The Impact of Sleep Debt on Excess Adiposity and Insulin Sensitivity in Patients with Early Type 2 Diabetes Mellitus

Abstract

Study Objectives:We examined cross-sectional and prospective associations between sleep debt and adiposity measures, as well as homeostatic model assessment-insulin resistance (HOMA-IR) in early type 2 diabetes. Methods: Prospective data analysis from participants of a randomized controlled trial based on an intensive lifestyle intervention (usual care, diet, or diet and physical activity). Data were collected at baseline, 6 months, and 12 months post-intervention. The study was performed across five secondary care centers in the United Kingdom. Patients (n = 593) with a recent diagnosis of type 2 diabetes were recruited. Objective height and weight were ascertained for obesity status (body mass index [BMI]; ≥ 30 kg/m 2 ), waist circumference (cm) for central adiposity, and fasting blood samples drawn to examine insulin resistance (IR). Seven-day sleep diaries were used to calculate weekday sleep debt at baseline, calculated as average weekend sleep duration minus average weekday sleep duration. Results: At baseline, compared to those without weekday sleep debt, those with weekday sleep debt were 72% more likely to be obese (OR = 1.72 [95% CI:1.03-2.88]). At six months, weekday sleep debt was significantly associated with obesity and IR after adjustment, OR = 1.90 (95% CI:1.10-3.30), OR = 2.07 (95% CI:1.02-4.22), respectively. A further increase at 12 months was observed for sleep debt with obesity and IR: OR = 2.10 (95% CI:1.14-3.87), OR = 3.16 (95% CI:1.38-7.24), respectively. For every 30 minutes of weekday sleep debt, the risk of obesity and IR at 12 months increased by 18% and 41%, respectively. Conclusions: Sleep debt resulted in long-term metabolic disruption, which may promote the progression of type 2 diabetes in newly diagnosed patients. Sleep hygiene/education could be an important factor for future interventions to target early diabetes. Keywords: insulin resistance, type 2 diabetes mellitus, sleep debt, obesity, body mass index, waist circumference, central adiposity Citation: Arora T, Chen MZ, Cooper AR, Andrews RC, Taheri S. The impact of sleep debt on excess adiposity and insulin sensitivity in patients with early type 2 diabetes mellitus. J Clin Sleep Med 2016;12(5):673-680. I NTRO DUCTI O NThe International Diabetes Federation recently estimated that, globally, over 382 million individuals had diabetes in 2013 (an estimated 46.3% undiagnosed) and that this number is expected to rise to 592 million by 2035.1 The majority of affected individuals (over 90%) have type 2 diabetes, which is closely related to excess adiposity and its associated lifestyle factors such as poor diet and low physical activity. Sleep (duration and quality) may be another important factor associated with both obesity and type 2 diabetes, as suggested by both population and experimental studies.2-6 It has been hypothesized that social and work demands increasingly result in shorter sleep duration than required physiologically. 7 This sleep loss, accumulated into a sleep debt during weekdays, may be partially repaid by extra...

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“…), cardiovascular system (hypertension), loss of performance, GIT events, reproduction/sexual repercussions, etc. (60). It should be considered, still, that the sleep/wake cycle is only one among several others affected systems in melatonin-deficient adults and children.…”

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“…At baseline, these people compared to those without weekday sleep debt, were 72% more likely to become obese, while 6 months later, the sleep debt was significantly associated with obesity and IR after adjustment (OR = 1.90 and 2.07, respectively). A further increase was observed at 12 months of sleep debt with OR of 2.10 and 3.16, for obesity and IR, respectively [99] .…”

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“…However, if this does not occur and the sleep-debt persists over weeks, months or even years it has been linked with challenging system level and metabolic homeostasis. This can lead to disruption involving an increased secretion of cortisol, poor blood pressure control, higher C-reactive protein, triglycerides and low-density lipoprotein cholesterol levels (Arora et al 2016). Resulting in an increase in the risks of heart disease, diabetes, depression and obesity (Irish et al 2015).…”