Diabetes Care：睡眠或有助于T1DM患者血糖和血压控制

睡眠不足与胰岛素敏感性恶化有关。针对睡眠时间缩短对1型糖尿病患者产生影响的研究较少。睡眠缩减是否影响1型糖尿病患者的HbA1c水平仍是未知的。针对此问题，来自法国约瑟夫傅立叶大学国家卫生和医学研究学院(INSERM)缺氧病理生理学(HP2)实验室的Anne-Laure Borel博士等人进行了一项研究，研究发现，1型糖尿病患者睡眠时间缩短与高水平HbA1c以及非杓形高血压有关，并可能对微血管并发症风险有长期有害影响。研究结果在线发表于2013年5月28日的美国《糖尿病治疗》(Diabetes Care)杂志上。

研究纳入79例1型糖尿病患者(中位年龄40岁[IQR 23-49]，47%男性)，采用腕部活动记录仪评价日常生活中连续3天内的平均睡眠时间。同时对37名患者进行24h动态血压监测(ABPM)。并对医疗史、睡眠调查表和糖尿病相关生活质量(DQOL)进行评价。

结果显示，睡眠时间较短(<6.5h)患者(n=21)的HbA1c水平比睡眠时间超过6.5h的患者(n=58)高。多变量线性回归模型包括睡眠时间长短、糖尿病病程、DQOL评分和日常活动，睡眠时间是唯一一个与HbA1c独立相关的变量(R2=10%)。在进行24h ABPM的患者中，非杓形高血压患者睡眠时间较杓形高血压患者缩短。

研究发现，1型糖尿病患者睡眠时间较短与高水平HbA1c以及非杓形高血压相关，预计对微血管并发症风险有长期有害影响。研究人员建议，进一步的研究应该评价延长睡眠时间是否能改善1型糖尿病患者HbA1c水平和血压。

Short Sleep Duration Measured by Wrist Actimetry Is Associated With Deteriorated Glycemic Control in Type 1 Diabetes.
Abstract
OBJECTIVESleep restriction has been associated with deteriorated insulin sensitivity. The effects of short sleep duration have been explored little in patients with type 1 diabetes. This study addresses the question of whether sleep curtailment affects HbA1c levels in patients with type 1 diabetes.RESEARCH DESIGN AND METHODSSeventy-nine adult patients with type 1 diabetes (median age 40 years [IQR 23-49]; 47% men) were recruited to wear a wrist actimetry sensor during 3 consecutive days to assess mean sleep duration during normal daily life. A subsample of 37 patients also performed a 24- h ambulatory blood pressure monitoring (ABPM). Medical history, sleep questionnaires, and diabetes-related quality of life (DQOL) were assessed.RESULTSPatients having shorter sleep duration-less than 6.5 h (n = 21)-had higher levels of HbA1c (P = 0.01) than patients with longer sleep duration, above 6.5 h (n = 58). In a multivariable regression model including shorter versus longer sleep duration, diabetes duration, DQOL score, and daily activity, sleep duration was the only variable independently associated with HbA1c (R2 = 10%). In patients who performed 24-h ABPM, patients with a nondipping pattern of blood pressure exhibited shorter sleep duration than patients with a dipping pattern of blood pressure.CONCLUSIONSShorter sleep duration is associated with higher HbA1c levels in patients with type 1 diabetes, as well as with a nondipping pattern of blood pressure, anticipating a long-term deleterious impact on the risk of microvascular complications. Further studies should test whether extending the duration of sleep may improve both HbA1c and blood pressure in type 1 diabetes.