Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of Illinois Chicago, Chicago, Illinois, USA.
Department of Ophthalmology and Visual Sciences, University of Illinois Chicago, Chicago, Illinois, USA.
J Sleep Res. 2024 May;33(3):e13989. doi: 10.1111/jsr.13989. Epub 2023 Jul 6.
Sleep irregularity and variability have been shown to be detrimental to cardiometabolic health. The present pilot study explored if higher day-to-day sleep irregularity and variability were associated with systemic inflammation, as assessed by high-sensitivity C-reactive protein, in type 2 diabetes. Thirty-five patients with type 2 diabetes (mean age 54.3 years, 54.3% female) who were not shift-workers participated. The presence of diabetic retinopathy was determined. The standard deviation of sleep duration and sleep midpoint across all recorded nights were used to quantify sleep variability and regularity, respectively, assessed by 14-day actigraphy. The presence and severity of sleep apnea were assessed using an overnight home monitor. Low-density lipoprotein, haemoglobin A1C and high-sensitivity C-reactive protein were collected. Multiple regression analysis using natural-log-transformed values was performed to establish an independent association between sleep variability and high-sensitivity C-reactive protein. Twenty-two (62.9%) patients had diabetic retinopathy. The median (interquartile range) of high-sensitivity C-reactive protein was 2.4 (1.4, 4.6) mg L. Higher sleep variability was significantly associated with higher high-sensitivity C-reactive protein (r = 0.342, p = 0.044), as was haemoglobin A1C (r = 0.431, p = 0.010) and low-density lipoprotein (r = 0.379, p = 0.025), but not sleep regularity, sleep apnea severity or diabetic retinopathy. Multiple regression analysis showed that higher sleep variability (B = 0.907, p = 0.038) and higher HbA1c (B = 1.519, p = 0.035), but not low-density lipoprotein, contributed to higher high-sensitivity C-reactive protein. In conclusion, higher sleep variability in patients with type 2 diabetes who were not shift-workers was independently associated with higher systemic inflammation, conferring increased cardiovascular risk. Whether sleep interventions to reduce sleep variability can reduce systemic inflammation and improve cardiometabolic health should be investigated.
睡眠不规律和变异性已被证明对心血管代谢健康有害。本初步研究探讨了 2 型糖尿病患者中，日间睡眠不规律和变异性较高是否与全身炎症相关，全身炎症通过高敏 C 反应蛋白评估。35 名 2 型糖尿病患者（平均年龄 54.3 岁，54.3%为女性），均非轮班工作者，纳入研究。评估了糖尿病视网膜病变的存在。使用 14 天活动记录仪评估睡眠时长和睡眠中点的标准差分别来量化睡眠变异性和规律性。使用过夜家庭监测仪评估睡眠呼吸暂停的存在和严重程度。收集低密度脂蛋白、糖化血红蛋白 A1C 和高敏 C 反应蛋白。采用自然对数转换值的多元回归分析来确定睡眠变异性与高敏 C 反应蛋白之间的独立关联。22 名（62.9%）患者有糖尿病视网膜病变。高敏 C 反应蛋白的中位数（四分位距）为 2.4（1.4，4.6）mg/L。睡眠变异性越高，高敏 C 反应蛋白越高（r=0.342，p=0.044），糖化血红蛋白 A1C （r=0.431，p=0.010）和低密度脂蛋白（r=0.379，p=0.025）也越高，但睡眠规律性、睡眠呼吸暂停严重程度或糖尿病视网膜病变无此关联。多元回归分析表明，睡眠变异性越高（B=0.907，p=0.038）和糖化血红蛋白越高（B=1.519，p=0.035），但不是低密度脂蛋白，与高敏 C 反应蛋白越高相关。总之，非轮班工作的 2 型糖尿病患者睡眠变异性增加与全身炎症增加独立相关，增加心血管风险。是否可以通过睡眠干预来减少睡眠变异性，从而降低全身炎症并改善心血管代谢健康，这值得进一步研究。
