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      Metabolic, Endocrine, and Immune Consequences of Sleep Deprivation

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          Abstract

          Over the last three to four decades, it has been observed that the average total hours of sleep have decreased to less than seven hours per person per night. Concomitantly, global figures relating to obesity and diabetes mellitus have increased in an alarming fashion in adults and children, and it has been hypothesized that neuro-hormonal changes accompanying this behavioral sleep deprivation may lead to insulin resistance and, subsequently, to diabetes mellitus. Sleep deprivation has been associated with multiple physiological changes, including increased cortisol and ghrelin levels, decreased leptin levels and impaired glucose metabolism. Experimental studies have also shown an increase in inflammatory and pro-inflammatory markers, which are indicators of body stress, under sleep deprivation. This review elaborates further on this hypothesis, exploring the molecular basis for the link between both entities and the underlying pathophysiology that results in insulin resistance and diabetes mellitus. We review the results of experimental and epidemiological studies, specifically examining the relationship between sleep duration and the immune and endocrine systems.

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          Self-reported and measured sleep duration: how similar are they?

          Diane S. Lauderdale, Kristen Knutson, Lijing L. Yan … (2008)
          Recent epidemiologic studies have found that self-reported duration of sleep is associated with obesity, diabetes, hypertension, and mortality. The extent to which self reports of sleep duration are similar to objective measures and whether individual characteristics influence the degree of similarity are not known. Eligible participants at the Chicago site of the Coronary Artery Risk Development in Young Adults Study were invited to participate in a 2003-2005 ancillary sleep study; 82% (n = 669) agreed. Sleep measurements collected in 2 waves included 3 days each of wrist actigraphy, a sleep log, and questions about usual sleep duration. We estimate the average difference and correlation between subjectively and objectively measured sleep by using errors-in-variables regression models. Average measured sleep was 6 hours, whereas the average from subjective reports was 6.8 hours. Subjective reports increased on average by 34 minutes for each additional hour of measured sleep. Overall, the correlation between reported and measured sleep duration was 0.47. Our model suggests that persons sleeping 5 hours over-reported their sleep duration by 1.2 hours, and those sleeping 7 hours over-reported by 0.4 hours. The correlations and average differences between self-reports and measured sleep varied by health, sociodemographic, and sleep characteristics. In a population-based sample of middle-aged adults, subjective reports of habitual sleep are moderately correlated with actigraph-measured sleep, but are biased by systematic over-reporting. The true associations between sleep duration and health may differ from previously reported associations between self-reported sleep and health.
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            Early life risk factors for obesity in childhood: cohort study.

            John J Reilly, Julie Armstrong, Ahmad R Dorosty … (2005)
            To identify risk factors in early life (up to 3 years of age) for obesity in children in the United Kingdom. Prospective cohort study. Avon longitudinal study of parents and children, United Kingdom. 8234 children in cohort aged 7 years and a subsample of 909 children (children in focus) with data on additional early growth related risk factors for obesity. Obesity at age 7 years, defined as a body mass index (3) 95th centile relative to reference data for the UK population in 1990. Eight of 25 putative risk factors were associated with a risk of obesity in the final models: parental obesity (both parents: adjusted odds ratio, 10.44, 95% confidence interval 5.11 to 21.32), very early (by 43 months) body mass index or adiposity rebound (15.00, 5.32 to 42.30), more than eight hours spent watching television per week at age 3 years (1.55, 1.13 to 2.12), catch-up growth (2.60, 1.09 to 6.16), standard deviation score for weight at age 8 months (3.13, 1.43 to 6.85) and 18 months (2.65, 1.25 to 5.59); weight gain in first year (1.06, 1.02 to 1.10 per 100 g increase); birth weight, per 100 g (1.05, 1.03 to 1.07); and short (< 10.5 hours) sleep duration at age 3 years (1.45, 1.10 to 1.89). Eight factors in early life are associated with an increased risk of obesity in childhood.
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              Mortality associated with sleep duration and insomnia.

              Daniel F. Kripke, Lawrence Garfinkel, Deborah L. Wingard … (2002)
              Patients often complain about insufficient sleep or chronic insomnia in the belief that they need 8 hours of sleep. Treatment strategies may be guided by what sleep durations predict optimal survival and whether insomnia might signal mortality risks. In 1982, the Cancer Prevention Study II of the American Cancer Society asked participants about their sleep duration and frequency of insomnia. Cox proportional hazards survival models were computed to determine whether sleep duration or frequency of insomnia was associated with excess mortality up to 1988, controlling simultaneously for demographics, habits, health factors, and use of various medications. Participants were more than 1.1 million men and women from 30 to 102 years of age. The best survival was found among those who slept 7 hours per night. Participants who reported sleeping 8 hours or more experienced significantly increased mortality hazard, as did those who slept 6 hours or less. The increased risk exceeded 15% for those reporting more than 8.5 hours sleep or less than 3.5 or 4.5 hours. In contrast, reports of "insomnia" were not associated with excess mortality hazard. As previously described, prescription sleeping pill use was associated with significantly increased mortality after control for reported sleep durations and insomnia. Patients can be reassured that short sleep and insomnia seem associated with little risk distinct from comorbidities. Slight risks associated with 8 or more hours of sleep and sleeping pill use need further study. Causality is unproven.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Open Respir Med J
                Journal ID (publisher-id): TORMJ
                Title: The Open Respiratory Medicine Journal
                Publisher: Bentham Open
                ISSN (Electronic): 1874-3064
                Publication date (Electronic): 23 June 2011
                Publication date Collection: 2011
                Volume: 5
                Pages: 31-43
                Affiliations
                [1 ]Department of Pulmonary Medicine, Rashid Hospital, Dubai Health Authority, United Arab Emirates
                [2 ]University Sleep Disorders Center, College of Medicine, King Saud University, Riyadh, Saudi Arabia
                Author notes
                [* ]Address correspondence to this author at the University Sleep Disorders Center, College of Medicine, King Saud University, P.O. Box 225503, Riyadh 11324, Saudi Arabia; Tel: 966-1-467-9179; Fax: 966-1-467-9495; E-mail: ashammam2@ 123456gmail.com
                Article
                Publisher ID: TORMJ-5-31
                DOI: 10.2174/1874306401105010031
                PMC ID: 3132857
                PubMed ID: 21754974
                SO-VID: 60112473-4147-4bd1-87d3-1449342aedfb
                Copyright © © AlDabal and BaHammam; Licensee Bentham Open.
                License:

                This is an open access article licensed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted, non-commercial use, distribution and reproduction in any medium, provided the work is properly cited.

                History
                Date received : 20 January 2011
                Date revision received : 18 April 2011
                Date accepted : 2 May 2011
                Categories
                Subject: Article

                ScienceOpen disciplines: Respiratory medicine
                Keywords: obesity,leptin.,insulin resistance,diabetes mellitus,ghrelin,glucose intolerance,sleep deprivation
                Data availability:
                ScienceOpen disciplines: Respiratory medicine
                Keywords: obesity, leptin., insulin resistance, diabetes mellitus, ghrelin, glucose intolerance, sleep deprivation

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