Sleep loss: a novel risk factor for insulin resistance and Type 2 diabetes

J Appl Physiol 99: 2008-2019, 2005; doi:10.1152/japplphysiol.00660.2005
8750-7587/05 $8.00

INVITED REVIEW

HIGHLIGHTED TOPICS
Physiology and Pathophysiology of Sleep Apnea
Sleep loss: a novel risk factor for insulin resistance and Type 2 diabetes
Karine Spiegel,1 Kristen Knutson,2 Rachel Leproult,2 Esra Tasali,2 and Eve Van Cauter2

1Laboratoire de Physiologie, Centre d'Etude des Rythmes Biologiques (CERB), Université Libre de Bruxelles, Belgium; and 2Department of Medicine, University of Chicago, Chicago, Illinois

Chronic sleep loss as a consequence of voluntary bedtime restriction is an endemic condition in modern society. Although sleep exerts marked modulatory effects on glucose metabolism, and molecular mechanisms for the interaction between sleeping and feeding have been documented, the potential impact of recurrent sleep curtailment on the risk for diabetes and obesity has only recently been investigated. In laboratory studies of healthy young adults submitted to recurrent partial sleep restriction, marked alterations in glucose metabolism including decreased glucose tolerance and insulin sensitivity have been demonstrated. The neuroendocrine regulation of appetite was also affected as the levels of the anorexigenic hormone leptin were decreased, whereas the levels of the orexigenic factor ghrelin were increased. Importantly, these neuroendocrine abnormalities were correlated with increased hunger and appetite, which may lead to overeating and weight gain. Consistent with these laboratory findings, a growing body of epidemiological evidence supports an association between short sleep duration and the risk for obesity and diabetes. Chronic sleep loss may also be the consequence of pathological conditions such as sleep-disordered breathing. In this increasingly prevalent syndrome, a feedforward cascade of negative events generated by sleep loss, sleep fragmentation, and hypoxia are likely to exacerbate the severity of metabolic disturbances. In conclusion, chronic sleep loss, behavioral or sleep disorder related, may represent a novel risk factor for weight gain, insulin resistance, and Type 2 diabetes.

obstructive sleep apnea; sympathovagal balance; glucose metabolism; appetite regulation; obesity

Address for reprint requests and other correspondence: K. Spiegel, Laboratoire de Physiologie, Centre d'Etude des Rythmes Biologiques (CERB), Université Libre de Bruxelles, Campus Hôpital Erasme-CPI 604, 808, Route de Lennik, B-1070 Bruxelles, Belgium (e-mail: kspiegel@ulb.ac.be)