Sunday, January 31, 2016

Sleep Science Update: New Insights into the Effect of a Lack of Quality Sleep on Glucose Control and Diabesity Risk

Blue light is not the only enemy of sleep, but it's the most prevalent one, today.
Personally, I believe that sleep, "a condition of body and mind which typically recurs for several hours every night, in which the nervous system is inactive, the eyes closed, the postural muscles relaxed, and consciousness practically suspended" (that's what Google's "define"-feature will tell you about sleep), is still an under-appreciated determinant of optimal health and performance.

Evidence to support this assertion comes from a series of studies that were presented at the Winter Meeting of the British Nutrition Society on December 8-9, 2015 - a meeting with the telling title: "Roles of sleep and circadian rhythms in the origin and nutritional management of obesity and metabolic disease" (O'Sullivan. 2015).
Learn more about the health effects of correct / messed up circadian rhythms

Sunlight, Bluelight, Backlight and Your Clock

Sunlight a La Carte: "Hack" Your Rhythm
Breaking the Fast to Synchronize the Clock

Fasting (Re-)Sets the Peripheral Clock

Vitamin A & Caffeine Set the Clock

Pre-Workout Supps Could Ruin Your Sleep
  • Circadian disruption in shift workers – the effects of insufficient sleep on dietary and lifestyle behaviours (Nea. 2016) - It will not surprise you that shift workers report more sleep problems compared to the general public. Studies estimate that 10–30 % of shift workers suffer from a circadian rhythm disorder known as “shift work disorder”(Gumenyuk. 2012). With their new quantitative study, a team of young researchers from the Dublin Institute of Technology and the University of Ulster provides some insights into the consequences of this problem.

    As the scientists point out, overall, just 34·3 % of the sample was achieving adequate sleep. A number of factors were associated with insufficient sleep – being male (p < 0·001), being 35–54 years of age (p < 0·001), having adult/child dependents (p < 0·001), working in larger organisations (p = 0·045), working in distribution/logistics, manufacturing or construction (p = 0·005), working night shifts (p = 0·042), and working longer shifts (p = 0·002).
    Factors that increased the subject's risk of not getting adequate sleep (Nea. 2016).
    Furthermore, the scientists observed that insufficient sleep had an effect on the diet of workers. Those who did not achieve adequate sleep were more likely to skip meals on working days and skipped meals significantly more frequently (p = 0·023).
    "Workers with insufficient sleep were also significantly less likely to consume the recommended 5 portions of fruit and vegetables per day (37·5 % vs 43·3 %, p = 0·045) and were less likely to consume the recommended 3 portions of milk/cheese/yoghurt per day (11·6 % vs 8·1 %, p = 0·050). In addition, those with insufficient sleep had higher prevalence of hypertension (10·2 % vs 5·7 %, p = 0·008) and depression/anxiety (7·3 % vs 3·4 %, p = 0·008)" (Nea. 2016)
    Participants were also questioned how they perceived shift work impacts on various aspects of their lives. Compared to those who achieve adequate sleep, those who had insufficient sleep were significantly more likely to report that shift work had a negative effect on their physical health (p < 0·001), mental health (p = 0·003), family life (p = 0·001), social life (p = 0·046), physical activity levels (p = 0·029) and overall quality of life (p = 0·002). Those with insufficient sleep were also significantly more likely to report that shift work increases how much alcohol they drink (p = 0·041).
  • Oral glucose tolerance test results are affected by prior sleep duration: a randomised control crossover trial of normoglycaemic adults (Ellison. 2016) - As Ellison et al. rightly point out, "[o]ral glucose tolerance tests (OGTTs) remain the key clinical tool for assessing glucose control and diagnosing diabetes" (Ellison. 2016). In that, they criticize that "[c]urrent guidelines for administering such tests emphasise the importance of a preceding 8 hour fast (often undertaken overnight) but overlook the potential role that preceding sleeping patterns night might play in glucose control the following day" (ibid.). In view of the number of recent observational and experimental studies, which suggest that poor sleep is associated with an increased risk of diabetes, these tests may very well be messed up by a lack of sleep during the previous 8h fast. The aim of the latest study by scientists from the Sound Asleep Laboratory in Leeds was therefore "to explore the effect of early vs. late bedtimes on OGTT results using a cross-over randomised controlled trial" (ibid.).

    To this ends, the authors recruited 40 normoglycemic adults who were, after they had been stratification by self-reported pre-existing sleep patterns (as assessed using the Pittsburgh Sleep Quality Index; PSQI), allocated to either a ‘short’ (2·00am-7·00am) then ‘long’ (10·00pm−7·00am), or a ‘long’ then ‘short’ sleep duration, on two consecutive nights.
    "On each occasion, objective measures of sleep were obtained using the ‘SleepMeister’ application on an iPhone 4, with additional subjective assessments of sleep provided by subsequent completion of a version of the PSQI adapted to generate self-reports of sleep during the preceding night (as opposed to the preceding month). On each of the mornings following ‘short’ or ‘long’ sleep, participants again completed the PSQI and underwent a two-hour 75 g oral glucose tolerance test (OGTT), with blood glucose readings taken at 0, +30, +60, +90 and +120 minutes thereafter using finger-prick tests. Data were analysed using STATA v12. Ethical approval was granted by the University of Leeds REC (Ref:HSLTLM12075)" (Ellison. 2016).
    As it was to be expected, both the ‘SleepMeister’ application and the PSQI recorded significantly later bedtimes (SleepMeister: −19·9; 95 %CI: −20·1,−19·7; PSQI: −19·9; 95 %CI: −20·1,−19·7) and significantly shorter sleep durations (decimal hours: ‘SleepMeister’: −3·8;95 %CI: −4·3,−3·4; PSQI: −3·4; 95 %CI: −3·9,−2·9) following a 2am (vs.10pm) bedtime (i.e. ‘short’ and ‘long’ sleep duration, respectively) - a fact, the scientists consider evidence "that levels of compliance were high" (ibid.).

    In spite of that, there was no significant effect of sleep duration on fasting blood glucose levels prior to the OGTT after adjustment for sleep duration sequence (i.e. ‘short’ then ‘long’ vs. ‘long’ then ‘short’) and a modest imbalance in gender between the two intervention sequence group.
    Figure 2: Normal response (=expected response in OGGT, not the actual response of the subjects, because the absolute values are not disclosed in the abstract and an FT is not yet available) vs. calculated response as a consquence of insufficient sleep (normal + difference, rel. difference above bars | Ellison. 2016).
    What did differ, though, were the glucose levels recorded after the ingestion of 75 g glucose, which were consistently higher following a ‘short’ as opposed to a ‘long’ sleep duration, as well as the levels recorded at +60 and +90 minutes, which were likewise significantly higher by 1·18 mmol/l (95 %CI: 0·43,1·92; p = 0·003) and 0·55 mmol/l (95 %CI: 0·05,1·06; p = 0·032), respectively. These results, the scientists say, "indicate that short sleep duration the night before results in an immediate elevation in blood glucose levels the following morning in normoglycaemic adults" (ibid.). That this is a problem, should be obvious, after all it may falsely classify healthy individuals as pre-diabetics. Therefore, "further standardisation of pre-OGTT sleep duration, similar to that for an overnight fast," (ibid.) appears warranted.
  • Less Sleep Duration and Poor Sleep Quality Lead to Obesity (Parvaneh. 2016) - In a recent cross-sectional study that was carried out to investigate the association of sleep deprivation and sleep quality with obesity, Malaysian scientists analyzed data from 225 Iranian adults (109 males and 116 females) aged 20–55 years.
    "Heart Questionnaire (SHHQ), International Physical Activity Questionnaire (IPAQ) and a 24-hour dietary recall were interview-administered to evaluate sleep pattern, physical activity and dietary intake of the subjects. Besides, anthropometric also were measured, then subjects were categorized into normal weight and over-weight/obese based on WHO (2000). Sleep duration and sleep quality were assessed based on 2 groups of normal weight and overweight/obese" (Parvaneh. 2016).
    The scientists' analysis of the data revealed that overweight/obese individuals have significantly shorter sleep duration (5·37 ± 1·1 hours) as compared to normal weight subjects (6·54 ± 1·06 hours).
    Figure 3: Overweight / obesity is linked to sign. sleep problems (Parvaneh. 2016).
    Sleep duration was yet not the parameter the scientists from the National University of Malaysia identified as a major risk factor for obesity - that was a poor sleep quality, which was associated with a 100% increased risk for being overweight or obese (OR: 2·0, 95 % CI: 1·18–3·37, p < 0·05). As a conclusion, the scientists state that "lower sleep quality and sleep duration increase the risk of being overweight and obese" and demand: "[S]trategies for the management of obesity should incorporate consideration on sleeping pattern" (Parvaneh. 2016). These strategies, by the way, may also help people keep their triglyceride levels in check. After all, another study that was presented at the same meeting of the Nutrition Society suggests that a high sleep efficiency shows a strong and negative correlation with triglycrides and another important marker of heart disease risk, the total cholesterol to HDL ratio (Al Khatib. 2016).
  • Is insulin resistance associated with light at night in healthy sleep deprived individuals? (AlBreiki. 2016) - The simple answer to this question is "Yes!". The more complex one is that a recent study that was designed to investigate the impact of light and/or endogenous melatonin on plasma hormones and metabolites prior to and after a set meal in healthy sleep deprived subjects found that bright blunts the release of melatonin and the effects of insulin on glucose disposal.

    In the study, seventeen healthy participants, 8 females (22·2 years (SD 2·59) BMI 23·62 kg/m2 (SD 2·3)) 9 males (22·8 years (SD 3·5) BMI 23·8 kg/m2 (SD 2·06)) were randomised to a two way cross over design protocol; dim light condition (<5lux) and bright light condition (>500lux), separated by at least seven days.
    Melatonin promotes female weight loss - Suggested Read: "Trying to Lose Fat & Get "Toned"? Taking 1-3 mg Melatonin Helps Women Lose 7% Body Fat, Gain 3.5% Lean Mass".
    "Each session started at 18:00 h and finished at 06:00 h the next day. All participants were sleep deprived and semi-recumbent throughout the session. An isocalorific breakfast was consumed at 08:00 h and lunch was timed to be 10 hours before the evening meal. Each participant consumed an evening meal (1066 Kcal, 38 g protein, 104 g CHO, 54 g fat, 7 g fibre) at an individualised time based on estimated melatonin onset. Plasma and saliva samples were collected at specific time intervals to assess glucose, insulin and melatonin levels" (AlBreiki. 2016).
    As previously stated, the bright light reduced the salivary levels of melatonin significantly (p = 0·005). What is more relevant to the research question, however is that it also increased the postprandial glucose and insulin levels significantly compared to dim lights (p = 0·02, p = 0·001) respectively.

    Figure 3: Effect of light intensity on melatonin levels and glucose response of 8 female and 9 male normal-weight normoglycemic subjects to standardized meal consumed at night (AlBreiki. 2016).
    For the scientists this result is not exactly surprising. They had expected that the melatonin release would be suppressed due to the light intensity; that the increase in insulin was not able to compensate for the light-induced increased glucose resistance, however, shows that the ill effects of a  'night-shift-esque' bright light exposure at night on glucose metabolism are more severe than previously thought.
Redeem your sleep dept, now!
Bottom line: Along with studies highlighting the importance of sufficient hours of quality sleep on glucose control in pregnancy (Alghamdi. 2016; Alnaja. 2016) and the "largest study to-date to demonstrate a strong inverse association between late-onset diabetes and poor sleep, even after adjustment for potential confounding factors" (Alfazaw. 2016), the previously discussed studies highlight that sleep hygiene' is as important for your health as "clean eating" (whatever that maybe) and a sufficient amount of light and intense physical activity | Comment on Facebook!
  • AlBreiki, et al. "Is insulin resistance associated with light at night in healthy sleep deprived individuals?" Proceedings of the Nutrition Society, 75 (2016). 
  • Alfazaw, et al. "Variation in sleep is associated with diagnosis of late-onset diabetes: a cross-sectional analysis of self-reported data from the first wave of ‘Understanding Society’ (the UK Household Longitudinal Study)." Proceedings of the Nutrition Society, 75 (2016). 
  • Alghamdi, et al. "Short sleep duration is associated with an increased risk of gestational diabetes: Systematic review and meta-analysis." Proceedings of the Nutrition Society, 75 (2016). 
  • Alnaja, et al. "Relationship between sleep quality, sleep duration and glucose control in pregnant women with gestational diabetes." Proceedings of the Nutrition Society, 75 (2016). 
  • Al Khatib, et al. "The Sleep-E Study: An on-going cross-sectional study investigating associations of sleep quality and cardio-metabolic risk factors." Proceedings of the Nutrition Society, 75 (2016). 
  • DeFronzo, Ralph A. "The triumvirate: β-cell, muscle, liver. A collusion responsible for NIDDM." Diabetes 37.6 (1988): 667-687.
  • Ellison, et al. "Oral glucose tolerance test results are affected by prior sleep duration: a randomised control crossover trial of normoglycaemic adults." Proceedings of the Nutrition Society, 75 (2016). 
  • Gumenyuk, Valentina, Thomas Roth, and Christopher L. Drake. "Circadian phase, sleepiness, and light exposure assessment in night workers with and without shift work disorder." Chronobiology international 29.7 (2012): 928-936.
  • Nea et al. "Circadian disruption in shift workers – the effects of insufficient sleep on dietary and lifestyle behaviours." Proceedings of the Nutrition Society, 75 (2016). 
  • O’Sullivan (ed.). "Roles of sleep and circadian rhythms in the origin and nutritional management of obesity and metabolic disease." Proceedings of the Nutrition Society. Volume 75 / Issue OCE1 - Winter Meeting, 8–9 December 2015. Published January 2016: E1-E42.
  • Parvaneh, et al. "Less Sleep Duration and Poor Sleep Quality Lead to Obesity." Proceedings of the Nutrition Society, 75 (2016). 
  • Peschke, Elmar. "Melatonin, endocrine pancreas and diabetes." Journal of pineal research 44.1 (2008): 26-40.