Greater sleep variability is associated with higher systemic inflammation in type 2 diabetes

J Sleep Res. 2024 May;33(3):e13989. doi: 10.1111/jsr.13989. Epub 2023 Jul 6.


Sleep irregularity and variability have been shown to be detrimental to cardiometabolic health. The present pilot study explored if higher day-to-day sleep irregularity and variability were associated with systemic inflammation, as assessed by high-sensitivity C-reactive protein, in type 2 diabetes. Thirty-five patients with type 2 diabetes (mean age 54.3 years, 54.3% female) who were not shift-workers participated. The presence of diabetic retinopathy was determined. The standard deviation of sleep duration and sleep midpoint across all recorded nights were used to quantify sleep variability and regularity, respectively, assessed by 14-day actigraphy. The presence and severity of sleep apnea were assessed using an overnight home monitor. Low-density lipoprotein, haemoglobin A1C and high-sensitivity C-reactive protein were collected. Multiple regression analysis using natural-log-transformed values was performed to establish an independent association between sleep variability and high-sensitivity C-reactive protein. Twenty-two (62.9%) patients had diabetic retinopathy. The median (interquartile range) of high-sensitivity C-reactive protein was 2.4 (1.4, 4.6) mg L-1. Higher sleep variability was significantly associated with higher high-sensitivity C-reactive protein (r = 0.342, p = 0.044), as was haemoglobin A1C (r = 0.431, p = 0.010) and low-density lipoprotein (r = 0.379, p = 0.025), but not sleep regularity, sleep apnea severity or diabetic retinopathy. Multiple regression analysis showed that higher sleep variability (B = 0.907, p = 0.038) and higher HbA1c (B = 1.519, p = 0.035), but not low-density lipoprotein, contributed to higher high-sensitivity C-reactive protein. In conclusion, higher sleep variability in patients with type 2 diabetes who were not shift-workers was independently associated with higher systemic inflammation, conferring increased cardiovascular risk. Whether sleep interventions to reduce sleep variability can reduce systemic inflammation and improve cardiometabolic health should be investigated.

Keywords: glycaemic control; sleep inconsistencies; sleep regularity.

MeSH terms

  • Actigraphy*
  • Aged
  • C-Reactive Protein* / analysis
  • Diabetes Mellitus, Type 2* / complications
  • Diabetes Mellitus, Type 2* / physiopathology
  • Diabetic Retinopathy / etiology
  • Diabetic Retinopathy / physiopathology
  • Female
  • Glycated Hemoglobin / analysis
  • Humans
  • Inflammation* / blood
  • Inflammation* / physiopathology
  • Lipoproteins, LDL / blood
  • Male
  • Middle Aged
  • Pilot Projects
  • Sleep / physiology
  • Sleep Apnea Syndromes / complications
  • Sleep Apnea Syndromes / physiopathology
  • Sleep Wake Disorders / etiology
  • Sleep Wake Disorders / physiopathology


  • C-Reactive Protein
  • Glycated Hemoglobin
  • Lipoproteins, LDL