title: Sleep architecture and glucose and insulin homeostasis in obese adolescents.
abstract: OBJECTIVE
  Sleep deprivation is associated with increased risk of adult type 2 diabetes mellitus (T2DM). It is uncertain whether sleep deprivation and/or altered sleep architecture affects glycemic regulation or insulin sensitivity or secretion. We hypothesized that in obese adolescents, sleep disturbances would associate with altered glucose and insulin homeostasis.
  
  
  METHODS
  This cross-sectional observational study of 62 obese adolescents took place at the Clinical and Translational Research Center and Sleep Laboratory in a tertiary care children's hospital. Subjects underwent oral glucose tolerance test (OGTT), anthropometric measurements, overnight polysomnography, and frequently sampled intravenous glucose tolerance test (FSIGT). Hemoglobin A(1c) (HbA(1c)) and serial insulin and glucose levels were obtained, indices of insulin sensitivity and secretion were calculated, and sleep architecture was assessed. Correlation and regression analyses were performed to assess the association of total sleep and sleep stages with measures of insulin and glucose homeostasis, adjusted for confounding variables.
  
  
  RESULTS
  We found significant U-shaped (quadratic) associations between sleep duration and both HbA(1c) and serial glucose levels on OGTT and positive associations between slow-wave sleep (N3) duration and insulin secretory measures, independent of degree of obesity, pubertal stage, sex, and obstructive sleep apnea measures.
  
  
  CONCLUSIONS
  Insufficient and excessive sleep was associated with short-term and long-term hyperglycemia in our obese adolescents. Decreased N3 was associated with decreased insulin secretion. These effects may be related, with reduced insulin secretory capacity leading to hyperglycemia. We speculate that optimizing sleep may stave off the development of T2DM in obese adolescents.
authors.affiliation: Division of Pediatric Endocrinology and Diabetes, The Children’s Hospital of Philadelphia, PA, USA. koren@email.chop.edu
authors.forename: Dorit
authors.initials: D
authors.lastname: Koren
authors.forename: Lorraine E
authors.initials: LE
authors.lastname: Levitt Katz
authors.forename: Preneet C
authors.initials: PC
authors.lastname: Brar
authors.forename: Paul R
authors.initials: PR
authors.lastname: Gallagher
authors.forename: Robert I
authors.initials: RI
authors.lastname: Berkowitz
authors.forename: Lee J
authors.initials: LJ
authors.lastname: Brooks
mesh_terms: D000293:Adolescent; D001786:Blood Glucose / Q000378:metabolism*; D015992:Body Mass Index; D002648:Child; D003430:Cross-Sectional Studies; D003920:Diabetes Mellitus / Q000097:blood / Q000503:physiopathology*; D005260:Female; D005951:Glucose Tolerance Test; D006442:Glycated Hemoglobin / Q000032:analysis; D006706:Homeostasis; D006776:Hospitals, Pediatric; D006801:Humans; D006943:Hyperglycemia; D007328:Insulin / Q000097:blood / Q000378:metabolism*; D000078790:Insulin Secretion; D008297:Male; D009765:Obesity / Q000097:blood / Q000503:physiopathology*; D015143:Philadelphia; D017286:Polysomnography; D012680:Sensitivity and Specificity; D012890:Sleep / Q000502:physiology*; D012893:Sleep Wake Disorders / Q000503:physiopathology*
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin; D007328:Insulin