Association of Sleep Deprivation With Reduction in Insulin Sensitivity as Assessed by the Hyperglycemic Clamp Technique in Adolescents

Abstract

; for the Brazilian Metabolic Syndrome Study (BRAMS) Investigators IMPORTANCE The association between short sleep duration and decreased insulin sensitivity in adolescents has been described. However, to our knowledge, no studies have investigated this association measuring insulin sensitivity by the hyperglycemic clamp technique. OBJECTIVES To compare the distributions of parameters of insulin resistance in adolescents with sleep deprivation vs adequate sleep, and to investigate the association between sleep deprivation and insulin sensitivity. DESIGN, SETTING, AND PARTICIPANTS Cross-sectional multicenter study using data from the Brazilian Metabolic Syndrome Study conducted from June 29, 2011, to December 3, 2014, at an obesity outpatient clinic at the University of Campinas and public schools, with a convenience sample of 615 adolescents aged 10 to 19.9 years with a body mass index (BMI; calculated as weight in kilograms divided by height in meters squared) for age and sex at the fifth percentile or higher. A subsample of 81 adolescents underwent the hyperglycemic clamp technique. MAIN OUTCOMES AND MEASURES The self-reported sleep duration was used to classify the population into 2 groups: adolescents with sleep deprivation (<8 hours/night) and adolescents with adequate sleep (Ն8 hours/night). Insulin sensitivity was assessed using the hyperglycemic clamp technique. RESULTS Among the 615 adolescents (56.3% female; median age, 15.9 years [interquartile range, 12.9-17.8 years]) included in the sample, the mean (SD) sleep duration was 7.9 (1.7) hours/night. The adolescents with sleep deprivation (n = 257) compared with those with adequate sleep (n = 358) had a higher median (interquartile range) age (17.

Inadequate sleep as a contributor to type 2 diabetes in children and adolescents

“…Moreover, Koren et al 31 found that a sleep duration between 7 and 8.5 h per night in obese children and adolescents was associated with optimal glucose homeostasis. Although these two studies 30, 31 have reported a U-shaped relationship between sleep duration and T2D biomarkers, similar to the relationship seen in adults, 11, 12, 13 other studies 19, 25, 26, 27, 28, 29, 32, 33, 34, 35 in the pediatric population did not or could not report the linearity or the shape of the relationship between sleep duration and glucose homeostasis biomarkers.…”

“…These findings are not surprising when considering that most studies, regardless of the methods or the study design used, have reported no association between sleep duration and blood glucose levels in children. 16, 17, 20, 22, 23, 24, 25, 28, 29, 30, 32, 36, 37 Nevertheless, one study by Zhu et al 35 did find a negative association between glucose and sleep time after adjusting for adiposity, maturation, age, sex and obstructive sleep apnea. Overall, these studies indicate that glucose may not be the prime marker in the association between short sleep duration and T2D in the pediatric population.…”

“…In cross-sectional studies, the role of adiposity in the relationship between sleep duration and insulin resistance is also ambiguous. It is of interest to note that out of the 11 cross-sectional studies 19, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35 that have reported an association between sleep duration and T2D biomarkers, only 4 studies 28, 32, 34, 35 have presented results independent of adiposity and 2 studies 29, 31 were conducted with obese children; however, in both studies short sleep duration was associated with insulin resistance independent of the level of adiposity. For instance, Flint et al 29 reported that short sleep duration (⩽6 h per night) in obese children was associated with higher peak insulin, higher fasting insulin and lower whole-body insulin sensitivity, independent of the level of obesity and age.…”

“…De Bernardi Rodrigues et al 28 used the hyperglycemic clamp technique on a subsample of adolescents to measure insulin sensitivity. Although they found no association between short sleep duration (<8 h per night) and insulin resistance in the overall sample, they observed a lower median IQR insulin sensitivity index in the subsample of adolescents with short sleep duration compared with those with ⩾8 h of sleep per night after controlling for age and sex.…”

Outpatient versus inpatient mixed meal tolerance and arginine stimulation testing yields comparable measures of variability for assessment of beta cell function

“…Attention was paid to minimize such sources of variability. Conversely, it is possible that without an overnight stay, which could disrupt sleep and worsen metabolic outcomes [9,10], there may have been less metabolic stress. This may have helped counter any increase in variability arising from other sources as an outpatient.…”