Associations of sleep disturbance and duration with metabolic risk factors in obese persons with type 2 diabetes: data from the Sleep AHEAD Study

Abstract

Marie-Pierre St-Onge,1 Gary Zammit,2 David M Reboussin,3 Samuel T Kuna,4 Mark H Sanders,8 Richard Millman,6 Anne B Newman,5 Thomas A Wadden,4 Rena R Wing,6 F Xavier Pi-Sunyer,1 Gary D Foster7 Sleep AHEAD Research Group*1New York Obesity Research Center, St Luke's/Roosevelt Hospital, New York, NY, USA; 2Clinilabs, New York, NY, USA; 3Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA; 4Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA; 5Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA, USA; 6Department of Psychiatry and Human Behavior, Brown University, Providence, RI, USA; 7Center for Obesity Research and Education, Temple University, Philadelphia, PA, USA; 8Department of Medicine, Division of Pulmonary, Allergy and Critical Care Medicine, University of Pittsburgh, PA, USA*A full list of the members of the Sleep AHEAD Research Group is available in an online appendixPurpose: Some studies have found an association between sleep disturbances and metabolic risk, but none has examined this association in individuals with type 2 diabetes. The objective of this study was to determine the relationship between sleep disturbances and metabolic risk factors in obese patients with type 2 diabetes.Patients and methods: This study was a cross-sectional examination of the relationship between sleep parameters (apnea/hypopnea index [AHI], time spent in various sleep stages) and metabolic risk markers (fasting glucose, hemoglobin A1c, lipids) using baseline data of the Sleep AHEAD cohort. Subjects (n = 305) were participants in Sleep AHEAD (Action for Health in Diabetes), a four-center ancillary study of the Look AHEAD study, a 16-center clinical trial of overweight and obese participants with type 2 diabetes, designed to assess the long-term effects of an intensive lifestyle intervention on cardiovascular events. All participants underwent one night of in-home polysomnography and provided a fasting blood sample. Regression analyses estimated the relationship between sleep variables and metabolic risk factors. Models were adjusted for study center, age, sex, race/ethnicity, waist circumference, smoking, alcohol intake, diabetes duration, and relevant medications.Results: Of 60 associations tested, only one was significant: fasting glucose was associated with sleep efficiency (estimate −0.53 ± [standard error] 0.26, P = 0.041). No associations were found between any of the sleep variables and lipid profile or hemoglobin A1c.Conclusions: The present data show only weak associations between select sleep variables and metabolic risk factors and do not provide strong support for a role of sleep on metabolic abnormalities in obese patients with type 2 diabetes.Keywords: obesity, obstructive sleep apnea, metabolic risk, sleep, diabetes