmán-Ruiz MA, Cruz M, Guerrero-Vargas NN, Velázquez-Moctezuma J, Hurtado-Alvarado G. Metabolic Disturbances Induced by Sleep Restriction as Potential Triggers for Alzheimer's Disease. Front Integr Neurosci 2021; 15:722523. [PMID: 34539357 PMCID: PMC8447653 DOI: 10.3389/fnint.2021.722523] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 07/26/2021] [Indexed: 01/15/2023] Open
Abstract
Sleep has a major role in learning, memory consolidation, and metabolic function. Although it is known that sleep restriction increases the accumulation of amyloid β peptide (Aβ) and the risk to develop Alzheimer's disease (AD), the mechanism behind these effects remains unknown. In this review, we discuss how chronic sleep restriction induces metabolic and cognitive impairments that could result in the development of AD in late life. Here, we integrate evidence regarding mechanisms whereby metabolic signaling becomes disturbed after short or chronic sleep restriction in the context of cognitive impairment, particularly in the accumulation of Aβ in the brain. We also discuss the role of the blood-brain barrier in sleep restriction with an emphasis on the transport of metabolic signals into the brain and Aβ clearance. This review presents the unexplored possibility that the alteration of peripheral metabolic signals induced by sleep restriction, especially insulin resistance, is responsible for cognitive deficit and, subsequently, implicated in AD development.
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Affiliation(s)
- Jesús Enrique García-Aviles
- Area of Neurosciences, Biology of Reproduction Department, Ciencias Biológicas y de la Salud, Universidad Autónoma Metropolitana, Unidad Iztapalapa, Mexico City, Mexico.,Posgrado en Biología Experimental, Universidad Autónoma Metropolitana, Unidad Iztapalapa, Mexico City, Mexico
| | - Rebeca Méndez-Hernández
- Instituto de Investigaciones Biomédicas, Universidad Nacional Autónoma de México, Ciudad Universitaria, Mexico City, Mexico
| | - Mara A Guzmán-Ruiz
- Departamento de Fisiología, Facultad de Medicina, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Miguel Cruz
- Instituto Mexicano del Seguro Social, Centro Médico Nacional Siglo XXI, Hospital de Especialidades, Unidad de Investigación Médica en Bioquímica, Mexico City, Mexico
| | - Natalí N Guerrero-Vargas
- Departamento de Anatomía, Facultad de Medicina, Universidad Nacional Autónoma de México, México City, Mexico
| | - Javier Velázquez-Moctezuma
- Area of Neurosciences, Biology of Reproduction Department, Ciencias Biológicas y de la Salud, Universidad Autónoma Metropolitana, Unidad Iztapalapa, Mexico City, Mexico
| | - Gabriela Hurtado-Alvarado
- Instituto de Investigaciones Biomédicas, Universidad Nacional Autónoma de México, Ciudad Universitaria, Mexico City, Mexico
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11
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Muhammad HFL, Pratama SA, Sulistyoningrum DC, Hartono MN, Huriyati E, Lee YY, Muda WAMW. The impact of sleep quality and duration on leptin, appetite, and obesity indices in adults. MEDICAL JOURNAL OF INDONESIA 2020. [DOI: 10.13181/mji.oa.203707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
BACKGROUND Poor sleep duration and quality were previously reported to increase the risk of obesity. This study was aimed to evaluate the impact of sleep quality and duration on leptin, appetite, and adiposity in Indonesian adults.
METHODS This cross-sectional study recruited adults in Yogyakarta, Indonesia, in 2016. Sleep quality was assessed using the Pittsburgh sleep quality index, appetite was evaluated using the community nutrition appetite questionnaire, and dietary intake was assessed by interviews using the semi-quantitative food frequency questionnaire. Sleep duration was also asked. Obesity indices were measured using the body mass index (BMI), waist-hip circumference, and percentage of body fat. Leptin was analyzed using the enzyme-linked immunosorbent assay. A Spearman analysis was done to evaluate the correlation between sleep quality, sleep duration, anthropometric measures, dietary intake, appetite, and leptin.
RESULTS 244 adults participated in this study. This study showed that lower sleep quality and duration was significantly correlated with higher body weight (r = 0.129, p = 0.043 and r = −0.228, p<0.001), BMI (r = 0.176, p = 0.006 and r = −0.202, p = 0.001), and waist circumference (r = 0.179, p = 0.005 and r = −0.254, p<0.001). There was a correlation between poor sleep quality and higher leptin concentration (r = 0.186, p = 0.004). Sleep quality and duration were not associated with appetite (r = 0.109, p = 0.109 and r = −0.043, p = 0.500).
CONCLUSIONS This study found that lower sleep quality was correlated with higher BMI, higher leptin concentration, but not appetite.
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Abstract
PURPOSE OF REVIEW Sleep and obesity share a bidirectional relationship, and weight loss has been shown to enhance sleep. Aiming to extend sleep on its own or as part of a lifestyle intervention may attenuate health consequences of short sleep. This review highlights several sleep extension approaches, discusses feasibility of each, and summarizes findings relevant to obesity. RECENT FINDINGS Sleep extension in response to experimental sleep restriction demonstrates partial rescue of cardiometabolic dysfunction in some but not all studies. Adequate sleep on a nightly basis may be necessary for optimal health. While initial sleep extension interventions in habitually short sleepers have been met with obstacles, preliminary findings suggest that sleep extension or sleep hygiene interventions may improve glycemic control, decrease blood pressure, and enhance weight loss. Sleep extension has the potential to attenuate obesity risk and cardiometabolic dysfunction. There is tremendous opportunity for future research that establishes a minimum threshold for sleep extension effectiveness and addresses logistical barriers identified in seminal studies.
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Affiliation(s)
- Kristin K Hoddy
- Pennington Biomedical Research Center, 6400 Perkins Road, Baton Rouge, LA, 70808, USA.
| | - Kaitlin S Potts
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, 70112, USA
| | - Lydia A Bazzano
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, 70112, USA
| | - John P Kirwan
- Pennington Biomedical Research Center, 6400 Perkins Road, Baton Rouge, LA, 70808, USA
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13
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Finger AM, Dibner C, Kramer A. Coupled network of the circadian clocks: a driving force of rhythmic physiology. FEBS Lett 2020; 594:2734-2769. [PMID: 32750151 DOI: 10.1002/1873-3468.13898] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 07/06/2020] [Accepted: 07/21/2020] [Indexed: 12/15/2022]
Abstract
The circadian system is composed of coupled endogenous oscillators that allow living beings, including humans, to anticipate and adapt to daily changes in their environment. In mammals, circadian clocks form a hierarchically organized network with a 'master clock' located in the suprachiasmatic nucleus of the hypothalamus, which ensures entrainment of subsidiary oscillators to environmental cycles. Robust rhythmicity of body clocks is indispensable for temporally coordinating organ functions, and the disruption or misalignment of circadian rhythms caused for instance by modern lifestyle is strongly associated with various widespread diseases. This review aims to provide a comprehensive overview of our current knowledge about the molecular architecture and system-level organization of mammalian circadian oscillators. Furthermore, we discuss the regulatory roles of peripheral clocks for cell and organ physiology and their implication in the temporal coordination of metabolism in human health and disease. Finally, we summarize methods for assessing circadian rhythmicity in humans.
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Affiliation(s)
- Anna-Marie Finger
- Laboratory of Chronobiology, Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.,Berlin Institute of Health (BIH), Berlin, Germany
| | - Charna Dibner
- Division of Endocrinology, Diabetes, Nutrition, and Patient Education, Department of Medicine, University Hospital of Geneva, Geneva, Switzerland.,Department of Cell Physiology and Metabolism, Faculty of Medicine, University of Geneva, Geneva, Switzerland.,Diabetes Center, Faculty of Medicine, University of Geneva, Geneva, Switzerland.,Institute of Genetics and Genomics in Geneva (iGE3), University of Geneva, Geneva, Switzerland
| | - Achim Kramer
- Laboratory of Chronobiology, Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.,Berlin Institute of Health (BIH), Berlin, Germany
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14
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Brouwer A, Asare Bediako I, Paszkiewicz RL, Kolka CM, Bergman RN, Broussard JL. Impact of sleep deprivation and high-fat feeding on insulin sensitivity and beta cell function in dogs. Diabetologia 2020; 63:875-884. [PMID: 32016566 PMCID: PMC7304935 DOI: 10.1007/s00125-019-05084-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Accepted: 11/06/2019] [Indexed: 12/15/2022]
Abstract
AIMS/HYPOTHESIS Insufficient sleep is increasingly recognised as a major risk factor for the development of obesity and diabetes, and short-term sleep loss in clinical studies leads to a reduction in insulin sensitivity. Sleep loss-induced metabolic impairments are clinically relevant, since reductions in insulin sensitivity after sleep loss are comparable to insulin sensitivity differences between healthy individuals and those with impaired glucose tolerance. However, the relative effects of sleep loss vs high-fat feeding in the same individual have not been assessed. In addition, to our knowledge no diurnal (active during the daytime) non-human mammalian model of sleep loss-induced metabolic impairment exists, which limits our ability to study links between sleep and metabolism. METHODS This study examined the effects of one night of total sleep deprivation on insulin sensitivity and beta cell function, as assessed by an IVGTT, before and after 9 months of high-fat feeding in a canine model. RESULTS One night of total sleep deprivation in lean dogs impaired insulin sensitivity to a similar degree as a chronic high-fat diet (HFD)(normal sleep: 4.95 ± 0.45 mU-1 l-1 min-1; sleep deprivation: 3.14 ± 0.21 mU-1 l-1 min-1; HFD: 3.74 ± 0.48 mU-1 l-1 min-1; mean ± SEM). Hyperinsulinaemic compensation was induced by the chronic HFD, suggesting adequate beta cell response to high-fat feeding. In contrast, there was no beta cell compensation after one night of sleep deprivation, suggesting that there was metabolic dysregulation with acute sleep loss that, if sustained during chronic sleep loss, could contribute to the risk of type 2 diabetes. After chronic high-fat feeding, acute total sleep deprivation did not cause further impairments in insulin sensitivity (sleep deprivation + chronic HFD: 3.28 mU-1 l-1 min-1). CONCLUSIONS/INTERPRETATION Our findings provide further evidence that sleep is important for metabolic health and establish a diurnal animal model of metabolic disruption during insufficient sleep.
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Affiliation(s)
- Annelies Brouwer
- Sleep and Metabolism Laboratory, Department of Health and Exercise Science, Colorado State University, 1582 Campus Delivery, Fort Collins, CO, 80523-1582, USA
- Amsterdam UMC, Vrije Universiteit, Department of Psychiatry, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
- GGZ inGeest Specialized Mental Health Care, Amsterdam, the Netherlands
| | - Isaac Asare Bediako
- Diabetes and Obesity Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Rebecca L Paszkiewicz
- Diabetes and Obesity Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Cathryn M Kolka
- Diabetes and Obesity Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Richard N Bergman
- Diabetes and Obesity Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Josiane L Broussard
- Sleep and Metabolism Laboratory, Department of Health and Exercise Science, Colorado State University, 1582 Campus Delivery, Fort Collins, CO, 80523-1582, USA.
- Diabetes and Obesity Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
- Division of Endocrinology, Metabolism and Diabetes, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
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15
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Sinturel F, Petrenko V, Dibner C. Circadian Clocks Make Metabolism Run. J Mol Biol 2020; 432:3680-3699. [PMID: 31996313 DOI: 10.1016/j.jmb.2020.01.018] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 01/16/2020] [Accepted: 01/16/2020] [Indexed: 12/12/2022]
Abstract
Most organisms adapt to the 24-h cycle of the Earth's rotation by anticipating the time of the day through light-dark cycles. The internal time-keeping system of the circadian clocks has been developed to ensure this anticipation. The circadian system governs the rhythmicity of nearly all physiological and behavioral processes in mammals. In this review, we summarize current knowledge stemming from rodent and human studies on the tight interconnection between the circadian system and metabolism in the body. In particular, we highlight recent advances emphasizing the roles of the peripheral clocks located in the metabolic organs in regulating glucose, lipid, and protein homeostasis at the organismal and cellular levels. Experimental disruption of circadian system in rodents is associated with various metabolic disturbance phenotypes. Similarly, perturbation of the clockwork in humans is linked to the development of metabolic diseases. We discuss recent studies that reveal roles of the circadian system in the temporal coordination of metabolism under physiological conditions and in the development of human pathologies.
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Affiliation(s)
- Flore Sinturel
- Department of Medicine, Division of Endocrinology, Diabetes, Hypertension and Nutrition, Faculty of Medicine, University of Geneva, Rue Michel-Servet, 1, CH-1211, Geneva, 14, Switzerland; Department of Cell Physiology and Metabolism, Faculty of Medicine, University of Geneva, Geneva, Switzerland; Diabetes Center, Faculty of Medicine, University of Geneva, Geneva, Switzerland; Institute of Genetics and Genomics of Geneva (iGE3), University of Geneva, Geneva, Switzerland.
| | - Volodymyr Petrenko
- Department of Medicine, Division of Endocrinology, Diabetes, Hypertension and Nutrition, Faculty of Medicine, University of Geneva, Rue Michel-Servet, 1, CH-1211, Geneva, 14, Switzerland; Department of Cell Physiology and Metabolism, Faculty of Medicine, University of Geneva, Geneva, Switzerland; Diabetes Center, Faculty of Medicine, University of Geneva, Geneva, Switzerland; Institute of Genetics and Genomics of Geneva (iGE3), University of Geneva, Geneva, Switzerland
| | - Charna Dibner
- Department of Medicine, Division of Endocrinology, Diabetes, Hypertension and Nutrition, Faculty of Medicine, University of Geneva, Rue Michel-Servet, 1, CH-1211, Geneva, 14, Switzerland; Department of Cell Physiology and Metabolism, Faculty of Medicine, University of Geneva, Geneva, Switzerland; Diabetes Center, Faculty of Medicine, University of Geneva, Geneva, Switzerland; Institute of Genetics and Genomics of Geneva (iGE3), University of Geneva, Geneva, Switzerland.
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16
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Impaired Insulin Profiles Following a Single Night of Sleep Restriction: The Impact of Acute Sprint Interval Exercise. Int J Sport Nutr Exerc Metab 2019; 30:139–144. [PMID: 31816598 DOI: 10.1123/ijsnem.2019-0235] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 10/02/2019] [Accepted: 10/18/2019] [Indexed: 11/18/2022]
Abstract
Experimental sleep restriction (SR) has demonstrated reduced insulin sensitivity in healthy individuals. Exercise is well-known to be beneficial for metabolic health. A single bout of exercise has the capacity to increase insulin sensitivity for up to 2 days. Therefore, the current study aimed to determine if sprint interval exercise could attenuate the impairment in insulin sensitivity after one night of SR in healthy males. Nineteen males were recruited for this randomized crossover study which consisted of four conditions-control, SR, control plus exercise, and sleep restriction plus exercise. Time in bed was 8 hr (2300-0700) in the control conditions and 4 hr (0300-0700) in the SR conditions. Conditions were separated by a 1-week entraining period. Participants slept at home, and compliance was assessed using wrist actigraphy. Following the night of experimental sleep, participants either conducted sprint interval exercise or rested for the equivalent duration. An oral glucose tolerance test was then conducted. Blood samples were obtained at regular intervals for measurement of glucose and insulin. Insulin concentrations were higher in SR than control (p = .022). Late-phase insulin area under the curve was significantly lower in sleep restriction plus exercise than SR (862 ± 589 and 1,267 ± 558; p = .004). Glucose area under the curve was not different between conditions (p = .207). These findings suggest that exercise improves the late postprandial response following a single night of SR.
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17
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Juelich J, Lindseth G, Petros TV. The effects of sleep on neurobehavioral outcomes. Arch Psychiatr Nurs 2019; 33:51-57. [PMID: 31711594 DOI: 10.1016/j.apnu.2019.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 08/07/2019] [Accepted: 08/18/2019] [Indexed: 10/26/2022]
Affiliation(s)
- Janell Juelich
- 430 Oxford St, Stop 9025, University of North Dakota, Grand Forks, ND 58202-9025, United States of America.
| | - Glenda Lindseth
- 430 Oxford St, Stop 9025, University of North Dakota, Grand Forks, ND 58202-9025, United States of America.
| | - Thomas V Petros
- 430 Oxford St, Stop 9025, University of North Dakota, Grand Forks, ND 58202-9025, United States of America.
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18
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Zhu B, Shi C, Park CG, Zhao X, Reutrakul S. Effects of sleep restriction on metabolism-related parameters in healthy adults: A comprehensive review and meta-analysis of randomized controlled trials. Sleep Med Rev 2019; 45:18-30. [DOI: 10.1016/j.smrv.2019.02.002] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 01/26/2019] [Accepted: 02/04/2019] [Indexed: 12/19/2022]
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19
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So-Ngern A, Chirakalwasan N, Saetung S, Chanprasertyothin S, Thakkinstian A, Reutrakul S. Effects of Two-Week Sleep Extension on Glucose Metabolism in Chronically Sleep-Deprived Individuals. J Clin Sleep Med 2019; 15:711-718. [PMID: 31053213 DOI: 10.5664/jcsm.7758] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Accepted: 01/14/2019] [Indexed: 12/24/2022]
Abstract
STUDY OBJECTIVES Sleep deprivation is known to be associated with insulin resistance and diabetes risk. This study investigated whether 2-week sleep extension in chronically sleep-deprived individuals would improve glucose metabolism. METHODS A crossover study was conducted in volunteers without diabetes who reported sleeping ≤ 6 h/night. They were randomized to maintain their habitual sleep or extend sleep time for 2 weeks, then crossed over after a washout period. Sleep was monitored by actigraphy. Oral glucose tolerance tests (75 g) with insulin levels was performed at the end of each period. Mixed-effect linear regression analysis, adjusting for sequence and period effects, was applied. RESULTS A total of 21 participants (19 females) with mean (standard deviation) age of 33.1 (6.1) years completed the protocol. Mean sleep duration during habitual sleep was 318.7 (44.3) minutes and the participants extended their sleep by 36.0 (45.2) minutes during sleep extension. The average washout period was 21 (11) days. There were no significant effects of sleep extension on any metabolic parameters. The per-protocol analysis included eight participants who could sleep more than 6 hours during sleep extension (mean sleep duration 396 [25] minutes, extended by 60.1 [28.5] minutes). Among these individuals, sleep extension improved Homeostatic Model Assessment of Insulin Resistance (adjusted mean difference -0.50 [95% confidence interval [CI] -0.89, -0.11, P = .013]), early insulin secretion (insulinogenic index; mean difference 0.39 [95% CI 0.15, 0.63, P = .001]), and β-cell function (disposition index, mean difference 1.07 [95% CI 0.17, 1.97, P = .02]). CONCLUSIONS Sleep extension in chronically sleep-deprived individuals improved glucose metabolism in only those who could objectively extend their sleep to more than 6 h/night. Our findings suggest that a critical amount of sleep is needed to benefit metabolic outcomes.
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Affiliation(s)
- Apichart So-Ngern
- Division of Sleep Medicine, Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, 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
| | - Sunee Saetung
- Division of Endocrinology and Metabolism, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Suwannee Chanprasertyothin
- Research Center, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Ammarin Thakkinstian
- Section for Clinical Epidemiology and Biostatistics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Sirimon Reutrakul
- Division of Endocrinology and Metabolism, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.,Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of Illinois at Chicago, Chicago, Illinois
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20
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Abstract
Insulin resistance is a main determinant in the development of type 2 diabetes mellitus and a major cause of morbidity and mortality. The circadian timing system consists of a central brain clock in the hypothalamic suprachiasmatic nucleus and various peripheral tissue clocks. The circadian timing system is responsible for the coordination of many daily processes, including the daily rhythm in human glucose metabolism. The central clock regulates food intake, energy expenditure and whole-body insulin sensitivity, and these actions are further fine-tuned by local peripheral clocks. For instance, the peripheral clock in the gut regulates glucose absorption, peripheral clocks in muscle, adipose tissue and liver regulate local insulin sensitivity, and the peripheral clock in the pancreas regulates insulin secretion. Misalignment between different components of the circadian timing system and daily rhythms of sleep-wake behaviour or food intake as a result of genetic, environmental or behavioural factors might be an important contributor to the development of insulin resistance. Specifically, clock gene mutations, exposure to artificial light-dark cycles, disturbed sleep, shift work and social jet lag are factors that might contribute to circadian disruption. Here, we review the physiological links between circadian clocks, glucose metabolism and insulin sensitivity, and present current evidence for a relationship between circadian disruption and insulin resistance. We conclude by proposing several strategies that aim to use chronobiological knowledge to improve human metabolic health.
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Affiliation(s)
- Dirk Jan Stenvers
- Department of Endocrinology and Metabolism, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
| | - Frank A J L Scheer
- Division of Sleep Medicine, Harvard Medical School, Boston, MA, USA
- Medical Chronobiology Program, Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, MA, USA
| | - Patrick Schrauwen
- Department of Nutrition and Movement Sciences, NUTRIM, School for Nutrition and Translational Research in Metabolism, Maastricht University Medical Center, Maastricht, Netherlands
| | - Susanne E la Fleur
- Department of Endocrinology and Metabolism, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
- Laboratory for Endocrinology, Department of Clinical Chemistry, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
- Netherlands Institute for Neuroscience (NIN), Royal Dutch Academy of Arts and Sciences (KNAW), Amsterdam, Netherlands
| | - Andries Kalsbeek
- Department of Endocrinology and Metabolism, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands.
- Laboratory for Endocrinology, Department of Clinical Chemistry, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands.
- Netherlands Institute for Neuroscience (NIN), Royal Dutch Academy of Arts and Sciences (KNAW), Amsterdam, Netherlands.
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21
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Abdullah N, Murad NAA, Attia J, Oldmeadow C, Kamaruddin MA, Jalal NA, Ismail N, Jamal R, Scott RJ, Holliday EG. Differing Contributions of Classical Risk Factors to Type 2 Diabetes in Multi-Ethnic Malaysian Populations. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:E2813. [PMID: 30544761 PMCID: PMC6313591 DOI: 10.3390/ijerph15122813] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Revised: 12/03/2018] [Accepted: 12/04/2018] [Indexed: 12/12/2022]
Abstract
The prevalence of type 2 diabetes is escalating rapidly in Asian countries, with the rapid increase likely attributable to a combination of genetic and lifestyle factors. Recent research suggests that common genetic risk variants contribute minimally to the rapidly rising prevalence. Rather, recent changes in dietary patterns and physical activity may be more important. This nested case-control study assessed the association and predictive utility of type 2 diabetes lifestyle risk factors in participants from Malaysia, an understudied Asian population with comparatively high disease prevalence. The study sample comprised 4077 participants from The Malaysian Cohort project and included sub-samples from the three major ancestral groups: Malay (n = 1323), Chinese (n = 1344) and Indian (n = 1410). Association of lifestyle factors with type 2 diabetes was assessed within and across ancestral groups using logistic regression. Predictive utility was quantified and compared between groups using the Area Under the Receiver-Operating Characteristic Curve (AUC). In predictive models including age, gender, waist-to-hip ratio, physical activity, location, family history of diabetes and average sleep duration, the AUC ranged from 0.76 to 0.85 across groups and was significantly higher in Chinese than Malays or Indians, likely reflecting anthropometric differences. This study suggests that obesity, advancing age, a family history of diabetes and living in a rural area are important drivers of the escalating prevalence of type 2 diabetes in Malaysia.
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Affiliation(s)
- Noraidatulakma Abdullah
- School of Biomedical Sciences and Pharmacy, Faculty of Health and Medicine, University of Newcastle, Newcastle, New South Wales, 2308, Australia.
- UKM Medical Molecular Biology Institute (UMBI), Universiti Kebangsaan Malaysia, 56000, Kuala Lumpur, Malaysia.
| | - Nor Azian Abdul Murad
- UKM Medical Molecular Biology Institute (UMBI), Universiti Kebangsaan Malaysia, 56000, Kuala Lumpur, Malaysia.
| | - John Attia
- Clinical Research Design, IT and Statistical Support (CReDITSS) Unit, Hunter Medical Research Institute, Newcastle, New South Wales, 2305, Australia.
- Centre for Clinical Epidemiology and Biostatistics, School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Newcastle, New South Wales, 2308, Australia.
| | - Christopher Oldmeadow
- Clinical Research Design, IT and Statistical Support (CReDITSS) Unit, Hunter Medical Research Institute, Newcastle, New South Wales, 2305, Australia.
- Centre for Clinical Epidemiology and Biostatistics, School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Newcastle, New South Wales, 2308, Australia.
| | - Mohd Arman Kamaruddin
- UKM Medical Molecular Biology Institute (UMBI), Universiti Kebangsaan Malaysia, 56000, Kuala Lumpur, Malaysia.
| | - Nazihah Abd Jalal
- UKM Medical Molecular Biology Institute (UMBI), Universiti Kebangsaan Malaysia, 56000, Kuala Lumpur, Malaysia.
| | - Norliza Ismail
- UKM Medical Molecular Biology Institute (UMBI), Universiti Kebangsaan Malaysia, 56000, Kuala Lumpur, Malaysia.
| | - Rahman Jamal
- UKM Medical Molecular Biology Institute (UMBI), Universiti Kebangsaan Malaysia, 56000, Kuala Lumpur, Malaysia.
| | - Rodney J Scott
- School of Biomedical Sciences and Pharmacy, Faculty of Health and Medicine, University of Newcastle, Newcastle, New South Wales, 2308, Australia.
- Hunter Area Pathology Service, John Hunter Hospital, Newcastle, New South Wales, 2305, Australia.
| | - Elizabeth G Holliday
- Centre for Clinical Epidemiology and Biostatistics, School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Newcastle, New South Wales, 2308, Australia.
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22
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Wang X, Greer J, Porter RR, Kaur K, Youngstedt SD. Short-Term Moderate Sleep Restriction Decreases Insulin Sensitivity in Young Healthy Adults. Sleep Health 2018; 2:63-68. [PMID: 28819636 DOI: 10.1016/j.sleh.2015.11.004] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
CONTEXT AND PURPOSE The literature suggests that severe sleep loss of more than a few hours a night decreases glucose tolerance and insulin sensitivity. The aim of this study was to determine whether moderate sleep restriction had similar effects. METHODS Fifteen healthy non-obese (BMI=24.5±3.4 kg/m2) young adults (20.6±1.3 years) completed two 2-hour oral glucose tolerance tests (OGTT): one was after 3 days of time-in-bed restriction by 1-3 hours each night, and the other was after 3 days of ad libitum sleep. Glucose and insulin concentrations during OGTT, and fasting glucagon and cortisol concentrations were determined. The homeostasis model of insulin resistance (HOMA-IR), Matsuda index, and the quantitative insulin sensitivity check index (QUICKI) were calculated. RESULTS The total time-in-bed during the sleep restriction and the ad libitum phase was 5.98±0.76 and 7.98±0.54 hours/day, and total sleep time was 5.16±0.49 and 6.65±0.64 hours/day, respectively. Glucose concentrations before and 30, 60, 90, and 120 minutes following consumption of glucose and area under the curve were not different for the two OGTT (p > 0.10 for all). Insulin concentration at fasting and area under the curve during the OGTT were significantly higher (p = 0.034 and 0.038, respectively) following restricted sleep than following ad libitum sleep. Fasting glucagon concentration was also higher (p = 0.003). The HOMA-IR, Matsuda index, and QUICKI all suggested decreased insulin sensitivity following restricted sleep. CONCLUSION Short-term moderate sleep restriction reduced insulin sensitivity compared to ad libitum sleep in this group of healthy young adults.
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Affiliation(s)
- Xuewen Wang
- Exercise Science, University of South Carolina, Columbia, SC, USA.
| | - Julian Greer
- Exercise Science, University of South Carolina, Columbia, SC, USA
| | - Ryan R Porter
- Exercise Science, University of South Carolina, Columbia, SC, USA
| | - Kamaljeet Kaur
- Exercise Science, University of South Carolina, Columbia, SC, USA
| | - Shawn D Youngstedt
- College of Nursing and Health Innovation and College of Health Solutions, Arizona State University, Phoenix, AZ, USA
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Abstract
Leptin is a peptide hormone produced mainly in white adipose tissue. It is known to regulate energy homeostasis, inflammation, metabolism, and sympathetic nerve activity. Increasing evidence suggests it has a role in ventilatory function and upper airway obstruction. Leptin levels correlate positively with measurements of adiposity and can potentially provide important insights into the pathophysiology of diseases associated with obesity. Obesity is a strong risk factor for obstructive sleep apnea, a disease characterized by periodic upper airway occlusion during sleep. The neuromuscular activity that maintains upper airway patency during sleep and the anatomy of upper airway are key factors involved in its pathogenesis. Experimental studies using animal models of a low leptin state such as leptin deficiency have shown that leptin regulates sleep architecture, upper airway patency, ventilatory function, and hypercapnic ventilatory response. However, findings from human studies do not consistently support the data from the animal models. The effect of leptin on the pathophysiology of obstructive sleep apnea is being investigated, but the results of studies have been confounded by leptin's diurnal variation and the short-term effects of feeding, adiposity, age, and sex. Improved study design and methods of assessing functional leptin levels, specifically their central versus peripheral effects, will improve understanding of the role of leptin in sleep apnea.
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24
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Reutrakul S, Van Cauter E. Sleep influences on obesity, insulin resistance, and risk of type 2 diabetes. Metabolism 2018; 84:56-66. [PMID: 29510179 DOI: 10.1016/j.metabol.2018.02.010] [Citation(s) in RCA: 244] [Impact Index Per Article: 40.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Revised: 02/18/2018] [Accepted: 02/27/2018] [Indexed: 12/25/2022]
Abstract
A large body of epidemiologic evidence has linked insufficient sleep duration and quality to the risk of obesity, insulin resistance and type 2 diabetes. To address putative causal mechanisms, this review focuses on laboratory interventions involving several nights of experimental sleep restriction, fragmentation or extension and examining metabolically relevant outcomes. Sleep restriction has been consistently shown to increase hunger, appetite and food intake, with the increase in caloric intake in excess of the energy requirements of extended wakefulness. Findings regarding decreases in hormones promoting satiety or increases in hormones promoting hunger have been less consistent, possibly because of confounding effects of changes in adiposity when energy intake was not controlled and sampling protocols that did not cover the entire 24-h cycle. Imaging studies revealed alterations in neuronal activity of brain regions involved in food reward. An adverse impact of experimental sleep restriction on insulin resistance, leading to reduced glucose tolerance and increased diabetes risk, has been well-documented. There is limited evidence indicating that sleep fragmentation without reduction in sleep duration also results in a reduction in insulin sensitivity. The adverse metabolic outcomes of sleep disturbances appear to involve multiple mechanistic pathways acting in concert. Emerging evidence supports the benefits of behavioral, but not pharmacological, sleep extension on appetite and glucose metabolism. Further research should focus on the feasibility and efficacy of strategies to optimize sleep duration and quality on obesity and diabetes risk in at-risk populations as well as those with established diseases. Further work is needed to identify mechanistic pathways.
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Affiliation(s)
- Sirimon Reutrakul
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of Illinois at Chicago, Chicago, IL, USA.
| | - Eve Van Cauter
- The Section of Adult and Pediatric Endocrinology, Diabetes and Metabolism and Sleep, Metabolism and Health Center, Department of Medicine, The University of Chicago, Chicago, IL, USA
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25
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Pizinger TM, Aggarwal B, St-Onge MP. Sleep Extension in Short Sleepers: An Evaluation of Feasibility and Effectiveness for Weight Management and Cardiometabolic Disease Prevention. Front Endocrinol (Lausanne) 2018; 9:392. [PMID: 30072950 PMCID: PMC6058021 DOI: 10.3389/fendo.2018.00392] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Accepted: 06/25/2018] [Indexed: 01/28/2023] Open
Abstract
Sleep duration has become increasingly recognized as an important influencer of health. Epidemiologic and observational studies have shown associations between short sleep duration and increased risk for chronic cardiometabolic disorders, including obesity, type 2 diabetes, and cardiovascular disease. These associations have led to investigations into the potential causal pathways through which short sleep may increase risk for these disorders. Clinical intervention studies have demonstrated that restricting sleep in normal sleepers has adverse health effects, including insulin resistance, and increased blood pressure. The totality of evidence points to negative health effects of short sleep and the recognition of sleep as a lifestyle behavior that may be targeted for disease prevention. It is well established that consistent, adequate sleep is associated with the lowest risk of obesity and cardiometabolic disorders. Yet, it is unclear whether increasing sleep in short sleepers can improve health. In today's society, it is common for individuals to deprive themselves of sleep during the work week, with the intent to sleep longer during the weekend, or have "catch-up sleep." Studies that have examined the health effects of extended sleep, post-sleep restriction, revealed some improvements in health outcomes. However, it is uncertain whether the improvements observed with catch-up sleep are sufficient to reverse the negative health effects of constant sleep restriction. Few intervention studies have been undertaken to determine whether extending sleep, long-term, in short sleepers is feasible and whether it can reduce the disease risk burden associated with short sleep duration. The purpose of this review is to highlight these studies and evaluate information related to the impact of sleep extension on risk factors for chronic cardiometabolic disorders. We discuss limitations of current research, including variability in participant characteristics and the extent to which sleep behaviors are modified and monitored. Although the evidence-base for benefits of sleep extension is still in the early stages, studies to date indicate that prolonging sleep, in short sleepers, may improve cardiometabolic risk. Finally, our review calls attention to areas that require further study and for larger scale studies of behavior modification to establish the health effects of sleep extension in short sleepers.
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Affiliation(s)
- Theresa M. Pizinger
- Division of Endocrinology, Department of Medicine, New York Obesity Nutrition Research Center, Columbia University Medical Center, New York, NY, United States
| | - Brooke Aggarwal
- Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, NY, United States
| | - Marie-Pierre St-Onge
- Division of Endocrinology, Department of Medicine, New York Obesity Nutrition Research Center, Columbia University Medical Center, New York, NY, United States
- Institute of Human Nutrition, Columbia University Medical Center, New York, NY, United States
- *Correspondence: Marie-Pierre St-Onge
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26
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LeBlanc ES, Smith NX, Nichols GA, Allison MJ, Clarke GN. Insomnia is associated with an increased risk of type 2 diabetes in the clinical setting. BMJ Open Diabetes Res Care 2018; 6:e000604. [PMID: 30687505 PMCID: PMC6326337 DOI: 10.1136/bmjdrc-2018-000604] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Revised: 10/31/2018] [Accepted: 11/27/2018] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVE To determine the possible association between insomnia and risk of type 2 diabetes mellitus (T2DM) in the naturalistic clinical setting. RESEARCH DESIGN AND METHODS We conducted a retrospective cohort study to examine the risk of developing T2DM among patients with pre-diabetes with and without insomnia. Participants with pre-diabetes (identified by a physician or via two laboratory tests) between January 1, 2007 and December 31, 2015 and without sleep apnea were followed until December 31, 2016. Patients were determined to have T2DM when two of the following occurred within a 2-year window: physician-entered outpatient T2DM diagnosis (International Classification of Diseases [ICD]-9 250.00; ICD-10 E11), dispensing of an antihyperglycemia agent, and hemoglobin A1c (A1c) >6.5% (48 mmol/mol) or fasting plasma glucose (FPG) >125 mg/dL. One hospital inpatient stay with an associated T2DM diagnosis was also sufficient for classification of T2DM. RESULTS Our cohort consisted of 81 233 persons with pre-diabetes, 24 146 (29.7%) of whom had insomnia at some point during the 4.3-year average observation period. After adjustment for traditional risk factors, those with insomnia were 28% more likely to develop T2DM than those without insomnia (HR 1.28; 95% CI 1.24 to 1.33). The estimate was essentially unchanged after adjusting for baseline A1c level (HR 1.32; 95% CI 1.25 to 1.40) or FPG (HR 1.28; 95% CI 1.23 to 1.33). CONCLUSIONS Insomnia imparts an increased risk of T2DM comparable with that conferred by traditional risk factors (eg, overweight, non-white race, cardiovascular risk factors). This association could have clinical importance because it suggests a new potentially modifiable risk factor that could be targeted to prevent diabetes.
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Affiliation(s)
- Erin S LeBlanc
- Science Program Department, Kaiser Permanente Center for Health Research NW, Portland, Oregon, USA
| | - Ning X Smith
- Science Program Department, Kaiser Permanente Center for Health Research NW, Portland, Oregon, USA
| | - Gregory A Nichols
- Science Program Department, Kaiser Permanente Center for Health Research NW, Portland, Oregon, USA
| | - Michael J Allison
- Science Program Department, Kaiser Permanente Center for Health Research NW, Portland, Oregon, USA
| | - Gregory N Clarke
- Science Program Department, Kaiser Permanente Center for Health Research NW, Portland, Oregon, USA
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van Leeuwen WMA, Sallinen M, Virkkala J, Lindholm H, Hirvonen A, Hublin C, Porkka-Heiskanen T, Härmä M. Physiological and autonomic stress responses after prolonged sleep restriction and subsequent recovery sleep in healthy young men. Sleep Biol Rhythms 2017; 16:45-54. [PMID: 29367834 PMCID: PMC5754428 DOI: 10.1007/s41105-017-0122-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Accepted: 09/05/2017] [Indexed: 02/06/2023]
Abstract
Purpose Sleep restriction is increasingly common and associated with the development of health problems. We investigated how the neuroendocrine stress systems respond to prolonged sleep restriction and subsequent recovery sleep in healthy young men. Methods After two baseline (BL) nights of 8 h time in bed (TIB), TIB was restricted to 4 h per night for five nights (sleep restriction, SR, n = 15), followed by three recovery nights (REC) of 8 h TIB, representing a busy workweek and a recovery weekend. The control group (n = 8) had 8 h TIB throughout the experiment. A variety of autonomic cardiovascular parameters, together with salivary neuropeptide Y (NPY) and cortisol levels, were assessed. Results In the control group, none of the parameters changed. In the experimental group, heart rate increased from 60 ± 1.8 beats per minute (bpm) at BL, to 63 ± 1.1 bpm after SR and further to 65 ± 1.8 bpm after REC. In addition, whole day low-frequency to-high frequency (LF/HF) power ratio of heart rate variability increased from 4.6 ± 0.4 at BL to 6.0 ± 0.6 after SR. Other parameters, including salivary NPY and cortisol levels, remained unaffected. Conclusions Increased heart rate and LF/HF power ratio are early signs of an increased sympathetic activity after prolonged sleep restriction. To reliably interpret the clinical significance of these early signs of physiological stress, a follow-up study would be needed to evaluate if the stress responses escalate and lead to more unfavourable reactions, such as elevated blood pressure and a subsequent elevated risk for cardiovascular health problems.
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Affiliation(s)
- Wessel M A van Leeuwen
- 1Department of Physiology, Medicum, University of Helsinki, PO Box 63, 00014 Helsinki, Finland.,2Centre of Expertise for the Development of Work and Organizations, Finnish Institute of Occupational Health, Topeliuksenkatu 41 a A 00250 Helsinki, Finland.,3Division for Sleep and Alertness Research, Stress Research Institute, Stockholm University, 10691 Stockholm, Sweden
| | - Mikael Sallinen
- 2Centre of Expertise for the Development of Work and Organizations, Finnish Institute of Occupational Health, Topeliuksenkatu 41 a A 00250 Helsinki, Finland.,4Agora Centre, University of Jyväskylä, PO Box 35, 40014 Jyväskylä, Finland
| | - Jussi Virkkala
- 2Centre of Expertise for the Development of Work and Organizations, Finnish Institute of Occupational Health, Topeliuksenkatu 41 a A 00250 Helsinki, Finland.,5Department of Clinical Neurophysiology, Medical Imaging Centre, Pirkanmaa Hospital District, PO Box 2000, 33521 Tampere, Finland
| | - Harri Lindholm
- 6Centre of Expertise for Health and Work Ability, Finnish Institute of Occupational Health, Topeliuksenkatu 41 a A 00250 Helsinki, Finland
| | - Ari Hirvonen
- 6Centre of Expertise for Health and Work Ability, Finnish Institute of Occupational Health, Topeliuksenkatu 41 a A 00250 Helsinki, Finland
| | - Christer Hublin
- 2Centre of Expertise for the Development of Work and Organizations, Finnish Institute of Occupational Health, Topeliuksenkatu 41 a A 00250 Helsinki, Finland
| | - Tarja Porkka-Heiskanen
- 1Department of Physiology, Medicum, University of Helsinki, PO Box 63, 00014 Helsinki, Finland
| | - Mikko Härmä
- 2Centre of Expertise for the Development of Work and Organizations, Finnish Institute of Occupational Health, Topeliuksenkatu 41 a A 00250 Helsinki, Finland
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28
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The Impact of Shiftwork on Skeletal Muscle Health. Nutrients 2017; 9:nu9030248. [PMID: 28282858 PMCID: PMC5372911 DOI: 10.3390/nu9030248] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Revised: 02/26/2017] [Accepted: 03/03/2017] [Indexed: 01/11/2023] Open
Abstract
(1) Background: About one in four workers undertake shift rosters that fall outside the traditional 7 a.m.-6 p.m. scheduling. Shiftwork alters workers' exposure to natural and artificial light, sleep patterns, and feeding patterns. When compared to the rest of the working population, shiftworkers are at a greater risk of developing metabolic impairments over time. One fundamental component of metabolic health is skeletal muscle, the largest organ in the body. However, cause-and-effect relationships between shiftwork and skeletal muscle health have not been established; (2) Methods: A critical review of the literature was completed using online databases and reference lists; (3) Results: We propose a conceptual model drawing relationships between typical shiftwork consequences; altered light exposure, sleep patterns, and food and beverage consumption, and drivers of skeletal muscle health-protein intake, resistance training, and hormone release. At present, there is no study investigating the direct effect of shiftwork on skeletal muscle health. Instead, research findings showing that acute consequences of shiftwork negatively influence skeletal muscle homeostasis support the validity of our model; (4) Conclusion: Further research is required to test the potential relationships identified in our review, particularly in shiftwork populations. Part of this testing could include skeletal muscle specific interventions such as targeted protein intake and/or resistance-training.
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29
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Restless legs syndrome and cardiovascular disease: a research roadmap. Sleep Med 2016; 31:10-17. [PMID: 28065687 DOI: 10.1016/j.sleep.2016.08.008] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Revised: 08/30/2016] [Accepted: 08/31/2016] [Indexed: 12/14/2022]
Abstract
In this paper, we first critically appraise the epidemiologic literature examining the association of restless legs syndrome (RLS) with cardiovascular disease (CVD) and then consider whether lessons learned from the study of cardiovascular consequences of other sleep disorders might inform a research agenda to examine the potential mechanisms of cardiovascular morbidity of RLS. Cross-sectional and longitudinal studies are both mixed as to whether there is a meaningful association of RLS and CVD. On the other hand, numerous cross-sectional and longitudinal observational studies have shown a strong association of obstructive sleep apnea (OSA) with CVD risk. Each of the potential mediating mechanisms in OSA may also be assessed in RLS, including 1) neural mechanisms such as increased central sympathetic outflow, impaired baroreflex function, diminished heart rate and blood pressure variability, and increased chemoreflex sensitivity, 2) metabolic mechanisms such as glucose intolerance and reduced insulin sensitivity/diabetes as a result of sleep disturbance in RLS, 3) oxidative stress, 4) systemic or vascular inflammatory mechanisms, and 5) vascular mechanisms including impaired endothelial functioning, increased aortic stiffness, hypothalamic-pituitary axis activation or renin-angiotensin-aldosterone activation. Three known characteristics of RLS may contribute to these specific mechanisms of increased cardiovascular risk: 1) periodic limb movements of sleep, which are associated with large increases in heart rate and blood pressure, 2) sleep fragmentation and sleep deprivation, which are known to produce adverse consequences for neural, metabolic, oxidative, inflammatory, and vascular systems, and 3) iron deficiency, which is an emerging risk for cardiovascular disease. Future research priorities include additional epidemiologic studies which characterize multiple CVD risk factors, case-control studies which examine known markers of cardiovascular risk, and small clinical trials which assess the effects of RLS treatment on intermediate physiological markers such as sympathetic activity or baroreflex control, measures of vascular stiffness and reactivity, or measures of insulin sensitivity and glucose tolerance.
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30
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St-Onge MP, Grandner MA, Brown D, Conroy MB, Jean-Louis G, Coons M, Bhatt DL. Sleep Duration and Quality: Impact on Lifestyle Behaviors and Cardiometabolic Health: A Scientific Statement From the American Heart Association. Circulation 2016; 134:e367-e386. [PMID: 27647451 DOI: 10.1161/cir.0000000000000444] [Citation(s) in RCA: 536] [Impact Index Per Article: 67.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Sleep is increasingly recognized as an important lifestyle contributor to health. However, this has not always been the case, and an increasing number of Americans choose to curtail sleep in favor of other social, leisure, or work-related activities. This has resulted in a decline in average sleep duration over time. Sleep duration, mostly short sleep, and sleep disorders have emerged as being related to adverse cardiometabolic risk, including obesity, hypertension, type 2 diabetes mellitus, and cardiovascular disease. Here, we review the evidence relating sleep duration and sleep disorders to cardiometabolic risk and call for health organizations to include evidence-based sleep recommendations in their guidelines for optimal health.
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31
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Juul KV, Jessen N, Bliwise DL, van der Meulen E, Nørgaard JP. Delaying time to first nocturnal void may have beneficial effects on reducing blood glucose levels. Endocrine 2016; 53:722-9. [PMID: 27003433 DOI: 10.1007/s12020-016-0920-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Accepted: 03/09/2016] [Indexed: 11/29/2022]
Abstract
Experimental studies disrupting sleep and epidemiologic studies of short sleep durations indicate the importance of deeper and longer sleep for cardiometabolic health. We examined the potential beneficial effects of lengthening the first uninterrupted sleep period (FUSP) on blood glucose. Long-term data (≥3 months of treatment) were derived from three clinical trials, testing low-dose (10-100 µg) melt formulations of desmopressin in 841 male and female nocturia patients (90 % of which had nocturnal polyuria). We performed post hoc multiple regression with non-fasting blood glucose as dependent variable and the following potential covariates/factors: time-averaged change of FUSP since baseline, age, gender, race, ethnicity, baseline glucose, baseline weight, change in weight, patient metabolic status (normal, metabolic syndrome, type II diabetes), dose, follow-up interval, and time of random glucose sampling. Increases in FUSP resulted in statistically significant reductions in blood glucose (p = 0.0131), even after controlling for all remaining covariates. Per hour increase in time to first void was associated with glucose decreases of 1.6 mg/dL. This association was more pronounced in patients with increased baseline glucose levels (test of baseline glucose by FUSP change interaction: p < 0.0001). Next to FUSP change, other statistically significant confounding factors/covariates also associated with glucose changes were gender, ethnicity, metabolic subgroup, and baseline glucose. These analyses indicate that delaying time to first void may have beneficial effects on reducing blood glucose in nocturia patients. These data are among the first to suggest that improving sleep may have salutary effects on a cardiometabolic measure.
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Affiliation(s)
- Kristian Vinter Juul
- Faculty of Medicine and Health Sciences, University of Ghent, 9000, Ghent, Belgium.
| | - Niels Jessen
- Department for Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Donald L Bliwise
- Program in Sleep, Aging and Chronobiology, Emory University School of Medicine, Atlanta, GA, USA
| | | | - Jens Peter Nørgaard
- Faculty of Medicine and Health Sciences, University of Ghent, 9000, Ghent, Belgium
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32
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Chennaoui M, Arnal PJ, Drogou C, Sauvet F, Gomez-Merino D. Sleep extension increases IGF-I concentrations before and during sleep deprivation in healthy young men. Appl Physiol Nutr Metab 2016; 41:963-70. [DOI: 10.1139/apnm-2016-0110] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Sleep deprivation is known to suppress circulating trophic factors such as insulin-like growth factor (IGF)-I and brain-derived neurotrophic factor (BDNF). This experiment examined the effect of an intervention involving 6 nights of extended sleep before total sleep deprivation on this catabolic profile. In a randomized crossover design, 14 young men (age range: 26–37 years) were either in an extended (EXT; time in bed: 2100–0700 h) or habitual (HAB: 2230–0700 h) sleep condition, followed by 3 days in the laboratory with blood sampling at baseline (B), after 24 h of sleep deprivation (24h-SD), and after 1 night of recovery sleep (R). In the EXT condition compared with the HAB condition, free IGF-I levels were significantly higher at B, 24h-SD, and R (P < 0.001), and those of total IGF-I at B and 24h-SD (P < 0.05). EXT did not influence growth hormone, IGF binding protein 3, BDNF, insulin, and glucose levels. The only effect of 24 h of sleep deprivation was for insulin levels, which were significantly higher after R compared with B. In a healthy adult, additional sleep over 1 week increased blood concentrations of the anabolic factor IGF-I before and during 24 h of sleep deprivation and after the subsequent recovery night without effects on BDNF. With further research, these findings may prove to be important in guiding effective lifestyle modifications to limit physical or cognitive deficits associated with IGF-I decrease with age.
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Affiliation(s)
- Mounir Chennaoui
- French Armed Forces Biomedical Research Institute (IRBA), Neurosciences et Contraintes Opérationnelles, Brétigny sur Orge cedex, France
- Université Paris Descartes, Hôtel Dieu, EA7330 VIFASOM (Vigilance Fatigue et Sommeil), Paris, France
| | - Pierrick J. Arnal
- French Armed Forces Biomedical Research Institute (IRBA), Neurosciences et Contraintes Opérationnelles, Brétigny sur Orge cedex, France
- Université Paris Descartes, Hôtel Dieu, EA7330 VIFASOM (Vigilance Fatigue et Sommeil), Paris, France
- Laboratoire de Physiologie de l’Exercice, Université de Lyon, 42000 Saint Etienne, France
| | - Catherine Drogou
- French Armed Forces Biomedical Research Institute (IRBA), Neurosciences et Contraintes Opérationnelles, Brétigny sur Orge cedex, France
- Université Paris Descartes, Hôtel Dieu, EA7330 VIFASOM (Vigilance Fatigue et Sommeil), Paris, France
| | - Fabien Sauvet
- French Armed Forces Biomedical Research Institute (IRBA), Neurosciences et Contraintes Opérationnelles, Brétigny sur Orge cedex, France
- Université Paris Descartes, Hôtel Dieu, EA7330 VIFASOM (Vigilance Fatigue et Sommeil), Paris, France
| | - Danielle Gomez-Merino
- French Armed Forces Biomedical Research Institute (IRBA), Neurosciences et Contraintes Opérationnelles, Brétigny sur Orge cedex, France
- Université Paris Descartes, Hôtel Dieu, EA7330 VIFASOM (Vigilance Fatigue et Sommeil), Paris, France
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33
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Perfect MM, Beebe D, Levine-Donnerstein D, Frye SS, Bluez GP, Quan SF. The Development of a Clinically Relevant Sleep Modification Protocol for Youth with Type 1 Diabetes. CLINICAL PRACTICE IN PEDIATRIC PSYCHOLOGY 2016; 4:227-240. [PMID: 27747146 DOI: 10.1037/cpp0000145] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Findings from type 2 diabetes research indicate that sleep is both a predictor of onset and a correlate of disease progression. However, the role sleep plays in glucose regulation and daytime functioning in youth with type 1 diabetes mellitus (T1DM) has not been systematically investigated. Nonetheless, preliminary findings have supported that various sleep parameters are strongly correlated to health-related and neurobehavioral outcomes in youth with T1DM. This suggests that improving sleep might reduce morbidity. A critical step in developing evidence-based guidelines regarding sleep in diabetes management is to first determine that sleep modification in natural settings is possible (i.e., instructing youth to have a healthy sleep opportunity leads to more total sleep time) and that an increased sleep duration impacts disease and psychosocial outcomes in these youth. This article describes the background, design, and feasibility of an ongoing randomized clinical trial that aims to examine if increasing sleep relative to youth's own sleep routines affects glucose control and daytime functioning.
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Affiliation(s)
- Michelle M Perfect
- Disability and Psychoeducational Studies, University of Arizona, Tucson, AZ
| | - Dean Beebe
- Department of Pediatrics, Cincinnati's Children's Hospital Medical Center, Cincinnati, OH
| | | | - Sara S Frye
- Disability and Psychoeducational Studies, University of Arizona, Tucson, AZ
| | - Grai P Bluez
- Disability and Psychoeducational Studies, University of Arizona, Tucson, AZ
| | - Stuart F Quan
- Arizona Respiratory Center, University of Arizona, Tucson, AZ; Division of Sleep Medicine, Harvard Medical School, Boston, MA
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Aho V, Ollila HM, Kronholm E, Bondia-Pons I, Soininen P, Kangas AJ, Hilvo M, Seppälä I, Kettunen J, Oikonen M, Raitoharju E, Hyötyläinen T, Kähönen M, Viikari JSA, Härmä M, Sallinen M, Olkkonen VM, Alenius H, Jauhiainen M, Paunio T, Lehtimäki T, Salomaa V, Orešič M, Raitakari OT, Ala-Korpela M, Porkka-Heiskanen T. Prolonged sleep restriction induces changes in pathways involved in cholesterol metabolism and inflammatory responses. Sci Rep 2016; 6:24828. [PMID: 27102866 PMCID: PMC4840329 DOI: 10.1038/srep24828] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2015] [Accepted: 04/05/2016] [Indexed: 12/22/2022] Open
Abstract
Sleep loss and insufficient sleep are risk factors for cardiometabolic diseases, but data on how insufficient sleep contributes to these diseases are scarce. These questions were addressed using two approaches: an experimental, partial sleep restriction study (14 cases and 7 control subjects) with objective verification of sleep amount, and two independent epidemiological cohorts (altogether 2739 individuals) with questions of sleep insufficiency. In both approaches, blood transcriptome and serum metabolome were analysed. Sleep loss decreased the expression of genes encoding cholesterol transporters and increased expression in pathways involved in inflammatory responses in both paradigms. Metabolomic analyses revealed lower circulating large HDL in the population cohorts among subjects reporting insufficient sleep, while circulating LDL decreased in the experimental sleep restriction study. These findings suggest that prolonged sleep deprivation modifies inflammatory and cholesterol pathways at the level of gene expression and serum lipoproteins, inducing changes toward potentially higher risk for cardiometabolic diseases.
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Affiliation(s)
- Vilma Aho
- Department of Physiology, Faculty of Medicine, University of Helsinki, Finland
| | - Hanna M Ollila
- Department of Physiology, Faculty of Medicine, University of Helsinki, Finland
- Genomics and Biomarkers unit and Institute for Molecular Medicine FIMM, National Institute for Health and Welfare, Helsinki, Finland
- Department of Psychiatry, University of Helsinki and Helsinki University Hospital, Finland
- Stanford University Center for Sleep Sciences, Palo Alto, CA, USA
| | - Erkki Kronholm
- Department of Chronic Disease Prevention, Population Studies Unit, National Institute for Health and Welfare, Turku, Finland
| | - Isabel Bondia-Pons
- VTT Technical Research Centre of Finland, Espoo, Finland
- Steno Diabetes Center A/S, Gentofte, Denmark
| | - Pasi Soininen
- Computational Medicine, Institute of Health Sciences, University of Oulu, Oulu, Finland
- NMR Metabolomics Laboratory, School of Pharmacy, University of Eastern Finland, Kuopio, Finland
| | - Antti J Kangas
- Computational Medicine, Institute of Health Sciences, University of Oulu, Oulu, Finland
| | - Mika Hilvo
- VTT Technical Research Centre of Finland, Espoo, Finland
| | - Ilkka Seppälä
- Department of Clinical Chemistry, Fimlab Laboratories, and University of Tampere, School of Medicine, Tampere, Finland
| | - Johannes Kettunen
- Genomics and Biomarkers unit and Institute for Molecular Medicine FIMM, National Institute for Health and Welfare, Helsinki, Finland
- Computational Medicine, Institute of Health Sciences, University of Oulu, Oulu, Finland
- NMR Metabolomics Laboratory, School of Pharmacy, University of Eastern Finland, Kuopio, Finland
| | - Mervi Oikonen
- Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland
| | - Emma Raitoharju
- Department of Clinical Chemistry, Fimlab Laboratories, and University of Tampere, School of Medicine, Tampere, Finland
| | - Tuulia Hyötyläinen
- VTT Technical Research Centre of Finland, Espoo, Finland
- Steno Diabetes Center A/S, Gentofte, Denmark
| | - Mika Kähönen
- Department of Clinical Physiology, University of Tampere and Tampere University Hospital, Tampere, Finland
| | - Jorma S A Viikari
- Department of Medicine, University of Turku, and Division of Medicine, Turku University Hospital, Turku, Finland
| | - Mikko Härmä
- Brain and Work Research Centre, Finnish Institute of Occupational Health, Helsinki, Finland
| | - Mikael Sallinen
- Brain and Work Research Centre, Finnish Institute of Occupational Health, Helsinki, Finland
- Agora Center, University of Jyväskylä, Jyväskylä, Finland
| | - Vesa M Olkkonen
- Minerva Foundation Institute for Medical Research, Helsinki, Finland
- Institute of Biomedicine, Anatomy, University of Helsinki, Finland
| | - Harri Alenius
- Unit of Excellence for Immunotoxicology, Finnish Institute of Occupational Health, Helsinki, Finland
| | - Matti Jauhiainen
- Genomics and Biomarkers unit and Institute for Molecular Medicine FIMM, National Institute for Health and Welfare, Helsinki, Finland
| | - Tiina Paunio
- Genomics and Biomarkers unit and Institute for Molecular Medicine FIMM, National Institute for Health and Welfare, Helsinki, Finland
- Department of Psychiatry, University of Helsinki and Helsinki University Hospital, Finland
| | - Terho Lehtimäki
- Department of Clinical Chemistry, Fimlab Laboratories, and University of Tampere, School of Medicine, Tampere, Finland
| | - Veikko Salomaa
- Department of Chronic Disease Prevention, National Institute for Health and Welfare, Helsinki, Finland
| | - Matej Orešič
- VTT Technical Research Centre of Finland, Espoo, Finland
- Steno Diabetes Center A/S, Gentofte, Denmark
| | - Olli T Raitakari
- Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland
- Department of Clinical Physiology and Nuclear Medicine, Turku University Hospital, Turku, Finland
| | - Mika Ala-Korpela
- Computational Medicine, Institute of Health Sciences, University of Oulu, Oulu, Finland
- NMR Metabolomics Laboratory, School of Pharmacy, University of Eastern Finland, Kuopio, Finland
- Oulu University Hospital, Oulu, Finland
- Computational Medicine, School of Social and Community Medicine &Medical Research Council Integrative Epidemiology Unit, University of Bristol, Bristol, United Kingdom
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Olson CA, Hamilton NA, Somers VK. Percentage of REM sleep is associated with overnight change in leptin. J Sleep Res 2016; 25:419-25. [PMID: 26919408 DOI: 10.1111/jsr.12394] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Accepted: 01/09/2016] [Indexed: 12/21/2022]
Abstract
Sleep contributes importantly to energy homeostasis, and may impact hormones regulating appetite, such as leptin, an adipocyte-derived hormone. There is increasing evidence that sleep duration, and reduced rapid eye movement sleep, are linked to obesity. Leptin has central neural effects beyond modulation of appetite alone. As sleep is not a unifrom process, interactions between leptin and sleep stages including rapid eye movement sleep may play a role in the relationship between sleep and obesity. This study examined the relationship between serum leptin and rapid eye movement sleep in a sample of healthy adults. Participants were 58 healthy adults who underwent polysomnography. Leptin was measured before and after sleep. It was hypothesized that a lower percentage of rapid eye movement sleep would be related to lower leptin levels during sleep. The relationship between percentage of rapid eye movement sleep and leptin was analysed using hierarchical linear regression. An increased percentage of rapid eye movement sleep was related to a greater reduction in leptin during sleep even when controlling for age, gender, percent body fat and total sleep time. A greater percentage of rapid eye movement sleep was accompanied by more marked reductions in leptin. Studies examining the effects of selective rapid eye movement sleep deprivation on leptin levels, and hence on energy homeostasis in humans, are needed.
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Affiliation(s)
- Christy A Olson
- Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA.,Department of Psychiatry and Human Behavior, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Nancy A Hamilton
- Department of Psychology, University of Kansas, Lawrence, KS, USA
| | - Virend K Somers
- Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
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Abstract
Inadequate sleep is increasingly pervasive, and the impact on health remains to be fully understood. The cardiovascular consequences alone appear to be substantial. This review summarizes epidemiologic evidence regarding the association between extremes of sleep duration and the prevalence and incidence of cardiovascular diseases. The adverse effects of experimental sleep loss on physiological functions are discussed, along with cardiovascular risk factors that may underlie the association with increased morbidity and mortality. Current data support the concept that inadequate sleep duration confers heightened cardiovascular risk. Thus implementation of preventative strategies may reduce the potential disease burden associated with this high-risk behavior.
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Affiliation(s)
- Naima Covassin
- Division of Cardiovascular Diseases, Mayo Clinic, 200 First Street, Rochester, MN 55905, USA.
| | - Prachi Singh
- Division of Cardiovascular Diseases, Mayo Clinic, 200 First Street, Rochester, MN 55905, USA
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Broussard JL, Kilkus JM, Delebecque F, Abraham V, Day A, Whitmore HR, Tasali E. Elevated ghrelin predicts food intake during experimental sleep restriction. Obesity (Silver Spring) 2016; 24:132-8. [PMID: 26467988 PMCID: PMC4688118 DOI: 10.1002/oby.21321] [Citation(s) in RCA: 101] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Revised: 08/03/2015] [Accepted: 08/05/2015] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Sleep curtailment has been linked to obesity, but underlying mechanisms remain to be elucidated. This study assessed whether sleep restriction alters 24-h profiles of appetite-regulating hormones ghrelin, leptin, and pancreatic polypeptide during a standardized diet and whether these hormonal alterations predict food intake during ad libitum feeding. METHODS Nineteen healthy, lean men were studied under normal sleep and sleep restriction in a randomized crossover design. Blood samples were collected for 24 h during standardized meals. Subsequently, participants had an ad libitum feeding opportunity (buffet meals and snacks) and caloric intake was measured. RESULTS Ghrelin levels were increased after sleep restriction as compared with normal sleep (P < 0.01). Overall, sleep restriction did not alter leptin or pancreatic polypeptide profiles. Sleep restriction was associated with an increase in total calories from snacks by 328 ± 140 kcal (P = 0.03), primarily from carbohydrates (P = 0.02). The increase in evening ghrelin during sleep restriction was correlated with higher consumption of calories from sweets (r = 0.48, P = 0.04). CONCLUSIONS Sleep restriction as compared with normal sleep significantly increases ghrelin levels. The increase in ghrelin is associated with higher consumption of calories. Elevated ghrelin may be a mechanism by which sleep loss leads to increased food intake and the development of obesity.
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Affiliation(s)
| | | | | | | | - Andrew Day
- Department of Medicine, University of Wisconsin Hospitals and Clinics, Madison, WI
| | | | - Esra Tasali
- Department of Medicine, University of Chicago, Chicago IL
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Abstract
Pre-diabetes and diabetes occur secondary to a constellation of pathophysiological abnormalities that culminate in insulin resistance, which results in reduced cellular glucose uptake and increased glucose production. Although pre-diabetes and diabetes have a strong genetic basis, they are largely environmentally driven through lifestyle factors. Traditional lifestyle factors such as diet and physical activity do not fully explain the dramatic rise in the incidence and prevalence of diabetes mellitus. Sleep has emerged as an additional lifestyle behavior, important for metabolic health and energy homeostasis. In this article, we review the current evidence surrounding the sleep-diabetes association.
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Affiliation(s)
- Teresa Arora
- Department of Medicine, Weill Cornell Medical College in Qatar, Room C008, Qatar Foundation, Education City, PO Box 24144, Doha, Qatar
- Department of Medicine, Weill Cornell Medical College, New York, USA
| | - Shahrad Taheri
- Department of Medicine, Weill Cornell Medical College in Qatar, Room C008, Qatar Foundation, Education City, PO Box 24144, Doha, Qatar.
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Eckel RH, Depner CM, Perreault L, Markwald RR, Smith MR, McHill AW, Higgins J, Melanson EL, Wright KP. Morning Circadian Misalignment during Short Sleep Duration Impacts Insulin Sensitivity. Curr Biol 2015; 25:3004-10. [PMID: 26549253 DOI: 10.1016/j.cub.2015.10.011] [Citation(s) in RCA: 112] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Revised: 09/30/2015] [Accepted: 10/05/2015] [Indexed: 12/19/2022]
Abstract
Short sleep duration and circadian misalignment are hypothesized to causally contribute to health problems including obesity, diabetes, metabolic syndrome, heart disease, mood disorders, cognitive impairment, and accidents. Here, we investigated the influence of morning circadian misalignment induced by an imposed short nighttime sleep schedule on impaired insulin sensitivity, a precursor to diabetes. Imposed short sleep duration resulted in morning wakefulness occurring during the biological night (i.e., circadian misalignment)-a time when endogenous melatonin levels were still high indicating the internal circadian clock was still promoting sleep and related functions. We show the longer melatonin levels remained high after wake time, insulin sensitivity worsened. Overall, we find a simulated 5-day work week of 5-hr-per-night sleep opportunities and ad libitum food intake resulted in ∼20% reduced oral and intravenous insulin sensitivity in otherwise healthy men and women. Reduced insulin sensitivity was compensated by an increased insulin response to glucose, which may reflect an initial physiological adaptation to maintain normal blood sugar levels during sleep loss. Furthermore, we find that transitioning from the imposed short sleep schedule to 9-hr sleep opportunities for 3 days restored oral insulin sensitivity to baseline, but 5 days with 9-hr sleep opportunities was insufficient to restore intravenous insulin sensitivity to baseline. These findings indicate morning wakefulness and eating during the biological night is a novel mechanism by which short sleep duration contributes to metabolic dysregulation and suggests food intake during the biological night may contribute to other health problems associated with short sleep duration.
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Affiliation(s)
- Robert H Eckel
- Division of Endocrinology, Metabolism, and Diabetes, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Christopher M Depner
- Sleep and Chronobiology Laboratory, Department of Integrative Physiology, University of Colorado Boulder, Boulder CO, 80309, USA
| | - Leigh Perreault
- Division of Endocrinology, Metabolism, and Diabetes, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Rachel R Markwald
- Sleep and Chronobiology Laboratory, Department of Integrative Physiology, University of Colorado Boulder, Boulder CO, 80309, USA
| | - Mark R Smith
- Sleep and Chronobiology Laboratory, Department of Integrative Physiology, University of Colorado Boulder, Boulder CO, 80309, USA
| | - Andrew W McHill
- Sleep and Chronobiology Laboratory, Department of Integrative Physiology, University of Colorado Boulder, Boulder CO, 80309, USA
| | - Janine Higgins
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Edward L Melanson
- Division of Endocrinology, Metabolism, and Diabetes, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA; Division of Geriatric Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Kenneth P Wright
- Division of Endocrinology, Metabolism, and Diabetes, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA; Sleep and Chronobiology Laboratory, Department of Integrative Physiology, University of Colorado Boulder, Boulder CO, 80309, USA.
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40
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St-Onge MP, Shechter A. Sleep disturbances, body fat distribution, food intake and/or energy expenditure: pathophysiological aspects. Horm Mol Biol Clin Investig 2015; 17:29-37. [PMID: 25372728 DOI: 10.1515/hmbci-2013-0066] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2013] [Accepted: 01/10/2014] [Indexed: 12/19/2022]
Abstract
Data from cross-sectional and longitudinal studies have illustrated a relationship between short sleep duration (SSD) and weight gain. Individuals with SSD are heavier and gain more weight over time than normal-duration sleepers. This sleep-obesity relationship may have consequences for obesity treatments, as it appears that short sleepers have reduced ability to lose weight. Laboratory-based clinical studies found that experimental sleep restriction affects energy expenditure and intake, possibly providing a mechanistic explanation for the weight gain observed in chronic short sleepers. Specifically, compared to normal sleep duration, sleep restriction increases food intake beyond the energetic costs of increased time spent awake. Reasons for this increased energy intake after sleep restriction are unclear but may include disrupted appetite-regulating hormones, altered brain mechanisms involved in the hedonic aspects of appetite, and/or changes in sleep quality and architecture. Obstructive sleep apnea (OSA) is a disorder at the intersection of sleep and obesity, and the characteristics of the disorder illustrate many of the effects of sleep disturbances on body weight and vice versa. Specifically, while obesity is among the main risk factors for OSA, the disorder itself and its associated disturbances in sleep quality and architecture seem to alter energy balance parameters and may induce further weight gain. Several intervention trials have shown that weight loss is associated with reduced OSA severity. Thus, weight loss may improve sleep, and these improvements may promote further weight loss. Future studies should establish whether increasing sleep duration/improving sleep quality can induce weight loss.
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41
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Leproult R, Deliens G, Gilson M, Peigneux P. Beneficial impact of sleep extension on fasting insulin sensitivity in adults with habitual sleep restriction. Sleep 2015; 38:707-15. [PMID: 25348128 DOI: 10.5665/sleep.4660] [Citation(s) in RCA: 125] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2014] [Accepted: 10/05/2014] [Indexed: 12/11/2022] Open
Abstract
STUDY OBJECTIVES A link between sleep loss and increased risk for the development of diabetes is now well recognized. The current study investigates whether sleep extension under real-life conditions is a feasible intervention with a beneficial impact on glucose metabolism in healthy adults who are chronically sleep restricted. DESIGN Intervention study. PARTICIPANTS Sixteen healthy non-obese volunteers (25 [23, 27.8] years old, 3 men). INTERVENTIONS Two weeks of habitual time in bed followed by 6 weeks during which participants were instructed to increase their time in bed by one hour per day. MEASUREMENTS AND RESULTS Continuous actigraphy monitoring and daily sleep logs during the entire study. Glucose and insulin were assayed on a single morning blood sample at the end of habitual time in bed and at the end of sleep extension. Home polysomnography was performed during one weekday of habitual time in bed and after 40 days of sleep extension. Sleep time during weekdays increased (mean actigraphic data: +44 ± 34 minutes, P < 0.0001; polysomnographic data: +49 ± 68 minutes, P = 0.014), without any significant change during weekends. Changes from habitual time in bed to the end of the intervention in total sleep time correlated with changes in glucose (r = +0.53, P = 0.041) and insulin levels (r = -0.60, P = 0.025), as well as with indices of insulin sensitivity (r = +0.76, P = 0.002). CONCLUSIONS In healthy adults who are chronically sleep restricted, a simple low cost intervention such as sleep extension is feasible and is associated with improvements in fasting insulin sensitivity.
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Affiliation(s)
- Rachel Leproult
- Neuropsychology and Functional Neuroimaging Research Unit, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Gaétane Deliens
- Neuropsychology and Functional Neuroimaging Research Unit, Université Libre de Bruxelles (ULB), Brussels, Belgium.,CO3-Consciousness, Cognition & Computation Group, Center for Research in Cognition and Neurosciences and the ULB Neuroscience Institute, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Médhi Gilson
- Neuropsychology and Functional Neuroimaging Research Unit, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Philippe Peigneux
- Neuropsychology and Functional Neuroimaging Research Unit, Université Libre de Bruxelles (ULB), Brussels, Belgium
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Briançon-Marjollet A, Weiszenstein M, Henri M, Thomas A, Godin-Ribuot D, Polak J. The impact of sleep disorders on glucose metabolism: endocrine and molecular mechanisms. Diabetol Metab Syndr 2015. [PMID: 25834642 DOI: 10.1186/s13098- 015-0018-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Modern lifestyle has profoundly modified human sleep habits. Sleep duration has shortened over recent decades from 8 to 6.5 hours resulting in chronic sleep deprivation. Additionally, irregular sleep, shift work and travelling across time zones lead to disruption of circadian rhythms and asynchrony between the master hypothalamic clock and pacemakers in peripheral tissues. Furthermore, obstructive sleep apnea syndrome (OSA), which affects 4 - 15% of the population, is not only characterized by impaired sleep architecture but also by repetitive hemoglobin desaturations during sleep. Epidemiological studies have identified impaired sleep as an independent risk factor for all cause of-, as well as for cardiovascular, mortality/morbidity. More recently, sleep abnormalities were causally linked to impairments in glucose homeostasis, metabolic syndrome and Type 2 Diabetes Mellitus (T2DM). This review summarized current knowledge on the metabolic alterations associated with the most prevalent sleep disturbances, i.e. short sleep duration, shift work and OSA. We have focused on various endocrine and molecular mechanisms underlying the associations between inadequate sleep quality, quantity and timing with impaired glucose tolerance, insulin resistance and pancreatic β-cell dysfunction. Of these mechanisms, the role of the hypothalamic-pituitary-adrenal axis, circadian pacemakers in peripheral tissues, adipose tissue metabolism, sympathetic nervous system activation, oxidative stress and whole-body inflammation are discussed. Additionally, the impact of intermittent hypoxia and sleep fragmentation (key components of OSA) on intracellular signaling and metabolism in muscle, liver, fat and pancreas are also examined. In summary, this review provides endocrine and molecular explanations for the associations between common sleep disturbances and the pathogenesis of T2DM.
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Affiliation(s)
- Anne Briançon-Marjollet
- Université Grenoble Alpes, HP2, F-38041 Grenoble, Cedex France.,INSERM U1042, F-38041 Grenoble, Cedex France
| | - Martin Weiszenstein
- Centre for Research on Diabetes, Metabolism and Nutrition, Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Marion Henri
- Université Grenoble Alpes, HP2, F-38041 Grenoble, Cedex France.,INSERM U1042, F-38041 Grenoble, Cedex France
| | - Amandine Thomas
- Université Grenoble Alpes, HP2, F-38041 Grenoble, Cedex France.,INSERM U1042, F-38041 Grenoble, Cedex France
| | - Diane Godin-Ribuot
- Université Grenoble Alpes, HP2, F-38041 Grenoble, Cedex France.,INSERM U1042, F-38041 Grenoble, Cedex France
| | - Jan Polak
- Centre for Research on Diabetes, Metabolism and Nutrition, Third Faculty of Medicine, Charles University, Prague, Czech Republic.,2nd Internal Medicine Department, University Hospital Kralovske Vinohrady, Prague, Czech Republic.,Sports Medicine Department, Third Faculty of Medicine, Charles University in Prague, Ruska 87, Praha 10, 100 00 Czech Republic
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43
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Habitual sleep variability, not sleep duration, is associated with caloric intake in adolescents. Sleep Med 2015; 16:856-61. [PMID: 26002758 DOI: 10.1016/j.sleep.2015.03.004] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2015] [Revised: 02/27/2015] [Accepted: 03/03/2015] [Indexed: 11/21/2022]
Abstract
OBJECTIVE The objective of this study was to investigate the associations between objectively measured habitual sleep duration (HSD), habitual sleep variability (HSV), and energy and snack intake in adolescents. METHODS We used data from 324 adolescents who participated in the Penn State Child Cohort follow-up examination. Actigraphy was used over seven consecutive nights to estimate nightly sleep duration. The seven-night mean and standard deviation of sleep duration were used to represent HSD and HSV, respectively. The Youth/Adolescent Food Frequency Questionnaire was used to obtain the daily average total energy, protein, fat, and carbohydrate intake, and number of snacks consumed. Linear regression models were used to investigate the associations between habitual sleep patterns and caloric, protein, fat, and carbohydrate intake. Proportional odds models were used to associate habitual sleep patterns with snack consumption. RESULTS After adjusting for age, sex, race, body mass index (BMI) percentile, and smoking status, an increased HSV was associated with a higher energy intake, particularly from fat and carbohydrate. For example, with a 1-h increase in HSV, there was a 170 (66)-kcal increase in the daily total energy intake. An increased HSV was also related to increased snack consumption, especially snacks consumed after dinner. For instance, a 1-h increase in HSV was associated with 65% and 94% higher odds of consuming more snacks after dinner during school/workdays and weekends/vacation days, respectively. Neither energy intake nor snack consumption was significantly related to HSD. CONCLUSION High habitual sleep variability, not habitual sleep duration, is related to increased energy and food consumption in adolescents. Maintaining a regular sleep pattern may decrease the risk of obesity in adolescents.
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44
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Sleep habits and diabetes. DIABETES & METABOLISM 2015; 41:263-271. [PMID: 25623152 DOI: 10.1016/j.diabet.2014.12.004] [Citation(s) in RCA: 79] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2014] [Revised: 12/09/2014] [Accepted: 12/29/2014] [Indexed: 01/07/2023]
Abstract
Sleep duration has been constantly decreasing over the past 50 years. Short sleep duration, sleep quality and, recently, long sleep duration have all been linked to poor health outcomes, increasing the risk of developing metabolic diseases and cardiovascular events. Beyond the duration of sleep, the timing of sleep may also have consequences. Having a tendency to go early to bed (early chronotype) compared with the habit of going to bed later (late chronotype) can interfere considerably with social schedules (school, work). Eventually, a misalignment arises in sleep timing between work days and free days that has been described as 'social jet lag'. The present review looks at how different sleep habits can interfere with diabetes, excluding sleep breathing disorders, and successively looks at the effects of sleep duration, chronotype and social jet lag on the risk of developing diabetes as well as on the metabolic control of both type 1 and type 2 diabetes. Finally, this review addresses the current state of knowledge of physiological mechanisms that could be linking sleep habits and metabolic health.
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45
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Zhang B, Hao Y, Zhou J, Jia F, Li X, Tang Y, Zheng H. The association between sleep patterns and overweight/obesity in Chinese children: a cross-sectional study. Neuropsychiatr Dis Treat 2015; 11:2209-16. [PMID: 26346134 PMCID: PMC4556246 DOI: 10.2147/ndt.s90838] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE This study evaluated the association between sleep patterns and the risk of being overweight/obese in Chinese children. METHODS A total of 3,086 children (1,608 boys and 1,478 girls) between 7 and 14 years of age and studying in primary schools were recruited as eligible study participants in this study. We collected the information about children regarding sleep patterns, body height and weight, insomnia, healthy status, time allocation of daily activities, and demographic characteristics using a parental-reported questionnaire. RESULTS Overweight/obese children were younger, predominantly male, and more prone to have suffered from illness in the past 12 months compared to normal-weight peers. They were also less prone to compensate for sleep deficits during weekends (47.6% vs 39.1%; χ (2)=11.637, P<0.001) and holidays (52.0% vs 42.0%; χ (2)=16.057, P<0.001). Sleep duration on weekdays did not affect the risk of being overweight/obese. The adjusted odds ratios for overweight/obesity (noncompensated) group using the compensated group as a reference were 1.197 (95% confidence interval [CI]: 1.004-1.493) during weekends and 1.309 (95% CI: 1.052-1.630) during holidays. CONCLUSION Compensation for sleep deficits on non-weekdays may ameliorate the risk of being overweight/obese in Chinese children. Moreover, no significant association between the risk of being overweight/obese and sleep duration on weekdays was demonstrated in the current study, which may be due to pervasive sleep insufficiency on weekdays in Chinese children.
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Affiliation(s)
- Bin Zhang
- Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangdong Mental Health Centre, Guang Zhou Medical University, Guangzhou, People's Republic of China
| | - Yanli Hao
- Department of Human Anatomy, Guang Zhou Medical University, Guangzhou, People's Republic of China
| | - Jiangyan Zhou
- Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangdong Mental Health Centre, Guang Zhou Medical University, Guangzhou, People's Republic of China ; Department of Psychiatry, Southern Medical University, Guangzhou, People's Republic of China
| | - Fujun Jia
- Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangdong Mental Health Centre, Guang Zhou Medical University, Guangzhou, People's Republic of China
| | - Xueli Li
- Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangdong Mental Health Centre, Guang Zhou Medical University, Guangzhou, People's Republic of China
| | - Yi Tang
- Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangdong Mental Health Centre, Guang Zhou Medical University, Guangzhou, People's Republic of China
| | - Huirong Zheng
- Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangdong Mental Health Centre, Guang Zhou Medical University, Guangzhou, People's Republic of China
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46
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Leproult R, Copinschi G. Endocrine–Metabolic Disorders and Sleep Medicine. Sleep Med 2015. [DOI: 10.1007/978-1-4939-2089-1_50] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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47
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Briançon-Marjollet A, Weiszenstein M, Henri M, Thomas A, Godin-Ribuot D, Polak J. The impact of sleep disorders on glucose metabolism: endocrine and molecular mechanisms. Diabetol Metab Syndr 2015; 7:25. [PMID: 25834642 PMCID: PMC4381534 DOI: 10.1186/s13098-015-0018-3] [Citation(s) in RCA: 138] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2014] [Accepted: 03/05/2015] [Indexed: 12/11/2022] Open
Abstract
Modern lifestyle has profoundly modified human sleep habits. Sleep duration has shortened over recent decades from 8 to 6.5 hours resulting in chronic sleep deprivation. Additionally, irregular sleep, shift work and travelling across time zones lead to disruption of circadian rhythms and asynchrony between the master hypothalamic clock and pacemakers in peripheral tissues. Furthermore, obstructive sleep apnea syndrome (OSA), which affects 4 - 15% of the population, is not only characterized by impaired sleep architecture but also by repetitive hemoglobin desaturations during sleep. Epidemiological studies have identified impaired sleep as an independent risk factor for all cause of-, as well as for cardiovascular, mortality/morbidity. More recently, sleep abnormalities were causally linked to impairments in glucose homeostasis, metabolic syndrome and Type 2 Diabetes Mellitus (T2DM). This review summarized current knowledge on the metabolic alterations associated with the most prevalent sleep disturbances, i.e. short sleep duration, shift work and OSA. We have focused on various endocrine and molecular mechanisms underlying the associations between inadequate sleep quality, quantity and timing with impaired glucose tolerance, insulin resistance and pancreatic β-cell dysfunction. Of these mechanisms, the role of the hypothalamic-pituitary-adrenal axis, circadian pacemakers in peripheral tissues, adipose tissue metabolism, sympathetic nervous system activation, oxidative stress and whole-body inflammation are discussed. Additionally, the impact of intermittent hypoxia and sleep fragmentation (key components of OSA) on intracellular signaling and metabolism in muscle, liver, fat and pancreas are also examined. In summary, this review provides endocrine and molecular explanations for the associations between common sleep disturbances and the pathogenesis of T2DM.
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Affiliation(s)
- Anne Briançon-Marjollet
- />Université Grenoble Alpes, HP2, F-38041 Grenoble, Cedex France
- />INSERM U1042, F-38041 Grenoble, Cedex France
| | - Martin Weiszenstein
- />Centre for Research on Diabetes, Metabolism and Nutrition, Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Marion Henri
- />Université Grenoble Alpes, HP2, F-38041 Grenoble, Cedex France
- />INSERM U1042, F-38041 Grenoble, Cedex France
| | - Amandine Thomas
- />Université Grenoble Alpes, HP2, F-38041 Grenoble, Cedex France
- />INSERM U1042, F-38041 Grenoble, Cedex France
| | - Diane Godin-Ribuot
- />Université Grenoble Alpes, HP2, F-38041 Grenoble, Cedex France
- />INSERM U1042, F-38041 Grenoble, Cedex France
| | - Jan Polak
- />Centre for Research on Diabetes, Metabolism and Nutrition, Third Faculty of Medicine, Charles University, Prague, Czech Republic
- />2nd Internal Medicine Department, University Hospital Kralovske Vinohrady, Prague, Czech Republic
- />Sports Medicine Department, Third Faculty of Medicine, Charles University in Prague, Ruska 87, Praha 10, 100 00 Czech Republic
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48
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Basch CE, Basch CH, Ruggles KV, Rajan S. Prevalence of sleep duration on an average school night among 4 nationally representative successive samples of American high school students, 2007-2013. Prev Chronic Dis 2014; 11:E216. [PMID: 25496556 PMCID: PMC4264412 DOI: 10.5888/pcd11.140383] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Consistency, quality, and duration of sleep are important determinants of health. We describe sleep patterns among demographically defined subgroups from the Youth Risk Behavior Surveillance System reported in 4 successive biennial representative samples of American high school students (2007 to 2013). Across the 4 waves of data collection, 6.2% to 7.7% of females and 8.0% to 9.4% of males reported obtaining 9 or more hours of sleep. Insufficient duration of sleep is pervasive among American high school students. Despite substantive public health implications, intervention research on this topic has received little attention.
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Affiliation(s)
- Charles E Basch
- Richard March Hoe Professor of Health and Education, Department of Health and Behavior Studies, Box 114, Teachers College, Columbia University, New York, NY 10027. Telephone: 212-678-3983. E-mail:
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49
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Sleep and exercise: a reciprocal issue? Sleep Med Rev 2014; 20:59-72. [PMID: 25127157 DOI: 10.1016/j.smrv.2014.06.008] [Citation(s) in RCA: 374] [Impact Index Per Article: 37.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2014] [Revised: 06/17/2014] [Accepted: 06/20/2014] [Indexed: 12/18/2022]
Abstract
Sleep and exercise influence each other through complex, bilateral interactions that involve multiple physiological and psychological pathways. Physical activity is usually considered as beneficial in aiding sleep although this link may be subject to multiple moderating factors such as sex, age, fitness level, sleep quality and the characteristics of the exercise (intensity, duration, time of day, environment). It is therefore vital to improve knowledge in fundamental physiology in order to understand the benefits of exercise on the quantity and quality of sleep in healthy subjects and patients. Conversely, sleep disturbances could also impair a person's cognitive performance or their capacity for exercise and increase the risk of exercise-induced injuries either during extreme and/or prolonged exercise or during team sports. This review aims to describe the reciprocal fundamental physiological effects linking sleep and exercise in order to improve the pertinent use of exercise in sleep medicine and prevent sleep disorders in sportsmen.
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50
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Reutrakul S, Van Cauter E. Interactions between sleep, circadian function, and glucose metabolism: implications for risk and severity of diabetes. Ann N Y Acad Sci 2014; 1311:151-73. [PMID: 24628249 DOI: 10.1111/nyas.12355] [Citation(s) in RCA: 196] [Impact Index Per Article: 19.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Sleep disturbances, including sleep insufficiency and sleep fragmentation, have been linked to abnormal glucose metabolism and increased diabetes risk. Well-controlled laboratory studies have provided insights regarding the underlying mechanisms. Several large prospective studies suggest that these sleep disturbances are associated with an increased risk of incident diabetes. Obstructive sleep apnea, which combines sleep fragmentation and hypoxemia, is a major risk factor for insulin resistance and possibly diabetes. Whether glycemic control in type 2 diabetes patients can be improved by treating sleep apnea remains controversial. Recently, sleep disturbances during pregnancy and their relationship to gestational diabetes and hyperglycemia have received considerable attention owing to potential adverse effects on maternal and fetal health. Additionally, evidence from animal models has identified disruption of the circadian system as a putative risk factor for adverse metabolic outcomes. The purpose of this review is to provide an update on the current state of knowledge linking sleep disturbances, circadian dysfunction, and glucose metabolism. Experimental, prospective, and interventional studies are discussed.
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Affiliation(s)
- Sirimon Reutrakul
- Division of Endocrinology and Metabolism, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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