Impact of Sleep and Sleep Loss on Glucose Homeostasis and Appetite Regulation

Department of Health Studies, University of Chicago, Chicago, Illinois.
Sleep Medicine Clinics 07/2007; 2(2):187-197. DOI: 10.1016/j.jsmc.2007.03.004
Source: PubMed


Over the past 30 years there has been an increase in the prevalence of obesity and diabetes, both of which can have serious consequences for longevity and quality of life. Sleep durations may have also decreased over this time period. This chapter reviews laboratory and epidemiologic evidence for an association between sleep loss and impairments in glucose metabolism and appetite regulation, which could increase the risk of diabetes or weight gain.

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Available from: Kristen L Knutson
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    • "Despite a growing body of evidence demonstrating an association between short sleep duration and current and future obesity in children aged 0–16 years [3,6-11], the causal relationship is still unclear. It is not known whether sleep loss affects the risk of obesity directly, through changes in function and levels of metabolic hormones such as glucagon-like peptide-1 [12] resulting in increased food intake, or if common behavioral or environmental factors such as hypo- or hyperactivity [13] and other types of stressors are involved, causing both sleep and weight disturbances [14,15]. However, few studies have included both assessments of physical activity intensity and sleep measures to clarify their reciprocal relationship and their association with BMI in children. "
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    ABSTRACT: The aim of this study is to describe the relationship between objective measures of sleep, physical activity and BMI in Swedish pre-adolescents. The day-to-day association between physical activity and sleep quality as well as week-day and weekend pattern of sleep is also described. We conducted a cross sectional study consisted of a cohort of 1.231 children aged six to ten years within the Stockholm county area. Sleep and physical activity were measured by accelerometry during seven consecutive days. Outcome measures are total sleep time, sleep efficiency, sleep start and sleep end; physical activity intensity divided into: sedentary (<1.5 METS), light (1.5 to 3 METS) and moderate-to-vigorous (> 3 METS); and Body Mass Index standard deviations score, BMIsds. Total sleep time decreased with increasing age, and was shorter in boys than girls on both weekdays and weekends. Late bedtime but consistent wake-up time during weekends made total sleep time shorter on weekends than on weekdays. Day-to-day within-subject analysis revealed that moderate-to-vigorous intense physical activity promoted an increased sleep efficiency the following night (CI < 0.001 to 0.047), while total sleep time was not affected (CI -0.003 to 0.043). Neither sleep duration (CI -0.024 to 0.022) nor sleep efficiency (CI -0.019 to 0.028) affected mean physical activity level the subsequent day. The between-subject analysis indicates that the sleep of children characterized by high moderate-to-vigorous physical activity during the day was frequently interrupted (SE = -.23, P < .01). A negative association between BMIsds and sleep duration was found (-.10, p < .01). Short sleep duration was associated with high BMI in six to ten year old children. This study underscores the importance of consistent bedtimes throughout the week for promoting sleep duration in preadolescents. Furthermore, this study suggests that a large proportion of intensive physical activity during the day might promote good sleep quality.
    Full-text · Article · Jun 2013 · International Journal of Behavioral Nutrition and Physical Activity
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    • "This is important because fragmented sleep is a serious problem. It reduces restorative deep sleep, that is, sleep quality with metabolic (Knutson 2007) and immunological (Redwine et al. 2000, Chiu et al. 2009) alterations. All three patients who succeeded in improving five or more of the nine outcome variables were prescribed increased physical activity, that is, number of steps and METs, which was also the most successful intervention in the whole group. "
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    ABSTRACT: This study aimed to evaluate effects of a non-pharmacological intervention on sleep, activity and fatigue in patients receiving peritoneal dialysis by the use of both actigraphy registration and self-assessed questionnaires. Insomnia is estimated to affect up to 60% of haemo- and peritoneal dialysis patients. It is associated with two common uremic symptoms, pruritus and restless legs syndrome. To our knowledge, no interventions have been evaluated by actigraphy. A prospective multiple baseline single-case experimental design. Two women and seven men with sleep problems, 48-77 years, treated with PD participated in a 17-week study from January 2009 to February 2011. Two interventions were separately implemented. First, a pressure-relieving mattress and second, a four week individual sleep hygiene and sleep scheduling intervention. The two interventions were evaluated both objectively by actigraphy and subjectively by questionnaires. A total of 315 sleep-wake cycles from nine individuals were evaluated. Three patients improved clinically significantly in five or more of the nine outcomes, i.e. sleep onset latency, nocturnal sleep duration, numbers and duration of napping, movement and fragmentation index, number of steps, metabolic equivalent unit, sleep efficiency and fatigue. The other six patients also showed improvements but to a lesser degree. Physical activity advice was the intervention that yielded most sleep improvements. This study illuminates the need for regular assessment of sleep and tiredness. It also demonstrates how a non-pharmacological treatment and self-management can be applied with renal supportive care to improve sleep quality. This study is a clinical example of a non-pharmacological intervention with supportive care and self-management. This model can improve health and reduce the pharmacological burden because hypnotics can be replaced by sleep hygiene self-care activities.
    Full-text · Article · Dec 2012 · Journal of Clinical Nursing
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    • "Few recent meta-analyses and systemic reviews of medical literature in this evolving branch of sleep medicine have thoroughly addressed the limitations of these epidemiological and laboratory studies and highlighted the importance of conducting well-designed, large scale and controlled studies with long follow-up time frames to address these significant findings. Furthermore, these studies should assess sleep duration objectively, rather than relying on self-reported questionnaires [50] [160] [161]. "
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    ABSTRACT: Over the last three to four decades, it has been observed that the average total hours of sleep have decreased to less than seven hours per person per night. Concomitantly, global figures relating to obesity and diabetes mellitus have increased in an alarming fashion in adults and children, and it has been hypothesized that neuro-hormonal changes accompanying this behavioral sleep deprivation may lead to insulin resistance and, subsequently, to diabetes mellitus. Sleep deprivation has been associated with multiple physiological changes, including increased cortisol and ghrelin levels, decreased leptin levels and impaired glucose metabolism. Experimental studies have also shown an increase in inflammatory and pro-inflammatory markers, which are indicators of body stress, under sleep deprivation. This review elaborates further on this hypothesis, exploring the molecular basis for the link between both entities and the underlying pathophysiology that results in insulin resistance and diabetes mellitus. We review the results of experimental and epidemiological studies, specifically examining the relationship between sleep duration and the immune and endocrine systems.
    Full-text · Article · Jun 2011 · The Open Respiratory Medicine Journal
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