Reutrakul Sirimon, Punjabi Naresh M., Van Cauter Eve
Dr. Sirimon Reutrakul is Associate Professor in the Division of Endocrinology and Metabolism, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
Dr. Naresh M. Punjabi is Professor in the Department of Medicine, Johns Hopkins University, Baltimore, MD
The term “sleep disturbance” is widely used to refer to a variety of conditions, including sleep insufficiency, sleep fragmentation, sleep disorders, such as sleep apnea, and misaligned sleep, as occurs in shift workers. Insufficient sleep and sleep fragmentation are linked to abnormal glucose metabolism, insulin sensitivity reduction of 20%–30%, and increased diabetes risk. Well-controlled laboratory studies have provided insights regarding the underlying mechanisms. Multiple large prospective studies have found that that these sleep disturbances increase the risk of incident diabetes by as much as 30%–50%. Obstructive sleep apnea (OSA), which combines sleep fragmentation and hypoxemia, has been identified as a risk factor for insulin resistance and diabetes. OSA is highly prevalent in patients with type 2 diabetes, affecting roughly two out of three patients, and its severity correlates with glycemic control. Whether glycemic control can be improved by treating OSA remains controversial. Sleep disturbances during pregnancy are linked to gestational diabetes and hyperglycemia, and there is evidence for potential adverse effects on maternal and fetal health. Evidence from animal models has identified disruption of the circadian system as a putative risk factor for adverse metabolic outcomes. Shift work, a condition of chronic circadian disruption, is linked to weight gain and incident obesity and diabetes. As sleep disturbances are increasingly common in modern society and may play a role in the epidemic of type 2 diabetes, strategies to prevent diabetes or reduce its severity should consider optimizing sleep health in at-risk populations. Intervention studies demonstrating that treating sleep disturbances may help prevent diabetes or improve glycemic control are lacking but have become an area of intense research.
“睡眠障碍”一词被广泛用于指代各种情况，包括睡眠不足、睡眠片段化、睡眠障碍（如睡眠呼吸暂停）以及轮班工作者出现的睡眠失调。睡眠不足和睡眠片段化与葡萄糖代谢异常、胰岛素敏感性降低20% - 30%以及糖尿病风险增加有关。严格控制的实验室研究已经对其潜在机制提供了见解。多项大型前瞻性研究发现，这些睡眠障碍会使糖尿病发病风险增加30% - 50%。阻塞性睡眠呼吸暂停（OSA），它兼具睡眠片段化和低氧血症，已被确定为胰岛素抵抗和糖尿病的一个风险因素。OSA在2型糖尿病患者中非常普遍，大约三分之二的患者受其影响，并且其严重程度与血糖控制相关。通过治疗OSA是否能改善血糖控制仍存在争议。孕期的睡眠障碍与妊娠期糖尿病和高血糖有关，并且有证据表明对母婴健康存在潜在不良影响。动物模型的证据已确定昼夜节律系统紊乱是不良代谢结果的一个假定风险因素。轮班工作，一种慢性昼夜节律紊乱的情况，与体重增加、肥胖症发病以及糖尿病有关。由于睡眠障碍在现代社会中越来越普遍，并且可能在2型糖尿病的流行中起作用，预防糖尿病或降低其严重程度的策略应该考虑在高危人群中优化睡眠健康。缺乏表明治疗睡眠障碍可能有助于预防糖尿病或改善血糖控制的干预研究，但这已成为一个深入研究的领域。
