Sleep interventions and glucose metabolism: systematic review and meta-analysis

Kothari, Vallari; Cardona, Zulma; Chirakalwasan, Naricha; Anothaisintawee, Thunyarat; Reutrakul, Sirimon

doi:10.1016/j.sleep.2020.11.035

Cited by 38 publications

(36 citation statements)

References 37 publications

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“…While this finding does not support some prior studies that have demonstrated a potential link between decreased sleep duration and insulin resistance, it is consistent with findings from a randomised controlled trial of 42 normalweight adult short sleepers [11]. This may be because the effect of sleep duration in glycaemic control may be non-linear, with sleep affecting glucose metabolism only once sleep duration dips below a specific bound [11]. Moreover, sleep duration for the vast majority of PREDICT1 participants fell within the recommended range, as indicated by the mean 6.87 h of sleep within the lowest quartile of the SPT distribution (Table 1).…”

Section: Sptcontrasting

confidence: 72%

“…These and other data [8][9][10] point to a strong link between sleep quality/duration and glucose homeostasis. However, while there have been numerous large prospective cohort studies focused on the relationship between selfreported sleep, disease and wellbeing, objective data on sleep and postprandial glucose metabolism typically emanates from small studies conducted in tightly controlled settings and in specific population subgroups such as those suffering sleep disturbances owing to pregnancy, sleep apnoea, depression, obesity or diabetes [11]. Thus, the evidence base for potential recommendations concerning the effects of sleep on glucose metabolism in generally healthy people has considerable scope for expansion.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2021

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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

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Section: Sptcontrasting

confidence: 72%

Section: Introductionmentioning

confidence: 99%

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

et al. 2021

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“…In another study in 75 people with type 2 diabetes and insomnia receiving dexzopiclone or estazolam for 14 days, sleep was improved in both groups but only fasting glucose was significantly reduced in the dexzopiclone group. This suggests a direct effect of dexzopiclone on glycaemic control [ 44 ]. To date, no studies on the glycaemic effects of other hypnotics in type 2 diabetes have been published.…”

Section: Treating Sleep Disorders In Type 2 Diabetesmentioning

confidence: 99%

“…An elegant meta-analysis by Kothari et al [ 44 ] identified six studies showing that cognitive behavioural therapy for insomnia (CBT-I) and/or sleep education improved sleep quality measured by the Pittsburgh Sleep Quality Index (−1.31 [95% CI −1.83, −0.80]) and resulted in a non-significant HbA 1c reduction (−3.6 mmol/mol [−0.35%]; p = 0.13) in those with sleep disturbances or insomnia, including both the general population and people with type 2 diabetes. Only two small pilot studies on CBT-I in people with type 2 diabetes have been conducted, reporting a reduction in both HbA 1c levels after 3 weeks (2.8 ± 3.06 mmol/mol [0.26 ± 0.28%]) [ 63 ] and after 7 weeks (4.5 mmol/mol [0.41%]; p = 0.01) [ 64 ], as well as a 4.63 ( p = 0.002) decrease in Beck Depression Inventory measures [ 65 ] in the latter cohort.…”

Section: Treating Sleep Disorders In Type 2 Diabetesmentioning

confidence: 99%

Sleep disorders in people with type 2 diabetes and associated health outcomes: a review of the literature

et al. 2021

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Sleep disorders are linked to development of type 2 diabetes and increase the risk of developing diabetes complications. Treating sleep disorders might therefore play an important role in the prevention of diabetes progression. However, the detection and treatment of sleep disorders are not part of standardised care for people with type 2 diabetes. To highlight the importance of sleep disorders in people with type 2 diabetes, we provide a review of the literature on the prevalence of sleep disorders in type 2 diabetes and the association between sleep disorders and health outcomes, such as glycaemic control, microvascular and macrovascular complications, depression, mortality and quality of life. Additionally, we examine the extent to which treating sleep disorders in people with type 2 diabetes improves these health outcomes. We performed a literature search in PubMed from inception until January 2021, using search terms for sleep disorders, type 2 diabetes, prevalence, treatment and health outcomes. Both observational and experimental studies were included in the review. We found that insomnia (39% [95% CI 34, 44]), obstructive sleep apnoea (55–86%) and restless legs syndrome (8–45%) were more prevalent in people with type 2 diabetes, compared with the general population. No studies reported prevalence rates for circadian rhythm sleep–wake disorders, central disorders of hypersomnolence or parasomnias. Additionally, several cross-sectional and prospective studies showed that sleep disorders negatively affect health outcomes in at least one diabetes domain, especially glycaemic control. For example, insomnia is associated with increased HbA1c levels (2.51 mmol/mol [95% CI 1.1, 4.4]; 0.23% [95% CI 0.1, 0.4]). Finally, randomised controlled trials that investigate the effect of treating sleep disorders in people with type 2 diabetes are scarce, based on a small number of participants and sometimes inconclusive. Conventional therapies such as weight loss, sleep education and cognitive behavioural therapy seem to be effective in improving sleep and health outcomes in people with type 2 diabetes. We conclude that sleep disorders are highly prevalent in people with type 2 diabetes, negatively affecting health outcomes. Since treatment of the sleep disorder could prevent diabetes progression, efforts should be made to diagnose and treat sleep disorders in type 2 diabetes in order to ultimately improve health and therefore quality of life. Graphical abstract

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“…A favourable influence was found in three out of the four included studies with melatonin treatment, but due to heterogeneity between the included studies, a metaanalysis was not performed. 12 In the present systematic review and meta-analysis, we aimed to investigate the isolated effects of daily melatonin administration before bedtime for a minimum of 2 weeks on fasting plasma glucose, insulin, insulin sensitivity and HbA1c compared with placebo in healthy or metabolically challenged adults irrespective of underlying sleep disturbances.…”

Section: Introductionmentioning

confidence: 99%

Effects of daily administration of melatonin before bedtime on fasting insulin, glucose and insulin sensitivity in healthy adults and patients with metabolic diseases. A systematic review and meta‐analysis

Lauritzen

Kampmann

Smedegaard

et al. 2021

Clinical Endocrinology

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Background: Melatonin is increasingly used as a pharmacological sleep aid but it is also emerging as a regulator of glucose homoeostasis. Yet, previous research has been ambiguous with reports of both positive and negative effects of melatonin on glucose metabolism.Objectives: To assess the effect of daily treatment with melatonin on fasting glucose, insulin, insulin sensitivity and haemoglobin A1c (HbA1c) levels.Data Sources: MEDLINE, EMBASE, CENTRAL, clinicaltrials.gov and clinicaltrialsregister.eu were systematically searched.Eligibility Criteria, Participants and Interventions: All randomized, placebo-controlled studies with melatonin treatment were assessed. We included studies with daily melatonin treatment (≥2 weeks) of healthy adults or patients with metabolic diseases.Methods: Hedges' g differences were calculated for the metabolic parameters of the included studies, heterogeneity was assessed with χ 2 and I 2 tests and meta-analyses were performed with the random-effects model. Results: Long-term treatment with melatonin did not change fasting glucose significantly compared with placebo (g: −0.07 [−0.22 to 0.08], n = 603) but it reduced fasting insulin levels slightly (g: −0.27 [−0.50 to −0.04], n = 278) and trended towards reduced insulin resistance (HOMA-IR) (g: −0.20 [−0.44 to 0.03], n = 278). HbA1c levels were largely unaffected by melatonin treatment compared with placebo (g: 0.14 [−0.19 to 0.46], n = 142).Conclusions: With the available literature, melatonin seems to be a glucosemetabolic safe sleep aid in patients with metabolic diseases and in healthy adults. It may even have beneficial glucose-metabolic effects as fasting insulin levels were reduced in this meta-analysis, but the confidence intervals of the meta-analyses are wide, underscoring the need for further research within this field.

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Sleep interventions and glucose metabolism: systematic review and meta-analysis

Cited by 38 publications

References 37 publications

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

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

Sleep disorders in people with type 2 diabetes and associated health outcomes: a review of the literature

Effects of daily administration of melatonin before bedtime on fasting insulin, glucose and insulin sensitivity in healthy adults and patients with metabolic diseases. A systematic review and meta‐analysis

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