睡眠剝奪增加糖尿病風險


  【24drs.com】一篇新研究認為,慢性睡眠剝奪可能會增加發生第2型糖尿病的風險,導致增加胰島素阻抗性與代償性高胰島素血症。
  
  這些結果發表於聯合專業睡眠協會第25屆年會、SLEEP 2011。
  
  伊利諾州芝加哥大學的Plamen Penev博士報告指出,研究發現認為,一般健康年輕人的睡眠減少時可能更會有代謝風險,應給予他們一個值得進行生活型態改變的目標。
  
  這篇研究包括了47名健康研究對象(女性26人)、身體質量指數正常(平均23.8 kg/m2)、平均年紀26歲;因為這些研究對象的雙親之一有糖尿病,因此所有研究對象發生第2型糖尿病的風險都增加。
  
  根據研究對象的自然睡眠期間將他們分成兩組:睡眠時間少於6小時的睡眠時間短者(平均每晚319分鐘;n = 19人),以及睡眠達6小時以上的睡眠時間正常者(平均每晚409分鐘;n = 28人)。
  
  研究開始時,進行整夜的實驗室多層次睡眠檢查,以確保睡眠時間短者沒有睡眠異常。
  
  Penev博士表示,他們睡得和睡眠時間正常者一樣好,如果他們有穩定的睡眠模式、較少的覺醒,這表示他們有慢性睡眠剝奪— 也就是睡眠時間比正常情況少了1個半小時。
  
  研究開始時,也以口服75-g葡萄糖耐受度測試和空腹血糖值評估研究對象的葡萄糖耐受狀態,另外也評估他們的胰島素敏感性(胰島素敏感性指標和恆定模式評估–胰島素阻抗性)與β-細胞功能(校正胰島素反應)。
  
  使用腕動計和腰動計監測兩週的體能活動情況。
  
  採取多變項回歸分析控制每日體能活動、年紀、身體質量指數、性別和種族的差異,顯示睡眠較短者的胰島素阻抗性顯著較高(胰島素敏感指數分數7.7 vs 11.4;P = .013)。
  
  不過,Penev博士表示,在年輕時,只要體瘦且健康,β-細胞功能應可以跟上增加的胰島素需求,因此他們的葡萄糖耐受度測試都可說是相當正常。
  
  雖然不屬於事先設定的研究結果,兩週時的腕動計和腰動計監測顯示,睡眠時間最少的三分之一的活動力顯著低於一般睡眠時間者(每天122分鐘vs164分鐘;P = .040),Penev博士表示,有變胖的家族風險或久坐者,後來發生糖尿病的風險增加。
  
  會議主持人、密蘇里州聖路易華盛頓大學科學家Matthew Thimgan博士表示,這意味著需將那些有第2型糖尿病風險者納入考量,他們的睡眠期間和品質會影響他們發生該病的風險,如果他們睡眠不足,會加速惡化。
  
  他指出,有許多不同因素會影響一個人是否有足夠睡眠,如果是健康年輕人,往往是其生活型態或社經等環境因素。
  
  目前,他們的胰島素敏感性看來雖較低,但是他們可以產生足夠的胰島素來代償,不過,最後可能會無法如此,若他們睡眠不足,這情況還會更早發生。
  
  資料來源:http://www.24drs.com/professional/list/content.asp?x_idno=6547&x_classno=0&x_chkdelpoint=Y
  

Sleep Deprivation Increases Diabetes Risk

By Kate Johnson
Medscape Medical News

June 14, 2011 (Minneapolis, Minnesota) — Chronic sleep deprivation in people susceptible to developing type 2 diabetes results in increased insulin resistance and compensatory hyperinsulinemia, a new study suggests.

The results were presented here at SLEEP 2011, the 25th Anniversary Meeting of the Associated Professional Sleep Societies.

The findings suggest that sleep curtailment in these young, otherwise healthy individuals "may further amplify their pre-existing metabolic risk and potentially make them a valuable target for lifestyle intervention," reported Plamen Penev, MD, PhD, from the University of Chicago, Illinois.

'Short' vs 'Usual' Sleepers

The study included 47 healthy participants (26 female), with a normal body mass index (average, 23.8 kg/m2) and average age of 26 years. All participants were at increased risk of developing type 2 diabetes on the basis of a family history in which 1 or both parents had the disease, he reported.

The study divided the participants into 2 groups according to their natural sleep duration: short sleepers, who slept less than 6 hours (average, 319 minutes per night; n = 19), and usual sleepers, who slept 6 or more hours (average, 409 minutes per night; n = 28).

Baseline overnight laboratory polysomnography was done to ensure that short sleepers did not have a sleep disorder.

"They slept just as well as the usual sleepers," said Dr. Penev. "If anything they had more consolidated sleep patterns, with fewer arousals, which suggested to us that they had chronic sleep deprivation — with a sleep duration about an hour and a half shorter than the usual sleepers."

At baseline, participants were also assessed for glucose tolerance by using a 75-g oral glucose tolerance test and fasting blood glucose, as well as for insulin sensitivity (insulin sensitivity index and homeostasis model assessment–insulin resistance) and β-cell function (corrected insulin response).

Physical activity was monitored for 2 weeks by using wrist and waist actigraphy.

Multivariate regression analysis controlling for differences in daily physical activity, age, body mass index, sex, and ethnicity showed that short sleepers had significantly higher insulin resistance (insulin sensitivity index score, 7.7 vs 11.4; P = .013).

However, "β-cell function was able to keep up with the increased insulin demand at this young stage, when they're still lean and healthy, and accordingly their measures of glucose tolerance were quite comparable — they remained normoglycemic," said Dr. Penev.

Although not a predefined outcome of the study, 2 weeks of physical activity monitoring by wrist and waist actigraphy showed that participants in the lowest tertile of sleep duration had significantly decreased activity compared with usual sleepers (122 vs 164 minutes per day; P = .040), suggesting that "people with familial risk who become obese or sedentary amplify their risk for diabetes in the future," said Dr. Penev.

Sleep Duration and Quality

"This is something that people at risk for type 2 diabetes need to take into consideration, that their sleep duration and quality may influence their potential to actually develop the disease down the road and it could be pushed forward if they don't get enough sleep," said Matthew Thimgan, PhD, moderator of the session and staff scientist at Washington University in St. Louis, Missouri.

"There are many different factors that can influence whether or not someone is getting enough sleep. If you think about a healthy young adult, many times it's lifestyle factors or environment — depending on socioeconomic factors," he said.

"At this point in their lives the subjects showed lower insulin sensitivity, but they were able to produce enough insulin to compensate. But, eventually they may not be able to do that, and if they don’t get enough sleep that may occur sooner."

The study was supported by National Institutes of Health grants R01- HL089637, CTSA-RR 024999, and P60-DK020595. Dr. Penev and Dr. Thimgan have disclosed no relevant financial relationships.

The 25th Anniversary Meeting of the Associated Professional Sleep Societies. Abstract #O111. Presented June 13, 2011.

    
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