Sleep disordered breathing in REM sleep reverses the downward trend in glucose concentration

Objective: Regulation of glucose concentration depends on sleep stages with interstitial glucose concentration (IGC) declining in REM vs. stable IGC in NREM sleep. Apneas and hypopneas constituting sleep disordered breathing (SDB) are implicated in impaired glucose metabolism. Therefore, the aim of the study was to investigate whether SDB can influence IGC in REM and NREM sleep.

Methods: Thirty-two patients underwent standard polysomnography with continuous glucose monitoring system (CGMS) and a morning fasting glucose measurement. Eleven subjects were eligible due to the periodic occurrence of SDB in sleep; thus the presence of REM and NREM sleep with and without SDB (REM-, NREM-no-SDB and REM-, NREM-SDB, respectively).

Results: The IGC in REM-no-SDB declined, and its mean change was lower than that of NREM-no-SDB by almost 10-fold: -0.047±0.051 vs. -0.005±0.022 mmol/l · 5 min(-1), respectively (P=0.019, n=11). The occurrence of SDB in REM abolished this decline: 0.002±0.022 vs. -0.053±0.049 mmol/l · 5 min(-1) for REM-no-SDB (P=0.006; n=10). There was no difference between NREM-no-SDB and NREM-SDB in respect to IGC.

Conclusion: Occurrence of SDB in REM reversed the decline of IGC, while in NREM sleep SDB had no effect on IGC. SDB may affect neuro-endocrine regulations in REM sleep.