Electrocardiogram-based sleep spectrogram measures of sleep stability and glucose disposal in sleep disordered breathing.
OBJECTIVE
Sleep disordered breathing (SDB) is independently associated with insulin resistance, glucose intolerance, and type 2 diabetes mellitus. Experimental sleep fragmentation has been shown to impair insulin sensitivity. Conventional electroencephalogram (EEG)-based sleep-quality measures have been inconsistently associated with indices of glucose metabolism. This analysis explored associations between glucose metabolism and an EEG-independent measure of sleep quality, the sleep spectrogram, which maps coupled oscillations of heart-rate variability and electrocardiogram (ECG)-derived respiration. The method allows improved characterization of the quality of stage 2 non-rapid eye movement (NREM) sleep.


METHODS
Cross-sectional study.


METHODS
N/A.


METHODS
Nondiabetic subjects with and without SDB (n = 118) underwent the frequently sampled intravenous glucose tolerance test (FSIVGTT) and a full-montage polysomnogram. The sleep spectrogram was generated from ECG collected during polysomnography.


METHODS
N/A.


RESULTS
Standard polysomnographic stages (stages 1, 2, 3+4, and rapid eye movement [REM]) were not associated with the disposition index (D(I)) derived from the FSIVGTT. In contrast, spectrographic high-frequency coupling (a marker of stable or "effective" sleep) duration was associated with increased, and very-low-frequency coupling (a marker of wake/REM/transitions) associated with reduced D(I). This relationship was noted after adjusting for age, sex, body mass index, slow wave sleep, total sleep time, stage 1, the arousal index, and the apnea-hypopnea index.


CONCLUSIONS
ECG-derived sleep-spectrogram measures of sleep quality are associated with alterations in glucose-insulin homeostasis. This alternate mode of estimating sleep quality could improve our understanding of sleep and sleep-breathing effects on glucose metabolism.
Division of Pulmonary, Critical Care and Sleep Medicine, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02215, USA. mpogach@bidmc.harvard.edu
Melanie S
MS
Pogach
Naresh M
NM
Punjabi
Neil
N
Thomas
Robert J
RJ
Thomas
D000328:Adult; D003430:Cross-Sectional Studies; D004562:Electrocardiography; D005260:Female; D005947:Glucose / Q000378:metabolism*; D005951:Glucose Tolerance Test; D006801:Humans; D008297:Male; D008875:Middle Aged; D017286:Polysomnography; D012890:Sleep / Q000502:physiology*; D012891:Sleep Apnea Syndromes / Q000378:metabolism / Q000503:physiopathology*; D012894:Sleep Stages / Q000502:physiology
D005947:Glucose