Hemoglobin (Hb) A1c levels were significantly higher in men and women with diabetes who had short sleep duration and in women with poor sleep maintenance efficiency, according to a study published in Sleep. These findings suggest that behavioral sleep interventions may be of value in patients with diabetes.
The researchers examined the associations between sleep duration, variability, and maintenance efficiency among individuals with and without type 2 diabetes using 7-day wrist actigraphy, assessing sleep disordered breathing using the apnea-hypopnea index and nocturnal hypoxemia using home polysomnography with HbA1c.
Participants in the study were part of the Multi-Ethnic Study of Atherosclerosis (MESA), an ongoing multisite cohort of US adults. Using a regular MESA follow-up and ancillary MESA sleep study, 2049 participants (average age, 68.5 ± 9.2) with and without diabetes were included. Approximately 53.5% of participants were female, and average HbA1c was 6.0 ± 0.9.
Findings from the study showed a graded association between shorter average sleep duration and higher HbA1c concentrations among participants with diabetes. Poor sleep maintenance efficiency was also significantly associated with higher HbA1c among women with diabetes, but not among men. In addition, individuals without diabetes who had severe obstructive sleep apnea and nocturnal hypoxemia were found to have small increases in HbA1c. The same or greater increases in HbA1c were also observed for participants with diabetes, but the associations were not significant, possibly due to a smaller sample size. Additionally, the study compared values for HbA1c in accordance to sleep duration and efficiency and found comparable results to values from pharmacological and behavioral interventions targeting glycemic control.
The researchers proposed that the observed sex differences for sleep maintenance efficiency and HbA1c may have been due to a proinflammatory cytokine response; research has shown that sleep disturbances increase these responses in women, but not men.
Results of the study were limited by the cross-sectional nature of the data, which limits causal inference. Other limitations included the lack of inclusion of participants actively undergoing treatment for obstructive sleep apnea, which could lead to bias.
Findings from the study suggest that untreated sleep disordered breathing may contribute to abnormalities in glycemic control. The investigators concluded that behavioral interventions for sleep may offer significant value in the management of patients with diabetes and call for further research into sleep disorders and glycemic outcomes.
Whitaker KM, Lutsey PL, Ogilvie RP, et al. Associations between polysomnography and actigraphy-based sleep indices and glycemic control among those with and without type 2 diabetes: The Multi-Ethnic Study of Atherosclerosis [published online September 3, 2018]. Sleep. doi:10.1093/sleep/zsy172