The Impact of Nocturnal Hypoglycemia on Sleep in Subjects With Type 2 Diabetes

TY - JOUR

T1 - The Impact of Nocturnal Hypoglycemia on Sleep in Subjects With Type 2 Diabetes

AU - Jennum, Poul

AU - Stender-Petersen, Kirstine

AU - Rabøl, Rasmus

AU - Jørgensen, Niklas Rye

AU - Chu, Pei-Ling

AU - Madsbad, Sten

N1 - © 2015 by the American Diabetes Association. Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered.

PY - 2015/11

Y1 - 2015/11

N2 - OBJECTIVE The aim of this trial was to investigate the impact of nocturnal hypoglycemia on sleep patterns (assessed by polysomnography) and counterregulatory hormones. RESEARCH DESIGN AND METHODS In this single-blinded, crossover trial, 26 subjects with type 2 diabetes attended two experimental night visits (one normoglycemic and one hypoglycemic) in randomized order. Plasma glucose (PG) levels were controlled by hyperinsulinemic glucose clamping. On the hypoglycemic night, hypoglycemia was induced after reaching sleep stage N2 by turning off glucose infusion until the PG target of 2.722.8 mmol/L was reached and maintained for 15 min. Thereafter, subjects were brought back to normoglycemia for the rest of the night. On the normoglycemic night, PG was maintained at 5.027.0 mmol/L throughout the night. RESULTS During the first 4 h of sleep (024 h; after reaching sleep stage N2), no difference between experimental nights was observed in the rate of electroencephalographyidentified arousals or awakenings, but the rate of awakenings was 27% lower during 428 h and 20% lower during 028 h on the hypoglycemic night than on the normoglycemic night (both statistically significant). Total sleep time tended to be longer on the hypoglycemic night (observed means 366 vs. 349 min, P nonsignificant). Statistically significantly higher counterregulatory hormonal responses (adrenaline, growth hormone, and cortisol) to hypoglycemia were observed compared with normoglycemia. CONCLUSIONS Nocturnal hypoglycemia in patients with type 2 diabetes caused a decrease in awakening response in the 4-8-h period following the event. These findings underscore the risks associated with nocturnal hypoglycemia because nocturnal hypoglycemia potentially affects the patient's ability to wake up and respond with an adequate intake of carbohydrates.

AB - OBJECTIVE The aim of this trial was to investigate the impact of nocturnal hypoglycemia on sleep patterns (assessed by polysomnography) and counterregulatory hormones. RESEARCH DESIGN AND METHODS In this single-blinded, crossover trial, 26 subjects with type 2 diabetes attended two experimental night visits (one normoglycemic and one hypoglycemic) in randomized order. Plasma glucose (PG) levels were controlled by hyperinsulinemic glucose clamping. On the hypoglycemic night, hypoglycemia was induced after reaching sleep stage N2 by turning off glucose infusion until the PG target of 2.722.8 mmol/L was reached and maintained for 15 min. Thereafter, subjects were brought back to normoglycemia for the rest of the night. On the normoglycemic night, PG was maintained at 5.027.0 mmol/L throughout the night. RESULTS During the first 4 h of sleep (024 h; after reaching sleep stage N2), no difference between experimental nights was observed in the rate of electroencephalographyidentified arousals or awakenings, but the rate of awakenings was 27% lower during 428 h and 20% lower during 028 h on the hypoglycemic night than on the normoglycemic night (both statistically significant). Total sleep time tended to be longer on the hypoglycemic night (observed means 366 vs. 349 min, P nonsignificant). Statistically significantly higher counterregulatory hormonal responses (adrenaline, growth hormone, and cortisol) to hypoglycemia were observed compared with normoglycemia. CONCLUSIONS Nocturnal hypoglycemia in patients with type 2 diabetes caused a decrease in awakening response in the 4-8-h period following the event. These findings underscore the risks associated with nocturnal hypoglycemia because nocturnal hypoglycemia potentially affects the patient's ability to wake up and respond with an adequate intake of carbohydrates.

KW - Adult

KW - Blood Glucose

KW - Cross-Over Studies

KW - Diabetes Mellitus, Type 2

KW - Female

KW - Homeostasis

KW - Hormones

KW - Humans

KW - Hypoglycemia

KW - Hypoglycemic Agents

KW - Male

KW - Middle Aged

KW - Polysomnography

KW - Single-Blind Method

KW - Sleep

U2 - 10.2337/dc15-0907

DO - 10.2337/dc15-0907

M3 - Journal article

C2 - 26407587

SN - 0149-5992

VL - 38

SP - 2151

EP - 2157

JO - Diabetes Care

JF - Diabetes Care

IS - 11

ER -