Inadequate sleep as a contributor to impaired glucose tolerance: A cross-sectional study in children, adolescents, and young adults with circadian rhythm sleep-wake disorder

Pediatr Diabetes. 2020 Jun;21(4):557-564. doi: 10.1111/pedi.13003. Epub 2020 Mar 16.


Background: Sleep deprivation and circadian disruption are associated with decreased insulin sensitivity and hyperglycemia. It is uncertain whether circadian sleep-wake disorder (CRSWD), which relates to both the homeostatic sleep system and the circadian timing system, affects glycemic regulation and insulin secretion. We aimed to examine the associations among sleep duration, sleep architecture or circadian rhythm of the sleep-wake cycle, and glucose metabolism in children, adolescents, and young adults with CRSWD.

Methods: This cross-sectional observational study of 124 patients with CRSWD took place at Hyogo Children's Sleep and Development Medical Research Center in Hyogo, Japan. The patients underwent a 3-hour oral glucose tolerance test, anthropometric measurements, sleep-log analyses, and polysomnography. Analysis of covariance models were used to assess the association between sleep architecture or circadian rhythm of sleep-wake cycle and glucose/insulin homeostasis, adjusted for confounding variables such as age, gender, standardized body mass index, and sleep apnea index.

Results: Impaired glucose tolerance was detected in 25.8% of all patients with CRSWD. After adjustment for confounding variables, we found a negative association between total sleep time (TST) and the 2-hour plasma glucose level. Stage N1 (%TST) was also a significant predictor of 3-hour glucose level. However, we did not detect an association between circadian rhythm of the sleep-wake cycle and glucose/insulin measures.

Conclusions: Decreased sleep duration and increased stage N1 (%TST) were associated with hyperglycemia in patients with CRSWD. Further research should elucidate how circadian misalignment in patients with CRSWD is associated with glucose and insulin homeostasis.

Keywords: circadian rhythm; glucose tolerance test; insulin resistance; sleep wake disorders.

Publication types

  • Observational Study

MeSH terms

  • Adolescent
  • Adult
  • Blood Glucose / metabolism
  • Child
  • Circadian Rhythm / physiology
  • Cross-Sectional Studies
  • Female
  • Glucose Intolerance / blood
  • Glucose Intolerance / epidemiology*
  • Glucose Intolerance / etiology*
  • Humans
  • Japan / epidemiology
  • Male
  • Risk Factors
  • Sleep / physiology*
  • Sleep Deprivation / blood
  • Sleep Deprivation / complications
  • Sleep Deprivation / epidemiology
  • Sleep Disorders, Circadian Rhythm / blood
  • Sleep Disorders, Circadian Rhythm / complications
  • Sleep Disorders, Circadian Rhythm / epidemiology
  • Young Adult


  • Blood Glucose