Impact of insufficient sleep on dysregulated blood glucose control under standardised meal conditions

Abstract

Aims/hypothesis Sleep, diet and exercise are fundamental to metabolic homeostasis. In this secondary analysis of a repeated measures, nutritional intervention study, we tested whether an individual’s sleep quality, duration and timing impact glycaemic response to a breakfast meal the following morning. Methods Healthy adults’ data (N = 953 [41% twins]) were analysed from the PREDICT dietary intervention trial. Participants consumed isoenergetic standardised meals over 2 weeks in the clinic and at home. Actigraphy was used to assess sleep variables (duration, efficiency, timing) and continuous glucose monitors were used to measure glycaemic variation (>8000 meals). Results Sleep variables were significantly associated with postprandial glycaemic control (2 h incremental AUC), at both between- and within-person levels. Sleep period time interacted with meal type, with a smaller effect of poor sleep on postprandial blood glucose levels when high-carbohydrate (low fat/protein) (pinteraction = 0.02) and high-fat (pinteraction = 0.03) breakfasts were consumed compared with a reference 75 g OGTT. Within-person sleep period time had a similar interaction (high carbohydrate: pinteraction = 0.001, high fat: pinteraction = 0.02). Within- and between-person sleep efficiency were significantly associated with lower postprandial blood glucose levels irrespective of meal type (both p < 0.03). Later sleep midpoint (time deviation from midnight) was found to be significantly associated with higher postprandial glucose, in both between-person and within-person comparisons (p = 0.035 and p = 0.051, respectively). Conclusions/interpretation Poor sleep efficiency and later bedtime routines are associated with more pronounced postprandial glycaemic responses to breakfast the following morning. A person’s deviation from their usual sleep pattern was also associated with poorer postprandial glycaemic control. These findings underscore sleep as a modifiable, non-pharmacological therapeutic target for the optimal regulation of human metabolic health. Trial registrationClinicalTrials.gov NCT03479866. Graphical abstract

Objective sleep characteristics and continuous glucose monitoring profiles of type 2 diabetes patients in real‐life settings

“…Further supporting the mechanism, recent evidence from 953 healthy adults showed that a person's deviation from their usual sleep pattern was associated with higher postprandial glucose level. 32 The present study was among the first to examine the relationships between objective sleep variables and continuous glucose outcomes among adults with T2D. Our data indicated that timing of nocturnal sleep was directly associated with glucose variability during the same night.…”

Associations between the Dietary Inflammatory Index and Sleep Metrics in the Energy Balance Study (EBS)

“…Similarly, evidence has shown an association between sleep timing (i.e., bedtime and waketime) and dietary quality [ 64 , 65 ]. Although not yet fully understood, the causal pathway between dietary quality and sleep timing is mediated by biological mechanisms and hormonal responses, including postprandial glucose [ 64 , 65 ].…”

“…Similarly, evidence has shown an association between sleep timing (i.e., bedtime and waketime) and dietary quality [ 64 , 65 ]. Although not yet fully understood, the causal pathway between dietary quality and sleep timing is mediated by biological mechanisms and hormonal responses, including postprandial glucose [ 64 , 65 ]. Results from the PREDICT dietary intervention trial, composed of participants from the United Kingdom and the United States of America, found an association between increased postprandial glucose levels, which are described as a spike in the amount of glucose found in one’s plasma shortly after a meal that can contribute to cardiovascular and diabetic complications potentially causing an offset of circadian rhythms, and later sleep midpoint [ 65 ].…”

“…Although not yet fully understood, the causal pathway between dietary quality and sleep timing is mediated by biological mechanisms and hormonal responses, including postprandial glucose [ 64 , 65 ]. Results from the PREDICT dietary intervention trial, composed of participants from the United Kingdom and the United States of America, found an association between increased postprandial glucose levels, which are described as a spike in the amount of glucose found in one’s plasma shortly after a meal that can contribute to cardiovascular and diabetic complications potentially causing an offset of circadian rhythms, and later sleep midpoint [ 65 ]. Additionally, a study assessing circadian systems and behavioral cycles (i.e., sleep/wake and fasting/feeding cycles) in healthy adults, including shift-workers, found that circadian misalignment, defined as a misalignment between the body’s internal circadian clock and 24-hour behavioral or environmental cycles (i.e., shift-workers, who sleep during the day and work and eat at night), increased postprandial glucose [ 66 ].…”

Menopause is associated with postprandial metabolism, metabolic health and lifestyle: The ZOE PREDICT study

“…For example, in our cohort, post-menopausal females consumed higher intakes of dietary sugars and reported poorer sleep. These are both associated with more pronounced postprandial glycaemia 30 and increased risk of type-2 diabetes and cardiovascular disease. 31 Further, a decrease in physical activity energy expenditure and a shift to a more sedentary lifestyle associated with menopause 32 was recently demonstrated to be a direct effect of declining oestrogen 33 which may have been captured with more quantitative measures of physical activity in this study.…”