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Sleep Deprivation and Metabolic Syndrome Relationship
Sleep Deprivation and Metabolic Syndrome Relationship

Metabolic Syndrome

Metabolic syndrome includes a group of metabolic risk factors that increase the risk for diabetes, heart disease, stroke, and overall mortality.¹

 The criteria for the diagnosis of metabolic syndrome include a large waistline (abdominal obesity), increased blood levels of the fat-type triglycerides, elevated fasting blood sugar (glucose), increased blood pressure (hypertension), and decreased levels of the “good” cholesterol HDL. 

Metabolic syndrome is diagnosed when three out of the five listed criteria (or treatment for them) are present.² The prevalence of metabolic syndrome is high in the United States, as it affects approximately 35% of the adults. Its prevalence further increases with age and reaches 50% in individuals above the age of 60 years.¹ 

Metabolic syndrome is a multifactorial disease, which means that genetic predisposition, lifestyle, and environmental factors all interact and contribute to it. Several of the factors that contribute to the development of metabolic syndrome are modifiable, such as obesity, physical inactivity, and insulin resistance. These factors can be modified with lifestyle changes, including a healthy diet, physical activity, and weight reduction. The implementation of these health-promoting changes is particularly important due to the serious health risks associated with metabolic syndrome, especially heart disease and diabetes. 

However, other modifiable factors may also contribute to the development of metabolic syndrome. There is increasing evidence that sleep disturbances, including sleep deprivation and obstructive sleep apnea, as well as disturbances of the circadian rhythm also increase the risk of metabolic syndrome.³

 

"Did you know hydrogen water has been shown to reverse metabolic syndrome?"

 

Healthy Sleep and Sleep Disturbances 

It is necessary to get both the necessary quantity and quality of sleep in order to profit from all of its health benefits. The American Academy of Pediatrics has recommended 7–8 hours of sleep a day for adults ≥ 18 years old, whereas children need more sleep. Moreover, frequent disruptions of the sleep may interfere with the normal sleep phases and thus with its health benefits. 

Sleep deprivation is a prevalent problem and a major public health issue. It has been estimated that almost 35% of the adults in the United States routinely do not get enough sleep. Sleep deprivation has consistently been associated with increased all-cause mortality. Interestingly, excessive sleep has also been correlated with higher all-cause mortality than normal sleep.

 "Did you know hydrogen water was equivalent to caffeine at raising alertness after 24hrs of sleep deprivation"

 

Sleep Deprivation and Metabolic Syndrome  

Sleep deprivation affects the metabolic balance (homeostasis), which increases the risk of metabolic syndrome, obesity, insulin resistance, diabetes, and cardiovascular disease. The association between chronic sleep deprivation and metabolic syndrome has been confirmed by numerous cross-sectional studies.  A large prospective study has also determined that sleep deprivation is associated with an increased risk for the development of metabolic syndrome during a follow-up of an average of 2.6 years.¹⁰

Experimental Studies on the Metabolic Changes Induced by Sleep Deprivation

Experimental studies have also determined the effects of sleep deprivation on metabolism. They have demonstrated that sleep deprivation can induce metabolic risk factors, such as obesity, insulin resistance, hypertension, and dyslipidemia. Thus, it is well established that sleep deprivation increases the risk of weight gain. 

For example individuals subjected to sleep deprivation hours of with delayed bedtime nights gained on average kg weight compared the control group that slept 10 hours/night ¹¹  This and other studies have also shown that sleep deprived individuals consume more calories, especially late at night, than control individuals. Moreover, Markwald et al. have demonstrated that sleep deprivation for 5 days (5 hours of sleep/night) leads to a similar increase of body weight of 0.82 kg and raises the energy expenditure by approximately 5%.¹² Overall, sleep deprivation apparently stimulates food intake as a physiological adaptation to ensure sufficient energy for the additional wakefulness; however, the food intake surpasses the amount required to compensate for the increased energy expenditure.¹² 

Experimental studies have also shown that sleep deprivation reduces the sensitivity of cells to insulin and impairs the ability to clear glucose from the blood, which are signs of metabolic dysregulation.¹³ Moreover, sleep deprivation activates the function of the sympathetic nervous system, suppresses the function of the parasympathetic nervous system,¹⁴ and leads to hypertension especially during the night.¹⁵ 

The effect of sleep deprivation on lipoproteins has been more difficult to elucidate. Only some but not all of the experimental studies have demonstrated that sleep deprivation may induce changes in the lipoprotein content.¹⁶ ¹⁷ The induction of lipoprotein changes by sleep deprivation may be a slow process, and that may explain the inconsistency among the experimental studies. 

Molecular Mechanisms Underlying the Relationship Between Sleep Deprivation and Metabolic Syndrome

The molecular mechanisms through which sleep deprivation induces metabolic changes are complex. Peptide hormones, inflammatory markers, catecholamines, cortisol, and the circadian rhythm have been implicated in this process.

Sleep deprivation causes changes in the levels of the peptide hormones ghrelin and leptin. Most studies have found that sleep deprivation decreases leptin and increases ghrelin levels. ¹⁸  Leptin is secreted by the adipose tissue and modulates the feeling of satiety and the balance between energy expenditure and food intake. Leptin is also known as a “satiety hormone” because it signals to the brain the feeling of satiety. ¹⁹ Ghrelin is a gut hormone known also as the “hunger hormone” because it promotes food intake, the release of growth hormone, and fat deposition.²⁰ The effects of sleep deprivation on leptin and ghrelin promote the appetite, food intake, and weight gain.

Sleep deprivation induces also the levels of certain inflammatory molecules. The induction of inflammatory mediators is in turn associated with an increased risk for metabolic syndrome, cardiovascular disease, and diabetes. For example, sleep deprivation activates the lymphocytes, increases the C-reactive protein (CRP) levels, and stimulates the production of the proinflammatory cytokines interleukin (IL)-1beta, IL-6, and IL-17.²¹ ²² 

Moreover, sleep deprivation activates the catecholamine production, stimulates the sympathetic system, and suppresses the parasympathetic system.¹⁴ It also blunts the usual nocturnal decline in the stress hormone cortisol.²³ Finally, sleep deprivation changes the expression of certain genes related to the internal biological clock and the rhythm of the hormone melatonin.²⁴ In turn, disruptions of the biological clock and of the repetitive 24-hour rhythm, known as the circadian rhythm, may have negative metabolic consequences.²⁵

Can Healthy Sleep Habits Reverse the Negative Metabolic Consequences of Sleep Deprivation?

Extending the sleep duration to the normal range may help alleviate some of the negative metabolic consequences observed with sleep deprivation. For example, when overweight young adults who were sleep-deprived received behavioral counseling and extended their sleep duration, their overall appetite and especially desire for salty or sweet foods decreased.²⁶

 In another study, 3 nights of catch-up sleep managed to improve insulin resistance in patients with sleep deprivation. ²⁷ 

These results highlight the serious metabolic consequences associated with sleep deprivation and the importance of getting enough quality sleep. This is especially relevant because acquiring healthy sleep habits can counteract some of the negative metabolic effects of sleep deprivation for most people. However, special strategies may be necessary for shift workers or other individuals with schedules conflicting their biological clocks.

 

 Contributor Bio 

Dr. Zoya Marinova is a researcher and a medical doctor with experience in the fields of translational neuroscience, epigenetics, and molecular psychiatry.

 

Literature Sources

² NHLBI. https://www.nhlbi.nih.gov/health-topics/metabolic-syndrome.

³ Koren D, Dumin M, Gozal D. Role of sleep quality in the metabolic syndrome. Diabetes Metab Syndr Obes. 2016;9:281–310.

⁴  NHLBI.https://www.nhlbi.nih.gov/health-topics/sleep-deprivation-and-deficiency

⁵ CDC. Insufficient sleep is a public health problem. CDC features: data and statistics 2015. [Accessed April 13, 2016]. Available from:  http://www.cdc.gov/features/dssleep/

⁶ Liu Y, Wheaton AG, Chapman DP, Cunningham TJ, Lu H, Croft JB. Prevalence of healthy sleep duration among adults United States, 2014. MMWR Morb Mortal Wkly Rep. 2016;65(6):137–141.

⁷ Cappuccio FP, D’Elia L, Strazzullo P, Miller MA. Sleep duration and all-cause mortality: a systematic review and meta-analysis of prospective studies. Sleep. 2010;33(5):585–592

⁸ Iftikhar IH, Donley MA, Mindel J, Pleister A, Soriano S, Magalang UJ. Sleep duration and metabolic syndrome. An updated dose-risk meta-analysis. Ann Am Thorac Soc. 2015;12(9):1364–1372. 

⁹ Xi B, He D, Zhang M, Xue J, Zhou D. Short sleep duration predicts risk of metabolic syndrome: a systematic review and meta-analysis. Sleep Med Rev. 2014;18(4):293–297.

¹⁰ Kim JY, Yadav D, Ahn SV, Koh SB, Park JT, Yoon J, Yoo BS, Lee SH. A prospective study of total sleep duration and incident metabolic syndrome: the ARIRANG study. Sleep Med. 2015;16(12):1511–1515.

¹¹ Spaeth AM, Dinges DF, Goel N. Effects of experimental sleep restriction on weight gain, caloric intake, and meal timing in healthy adults. Sleep. 2013;36(7):981–990.

¹² Markwald RR, Melanson EL, Smith MR, Higgins J, Perreault L, Eckel RH, Wright KP Jr. Impact of insufficient sleep on total daily energy expenditure, food intake, and weight gain. Proc Natl Acad Sci U S A. 2013;110(14):5695–5700.

¹³ Buxton OM, Pavlova M, Reid EW, Wang W, Simonson DC, Adler GK. Sleep restriction for 1 week reduces insulin sensitivity in healthy men. Diabetes. 2010;59(9):2126–2133.

¹⁴ Zhong X, Hilton HJ, Gates GJ, et al. Increased sympathetic and decreased parasympathetic cardiovascular modulation in normal humans with acute sleep deprivation. J Appl Physiol (1985) 2005;98(6):2024–2032.

¹⁵ Ogawa Y, Kanbayashi T, Saito Y, Takahashi Y, Kitajima T, Takahashi K, Hishikawa Y, Shimizu T. Total sleep deprivation elevates blood pressure through arterial baroreflex resetting: a study with microneurographic technique. Sleep. 2003;26(8):986–989.

¹⁶ O'Keeffe M, Roberts AL, Kelleman M, Roychoudhury A, St-Onge MP. No effects of short-term sleep restriction, in a controlled feeding setting, on lipid profiles in normal-weight adults. J Sleep Res. 2013;22(6):717–720.

¹⁷ Aho V, Ollila HM, Kronholm E, Bondia-Pons I, Soininen P, Kangas AJ, Hilvo M, Seppälä I, Kettunen J, Oikonen M, Raitoharju E, Hyötyläinen T, Kähönen M, Viikari JS, Härmä M, Sallinen M, Olkkonen VM, Alenius H, Jauhiainen M, Paunio T, Lehtimäki T, Salomaa V, Orešič M, Raitakari OT, Ala-Korpela M, Porkka-Heiskanen T. Prolonged sleep restriction induces changes in pathways involved in cholesterol metabolism and inflammatory responses. Sci Rep. 2016;6:24828. 

¹⁸ Taheri S, Lin L, Austin D, Young T, Mignot E. Short sleep duration is associated with reduced leptin, elevated ghrelin, and increased body mass index. PLoS Med. 2004;1(3):e62.

¹⁹ Dornbush S, Aeddula NR. Physiology, Leptin. [Updated 2020 Apr 24]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan–.

²⁰ Pradhan G, Samson SL, Sun Y. Ghrelin: much more than a hunger hormone. Curr Opin Clin Nutr Metab Care. 2013;16(6):619–624.

²¹ van Leeuwen WM, Lehto M, Karisola P, Lindholm H, Luukkonen R, Sallinen M, Härmä M, Porkka-Heiskanen T, Alenius H. Sleep restriction increases the risk of developing cardiovascular diseases by augmenting proinflammatory responses through IL-17 and CRP. PLoS One. 2009;4(2):e4589.

²² Irwin M, Thompson J, Miller C, Gillin JC, Ziegler M. Effects of sleep and sleep deprivation on catecholamine and interleukin-2 levels in humans: clinical implications. J Clin Endocrinol Metab. 1999;84(6):1979–1985. 

²³ Spiegel K, Leproult R, Van Cauter E. Impact of sleep debt on metabolic and endocrine function. Lancet. 1999;354(9188):1435–1439.

²⁴ Ackermann K, Plomp R, Lao O, Middleton B, Revell VL, Skene DJ, Kayser M. Effect of sleep deprivation on rhythms of clock gene expression and melatonin in humans. Chronobiol Int. 2013;30(7):901–909.

²⁵ Scheer FA, Hilton MF, Mantzoros CS, Shea SA. Adverse metabolic and cardiovascular consequences of circadian misalignment. Proc Natl Acad Sci U S A. 2009;106(11):4453–4458.

²⁶ Tasali E, Chapotot F, Wroblewski K, Schoeller D. The effects of extended bedtimes on sleep duration and food desire in overweight young adults: a home-based intervention. Appetite. 2014;80:220–224.

²⁷ Killick R, Hoyos CM, Melehan KL, Dungan GC 2nd, Poh J, Liu PY. Metabolic and hormonal effects of 'catch-up' sleep in men with chronic, repetitive, lifestyle-driven sleep restriction. Clin Endocrinol (Oxf). 2015;83(4):498–507.