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Sleep Restriction for One Week Reduces Insulin Sensitivity in Healthy Men

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Sleep Restriction for One Week Reduces Insulin Sensitivity in Healthy Men Diabetes Publish Ahead of Print, published online June 28, 2010 SLEEP RESTRICTION FOR ONE WEEK REDUCES INSULIN SENSITIVITY IN HEALTHY MEN Running title: Insufficient sleep and insulin sensitivity Orfeu M Buxton1,2, Milena Pavlova2,3, Emily W. Reid1, Wei Wang1,2, Donald C. Simonson1,2, Gail K. Adler1,2 1 Department of Medicine, Brigham and Women’s Hospital, Boston, MA 2 Harvard Medical School, Boston, MA 3 Department of Neurology, Brigham and Women’s Hospital, Boston, MA Support: NIH/NCRR grant M01-RR02635, Cephalon Inc. Corresponding Author: Orfeu M. Buxton, Ph.D. Email: [email protected] Clinical Trial Reg. No.: NCT00895570; ClinicalTrials.gov Submitted 11 May 2009 and accepted 18 June 2010. This is an uncopyedited electronic version of an article accepted for publication in Diabetes. The American Diabetes Association, publisher of Diabetes, is not responsible for any errors or omissions in this version of the manuscript or any version derived from it by third parties. The definitive publisher-authenticated version will be available in a future issue of Diabetes in print and online at http://diabetes.diabetesjournals.org. Copyright American Diabetes Association, Inc., 2010 Insufficient sleep and insulin sensitivity Objective: Short sleep duration is associated with impaired glucose tolerance and an increased risk of diabetes. The effects of sleep restriction on insulin sensitivity have not been established. This study tests the hypothesis that decreasing nighttime sleep duration reduces insulin sensitivity and assesses the effects of a drug, modafinil, that increases alertness during wakefulness. Research Design and Methods: This twelve-day, inpatient General Clinical Research Center study included twenty healthy men (age 20-35 years, BMI 20-30 kg/m2). Subjects spent 10 hours/night in bed for ≥8 nights including 3 inpatient nights (sleep-replete condition), followed by 5 hours/night of time in bed for 7 nights (sleep-restricted condition). Subjects received modafinil (300 mg/day) or placebo during sleep restriction. Diet and activity were controlled. On the last two days of each condition we assessed glucose metabolism by intravenous glucose tolerance test (IVGTT) and euglycemic hyperinsulinemic clamp. Salivary cortisol, 24-hr urinary catecholamines, and neurobehavioral performance were measured. Results: IVGTT-derived insulin sensitivity was reduced 20 ± 24% (mean±SD) after sleep restriction (p=0.001), without significant alterations in the insulin secretory response. Similarly, insulin sensitivity assessed by clamp was reduced 11±5.5% (p< 0.04) after sleep restriction. Glucose tolerance and the Disposition Index were reduced by sleep restriction. These outcomes were not affected by modafinil treatment. Changes in insulin sensitivity did not correlate with changes in salivary cortisol (increase of 51±8% with sleep restriction, p<0.02), urinary catecholamines or slow wave sleep. Conclusion: Sleep restriction (5 hrs/night) for one week significantly reduces insulin sensitivity, raising concerns about effects of chronic insufficient sleep on disease processes associated with insulin resistance. ClinicalTrials.govID: NCT00895570 he average sleep duration in the United subjects (22). States has fallen below 7 hours per In healthy subjects, the mechanisms leading T night, a drop of about 2 hours per night to impaired glucose tolerance with short-term over the last century and more than 1 hour per reductions in nightly sleep duration are night over the last 40 years (1;2). Cross- unclear. Decreases in insulin secretion have sectional and longitudinal studies have been implicated and sleep restriction increases demonstrated a link between short sleep cortisol levels which could influence glucose duration or poor sleep quality and increased tolerance (22). Further, insulin resistance has risk of obesity (3-7), diabetes (7-11), been reported in two very different models of hypertension (12), cardiovascular disease disrupted sleep – sleep apnea (23) and (13;14), the metabolic syndrome (15), and experimental disruption of slow wave sleep early mortality (14;16-21). Short-term sleep (24). In the latter model, the extent of slow restriction (4 hours/night for one week in a wave sleep disruption predicted reductions in laboratory setting) impaired glucose tolerance insulin sensitivity (24). during a frequently sampled intravenous Our primary goal was to test the hypothesis glucose tolerance test (IVGTT) in healthy that sleep restriction in healthy subjects 2 Insufficient sleep and insulin sensitivity reduces insulin sensitivity as assessed by the urine toxicology screen. hyperinsulinemic euglycemic clamp Pre-study conditions. Before the experiment, technique. Insulin secretion was assessed subjects slept at home for at least 5 days using intravenous glucose tolerance tests. To (mean 8.9, range 5-21 days) with 10 hours per identify possible mechanisms by which sleep night of time in bed (TIB) from 10pm to 8am restriction may affect insulin sensitivity, we (±1 hr) in order to enter the experimental assessed the relationships between changes in portion of the protocol in a nearly ‘sleep- insulin sensitivity and changes in cortisol, replete’ state, i.e. with similar and presumably catecholamines and slow wave sleep. minimal amounts of ‘sleep debt' (31). Further, we tested the ability of modafinil to Subjects called into a time-stamped phone ameliorate the adverse effects of sleep answering system, wore wrist activity restriction on insulin sensitivity. Modafanil monitors (Minimitter, Bend OR), and activates central, wake-promoting completed a sleep diary to assure compliance dopaminergic and noradrenergic mechanisms with this schedule. (25;26) and ameliorates the adverse effects of Inpatient study conditions. Subjects were sleep deprivation on alertness and admitted to the General Clinical Research performance (27-29), impairments in which Center at Brigham and Women’s Hospital for have been attributed to reduced brain glucose a 12-day inpatient visit. The study began with utilization (30). Thus, we performed a 3-day baseline period of 10/hrs night TIB hyperinsulinemic euglycemic clamps and (continued from the pre-test period) and intravenous glucose tolerance twice, at baseline metabolic assessments, after which baseline in sleep-replete individuals and after subjects were scheduled for Sleep Restriction 7 nights of sleep restriction (5 hr in bed) in (5 hours/night TIB) for the following 7 nights healthy individuals randomized to daily with the sleep periods centered at the same treatment with placebo or modafinil. clock time of 0300. During the periods of wakefulness, subjects were allowed to METHODS perform activities such as writing, reading, Study Design. A schematic of this double- computer work, board or card games, movie blind, placebo-controlled, randomized, viewing, arts and crafts, listening to or clinical study is presented in Figure 1. playing music and light stretching. Subjects Procedures were approved by the Human were observed by research technicians Research Committee of the Brigham and throughout the protocol either in direct Women’s Hospital and conducted according interaction or remotely via video. Light levels to the principles expressed in the Declaration during sleep periods were essentially of Helsinki. All subjects provided written complete darkness (<1 lux) and <90 lux informed consent. during wakefulness, which simulations Subject recruitment and screening. Healthy suggest would lead to a <9 min mean male subjects were recruited using newspaper difference of circadian phase between sleep ads, flyers, and website postings. Subjects conditions (32). Subjects were randomized to were screened for sleep patterns and medical modafinil (100 mg per tablet) or placebo, 2 and psychological history, underwent a tablets at 0600, and 1 tablet at 1300 during the physical examination by a licensed physician, 7 days of Sleep Restriction. Post-Sleep and provided blood and urine samples to Restriction metabolic assessments were ensure that hematology and serum chemistry performed, and subjects were discharged on including metabolic and thyroid panels were day 12 after a recovery night of 10 hours TIB within normal limits. All subjects passed a (see Figure 1, Protocol Schema). Metabolic 3 Insufficient sleep and insulin sensitivity assessments are described below and overnight fast on the mornings of days 3 and consisted of an IVGTT, euglycemic 10, e.g. following the penultimate night of 10 hyperinsulinemic clamp, and collection of hours TIB and the penultimate (sixth) night of saliva and urine for hormone measurements. 5 hours TIB, respectively. Blood samples During each sleep period, scalp surface were drawn via an intravenous catheter every electrodes (Beckman Instrument Company, 5 min for 20 minutes starting at T= -20 min. Schiller Park, IL) were applied to specific At time 0 (9am), 0.3 g/kg glucose was infused locations on the subject’s face and scalp at over 1 minute via an intravenous catheter in least 2 hours prior to the scheduled sleep the non-sampling arm. Blood samples were period for recordings of central (C3 and C4) then taken at 2, 3, 4, 5, 6, 8, 10, 12, 14, 16 19, and occipital (O1 and O2) 21, 22, 24, 26, 28, 30, 35, 40, 45, 50, 55, 60, electroencephalogram (EEG), 70, 80, 90, 100, 120, 140, 160, and 180 min. electrooculogram (EOG: LOC and ROC), At time 20 min, human insulin (0.02U/kg; electromyogram (EMG), and Novolin R U-100, Novo Nordisk, Princeton, electrocardiogram (ECG). Data were NJ) was administered
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