Is sleep loss during hospitalization associated with hyperglycemia?

Shorter or less efficient sleep in the hospital was associated with higher risk of morning hyperglycemia in patients with and without diabetes. (LOE = 2b)

DePietro RH, Knutson KL, Spampinato L, et al. Association between inpatient sleep loss and hyperglycemia of hospitalization. Diabetes Care 2017;40(2):188-193.  [PMID:27903614]

Cohort (prospective)

Government

Uncertain

Inpatient (ward only)

These investigators identified 212 hospitalized patients at least 50 years old during a 4-year period. The patients were all on a general medicine ward and were ambulatory and had a morning blood draw for a basic metabolic panel. The authors excluded patients who were in respiratory isolation, readmitted within the past 2 weeks, transferred from another facility, had pre-existing sleep disorders, or had already been hospitalized for more than 72 hours. Wrist actigraphy using the Actiwatch 2 measured sleep duration. Sleep efficiency was determined by dividing sleep duration by the time spent in bed between bedtime and wake time as reported by the patient. Glucose readings were categorized as normal (60 - 110 mg/dL [3.3 - 6.1 mmol/L]), impaired (110 - 126 mg/dL [6.1 - 7 mmol/L]), or hyperglycemic (126 mg/dL or greater [>7 mmol/L]). The cohort was 60% female, 75% African American, and 33% had an existing diagnosis of diabetes. Mean sleep duration was slightly more than 5 hours and mean sleep efficiency was 70% (the authors state 80% is the normal threshold) with no significant difference between patients with and without diabetes. After adjusting for multiple factors, each additional hour of sleep was associated with an 11% lower odds of a higher glucose category in the morning (odds ratio [OR] = 0.89; 95% CI 0.80 - 0.99; P = .043). Additionally, every 10% increase in sleep efficiency was associated with 18% lower odds of a higher glucose category (OR = 0.82; 0.74 - 0.89; P < .001). The authors point out that a direction of causality cannot be proven in this observational study and that it is possible that hyperglycemia itself resulted in worse sleep, rather than vice versa.