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Do Sleep Disorders and Associated Treatments Impact Glucose Metabolism?

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Abstract

Over the past decade substantial evidence has accumulated implicating disorders of sleep in the pathogenesis of various metabolic abnormalities. This review, which is based on workshop discussions that took place at the 6th annual meeting of the International Sleep Disorders Forum: The Art of Good Sleep 2008 and a systematic literature search, provides a critical analysis of the available evidence implicating sleep disorders such as obstructive sleep apnoea (OSA), insomnia, short or long-term sleep duration and restless legs syndrome as potential risk factors for insulin resistance, glucose intolerance, type 2 diabetes mellitus and the metabolic syndrome. The review also highlights the evidence on whether treatment of specific sleep disorders can decrease metabolic risk. In total, 83 published reports were selected for inclusion. Although several studies show clear associations between sleep disorders and altered glucose metabolism, causal effects and the underlying pathophysiological mechanisms involved have not been fully elucidated. OSA appears to have the strongest association with insulin resistance, glucose intolerance, type 2 diabetes and the metabolic syndrome. There are, however, limited data supporting the hypothesis that effective treatment of sleep disorders, including OSA, has a favourable effect on glucose metabolism. Large randomized trials are thus required to address whether improvement of sleep quality and quantity can curtail excess metabolic risk. Research is also required to elucidate the mechanisms involved and to determine whether the effects of treatment for sleep disorders on glucose metabolism are dependent on the specific patient factors, the type of disorder and the duration of metabolic dysfunction. In conclusion, there is limited evidence on whether sleep disorders alter glucose metabolism and whether treatment can reduce the excess metabolic risk.

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Acknowledgements

The discussions that took place during a workshop at the 6th annual meeting of The International Sleep Disorders Forum: The Art of Good Sleep, held in 2008, contributed to the preparation of this article. The author would like to thank the following individuals who attended the workshop and contributed to the discussions: W. David Brown (USA), James Walsh (USA), Milton Erman (USA), George Slade (USA), David Neubauer (USA), Raffaele Ferri (Italy), Seung-Chul Hong (Korea) and Markku Partinen (Finland). The author would also like to thank Mary Hines and Matt Weitz from Wolters Kluwer Pharma Solutions for providing medical writing support in the preparation of this article. This assistance was supported by sanofi-aventis. The International Sleep Disorders Forum: The Art of Good Sleep 2008 was funded by sanofi-aventis.

Declaration of conflicts of interest: Dr Punjabi has received honoraria and travel support for continuing medical education lectures or symposia sponsored by Respironics and Resmed Inc. He is also participating in a multi-center clinical trial of sleep apnea treatment sponsored by Resmed.

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  1. Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, 5501 Hopkins Bayview Circle, Baltimore, Maryland, 21224, USA

    Naresh M. Punjabi

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Punjabi, N.M. Do Sleep Disorders and Associated Treatments Impact Glucose Metabolism?. Drugs 69 (Suppl 2), 13–27 (2009). https://doi.org/10.2165/11531150-000000000-00000

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