Short sleep duration is associated with a blood pressure nondipping pattern in type 1 diabetes: the DIAPASOM study

Anne-Laure Borel, Pierre-Yves Benhamou, Jean-Philippe Baguet, Isabelle Debaty, Patrick Levy, Jean-Louis Pépin, Jean-Michel Mallion, Anne-Laure Borel, Pierre-Yves Benhamou, Jean-Philippe Baguet, Isabelle Debaty, Patrick Levy, Jean-Louis Pépin, Jean-Michel Mallion

Abstract

Objective: To assess whether nocturnal blood pressure dipping status in type 1 diabetes is correlated with specific sleep characteristics and differences in nocturnal glycemic profiles.

Research design and methods: Twenty type 1 diabetic adult patients underwent sleep studies with simultaneous 24-h ambulatory blood pressure monitoring and continuous nocturnal glucose monitoring.

Results: Altogether, 55% of patients exhibited blunted blood pressure dipping. They did not differ from the dipper group in age, BMI, or systolic (SBP) and diastolic (DBP) blood pressure. Total sleep period (TSP) was higher in the dipper group (497 +/- 30 vs. 407 +/- 44 min for dippers and nondippers, respectively, P < 0.001). TSP was correlated with SBP and DBP day-night differences (r = 0.44 and 0.49, respectively). Periods of nocturnal hypoglycemia (i.e., % of TSP with glycemia <70 mg/dl) were longer in the dipper group (8.1 +/- 10.7 vs. 0.1 +/- 0.4% for dippers and nondippers, respectively, P = 0.02).

Conclusions: Dipping status in type 1 diabetes was associated with longer sleep duration and with hypoglycemia unawareness.

Figures

Figure 1
Figure 1
Sleep characteristics related to BP dipping status. Left: TST and sleep architecture in dipper and nondipper type 1 diabetic patients. TST was shorter in nondipper subjects. TST data are mean + SD. *P < 0.05. Right: Positive correlation between TSP and day-night SBP differences.

References

    1. Dost A, Klinkert C, Kapellen T, Lemmer A, Naeke A, Grabert M, Kreuder J, Holl RW. Arterial hypertension determined by ambulatory blood pressure profiles: contribution to microalbuminuria risk in a multicenter investigation in 2,105 children and adolescents with type 1 diabetes. Diabetes Care 2008; 31: 720– 725
    1. Benhamou PY, Halimi S, De Gaudemaris R, Boizel R, Pitiot M, Siche JP, Bachelot I, Mallion JM. Early disturbances of ambulatory blood pressure load in normotensive type 1 diabetic patients with microalbuminuria. Diabetes Care 1992; 15: 1614– 1619
    1. Stella P, Tabak AG, Zgibor JC, Orchard TJ. Late diabetes complications and non-dipping phenomenon in patients with type 1 diabetes. Diabetes Res Clin Pract 2006; 71: 14– 20
    1. Matthews KA, Kamarck TW, H Hall M, Strollo PJ, Owens JF, Buysse DJ, Lee L, Reis SE. Blood pressure dipping and sleep disturbance in African-American and Caucasian men and women. Am J Hypertens 2008; 21: 826– 831
    1. Schultes B, Jauch-Chara K, Gais S, Hallschmid M, Reiprich E, Kern W, Oltmanns KM, Peters A, Fehm HL, Born J. Defective awakening response to nocturnal hypoglycemia in patients with type 1 diabetes mellitus. PLoS Med 2007; 4: e69.
    1. O'Brien E, Asmar R, Beilin L, Imai Y, Mallion JM, Mancia G, Mengden T, Myers M, Padfield P, Palatini P, Parati G, Pickering T, Redon J, Staessen J, Stergiou G, Verdecchia P. European Society of Hypertension recommendations for conventional, ambulatory and home blood pressure measurement. J Hypertens 2003; 21: 821– 848
    1. Sleep-related breathing disorders in adults: recommendations for syndrome definition and measurement techniques in clinical research: the report of an American Academy of Sleep Medicine Task Force. Sleep 1999; 22: 667– 689
    1. Rebrin K, Steil GM, van Antwerp WP, Mastrototaro JJ. Subcutaneous glucose predicts plasma glucose independent of insulin: implications for continuous monitoring. Am J Physiol 1999; 277: E561– E571
    1. Tamborlane WV, Beck RW, Bode BW, Buckingham B, Chase HP, Clemons R, Fiallo-Scharer R, Fox LA, Gilliam LK, Hirsch IB, Huang ES, Kollman C, Kowalski AJ, Laffel L, Lawrence JM, Lee J, Mauras N, O'Grady M, Ruedy KJ, Tansey M, Tsalikian E, Weinzimer S, Wilson DM, Wolpert H, Wysocki T, Xing D. Continuous glucose monitoring and intensive treatment of type 1 diabetes. N Engl J Med 2008; 359: 1464– 1476
    1. Reliability and validity of a diabetes quality-of-life measure for the diabetes control and complications trial (DCCT): the DCCT Research Group. Diabetes Care 1988; 11: 725– 732
    1. Fagard RH, Staessen JA, Thijs L. Optimal definition of daytime and night-time blood pressure. Blood Press Monit 1997; 2: 315– 321
    1. Gangwisch JE, Heymsfield SB, Boden-Albala B, Buijs RM, Kreier F, Pickering TG, Rundle AG, Zammit GK, Malaspina D. Short sleep duration as a risk factor for hypertension: analyses of the first National Health and Nutrition Examination Survey. Hypertension 2006; 47: 833– 839
    1. Ziegler MG. Sleep disorders and the failure to lower nocturnal blood pressure. Curr Opin Nephrol Hypertens 2003; 12: 97– 102
    1. Tu E, Twigg SM, Semsarian C. Sudden death in type 1 diabetes: the mystery of the ‘dead in bed’ syndrome. Int J Cardiol 1August2008. [ Epub ahead of print]
    1. Pillar G, Schuscheim G, Weiss R, Malhotra A, McCowen KC, Shlitner A, Peled N, Shehadeh N. Interactions between hypoglycemia and sleep architecture in children with type 1 diabetes mellitus. J Pediatr 2003; 142: 163– 168

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