Association Between Inpatient Sleep Loss and Hyperglycemia of Hospitalization

Abstract

OBJECTIVETo determine whether inpatient sleep duration and efficiency are associated with a greater risk of hyperglycemia in hospitalized patients with and without diabetes.RESEARCH DESIGN AND METHODSIn this retrospective analysis of a prospective cohort study, medical inpatients ≥50 years of age were interviewed, and their charts were reviewed to obtain demographic data and diagnosis. Using World Health Organization criteria, patients were categorized as having normal blood glucose, impaired fasting blood glucose, or hyperglycemia based on morning glucose from the electronic health record. Wrist actigraphy measured sleep. Multivariable ordinal logistic regression models, controlling for subject random effects, tested the association between inpatient sleep duration and proportional odds of hyperglycemia versus impaired fasting blood glucose or impaired fasting blood glucose versus normal blood glucose in hospitalized adults.RESULTSA total of 212 patients (60% female and 74% African American) were enrolled. Roughly one-third (73, 34%) had diabetes. Objective inpatient sleep measures did not differ between patients with or without diabetes. In ordinal logistic regression models, each additional hour of in-hospital sleep was associated with an 11% (odds ratio 0.89 [95% CI 0.80, 0.99]; P = 0.043) lower proportional odds of a higher glucose category the next morning (hyperglycemia vs. elevated and elevated vs. normal). Every 10% increase in sleep efficiency was associated with an 18% lower proportional odds of a higher glucose category (odds ratio 0.82 [95% CI 0.74, 0.89]; P < 0.001).CONCLUSIONSAmong medical inpatients, both shorter sleep duration and worse sleep efficiency were independently associated with greater proportional odds of hyperglycemia and impaired fasting glucose.

The Glymphatic System in Diabetes-Induced Dementia

“…A recent study demonstrated that impaired sleep duration was recorded in hyperglycemia patients ( 162 ). Epidemiological studies also showed that short duration and poor quality of sleep increase the risk of diabetes in adults ( 163 , 164 ).…”

Sleep in Hospitalized Patients

“…SWD and sleep deprivation have numerous deleterious effects (Figure 1), including autonomic dysfunction, impairment of the hypothalamic-pituitary-adrenal axis, and immunologic dysregulation 29 . Among hospitalized patients, reduced sleep duration and impaired sleep efficiency were independently associated with greater likelihood for impaired fasting glucose and hyperglycemia 30 . 1,2,9,[29][30][31][32][33] Poor quality sleep increases likelihood for development of delirium, anxiety and mood disorders [34][35][36] .…”

“…Among hospitalized patients, reduced sleep duration and impaired sleep efficiency were independently associated with greater likelihood for impaired fasting glucose and hyperglycemia 30 . 1,2,9,[29][30][31][32][33] Poor quality sleep increases likelihood for development of delirium, anxiety and mood disorders [34][35][36] . Delirium and sleep deprivation have shared characteristics, including impaired attention, fluctuating mental status, disorganized thinking and altered level of consciousness 35 .…”

Sleep in Hospitalized Patients

“… Consequences of Sleep Wake Dysfunction and Sleep Deprivation [ 1 , 2 , 9 , 11 , 12 , 13 , 14 , 15 ]. …”

“…Patients with chronic medical disease are at a higher risk for experiencing co-morbid sleep wake disorders [ 10 ]. In fact, acute hospitalization for medical illness is a high-risk period for the development or exacerbation of SWD, which can result in deleterious consequences [ 9 , 11 , 12 , 13 , 14 , 15 ].…”