Division of Pulmonary Medicine, Department of Pediatrics, University of Colorado Anschutz Medical Campus & Children's Hospital Colorado, Aurora, CO.
Department of Applied Mathematics and Statistics, Colorado School of Mines, Golden, CO; Division of Endocrinology, Department of Pediatrics, University of Colorado Anschutz Medical Campus and Children's Hospital Colorado, Aurora, CO.
J Pediatr. 2019 Feb;205:257-264.e1. doi: 10.1016/j.jpeds.2018.10.027. Epub 2018 Nov 26.
To examine the relationship between insulin resistance (IR) and sleep/circadian health in overweight/obese adolescents. We hypothesized that insufficient and delayed sleep would be associated with IR in this population.
Thirty-one adolescents (mean age, 16.0 ± 1.4 years; 77% female) with body mass index ≥90th percentile for age/sex were recruited from outpatient clinics at a children's hospital. Participants underwent 1 week of objective home sleep monitoring with wrist actigraphy during the academic year. A 3-hour oral glucose tolerance test was conducted, followed by in-laboratory salivary dim-light melatonin sampling every 30-60 minutes from 5 p.m. to noon the next day. Regression analyses between sleep and circadian variables with IR were examined.
Longer sleep time and time in bed on weekends and weekdays and earlier weekday bedtime were significantly associated with better insulin sensitivity. Participants who obtained less than the median duration of sleep per night (6.6 hours) had evidence of IR with compensatory insulin secretion compared with those obtaining ≥6.6 hours of sleep. A wider phase angle between bedtime and melatonin onset, indicating a later circadian timing of sleep onset, was significantly associated with IR.
Short sleep duration, later weekday bedtime, and later circadian timing of sleep were associated with IR in a cohort of adolescents with overweight/obesity during the school year. Further research is needed to better understand the physiology underlying these observations and to evaluate the impact of improved sleep and circadian health on metabolic health in this at-risk population.
研究超重/肥胖青少年胰岛素抵抗（IR）与睡眠/昼夜节律健康之间的关系。我们假设，在该人群中，睡眠不足和延迟会与 IR 相关。
从儿童医院的门诊招募了 31 名青少年（平均年龄 16.0±1.4 岁，77%为女性），其体重指数（BMI）≥年龄/性别第 90 百分位数。参与者在学年期间进行了为期 1 周的在家客观睡眠监测，使用腕部活动记录仪。进行了 3 小时口服葡萄糖耐量试验，随后在下午 5 点至次日中午每 30-60 分钟进行一次实验室唾液暗光褪黑素采样。检查了睡眠和昼夜节律变量与 IR 之间的回归分析。
周末和工作日的睡眠时间和卧床时间较长，以及工作日早睡时间较早，与胰岛素敏感性更好相关。与获得≥6.6 小时睡眠的参与者相比，每晚睡眠时间少于中位数（6.6 小时）的参与者存在 IR 且伴有代偿性胰岛素分泌。表明睡眠开始昼夜节律时间较晚的睡眠时间和褪黑素开始时间之间的相位角较宽，与 IR 显著相关。
在学年期间，超重/肥胖青少年的睡眠时间较短、工作日早睡时间较晚以及睡眠昼夜节律时间较晚与 IR 相关。需要进一步研究以更好地了解这些观察结果背后的生理学，并评估改善睡眠和昼夜节律健康对该高危人群代谢健康的影响。
