Relationship between sleep disturbances, lipid profile and insulin sensitivity in type 1 diabetic patients: a cross-sectional study

Abstract

Objective The consequences of sleep deprivation in type 1 diabetes (T1D) patients are poorly understood. Our aim was to determine how sleep disorders influence lipid profile and insulin sensitivity in T1D patients. Materials and methods This was a cross-sectional study at a public university hospital. Demographic information and medical histories were obtained during regular scheduled visit of T1D patients to the outpatient clinic. Insulin sensitivity was obtained using the estimated glucose disposal rate (eGDR) formula. Sleep quality was assessed using the Pittsburgh Sleep Quality Index, Epworth Sleepiness Scale and Berlin Questionnaire. Results The adult participants (n = 66, 62% women) had a median age of 28.0 years (interquartile range 21.8-33.0). Six patients (9%) had metabolic syndrome according to the International Diabetes Federation criteria. Thirty patients (46%) were considered poor sleepers according to the Pittsburgh Sleep Quality Index. The LDL-c and total cholesterol levels of poor sleepers were higher than those of good sleepers (103 v. 81; p = 0.003 and 178.0 v. 159.5 mg/dL; p = 0.009, respectively). Three patients (4%) were at high risk of obstructive sleep apnea syndrome (OSAS) according to the Berlin Questionnaire. The eGDR was lower in the group of patients with high probability of having OSAS (6.0 v. 9.1 mg.kg -1 .min -1 ;p = .03). Conclusions Poor subjective quality of sleep and higher risk of OSAS were correlated with a worsened lipid profile and decreased insulin sensitivity, respectively. Therefore, T1D patients with sleep disturbances might have an increased cardiovascular risk in the future.

Sleep quality and sex-related factors in adult patients with immune-mediated diabetes: a large cross-sectional study

“…Males reporting normal sleep had significantly better glycemic control than males with poor sleep quality and females with or without poor sleep quality, suggesting a tighter relationship between glycemic control and sleep in males, contrary to females, whose sleep quality seems to be relatively independent of glycemic control. Our results are coherent also with the hypothesis that decreased insulin sensitivity may be a mechanism of altered sleep quality and duration [23], as highlighted by the increased TDD/Kg (a sign of insulin resistance) in males with poor sleep quality. In fact, insulin resistance has been reported to be influenced by sex and sex hormones levels, though the exact mechanism has not been discovered [30].…”

“…Previous studies attempted to analyze the sleep quality in patients with AD by means of objective (PSG, actigraphy) and subjective measures (self-reported questionnaires), showing that patients with T1D had a worse sleep quality than control subjects only when assessed by questionnaires rather than PSG or actigraphy [6]. The method of assessment of sleep quality may explain those differences, since Data are expressed as median with interquartile range in parentheses, or as frequencies T1D, type 1 diabetes; LADA, latent autoimmune diabetes of the adult; TDD, total daily (insulin) dose; MDI, multiple daily injections; CSII, continuous subcutaneous insulin infusion; SMPG, self-monitoring of plasma glucose; isCGM, intermittently scanned continuous glucose monitoring (device); rtCGM, real-time continuous glucose monitoring (device); HbA1c, glycated hemoglobin; SD, standard deviation † n = 435 [17][18][19][20][21][22][23][24][25]. The largest prevalence of altered sleep quality in patients with T1D (67%) was reported by Gilsanz and colleagues and doubled that of our population.…”

Association between Berlin Questionnaire Index and lipid profile

“…In this study, we concluded that male individuals at high risk for OSAS, selected using the Berlin questionnaire, had higher levels of total cholesterol, LDL-c, and HDL-c. In agreement, Mattos et al (2020) 14 evaluated sleep disorders and their relationship with the lipid profile in 66 individuals with type 1 diabetes mellitus. The Pittsburg sleep quality index, Epworth sleepiness scale, and Berlin questionnaire determined sleep quality.…”

Sleep: an emerging therapeutic target in diabetes care

“…Reduced sleep duration and quality were associated with higher glycemic variability along with greater stress and depression in type 1 diabetes mellitus [16]. In another study, type 1 diabetes mellitus patients with poor sleep quality had higher total and LDL cholesterol as compared to good sleepers [17].…”