SLEEP - Electrocardiogram-Based Sleep Spectrogram Measures of Sleep Stability and Glucose Disposal in Sleep Disordered Breathing

VOLUME 35, ISSUE 01

ELECTROCARDIOGRAM-BASED SLEEP SPECTRUM AND GLUCOSE IN SDB
Electrocardiogram-Based Sleep Spectrogram Measures of Sleep Stability and Glucose Disposal in Sleep Disordered Breathing

http://dx.doi.org/10.5665/sleep.1604

Melanie S. Pogach, MD¹; Naresh M. Punjabi, MD, PhD²; Neil Thomas¹; Robert J. Thomas, MD¹

¹Division of Pulmonary, Critical Care and Sleep Medicine, Beth Israel Deaconess Medical Center, Boston, MA; ²Division of Pulmonary and Critical Medicine, Johns Hopkins University, Baltimore, MD

Table of Contents

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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.

Citation:

Pogach MS; Punjabi NM; Thomas N; Thomas RJ. Electrocardiogram-based sleep spectrogram measures of sleep stability and glucose disposal in sleep disordered breathing. SLEEP 2012;35(1):139-148.