Delaying time to first nocturnal void may have beneficial effects on reducing blood glucose levels

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.

Habitual and Recent Sleep Durations: Graded and Interactive Risk for Impaired Glycemic Control in a Biracial Population

“…Recent data have suggested that in young, healthy subjects, extending sleep duration by an average of about 45 minutes per night was associated with improvement in insulin sensitivity [19], and as little as two nights of extended sleep following severe acute sleep loss were associated with recovery of the disposition index, reflecting both insulin sensitivity and the acute response of insulin to glucose infusion [20]. Lengthening the initial period of sleep (prior to first voiding episode) was also shown to have a beneficial effect on lowering blood glucose in a retrospective analysis [21]. We must consider our apparent protective effect of recent longer sleep as hypothesis-generating rather than conclusive, as no large-scale clinical trials have yet shown that improving sleep duration pharmacologically or behaviorally exerts a salutary influence on glucose control.…”

Pharmacologic management of nocturnal polyuria: a contemporary assessment of efficacy, safety, and progress toward individualized treatment

“…43,44 Treatment aimed at extending FUSP in particular may be central to mitigating the vast deleterious sequelae of nocturia, as was exemplified in a recent study of blood sugar in nocturia patients, which reported significant improvement in blood glucose upon successful prolongation of FUSP. 45 Consideration of more refined clinical endpoints, with a particular emphasis on graded treatment response, sleep, and the broader sequelae of nocturia, has facilitated a more holistic approach to nocturia evaluation and management. By the same token, there now exist several lines of evidence to suggest that the optimal dose range of desmopressin for nocturia may actually lie below the dose range initially surmised from the management of enuresis.…”

“…43,44 Treatment aimed at extending FUSP in particular may be central to mitigating the vast deleterious sequelae of nocturia, as was exemplified in a recent study of blood sugar in nocturia patients, which reported significant improvement in blood glucose upon successful prolongation of FUSP. 45…”

Nocturia and Sleep: Focus on Common Comorbidities and Their Association with Obstructive Sleep Apnea

“…A previous study accentuated the importance of sleep deprivation in the induction of obesity and resultant harmful effects on glycemic control [59]. Moreover, one study suggested that delaying time to first voiding during the night can significantly reduce blood glucose in type 2 DM patients [60]. Furthermore, sleep fragmentation induced by nocturia can increase the next-day fatigue and resultant sedentary activities, which can worsen glycemic control [61].…”