Table 5.
A summary of experimental studies that have investigated the association between sleep features and diabetes outcomes
| First author (year) | Sample/country | Study design | Sleep measure | Diabetes measure | Covariates | Findings |
|---|---|---|---|---|---|---|
| Schmid (2007) [108] | 10 men; 20–40 years; Germany | Randomized crossover design: 1 night TSD vs. 1 night of 8 h TIB | PSG | Hypoglycemic clamp at the end of each condition | None | Levels of glucose and insulin were unaffected by sleep condition |
| Tasali (2008) [84] | 5 men, 4 women, aged 20–31 years; US | Randomized crossover with 2 conditions: 2 nights baseline sleep vs. 3 nights SWS suppression | PSG | Glucose regulation assessed by IVGTT at the end of each condition | None | Significant decrease (~25%) in insulin sensitivity and reduced glucose tolerance (~23%) after 3 nights of SWS suppression |
| Stamatakis (2010) [52] | 9 men, 2 women; aged 18–29 years; US | Experimental | PSG: 2 nights of induced sleep fragmentation | IVGTT to determine insulin sensitivity, glucose effectiveness and insulin secretion at baseline and end of experimental condition | Insulin sensitivity significantly decreased (25.2%) after sleep fragmentation; glucose effectiveness significantly decreased by 20.9% after sleep fragmentation | |
| Tuomilehto (2009) [109] | 522 overweight participants with IGT at baseline; mean baseline age 55 ± 7 years; Finland | Randomized controlled trial: 265 randomized to intensive diet-exercise, 257 to control; 4 years intervention with 3 years post-intervention | Self-reported using activity diary based on 24 h prior to annual examination | Annual OGTT; IDM defined using WHO criteria | Age, sex, BMI, study center, smoking, alcohol, hypertension medication, baseline physical activity, 1 year change in body weight |
Control group: Incidence p/100 person-yrs ≤6.5 h HR = 1.68; 9–9.5 h HR = 2.29*; ≥10 h HR = 2.74* Intervention: ≤6.5 h HR = 1.44; 9–9.5 h HR = 1.10; ≥10 h HR = 0.73 |
| Nedeltcheva (2009) [110] | 5 women, 6 men; mean age 39 ± 5 years | Randomized crossover with 2 conditions: 14 days/nights 8.5 h and 5.5 h TIB | PSG | OGTT and IVGTT to determine glucose tolerance, glucose effectiveness, insulin secretion and insulin sensitivity at the end of each condition | None | Glucose after 2 h OGTT 10% higher after 5.5 h vs. 8.5 h; insulin sensitivity reduced 17.5% in 5.5 h condition |
| Van Leeuwen (2010) [111] | 23 healthy men; aged 19–29 years; Finland | Experimental study; 10 nights laboratory attendance (2 nights baseline, 5 nights of 4 h TIB, 3 nights of 8 h TIB. Control group spent 8 h TIB for 10 nights | PSG for 10 consecutive nights | Fasted blood samples during each experimental sleep condition for assessment of glucose and insulin | Insulin increased after sleep restriction to 160% and dropped back to 115% during 8 h recovery; insulin-to-glucose ratio increased significantly after sleep restriction | |
| Donga (2010) [38] | 5 men, 4 women; mean age 45 years; Netherlands | Experimental study: 1 night baseline TIB, 1 night 4 h TIB | PSG | Insulin sensitivity measured using the hyperinsulinemic euglycemic clamp technique | Insulin sensitivity decreased 19–25% after sleep restriction | |
| Garfinkel (2011) [112] | 11 men, 25 women, aged 46–77 years with T2DM; US | Randomized double-blinded, crossover trial (3 weeks of 2 mg melatonin vs. placebo with subsequent open labeled melatonin) | Wrist actigraphy in 22 (7 men, 15 women) with insomnia complaint | Physician diagnosed T2DM (16 using oral medication; 20 insulin-dependent) | No effect on glucose or HbA1c during cross over trial; HbA1c reduced with open-label melatonin from 9.13% (baseline) to 8.47% after 5 m | |
| Spiegel (1999) [31] | 11 healthy men; aged 18–27 years; US | Experimental study | PSG | IVGTT across 24 h | None | Glucose tolerance decreased by 40% after sleep restriction |
| Zielinski (2008) [32] | 33 healthy men and women; aged 50–70 years; US | Experimental randomized crossover study | Wrist actigraphy monitoring throughout study period | Pre and post OGTT | No significant association between sleep and glucose tolerance | |
| Reynolds (2012) [35] | 14 healthy men; aged 22–36 years; Australia | Experimental study: 5 nights 4 h TIB, 1 recovery night 10 h TIB | Wrist actigraphy and PSG | Blood sampling to determine glucose and insulin; HOMA-IR calculated; CGM | None | Glucose, insulin and HOMA-IR were significantly higher after sleep restriction vs. baseline |
| Broussard (2012) [34] | 7 healthy (1 woman, 6 men); aged 18–30 years; US | Randomized crossover study: 4 nights of 4.5 h TIB or 8.5 h TIB | PSG | IVGTT to determined insulin sensitivity | Insulin sensitivity significantly reduced by 16% after sleep restriction | |
| Bell (2013) [113] | 6 men, 5 women; mean age 26 years; at risk for T2DM; US | Randomized crossover study with 2 conditions: 8 nights of either 8.5 h TIB or 5.5 h TIB | Wrist actigraphy | Fasting plasma glucose obtained on the last morning of each condition | None | Sleep restriction associated with lower glucose level |
| Leproult (2014) [36] | 26 healthy (7 women, 19 men); aged 21–39 years; US | Non-randomized experimental | PSG | IVGTT and frequent blood sampling | None | Insulin sensitivity decreased after sleep restriction; effect doubled in men with circadian misalignment |
| Buxton (2012) [61] | Experimental study with circadian misalignment | |||||
| Rao (2015) [33] | 14 (8 men, 6 women) without T2DM; mean age 27 years; US | Randomized crossover study: 5 nights of 4 h TIB and 8 h TIB | Wrist actigraphy and PSG | Insulin sensitivity measured using OGTT and hyperinsulinemic-euglycemic clamp | None | Insulin sensitivity decreased by 25–29% following sleep restriction; hepatic insulin sensitivity was unaltered |
| Broussard (2015) [37] | 19 healthy men; aged 18–30 years; US | Randomized crossover study: 8.5 h TIB vs. 4.5 h TIB | Sleep diaries and continuous sleep-wake monitoring using wrist actigraphy | IVGTT to determine insulin, glucose and insulin sensitivity | None | Insulin sensitivity decreased after sleep restriction |
| Robertson (2013) [114] | 19 healthy men; aged 20–30 years; UK | Experimental study: sleep restriction vs. control for 3 weeks | Wrist actigraphy and sleep diary | Hyperinsulinemic-euglycemic clamp to assess insulin sensitivity | None | Insulin sensitivity significantly decreased after 1 week of sleep restriction |
| Gonzalez-Ortiz (2000) [115] | 28 healthy (14 men, 14 women); aged 19–23 years; Mexico | Randomized controlled trial: 24-h total sleep deprivation or habitual sleep | Unknown | Insulin suppression test | None | After sleep deprivation 18% increase in steady-state glucose concentration |
| VanHelder (1993) [116] | 10 healthy men; mean age 22 years; Canada | Randomized crossover study | Unknown | OGTT | None | Insulin response to OGTT was elevated after 60 h of TSD with sedentary activity vs. physical activity |
| Buxton (2010) [117] | 20 healthy men; aged 20–35 years; US | Experimental sleep study with 2 conditions | PSG | IVGTT and hyperinsulinemic-euglycemic clamp | None | Insulin sensitivity reduced by 11–20% after sleep restriction; glucose tolerance decreased |
PSG polysomnography, SWS slow wave sleep, IVGTT intravenous glucose tolerance test, IGT impaired glucose tolerance, OGTT oral glucose tolerance test, IDM incident diabetes mellitus, WHO World Health Organization, HR hazard ratio, TIB time in bed, T2DM type 2 diabetes mellitus, CGM continuous glucose monitoring, TSD total sleep deprivation
*p < 0.05