Glas Srp Akad Nauka Med. 2009(50):17-30.
Global epidemy of the obesity that developed all over the world, including highly industralized as well as non-industrialized countries, and parallel epidemy of Type 2 diabetes resulted in explosion of investigation devoted to explanation of pathogenetic mechanisms of this serious social and medical problems with the main idea to find adequate way of prevention as well as of treatment. Together with the observed epidemy of obesity and Type 2 diabetes, it was found parallel tendency for sleep curtailment, that was confirmed in numerous epidemiological studies, that coincide with its beginning and progress with this two epidemies. This facts lead to investigations with the idea to try to explaine possible mechanisms of the association between sleep curtailment, obesity and Type 2 diabetes. Having in mind that insulin resistance is one of the fundamental pathogenetic mechanism in these disorders, numerous studies were done with the aim to explain association between sleep curtailment and insulin resistance in obesity, Type 2 diabetes and metabolic syndrome. It was demonstrated that sleep curtailment may affect energy homeostasis of human organism with the effects on body weight increase through three different ways: appetite increase, prolongation of time for food intake and through decrease of energy expenditure. There are several postulated mechanism for the effect of sleep curtailment on development of insulin resistance as well as for predisposition for Type 2 diabetes. Among possible mechanism are included: increase of sympathetic neuronal activity, decreased cerebral utilisation of glucose, increase in evening cortisol values, growth hormone increase and disorder of neuroendocrine control of appetite which leads to risk for increase of body weight.
肥胖在全球范围内流行,涵盖高度工业化国家以及非工业化国家,与此同时2型糖尿病也在流行,这引发了大量研究,旨在阐释这一严重社会和医学问题的发病机制,主要目的是找到合适的预防和治疗方法。随着肥胖和2型糖尿病的流行,人们发现睡眠减少也呈平行趋势,这在众多流行病学研究中得到证实,且与这两种流行病的发生和发展相吻合。这些事实促使人们进行研究,试图解释睡眠减少、肥胖和2型糖尿病之间可能的关联机制。鉴于胰岛素抵抗是这些疾病的基本发病机制之一,众多研究旨在解释肥胖、2型糖尿病和代谢综合征中睡眠减少与胰岛素抵抗之间的关联。研究表明,睡眠减少可能通过三种不同方式影响人体能量平衡,进而导致体重增加:食欲增加、进食时间延长以及能量消耗减少。关于睡眠减少对胰岛素抵抗发展以及2型糖尿病易感性的影响,有几种假设机制。可能的机制包括:交感神经活动增加、大脑葡萄糖利用率降低、夜间皮质醇值升高、生长激素增加以及神经内分泌对食欲的控制紊乱,从而导致体重增加风险。