Altered Neuroendocrine Sleep Architecture in Patients With Type 1 Diabetes

  1. Kamila Jauch-Chara, MD1,
  2. Sebastian M. Schmid, MD2,
  3. Manfred Hallschmid, PHD3,
  4. Jan Born, PHD3 and
  5. Bernd Schultes, MD24
  1. 1Department of Psychiatry and Psychotherapy, University of Lübeck, Lübeck, Germany
  2. 2Department of Internal Medicine I, University of Lübeck, Lübeck, Germany
  3. 3Department of Neuroendocrinology, University of Lübeck, Lübeck, Germany
  4. 4Interdisciplinary Obesity Center, Kantonsspital St. Gallen, Rorschach, Switzerland
  1. Corresponding author: Bernd Schultes, MD, Interdisciplinary Obesity Center, Kantonsspital St. Gallen, Heidenerstr. 11, 9400 Rorschach, Switzerland. E-mail: bernd.schultes{at}kssg.ch

Abstract

OBJECTIVE—The modulatory influence of nocturnal sleep on neuroendocrine secretory activity is increasingly recognized as a factor critical to health. Disturbances of sleep may arise from and contribute to the disease process in chronically ill patients with type 1 diabetes.

RESEARCH DESIGN AND METHODS—Using standard polysomnography and repetitive blood sampling, neuroendocrine sleep architecture was assessed under well-controlled nonhypoglycemic conditions in 14 type 1 diabetic patients and 14 healthy control subjects matched for age, sex, and BMI.

RESULTS—As expected, plasma glucose (P = 0.02) and serum insulin (P < 0.001) levels were constantly higher in type 1 diabetic patients than in healthy subjects throughout the night. Beside these characteristic alterations of glucose metabolism, type 1 diabetic patients displayed higher blood levels of growth hormone (P = 0.001) and epinephrine (P = 0.02) during the entire night and higher levels of ACTH (P = 0.01) as well as a tendency toward higher cortisol levels (P = 0.072) during the first night-half, compared with healthy control subjects. Patients spent slightly less time in slow wave sleep (P = 0.09) during the first night-half (where this sleep stage predominates), and overall exhibited an increased proportion of stage 2 sleep (P = 0.01). Correspondingly, assessment of mood and symptoms after sleep revealed that subjective sleep was less restorative in type 1 diabetic patients than in healthy subjects.

CONCLUSIONS—Our data indicate distinct alterations in the neuroendocrine sleep architecture of patients with type 1 diabetes, which add to the generally adverse impact of the disease on the patients’ health.

Footnotes

  • Published ahead of print at http://care.diabetesjournals.org on 25 February 2008. DOI: 10.2337/dc07-1986.

    The costs of publication of this article were defrayed in part by the payment of page charges. This article must therefore be hereby marked “advertisement” in accordance with 18 U.S.C. Section 1734 solely to indicate this fact.

    • Accepted February 16, 2008.
    • Received October 14, 2007.
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  1. Published online before print February 25, 2008, doi: 10.2337/dc07-1986 Diabetes Care June 2008 vol. 31 no. 6 1183-1188
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