Sleep biosignature of Type 2 diabetes: a case-control study.
To determine whether or not the sleep disturbances associated with Type 2 diabetes affect the structure of sleep.



We designed a case-control study in 76 patients with Type 2 diabetes and 76 control subjects without Type 2 diabetes, matched by age, gender, BMI and waist and neck circumferences. A subgroup of 32 patients with Type 2 diabetes was also matched with 64 control subjects without Type 2 diabetes according to apnoea-hypopnoea index score. Examination included an overnight full polysomnography.



No differences in the percentage of time spent in either rapid eye movement or non-rapid eye movement sleep were observed between groups; however, patients with Type 2 diabetes had more microarousal events during sleep than control subjects [41.4 (total range 4.0-104.4) vs 20.7 (total range 1.3-94.5) events/h; P < 0.001]. These differences were mainly observed during the non-rapid eye movement sleep [7.4 (total range 0-107.2) vs 0.2 (total range 0-65.2) events/h; P < 0.001]. In addition, sleep variables related to oxygen saturation measures, such as the percentage of time spent with oxygen saturation ≤90%, were significantly greater during the rapid eye movement sleep in patients with Type 2 diabetes [20.3 (total range 0-99.2) vs. 10.5 (total range 0-94.0)%; P = 0.047]. This pattern was maintained in the subgroup of patients matched by apnoea-hypopnaea index. Finally, stepwise regression analyses showed that apnoea-hypopnoea index, the presence of Type 2 diabetes and fasting plasma glucose value were independently associated with the number of microarousals (R2=0.667).



Type 2 diabetes is associated with an altered sleep structure, with different effects according to rapid eye movement (increase in nocturnal hypoxia) or non-rapid eye movement (increase in sleep fragmentation) sleep.
Department of Endocrinology and Nutrition, Hospital Universitari Arnau de Vilanova, IRBLLEIDA, Universitat de Lleida, Lleida, Spain.|CIBER de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Department of Endocrinology, Diabetes and Metabolism Research Unit, Institut de Recerca i Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain.
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Lecube
CIBER Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III (ISCIII), Sleep Unit, Department of Neurophysiology, Institut de Recerca i Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain.
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Romero
CIBER Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III (ISCIII), Sleep Unit, Department of Pneumology, Institut de Recerca i Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain.
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Sampol
CIBER de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Department of Endocrinology, Diabetes and Metabolism Research Unit, Institut de Recerca i Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain.
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Mestre
CIBER de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Department of Endocrinology, Diabetes and Metabolism Research Unit, Institut de Recerca i Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain.
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Ciudin
Department of Endocrinology and Nutrition, Hospital Universitari Arnau de Vilanova, IRBLLEIDA, Universitat de Lleida, Lleida, Spain.
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Sánchez
CIBER de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Department of Endocrinology, Diabetes and Metabolism Research Unit, Institut de Recerca i Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain.
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Hernández
Department of Endocrinology and Nutrition, Corporació Sanitària Parc Taulí, Parc Taulí, Spain.
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Caixàs
Sleep Unit, Department of Pneumology, Corporació Sanitària Parc Taulí, Sabadell, Spain.
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Vigil
CIBER de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Department of Endocrinology, Diabetes and Metabolism Research Unit, Institut de Recerca i Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain.
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Simó
D000328:Adult; D000368:Aged; D001786:Blood Glucose / Q000032:analysis; D016022:Case-Control Studies; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000150:complications*; D005260:Female; D006801:Humans; D000860:Hypoxia / Q000209:etiology; D008297:Male; D008875:Middle Aged; D017286:Polysomnography; D012307:Risk Factors; D012891:Sleep Apnea Syndromes / Q000097:blood / Q000150:complications* / Q000453:epidemiology / Q000503:physiopathology; D020921:Sleep Arousal Disorders / Q000097:blood / Q000150:complications* / Q000453:epidemiology / Q000503:physiopathology; D012892:Sleep Deprivation / Q000097:blood / Q000150:complications* / Q000453:epidemiology / Q000503:physiopathology; D012893:Sleep Wake Disorders / Q000097:blood / Q000150:complications* / Q000453:epidemiology / Q000503:physiopathology; D012895:Sleep, REM; D013030:Spain / Q000453:epidemiology; D055815:Young Adult
D001786:Blood Glucose