A Paradoxical Diurnal Movement Pattern in Obese Subjects With Type 2 Diabetes

A contributor to impaired appetite and glycemic control?

• SPA, spontaneous physical activity level

Observational studies have found an association between self-reported impaired sleep quality and subsequent risk of type 2 diabetes (1,2). In a German cohort of 4,140 men and 4,129 women (aged 25–74 years), sleeping difficulties were associated with higher risk of developing type 2 diabetes during the mean follow-up period of 7.5 years (1). In the Nurses Health Study (70,026 U.S. women aged 40–65), short sleep duration (≤5 h per day) was associated with risk of incidents of diabetes over a 10-year period (2). A few short-term trials have demonstrated that sleep restriction is associated with increased sympathoadrenal secretion of cortisol and catecholamines (3,4), decreased evening leptin, and increased ghrelin levels (5). Chronic increased sympathoadrenal activity may alter glucose homeostasis and induce insulin resistance. Thus, impaired sleep quality may act as a stress factor, stimulating appetite, promoting weight gain, and impairing glycemic control, with subsequent increased risk of type 2 diabetes.

The weakness of previous studies is the self-reporting of sleep quality and risk of confounding by associated traits. We measured movement during sleep in type 2 diabetic patients and control subjects by an objective technique and compared the sleep problems of obese subjects with type 2 diabetes with those of nondiabetic obese subjects.