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Original Investigation | Adolescent and Young Adult Health

Association of Sleep Deprivation With Reduction in Insulin Sensitivity as Assessed by the Hyperglycemic Clamp Technique in Adolescents

Ana Maria De Bernardi Rodrigues, RN, MSc1,2,3; Cleliani de Cassia da Silva, RD, MSc2,3; Ana Carolina Junqueira Vasques, RD, PhD2,3,4; Daniella Fernandes Camilo, RD, MSc2,3; Francieli Barreiro, RD, MSc2,3; Roberta Soares Lara Cassani, RD, PhD2; Mariana Porto Zambon, MD, PhD3,5; Maria Ângela Reis de Góes Monteiro Antonio, MD, PhD3,5; Bruno Geloneze, MD, PhD2,3,6 ; for the Brazilian Metabolic Syndrome Study (BRAMS) Investigators
[+] Author Affiliations
1Faculty of Health and Life Sciences, University Center Nossa Senhora do Patrocinio, Itu, Brazil
2Laboratory of Investigation on Metabolism and Diabetes, Gastrocentro, University of Campinas, Campinas, Brazil
3Post-Graduate Program in Child and Adolescent Health, Faculty of Medical Science, University of Campinas, Campinas, Brazil
4School of Applied Sciences, University of Campinas, Limeira, Brazil
5Department of Pediatrics, University of Campinas, Campinas, Brazil
6National Institute of Science and Technology of Obesity and Diabetes, Campinas, Brazil
JAMA Pediatr. 2016;170(5):487-494. doi:10.1001/jamapediatrics.2015.4365.
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Importance  The association between short sleep duration and decreased insulin sensitivity in adolescents has been described. However, to our knowledge, no studies have investigated this association measuring insulin sensitivity by the hyperglycemic clamp technique.

Objectives  To compare the distributions of parameters of insulin resistance in adolescents with sleep deprivation vs adequate sleep, and to investigate the association between sleep deprivation and insulin sensitivity.

Design, Setting, and Participants  Cross-sectional multicenter study using data from the Brazilian Metabolic Syndrome Study conducted from June 29, 2011, to December 3, 2014, at an obesity outpatient clinic at the University of Campinas and public schools, with a convenience sample of 615 adolescents aged 10 to 19.9 years with a body mass index (BMI; calculated as weight in kilograms divided by height in meters squared) for age and sex at the fifth percentile or higher. A subsample of 81 adolescents underwent the hyperglycemic clamp technique.

Main Outcomes and Measures  The self-reported sleep duration was used to classify the population into 2 groups: adolescents with sleep deprivation (<8 hours/night) and adolescents with adequate sleep (≥8 hours/night). Insulin sensitivity was assessed using the hyperglycemic clamp technique.

Results  Among the 615 adolescents (56.3% female; median age, 15.9 years [interquartile range, 12.9-17.8 years]) included in the sample, the mean (SD) sleep duration was 7.9 (1.7) hours/night. The adolescents with sleep deprivation (n = 257) compared with those with adequate sleep (n = 358) had a higher median (interquartile range) age (17.0 [15.4-18.3] vs 14.1 [11.8-16.9] years), BMI (25.0 [21.2-29.3] vs 23.1 [19.5-27.6]), waist circumference (83.0 [73.5-95.4] vs 79.0 [68.5-91.0] cm), sagittal abdominal diameter (17.9 [15.8-20.8] vs 17.0 [15.0-19.8] cm), neck circumference (35.2 [33.0-38.0] vs 33.0 [30.0-35.5] cm), uric acid level (4.9 [4.0-5.8] vs 4.5 [3.7-5.5] mg/dL), and white blood cell count (7000 [5900-8200] vs 6600 [5600-7800] cells/μL) (all P < .05). Moreover, the adolescents with sleep deprivation had a lower median (interquartile range) insulin sensitivity index compared with those with adequate sleep (0.10 [0.05-0.21] vs 0.21 [0.09-0.33] mg · kgfat-free mass−1 · min−1 · mU/L × 100, respectively; difference, −0.01; 95% CI, −0.01 to −0.00; P = .02). After controlling for age and sex in the multivariate regression model, sleep deprivation remained an independent predictor for those variables. In the sleep deprivation group, BMI and central distribution of fat were higher in all categories of adiposity.

Conclusions and Relevance  Sleep deprivation (<8 hours of sleep per night) is associated with centripetal distribution of fat and decreased insulin sensitivity in adolescents. Therefore, investigations of sleep duration and sleep quality in adolescents should be included in clinical practice to promote, through health education, the eradication of the health risks associated with sleep restriction.

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Figure 1.
Distribution of Sleep Duration per Night for the Total Sample
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Figure 2.
Box and Whisker Plot Comparison of the Distribution of the Insulin Sensitivity Index (ISI) Obtained by the Hyperglycemic Clamp Technique in Adolescents With Adequate Sleep vs Sleep Deprivation

Adequate sleep was considered to be 8 hours/night or longer; sleep deprivation, less than 8 hours/night. Analysis was by Mann-Whitney U test. FFM indicates fat-free mass; horizontal line in center of each box, median; upper and lower borders of each box, 75th and 25th percentiles, respectively; and whiskers above and below each box, 90th and 10th percentiles, respectively.

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