Poor Sleep Quality Is Associated with Dawn Phenomenon and Impaired Circadian Clock Gene Expression in Subjects with Type 2 Diabetes Mellitus

Abstract

Aims. We investigated whether poor sleep quality is associated with both dawn phenomenon and impaired circadian clock gene expression in subjects with diabetes. Methods. 81 subjects with diabetes on continuous glucose monitoring were divided into two groups according to the Pittsburgh Sleep Quality Index. The magnitude of dawn phenomenon was quantified by its increment from nocturnal nadir to prebreakfast. Peripheral leucocytes were sampled from 81 subjects with diabetes and 28 normal controls at 09:00. Transcript levels of circadian clock genes (BMAL1, PER1, PER2, and PER3) were determined by real-time quantitative polymerase chain reaction. Results. The levels of HbA1c and fasting glucose and the magnitude of dawn phenomenon were significantly higher in the diabetes group with poor sleep quality than that with good sleep quality. Peripheral leucocytes from subjects with poor sleep quality expressed significantly lower transcript levels of BMAL1 and PER1 compared with those with good sleep quality. Poor sleep quality was significantly correlated with magnitude of dawn phenomenon. Multiple linear regression showed that sleep quality and PER1 were significantly independently correlated with dawn phenomenon. Conclusions. Dawn phenomenon is associated with sleep quality. Furthermore, mRNA expression of circadian clock genes is dampened in peripheral leucocytes of subjects with poor sleep quality.

Effect of Type 2 Diabetes Mellitus on the Hypoxia-Inducible Factor 1-Alpha Expression. Is There a Relationship with the Clock Genes?

“…Similarly, the combined downregulation in the expressions of CRY1 and PER3 at midnight predicted the severity of the disease in patients with obstructive sleep apnea/hypopnea syndrome [18]. Additionally, in patients with type 2 diabetes, those with the poorest sleep quality showed a dampened mRNA expression of clock genes such as BMAL1 and PER1 [33]. Therefore, we propose that the disorder in nocturnal breathing that characterize the sleep of patients with type 2 diabetes could alter the circadian rhythm (Figure 3).…”

The impact of dusk phenomenon on total glucose exposure in Chinese people with type 2 diabetes

“…There is a certain similarity between the dawn phenomenon and the dusk phenomenon in clinical characteristics, from which we may get some enlightenment. The mechanism of the dawn phenomenon is complex and diverse: the loss of β cell function, [ 20 ] growth hormone-induced insulin resistance, [ 21 ] increasing of circulating insulin-like growth factor binding protein-1 in the morning, [ 22 ] poor sleep quality, and the impairment of circadian clock [ 23 ] seemed to be closely involved in the pathophysiology of dawn phenomenon in people with diabetes. However, the correlation and regression analysis showed no relationship between the dawn phenomenon and the dusk phenomenon in our study.…”

Alterations of sleep quality and circadian rhythm genes expression in elderly thyroid nodule patients and risks associated with thyroid malignancy

“…Of note, studies have shown that circadian clock genes were associated with sleep outcomes in human research 13 . Thus, the essential question we addressed in our study was whether sleep quality and circadian rhythm genes expression were altered upon thyroid nodule patients, especially malignant nodules; whether poor sleep quality was the risk factor associated with thyroid malignancies; and whether there was a correlation between sleep disorders and circadian rhythm genes, which may be involved in the development of thyroid malignancy.…”