Effects of poor and short sleep on glucose metabolism and obesity risk

Abstract

The importance of sleep to hormones and glucose metabolism was first documented more than four decades ago. Since then, sleep curtailment has become an endemic behavior in modern society. In addition, the prevalence of sleep disorders, particularly obstructive sleep apnea (OSA), has increased. OSA is very common in endocrine and metabolic disorders, but often remains undiagnosed. This Review summarizes the laboratory and epidemiologic evidence that suggests how sleep loss, either behavioral or disease-related, and poor quality of sleep might promote the development of obesity and diabetes mellitus, and exacerbate existing endocrine conditions. Treatment of sleep disorders has the potential to improve glucose metabolism and energy balance. Screening for habitual sleep patterns and OSA might be critically important for patients with endocrine and metabolic disorders.

Figure 1

Results from intravenous glucose-tolerance tests in healthy individuals when fully rested and after sleep manipulations. a | Results when fully rested and after 5 nights of 4 h in bed; b | Results during baseline sleep and after 3 nights of suppression of slow-wave sleep. Abbreviation: SWS, slow-wave sleep. Permission for part a was obtained from Elsevier Ltd © Spiegel, K. et al. Impact of sleep debt on metabolic and endocrine function. Lancet 354, 1435–1439 (1999). Part b was adapted from Tasali, E. et al. Proc. Natl Acad. Sci. USA 105, 1044–1049 (2008).

Figure 2

Effect of sleep duration on leptin and ghrelin levels. a | Mean (±SEM) leptin and serum plasma ghrelin levels in healthy individuals after 2 days with 4 h or 10 h sleep periods. b | Mean (SEM) 24 h serum leptin profiles after 6 days of 4 h, 8 h and 12 h in bed in nine healthy, lean men, studied at bed rest who ate three identical carbohydrate-rich meals. At the end of these study periods, the participants slept an average of 3 h 48 min in the 4 h in bed group, 6 h 52 min in the 8 h in bed group, and 8 h 52 min in the 12 h in bed group. All characteristics of the 24 h leptin profile increased from the 4 h to the 12 h bedtime condition. The bars represent sleep periods. Permission for panel a was obtained from the American College of Physicians © Spiegel K et al. Brief communication: sleep curtailment in healthy young men is associated with decreased leptin levels, elevated ghrelin levels, and increased hunger and appetite. Ann. Intern. Med. 141, 846–850 (2004). Permission for panel b was obtained from The Endocrine Society © Spiegel K et al. Leptin levels are dependent on sleep duration: relationships with sympathovagal balance, carbohydrate regulation, cortisol, and thyrotropin. J Clin. Endocrinol. Metab. 89, 5762–5771 (2004).

Figure 3

Prevalence of impaired glucose tolerance and degree of insulin resistance, as assessed by the HOMA index, in control women without OSA, women with PCOS and without OSA, and women with PCOS and mild (5et al. Impact of obstructive sleep apnea on insulin resistance and glucose tolerance in women with polycystic ovary syndrome. J. Clin. Endocrinol. Metab. 93, 3878–3884 (2008).