Electrocardiogram-based sleep spectrogram measures of sleep stability and glucose disposal in sleep disordered breathing

Sleep. 2012 Jan 1;35(1):139-48. doi: 10.5665/sleep.1604.


Study objectives: Sleep disordered breathing (SDB) is independently associated with insulin resistance, glucose intolerance, and type 2 diabetes mellitus. Experimental sleep fragmentation has been shown to impair insulin sensitivity. Conventional electroencephalogram (EEG)-based sleep-quality measures have been inconsistently associated with indices of glucose metabolism. This analysis explored associations between glucose metabolism and an EEG-independent measure of sleep quality, the sleep spectrogram, which maps coupled oscillations of heart-rate variability and electrocardiogram (ECG)-derived respiration. The method allows improved characterization of the quality of stage 2 non-rapid eye movement (NREM) sleep.

Design: Cross-sectional study.

Setting: N/A.

Participants: Nondiabetic subjects with and without SDB (n = 118) underwent the frequently sampled intravenous glucose tolerance test (FSIVGTT) and a full-montage polysomnogram. The sleep spectrogram was generated from ECG collected during polysomnography.

Interventions: N/A.

Measurements and results: Standard polysomnographic stages (stages 1, 2, 3+4, and rapid eye movement [REM]) were not associated with the disposition index (D(I)) derived from the FSIVGTT. In contrast, spectrographic high-frequency coupling (a marker of stable or "effective" sleep) duration was associated with increased, and very-low-frequency coupling (a marker of wake/REM/transitions) associated with reduced D(I). This relationship was noted after adjusting for age, sex, body mass index, slow wave sleep, total sleep time, stage 1, the arousal index, and the apnea-hypopnea index.

Conclusions: ECG-derived sleep-spectrogram measures of sleep quality are associated with alterations in glucose-insulin homeostasis. This alternate mode of estimating sleep quality could improve our understanding of sleep and sleep-breathing effects on glucose metabolism.

Keywords: Disposition index; diabetes mellitus type 2; sleep quality; sleep spectrogram.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Cross-Sectional Studies
  • Electrocardiography*
  • Female
  • Glucose / metabolism*
  • Glucose Tolerance Test
  • Humans
  • Male
  • Middle Aged
  • Polysomnography
  • Sleep / physiology*
  • Sleep Apnea Syndromes / metabolism
  • Sleep Apnea Syndromes / physiopathology*
  • Sleep Stages / physiology


  • Glucose