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Clinical review: Wake-up call for insomnia sufferers

Recent research suggests that insomnia could be an early predictor of a range of conditions – from ADHD to type 2 diabetes, and even acute illnesses such as flu and Covid. Mark Greener reports.

The perplexing interactions between biology, environment and disease make sleep notoriously difficult to study. However, a recent investigation made possible by the increasingly widespread use of wearable technology brings some much needed clarity.

Researcher Varun Viswanath of the University of California, San Diego, and colleagues, analysed nine sleep characteristics during 5.10 million nights of data collected from 33,152 people (average age 44.4 years) and identified 13 sleep phenotypes.1 Eight of these showed some insomnia-like patterns, such as early-morning waking, being awake for at least 60 minutes during the night or being asleep for a total of less than 6.5 hours.

“People can move between different sleep phenotypes from one week to the next,” explains Viswanath. “The transitions between insomnia- like phenotypes tell us how complex sleep can be when we’re not sleeping well. Environmental changes are definitely reflected in these transitions, but so are many lifestyle and physiological factors. For example, you could be up late taking care of your newborn every night and then change phenotypes when you fall sick.”

The researchers found that transition patterns differed between individuals with and without various health issues, including conditions like diabetes, sleep apnoea, flu, fever and Covid-19.

People with diabetes or sleep apnoea seemed to be more likely to stay in insomnia-like sleep clusters. Sleep phenotypes also changed from the months before to the weeks around Covid-19, flu and fever. The results suggest that considering sleep dynamics could improve the detection and tracking of certain chronic health conditions.

“The perspectives offered by sleep phenotypes could help personalise our recommendations of sleep interventions for people who have kids, work night shifts or travel a lot for work, in addition to helping us better identify when certain health conditions affect these people,” Viswanath concludes.

“Glucose metabolism and insulin sensitivity show entrenched circadian patterns”

Sleep and diabetes

Glucose metabolism and insulin sensitivity show entrenched circadian patterns. A recent investigation found that consistent sleep patterns could reduce the risk of type 2 diabetes.2 Sleep patterns were analysed over seven nights.

During a follow-up of 7.5 years, type 2 diabetes risk was 15 per cent higher (not significant) in people whose day-to-day sleep duration varied by 31-45 minutes, on average. It was 28 per cent higher for those whose sleep varied by 46-60 minutes, 54 per cent higher for sleep variations of 61-90 minutes and 59 per cent higher for those whose sleep varied by at least 91 minutes.

People whose day-to-day sleep duration varied by at least 60 minutes on average had a 34 per cent higher diabetes risk than controls whose sleep varied by less than an hour. The association between irregular duration and type 2 diabetes was also more pronounced in individuals who spent longer asleep: 11 per cent for less than seven hours, 41 per cent with seven to eight hours and 65 per cent with more than eight hours of sleep.

“Our study identified a modifiable lifestyle factor that can help lower the risk of developing type 2 diabetes,” said author Dr Sina Kianersi from Brigham and Women’s Hospital, Boston, US. “Our findings have the potential to improve diabetes prevention on multiple levels. Clinically, they might inform better patient care and treatment plans. However, more research is needed to confirm the results in other populations.”

Another recent study associated short (less than seven hours) and long (nine hours or more) sleep durations with a higher prevalence of microvascular disease (retinopathy, nephropathy and neuropathy) in newly diagnosed type 2 diabetes patients. The Danish research, presented during the annual meeting of the European Association for the Study of Diabetes in Madrid, included 396 participants with a median age of 62 years and a mean diabetes duration of 3.5 years. Median BMI was 31kg/m2 and 68 per cent of participants received antihypertensives.

Analysis of accelerometers worn for 10 days showed that 12 per cent of participants had a short sleep duration and 28 per cent had a long sleep duration. In the short, optimal and long sleep duration groups, 38 per cent, 18 per cent and 31 per cent of patients respectively developed microvascular disease (MVD). Short and long sleep durations more than doubled MVD risk compared with the optimal time asleep.

In participants younger than 62 years, short sleep duration increased the risk of MVD by 23 per cent. However, in those older than 62 years, short sleep duration increased MVD risk almost six-fold.

Age amplifies the association between short sleep duration and microvascular disease, suggesting increased vulnerability among older individuals,” the authors say. “Lifestyle changes in those with type 2 diabetes may include sleep interventions. Further studies are needed to establish the role of sleep duration and quality.”

ADHD warning signs

A Spanish study has shown that sleep problems at eight to nine years of age could pre-warn of an increased risk of ADHD at age 10-11. The study, which enrolled 1,244 children, found that sleep problems increased the risk of inattention by 20 per cent, hyperactivity by 18 per cent, ADHD by 18 per cent and opposition by 14 per cent.3

The authors note that “evidence is not strong [enough] to establish a causal mechanism, but sleep problems could be considered an alarm sign for general health and, specifically, for ADHD symptoms”. Study author Llúcia González-Safont, from the University of Valencia in Spain, said the findings must be interpreted with caution.

“Although not all children with sleep disorders will develop symptoms of ADHD, detecting them at an early stage could contribute to preventing or mitigating future symptoms of behavioural problems like ADHD,” she said. “It would be useful to incorporate this type of screening tool into primary care programmes.”

References

  1. npj Digital Medicine 2024; 7:150
  2. Diabetes Care 2024; DOI:10.2337/dc24-0213
  3. European Journal of Pediatrics 2023; 182:5211-5222
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