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  • Title: Electrocardiogram-based sleep spectrogram measures of sleep stability and glucose disposal in sleep disordered breathing.
    Author: Pogach MS, Punjabi NM, Thomas N, Thomas RJ.
    Journal: Sleep; 2012 Jan 01; 35(1):139-48. PubMed ID: 22215928.
    Abstract:
    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.
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