October 28, 2019
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Diabetes more common with decreasing sleep efficiency in absence of sleep-disordered breathing

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Adults who have poor sleep efficiency but do not have sleep-disordered breathing may be more likely to have diabetes compared with those who have superior sleep efficiency, according to findings published in the Journal of Diabetes.

“Our results show that poor sleep efficiency is correlated with the prevalence of diabetes in participants without sleep-disordered breathing, but not in those with sleep-disordered breathing,” Bin Yan, PhD, a research assistant in the School of Medicine of Xi'an Jiaotong University, China, and colleagues wrote. “The causative relationship between sleep efficiency and diabetes also needs further exploration.”

Yan and colleagues analyzed data collected from 1995 to 1998 from 4,737 adults in the Sleep Heart Health Study. The researchers extracted data on sleep efficiency, which equated to the percentage of time spent in bed and actually sleeping. Participants who spent 85% or more time asleep while in bed were considered to have grade 1 sleep efficiency. Participants who spent between 80% and 84.9% of time sleeping while in bed were considered to have grade 2 sleep efficiency. Anyone with less time spent sleeping while in bed were considered to have grade 3 sleep efficiency.

In addition to sleep efficiency, data were also collected on apnea-hypopnea index, with at least five apnea-hypopnea events per hour the threshold used to identify sleep-disordered breathing, according to the researchers. Other sleep metrics that were assessed included wake after sleep onset, sleep latency, total arousal index, rapid eye movement percentage and slow-wave sleep, while the data from the Sleep Heart Health Study also allowed the researchers to identify instances of diabetes.

 
Adults who have poor sleep efficiency but do not have sleep-disordered breathing may be more likely to have diabetes compared with those who have superior sleep efficiency.
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The researchers found that diabetes was present in 9.3% of participants who had sleep-disordered breathing compared with 5.3% of those who did not have sleep-disordered breathing (P < .001). In addition, 10.3% of those with grade 3 sleep efficiency had diabetes while 7.1% of those with grade 2 sleep efficiency had diabetes and 5.7% of those with grade 1 sleep efficiency had diabetes (P < .001). The researchers noted that stage 3 sleep efficiency and diabetes were “closely related” but only in unadjusted models.

The researchers also examined how frequently diabetes occurred based on sleep-disordered breathing status. The difference in the percentage of participants with diabetes between sleep efficiency grades in those with sleep-disordered breathing did not reach significance. Conversely, among those who did not have sleep-disordered breathing, 9.5% of those with grade 3 sleep efficiency had diabetes while 5.6% of those with grade 2 sleep efficiency had diabetes and 3.5% of those with grade 1 sleep efficiency had diabetes (P < .001). In addition, diabetes was more likely among participants with grade 3 sleep efficiency and no sleep-disordered breathing compared with participants with grade 1 sleep efficiency and no sleep-disordered breathing (OR = 1.894; 95% CI, 1.187-3.022).

“Individuals with poor sleep efficiency are more prone to have poor sleep quality, which could change the levels of the appetite-related hormone leptin that controls feeding behavior, energy expenditure and glucose regulation by binding to homologous receptors in the brain,” the researchers wrote. “Besides, poor sleep efficiency may lead to impaired glucose tolerance, decreased insulin sensitivity and reduced acute insulin resistance.” – by Phil Neuffer

Disclosures: The authors report no relevant financial disclosures.