Sleep and circadian rhythms modulate or control daily physiological patterns with importance for normal metabolic health. Sleep deficiencies associated with insufficient sleep schedules, insomnia with short-sleep duration, sleep apnea, narcolepsy, circadian misalignment, shift work, night eating syndrome, and sleep-related eating disorder may all contribute to metabolic dysregulation. Sleep deficiencies and circadian disruption associated with metabolic dysregulation may contribute to weight gain, obesity, and type 2 diabetes potentially by altering timing and amount of food intake, disrupting energy balance, inflammation, impairing glucose tolerance, and insulin sensitivity. Given the rapidly increasing prevalence of metabolic diseases, it is important to recognize the role of sleep and circadian disruption in the development, progression, and morbidity of metabolic disease. Some findings indicate sleep treatments and countermeasures improve metabolic health, but future clinical research investigating prevention and treatment of chronic metabolic disorders through treatment of sleep and circadian disruption is needed.
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Papers of particular interest, published recently, have been highlighted as: • Of importance
James WP. WHO recognition of the global obesity epidemic. Int J Obes (Lond). 2008;32 Suppl 7:S120–6.
Sleep in America Poll. National Sleep Foundation. 2008.
Taheri S, Lin L, Austin D, Young T, Mignot E. Short sleep duration is associated with reduced leptin, elevated ghrelin, and increased body mass index. PLoS Med. 2004;1:e62.
Markwald RR, Melanson EL, Smith MR, Higgins J, Perreault L, Eckel RH, et al. Impact of insufficient sleep on total daily energy expenditure, food intake, and weight gain. Proc Natl Acad Sci U S A. 2013;110:5695–700. This controlled laboratory study modeled a work week of insufficent sleep with ad-libitum feeding and measured 24 hour energy expenditure using whole room calorimetry. The findings indicate that insufficinet sleep contributes to weight gain via excessive food intale associated with incresed energy expoenditure. The findings also indicate potential benefit of recovery sleep.
Nguyen J, Wright Jr KP. Influence of weeks of circadian misalignment on leptin levels. Nat Sci Sleep. 2010;2009:9–18.
Spiegel K, Tasali E, Leproult R, Scherberg N, Van Cauter E. Twenty-four-hour profiles of acylated and total ghrelin: relationship with glucose levels and impact of time of day and sleep. J Clin Endocrinol Metab. 2011;96:486–93.
Van Cauter E, Polonsky KS, Scheen AJ. Roles of circadian rhythmicity and sleep in human glucose regulation. Endocr Rev. 1997;18:716–38.
Scheer FA, Hilton MF, Mantzoros CS, Shea SA. Adverse metabolic and cardiovascular consequences of circadian misalignment. Proc Natl Acad Sci U S A. 2009;106:4453–8. This study employs a circadian research protocol called forced desynchrony to disassociate sleep and circadian modulation of cardiometabolic measures.
Markwald RRWJ, Kenneth P. Circadian Misalignment and Sleep Disruption in Shift Work: Implications for Fatigue and Risk of Weight Gain and Obesity. In: Shiromani P, Horvath T, Redline S, Van Cauter E, editors. Sleep loss and obesity : intersecting epidemics. New York: Springer; 2012. p. 101–18.
Marcheva B, Ramsey KM, Buhr ED, Kobayashi Y, Su H, Ko CH, et al. Disruption of the clock components CLOCK and BMAL1 leads to hypoinsulinemia and diabetes. Nature. 2010;466:627–31.
Turek FW, Joshu C, Kohsaka A, Lin E, Ivanova G, McDearmon E, et al. Obesity and metabolic syndrome in circadian Clock mutant mice. Science. 2005;308:1043–5.
Spiegel K, Knutson K, Leproult R, Tasali E, Van Cauter E. Sleep loss: a novel risk factor for insulin resistance and type 2 diabetes (1985). J Appl Physiol. 2005;99:2008–19.
Sack RL, Auckley D, Auger RR, Carskadon MA, Wright Jr KP, Vitiello MV, et al. Circadian rhythm sleep disorders: part I, basic principles, shift work and jet lag disorders. An American Academy of Sleep Medicine review. Sleep. 2007;30:1460–83.
Sack RL, Auckley D, Auger RR, Carskadon MA, Wright Jr KP, Vitiello MV, et al. Circadian rhythm sleep disorders: part II, advanced sleep phase disorder, delayed sleep phase disorder, free-running disorder, and irregular sleep-wake rhythm. An American Academy of Sleep Medicine review. Sleep. 2007;30:1484–501.
Wright Jr KP, Bogan RK, Wyatt JK. Shift work and the assessment and management of shift work disorder (SWD). Sleep Med Rev. 2013;17:41–54.
Buxton OM, Pavlova M, Reid EW, Wang W, Simonson DC, Adler GK. Sleep restriction for 1 week reduces insulin sensitivity in healthy men. Diabetes. 2010;59:2126–33.
Vgontzas AN, Zoumakis E, Bixler EO, Lin HM, Follett H, Kales A, et al. Adverse effects of modest sleep restriction on sleepiness, performance, and inflammatory cytokines. J Clin Endocrinol Metab. 2004;89:2119–26.
Vorona RD, Winn MP, Babineau TW, Eng BP, Feldman HR, Ware JC. Overweight and obese patients in a primary care population report less sleep than patients with a normal body mass index. Arch Intern Med. 2005;165:25–30.
Newman AB, Enright PL, Manolio TA, Haponik EF, Wahl PW. Sleep disturbance, psychosocial correlates, and cardiovascular disease in 5201 older adults: the Cardiovascular Health Study. J Am Geriatr Soc. 1997;45:1–7.
International Classification of Sleep Disorders, 3rd ed. American Academy of Sleep Medicine. 2014.
Vgontzas AN, Mastorakos G, Bixler EO, Kales A, Gold PW, Chrousos GP. Sleep deprivation effects on the activity of the hypothalamic-pituitary-adrenal and growth axes: potential clinical implications. Clin Endocrinol. 1999;51:205–15.
Pilcher JJ, Ginter DR, Sadowsky B. Sleep quality vs sleep quantity: relationships between sleep and measures of health, well-being and sleepiness in college students. J Psychosom Res. 1997;42:583–96.
Leger D. The cost of sleep-related accidents: a report for the National Commission on Sleep Disorders Research. Sleep. 1994;17:84–93.
Cappuccio FP, D'Elia L, Strazzullo P, Miller MA. Quantity and quality of sleep and incidence of type 2 diabetes: a systematic review and meta-analysis. Diabetes Care. 2010;33:414–20.
Cappuccio FP, Taggart FM, Kandala NB, Currie A, Peile E, Stranges S, et al. Meta-analysis of short sleep duration and obesity in children and adults. Sleep. 2008;31:619–26.
Spiegel K, Leproult R, L'Hermite-Baleriaux M, Copinschi G, Penev PD, Van Cauter E. Leptin levels are dependent on sleep duration: relationships with sympathovagal balance, carbohydrate regulation, cortisol, and thyrotropin. J Clin Endocrinol Metab. 2004;89:5762–71.
Calvin AD, Carter RE, Adachi T, Macedo PG, Albuquerque FN, van der Walt C, et al. Effects of experimental sleep restriction on caloric intake and activity energy expenditure. Chest. 2013;144:79–86.
Bosy-Westphal A, Hinrichs S, Jauch-Chara K, Hitze B, Later W, Wilms B, et al. Influence of partial sleep deprivation on energy balance and insulin sensitivity in healthy women. Obes Facts. 2008;1:266–73.
Spiegel K, Leproult R, Van Cauter E. Impact of sleep debt on metabolic and endocrine function. Lancet. 1999;354:1435–9.
Nedeltcheva AV, Kessler L, Imperial J, Penev PD. Exposure to recurrent sleep restriction in the setting of high caloric intake and physical inactivity results in increased insulin resistance and reduced glucose tolerance. J Clin Endocrinol Metab. 2009;94:3242–50.
Broussard JL, Ehrmann DA, Van Cauter E, Tasali E, Brady MJ. Impaired insulin signaling in human adipocytes after experimental sleep restriction: a randomized, crossover study. Ann Intern Med. 2012;157:549–57.
Leproult R, Holmback U, Van Cauter E. Circadian misalignment augments markers of insulin resistance and inflammation, independently of sleep loss. Diabetes. 2014. doi:10.2337/db13-1546.
Buxton OM, Cain SW, O'Connor SP, Porter JH, Duffy JF, Wang W, et al. Adverse metabolic consequences in humans of prolonged sleep restriction combined with circadian disruption. Sci Transl Med. 2012;4:129ra43. This study describes metabolic alterations in response to extended (3 weeks) sleep restriction combined with circadian misalignment, as well as subsequent recovery sleep.
Lamia KA, Storch KF, Weitz CJ. Physiological significance of a peripheral tissue circadian clock. Proc Natl Acad Sci U S A. 2008;105:15172–7.
Barclay JL, Husse J, Bode B, Naujokat N, Meyer-Kovac J, Schmid SM, et al. Circadian desynchrony promotes metabolic disruption in a mouse model of shiftwork. PLoS ONE. 2012;7:e37150.
Bouatia-Naji N, Bonnefond A, Cavalcanti-Proenca C, Sparso T, Holmkvist J, Marchand M, et al. A variant near MTNR1B is associated with increased fasting plasma glucose levels and type 2 diabetes risk. Nat Genet. 2009;41:89–94.
Kivimaki M, Batty GD, Hublin C. Shift work as a risk factor for future type 2 diabetes: evidence, mechanisms, implications, and future research directions. PLoS Med. 2011;8:e1001138.
Arble DM, Bass J, Laposky AD, Vitaterna MH, Turek FW. Circadian timing of food intake contributes to weight gain. Obesity. 2009;17:2100–2.
Hatori M, Vollmers C, Zarrinpar A, DiTacchio L, Bushong EA, Gill S, et al. Time-restricted feeding without reducing caloric intake prevents metabolic diseases in mice fed a high-fat diet. Cell Metab. 2012;15:848–60.
Coomans CP, van den Berg SA, Houben T, van Klinken JB, van den Berg R, Pronk AC, et al. Detrimental effects of constant light exposure and high-fat diet on circadian energy metabolism and insulin sensitivity. FASEB J. 2013;27:1721–32.
Lowden A, Moreno C, Holmback U, Lennernas M, Tucker P. Eating and shift work - effects on habits, metabolism and performance. Scand J Work Environ Health. 2010;36:150–62.
Debry G, Girault P, Lefort J. Thiebault J [Survey of the food habits of workers on shift work]. Bull Inst Natl Sante Rech Med. 1967;22:1169–202.
Morin CM, LeBlanc M, Daley M, Gregoire JP, Merette C. Epidemiology of insomnia: prevalence, self-help treatments, consultations, and determinants of help-seeking behaviors. Sleep Med. 2006;7:123–30.
Vgontzas AN, Fernandez-Mendoza J, Liao D, Bixler EO. Insomnia with objective short sleep duration: the most biologically severe phenotype of the disorder. Sleep Med Rev. 2013;17:241–54.
Ohayon MM. Epidemiology of insomnia: what we know and what we still need to learn. Sleep Med Rev. 2002;6:97–111.
Chedraui P, San Miguel G, Villacreses D, Dominguez A, Jaramillo W, Escobar GS, et al. Assessment of insomnia and related risk factors in postmenopausal women screened for the metabolic syndrome. Maturitas. 2013;74:154–9.
Vgontzas AN, Liao D, Pejovic S, Calhoun S, Karataraki M, Bixler EO. Insomnia with objective short sleep duration is associated with type 2 diabetes: a population-based study. Diabetes Care. 2009;32:980–5. Findings from this study provide the strongest evidence that there are differences between insomnia with short-sleep duration vs insomnia with normal sleep duration.
Troxel WM, Buysse DJ, Matthews KA, Kip KE, Strollo PJ, Hall M, et al. Sleep symptoms predict the development of the metabolic syndrome. Sleep. 2010;33:1633–40.
Knutson KL, Van Cauter E, Zee P, Liu K, Lauderdale DS. Cross-sectional associations between measures of sleep and markers of glucose metabolism among subjects with and without diabetes: the Coronary Artery Risk Development in Young Adults (CARDIA) Sleep Study. Diabetes Care. 2011;34:1171–6.
Keckeis M, Lattova Z, Maurovich-Horvat E, Beitinger PA, Birkmann S, Lauer CJ, et al. Impaired glucose tolerance in sleep disorders. PLoS ONE. 2010;5:e9444.
Vasisht KP, Kessler LE, Booth III JN, Imperial JG, Penev PD. Differences in insulin secretion and sensitivity in short-sleep insomnia. Sleep. 2013;36:955–7.
Sleep-related breathing disorders in adults: recommendations for syndrome definition and measurement techniques in clinical research. The Report of an American Academy of Sleep Medicine Task Force. Sleep. 1999;22:667–89.
Aronsohn RS, Whitmore H, Van Cauter E, Tasali E. Impact of untreated obstructive sleep apnea on glucose control in type 2 diabetes. Am J Respir Crit Care Med. 2010;181:507–13.
Papanas N, Steiropoulos P, Nena E, Tzouvelekis A, Maltezos E, Trakada G, et al. HbA1c is associated with severity of obstructive sleep apnea hypopnea syndrome in nondiabetic men. Vasc Health Risk Manag. 2009;5:751–6.
Ronksley PE, Hemmelgarn BR, Heitman SJ, Hanly PJ, Faris PD, Quan H, et al. Obstructive sleep apnoea is associated with diabetes in sleepy subjects. Thorax. 2009;64:834–9.
Schober AK, Neurath MF, Harsch IA. Prevalence of sleep apnoea in diabetic patients. Clin Respir J. 2011;5:165–72.
Steiropoulos P, Papanas N, Nena E, Tsara V, Fitili C, Tzouvelekis A, et al. Markers of glycemic control and insulin resistance in non-diabetic patients with Obstructive Sleep Apnea Hypopnea Syndrome: does adherence to CPAP treatment improve glycemic control? Sleep Med. 2009;10:887–91.
Weinstock TG, Wang X, Rueschman M, Ismail-Beigi F, Aylor J, Babineau DC, et al. A controlled trial of CPAP therapy on metabolic control in individuals with impaired glucose tolerance and sleep apnea. Sleep. 2012;35:617–25B.
Sharma SK, Agrawal S, Damodaran D, Sreenivas V, Kadhiravan T, Lakshmy R, et al. CPAP for the metabolic syndrome in patients with obstructive sleep apnea. N Engl J Med. 2011;365:2277–86. Findings that CPAP resolved MetS in 20 % of patients show strong potential benefit from CPAP. Future studies need to confirm and extend these initial findings to address critiques raised by some researchers.
Barcelo A, Barbe F, de la Pena M, Martinez P, Soriano JB, Pierola J, et al. Insulin resistance and daytime sleepiness in patients with sleep apnoea. Thorax. 2008;63:946–50.
Hassaballa HA, Tulaimat A, Herdegen JJ, Mokhlesi B. The effect of continuous positive airway pressure on glucose control in diabetic patients with severe obstructive sleep apnea. Sleep Breath. 2005;9:176–80.
Dawson A, Abel SL, Loving RT, Dailey G, Shadan FF, Cronin JW, et al. CPAP therapy of obstructive sleep apnea in type 2 diabetics improves glycemic control during sleep. J Clin Sleep Med. 2008;4:538–42.
West SD, Nicoll DJ, Wallace TM, Matthews DR, Stradling JR. Effect of CPAP on insulin resistance and HbA1c in men with obstructive sleep apnoea and type 2 diabetes. Thorax. 2007;62:969–74.
Coughlin SR, Mawdsley L, Mugarza JA, Wilding JP, Calverley PM. Cardiovascular and metabolic effects of CPAP in obese males with OSA. Eur Respir J. 2007;29:720–7.
Resnick HE, Redline S, Shahar E, Gilpin A, Newman A, Walter R, et al. Diabetes and sleep disturbances: findings from the Sleep Heart Health Study. Diabetes Care. 2003;26:702–9.
Aurora RN, Punjabi NM. Obstructive sleep apnoea and type 2 diabetes mellitus: a bidirectional association. Lancet Respir Med. 2013;1:329–38.
Schuld A, Hebebrand J, Geller F, Pollmacher T. Increased body-mass index in patients with narcolepsy. Lancet. 2000;355:1274–5.
Poli F, Plazzi G, Di Dalmazi G, Ribichini D, Vicennati V, Pizza F, et al. Body mass index-independent metabolic alterations in narcolepsy with cataplexy. Sleep. 2009;32:1491–7.
Dahmen N, Bierbrauer J, Kasten M. Increased prevalence of obesity in narcoleptic patients and relatives. Eur Arch Psychiatry Clin Neurosci. 2001;251:85–9.
Heier MS, Jansson TS, Gautvik KM. Cerebrospinal fluid hypocretin 1 deficiency, overweight, and metabolic dysregulation in patients with narcolepsy. J Clin Sleep Med. 2011;7:653–8.
Beitinger PA, Fulda S, Dalal MA, Wehrle R, Keckeis M, Wetter TC, et al. Glucose tolerance in patients with narcolepsy. Sleep. 2012;35:231–6. Findings strengthened by use of BMI matched controls.
Engel A, Helfrich J, Manderscheid N, Musholt PB, Forst T, Pfutzner A, et al. Investigation of insulin resistance in narcoleptic patients: dependent or independent of body mass index? Neuropsychiatr Dis Treat. 2011;7:351–6. Findings strengthened by use of BMI matched controls.
Jennum P, Ibsen R, Knudsen S, Kjellberg J. Comorbidity and mortality of narcolepsy: a controlled retro-and prospective national study. Sleep. 2013;36:835–40.
Lopes LA, Lins Cde M, Adeodato VG, Quental DP, de Bruin PF, Montenegro Jr RM, et al. Restless legs syndrome and quality of sleep in type 2 diabetes. Diabetes Care. 2005;28:2633–6.
Merlino G, Fratticci L, Valente M, Del Giudice A, Noacco C, Dolso P, et al. Association of restless legs syndrome in type 2 diabetes: a case-control study. Sleep. 2007;30:866–71.
Cuellar NG, Ratcliffe SJ. A comparison of glycemic control, sleep, fatigue, and depression in type 2 diabetes with and without restless legs syndrome. J Clin Sleep Med. 2008;4:50–6.
Rizzi M, Barrella M, Kotzalidis GD, Bevilacqua M. Periodic limbic movement disorder during sleep as diabetes-related syndrome?A Polysomnographic Study. ISRN Endocrinol. 2011;2011:246157.
Akerstedt T, Wright Jr KP. Sleep loss and fatigue in shift work and shift work disorder. Sleep Med Clin. 2009;4:257–71.
Painting, firefighting, and shiftwork. IARC Monogr Eval Carcinog Risks Hum. 2010;98:9–764.
Drake CL, Roehrs T, Richardson G, Walsh JK, Roth T. Shift work sleep disorder: prevalence and consequences beyond that of symptomatic day workers. Sleep. 2004;27:1453–62.
Flo E, Pallesen S, Mageroy N, Moen BE, Gronli J, Hilde Nordhus I, et al. Shift work disorder in nurses—assessment, prevalence and related health problems. PLoS ONE. 2012;7:e33981.
Ishizaki M, Morikawa Y, Nakagawa H, Honda R, Kawakami N, Haratani T, et al. The influence of work characteristics on body mass index and waist to hip ratio in Japanese employees. Ind Health. 2004;42:41–9.
Karlsson B, Knutsson A, Lindahl B. Is there an association between shift work and having a metabolic syndrome? Results from a population based study of 27,485 people. Occup Environ Med. 2001;58:747–52.
Di Lorenzo L, De Pergola G, Zocchetti C, L'Abbate N, Basso A, Pannacciulli N, et al. Effect of shift work on body mass index: results of a study performed in 319 glucose-tolerant men working in a Southern Italian industry. Int J Obes Relat Metab Disord. 2003;27:1353–8.
van Amelsvoort LG, Schouten EG, Kok FJ. Duration of shiftwork related to body mass index and waist to hip ratio. Int J Obes Relat Metab Disord. 1999;23:973–8.
Guo Y, Liu Y, Huang X, Rong Y, He M, Wang Y, et al. The effects of shift work on sleeping quality, hypertension and diabetes in retired workers. PLoS ONE. 2013;8:e71107.
Canuto R, Garcez AS, Olinto MT. Metabolic syndrome and shift work: a systematic review. Sleep Med Rev. 2013;17:425–31.
Monk TH, Buysse DJ. Exposure to shift work as a risk factor for diabetes. J Biol Rhythms. 2013;28:356–9.
Puttonen S, Viitasalo K, Harma M. The relationship between current and former shift work and the metabolic syndrome. Scand J Work Environ Health. 2012;38:343–8.
Suwazono Y, Sakata K, Okubo Y, Harada H, Oishi M, Kobayashi E, et al. Long-term longitudinal study on the relationship between alternating shift work and the onset of diabetes mellitus in male Japanese workers. J Occup Environ Med. 2006;48:455–61.
Birketvedt GS, Florholmen J, Sundsfjord J, Osterud B, Dinges D, Bilker W, et al. Behavioral and neuroendocrine characteristics of the night-eating syndrome. JAMA. 1999;282:657–63.
Allison KC, Lundgren JD, O'Reardon JP, Geliebter A, Gluck ME, Vinai P, et al. Proposed diagnostic criteria for night eating syndrome. Int J Eat Disord. 2010;43:241–7.
Goel N, Stunkard AJ, Rogers NL, Van Dongen HP, Allison KC, O'Reardon JP, et al. Circadian rhythm profiles in women with night eating syndrome. J Biol Rhythms. 2009;24:85–94.
Baron KG, Reid KJ, Horn LV, Zee PC. Contribution of evening macronutrient intake to total caloric intake and body mass index. Appetite. 2013;60:246–51.
Baron KG, Reid KJ, Kern AS, Zee PC. Role of sleep timing in caloric intake and BMI. Obesity. 2011;19:1374–81.
Winkelman JW. Clinical and polysomnographic features of sleep-related eating disorder. J Clin Psychiatry. 1998;59:14–9.
Brion A, Flamand M, Oudiette D, Voillery D, Golmard JL, Arnulf I. Sleep-related eating disorder vs sleepwalking: a controlled study. Sleep Med. 2012;13:1094–101.
Winkelman JW, Johnson EA, Richards LM. Sleep-related eating disorder. Handb Clin Neurol. 2011;98:577–85.
Gallant AR, Lundgren J, Drapeau V. The night-eating syndrome and obesity. Obes Rev. 2012;13:528–36.
Allison KC, Crow SJ, Reeves RR, West DS, Foreyt JP, Dilillo VG, et al. Binge eating disorder and night eating syndrome in adults with type 2 diabetes. Obesity. 2007;15:1287–93.
Kenneth P. Wright Jr. has received grant support from the NIH R01 HL109706, R21 DK092624.
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Conflict of Interest
Christopher M. Depner and Ellen R. Stothard declare that they have no conflict of interest. Kenneth P. Wright Jr. has been a Past Chair Scientific Advisory Board—fatigue and maritime work schedules for Northwestern University American Waterways Project; Past Chair Scientific Advisory Board—company developed sleep monitoring system for the general public for Zeo, Inc.; past consultant for Takeda Pharmaceuticals; has received honoraria from the University of Chicago and Associated Professional Sleep Societies; payment from Potomac Center for Medical Education for shift work sleep disorders in hospitals; and has received grant support for Philips, Inc.
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This article is part of the Topical Collection on Macrovascular Complications in Diabetes
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Depner, C.M., Stothard, E.R. & Wright, K.P. Metabolic Consequences of Sleep and Circadian Disorders. Curr Diab Rep 14, 507 (2014). https://doi.org/10.1007/s11892-014-0507-z
- Circadian misalignment
- Insufficient sleep
- Sleep deficiency
- Insulin sensitivity
- Energy balance
- Shift work
- Type 2 diabetes
- Metabolic syndrome
- Glucose tolerance
- Circadian disruption
- Sleep apnea
- Circadian disorders
- Metabolic consequences