Sleep efficiency as a determinant of insulin sensitivity in overweight and obese adolescents

Abstract

Insulin resistance (IR) occurs in a transient manner during puberty. Obese adolescents may be at risk for persistent IR during puberty. The objective of the study is to review the literature on the association of the anthropometry and lifestyle characteristics with insulin sensitivity in overweight and obese adolescents, and include data from a new study. Relevant papers were selected and reviewed. In addition, 137 overweight and obese adolescents (42 male/95 female, age 14.4 ± 2.3 years, BMI z-score +3.3 ± 0.7, HOMA-IR 3.4 ± 1.8) from the Centre for Overweight Adolescent and Children's Healthcare (MUMC+) were included in this study. Anthropometrics, Tanner stages, sleep characteristics, food intake behaviour and physical activity were determined, and possible associations with homeostasis model assessment of insulin resistance (HOMA-IR) were tested. Results: Overweight and obese adolescents with unfavourable fat partitioning and family history of NIDDM are at risk for persistent IR. Overweight and obese adolescents from the new cohort showed a higher HOMA-IR postpubertally. BMI z-score, age, pubertal stage and prepubertally total sleeping time (TST) and sleep efficiency (SE) were identified as significant contributors. Overweight and obese adolescents showed a persistently higher instead of transiently higher HOMA-IR during puberty, associated with BMI z-score, age, pubertal stage and prepubertally less TST and SE. Keywords: food intake behaviour, physical activity, pubertal persistent insulin resistance, pubertal transient insulin resistance, sleep Date submitted 9 April 2015; date of final acceptance 2 June 2015 IntroductionDuring puberty, adolescents undergo a series of biological, cognitive and psychosocial changes. One of the hallmarks of puberty is a change in endocrine conditions and changes in anthropometric factors, such as height, body weight and body composition. In parallel, behavioural changes, such as sleeping time, food intake behaviour and physical activity, driven both by biological processes or social and academic pressures, occur [1][2][3][4][5][6][7][8][9]. Together, these factors pose an increased risk for the development of excess weight and obesity, as well as comorbidities such as insulin resistance (IR), type 2 diabetes and cardiovascular disease, but also non-alcoholic fatty liver disease and obstructive sleep apnea syndrome [9].This review discusses insulin insensitivity during puberty, reviewing the existing evidence for possibly related changes in body weight, especially overweight and obesity, sleep characteristics, physical activity and food intake behaviour.In addition, data from a new, recent study on possible relationships between sleep efficiency (SE) and insulin sensitivity in overweight and obese adolescents are reported. Transient IR at PubertyPuberty is associated with transient IR and hyperglycaemia [10,11], due to an impaired ability of insulin to stimulateCorresponding to: Prof. Dr M. S. Westerterp-Plantenga, Department of Human Biology, Maastricht University, P.O. Box ...

Role of sleep quality in the metabolic syndrome

“…Lower sleep efficiency (the percentage of time in bed that is spent asleep) also predisposes to IR in overweight and obese adolescents 121. In one study, more variability in sleep duration was associated with higher insulin levels 101.…”

“…Although there are considerably less available data in children examining these associations than in adults, several studies have shown that insufficient sleep is associated with IR in obese children (but not in normal-weight children) and normal-weight and obese adolescents independently of obesity 118–121. Lower sleep efficiency (the percentage of time in bed that is spent asleep) also predisposes to IR in overweight and obese adolescents 121.…”

The association between sleep efficiency and diabetes mellitus in community‐dwelling individuals with or without sleep‐disordered breathing

“…Studies have found that poor SE is associated with obesity, metabolic syndrome, and hypertension . Besides, SE was also found to be a significant contributor for the insulin sensitivity in overweight and obese adolescents . However, there is no evidence on the association between SE and DM based on PSG records.…”

“…SE, which is usually the measure used to evaluate individuals for sleep fragmentation, is defined as the ratio of time spent asleep to total time in bed multiplied by 100 . Studies have found that poor SE is associated with obesity, metabolic syndrome, and hypertension . Besides, SE was also found to be a significant contributor for the insulin sensitivity in overweight and obese adolescents .…”

PREVIEW (Prevention of Diabetes Through Lifestyle Intervention and Population Studies in Europe and Around the World) study in children aged 10 to 17 years: Design, methods and baseline results

“…As expected, pubertal children with morbid obesity had a significantly higher HOMA‐IR than prepubertal children or children who were overweight. High HOMA‐IR in children with morbid obesity in this and previous studies indicates that these children in particular are at high risk of β‐cell exhaustion, which can result in decreased and insufficient β‐cell secretion and T2DM . The PREVIEW study aimed to provide more insight into longitudinal IR development during puberty in a 2‐year follow‐up design.…”