Department of Health and Human Physiology, College of Liberal Arts and Sciences, University of Iowa, Iowa City, IA.
Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, IA.
Sleep. 2018 Nov 1;41(11). doi: 10.1093/sleep/zsy172.
To examine the associations of sleep measures with hemoglobin A1c (HbA1c) among individuals with and without type 2 diabetes.
Data were from 2049 Multi-Ethnic Study of Atherosclerosis participants taking part in a sleep ancillary study. Cross-sectional linear regression models examined associations of actigraphy estimates of sleep (sleep duration, variability, and maintenance efficiency) and polysomnography measures (obstructive sleep apnea [OSA] and hypoxemia) with HbA1c, stratified by diabetes status. Primary models were adjusted for demographics, lifestyle behaviors, and obesity.
Among individuals with diabetes (20 per cent population), those who slept <5 hr/night had greater HbA1c than those who slept 7-8 hr/night (7.44 vs. 6.98 per cent, ptrend = 0.04), with no attenuation of associations after adjusting for OSA/hypoxemia. In women with diabetes, but not men, those in the lowest quartile of sleep maintenance efficiency had greater HbA1c than those in the highest quartile of sleep maintenance efficiency (7.60 vs. 6.97 per cent, ptrend < 0.01). Among those without diabetes, individuals with severe OSA or in the highest quartile of hypoxemia had significantly greater HbA1c than those without OSA or who were in the lowest quartile of hypoxemia (5.76 vs. 5.66 per cent, ptrend = 0.01; 5.75 vs. 5.66 per cent, ptrend < 0.01, respectively). Associations did not meaningfully differ by race/ethnicity.
Among individuals with diabetes, HbA1c was significantly higher in men and women with short sleep duration and in women with poor sleep maintenance efficiency, suggesting a role for behavioral sleep interventions in the management of diabetes. Among individuals without diabetes, untreated severe OSA/hypoxemia may adversely influence HbA1c.
检查睡眠测量与糖化血红蛋白 (HbA1c) 之间的关联，包括有和没有 2 型糖尿病的个体。
数据来自参加睡眠辅助研究的 2049 名多民族动脉粥样硬化研究参与者。横断面线性回归模型检查了活动记录仪估计的睡眠（睡眠时间、变异性和维持效率）和多导睡眠图测量（阻塞性睡眠呼吸暂停 [OSA] 和低氧血症）与 HbA1c 的关联，按糖尿病状态进行分层。主要模型调整了人口统计学、生活方式行为和肥胖。
在有糖尿病的个体（占 20%的人群）中，每晚睡眠<5 小时的个体 HbA1c 高于每晚睡眠 7-8 小时的个体（7.44% vs. 6.98%，ptrend = 0.04），在调整 OSA/低氧血症后，关联没有减弱。在患有糖尿病的女性中，但不是男性中，睡眠维持效率最低四分位的个体 HbA1c 高于睡眠维持效率最高四分位的个体（7.60% vs. 6.97%，ptrend <0.01）。在没有糖尿病的个体中，有严重 OSA 或处于低氧血症最高四分位的个体的 HbA1c 显著高于没有 OSA 或处于低氧血症最低四分位的个体（5.76% vs. 5.66%，ptrend = 0.01；5.75% vs. 5.66%，ptrend <0.01）。种族/民族之间的关联没有明显差异。
在有糖尿病的个体中，睡眠持续时间短的男性和女性以及睡眠维持效率差的女性的 HbA1c 显著升高，这表明行为性睡眠干预在糖尿病管理中的作用。在没有糖尿病的个体中，未经治疗的严重 OSA/低氧血症可能会对 HbA1c 产生不利影响。
