Subchronic sleep restriction causes tissue-specific insulin resistance
Open accessAbstract
CONTEXT: Short sleep duration is associated with an increased risk of type 2 diabetes. Subchronic sleep restriction (SR) causes insulin resistance, but the mechanisms and roles of specific tissues are unclear. OBJECTIVE: The purpose of this article was to determine whether subchronic SR altered (1) hepatic insulin sensitivity, (2) peripheral insulin sensitivity, and (3) substrate utilization. DESIGN: This was a randomized crossover study in which 14 subjects underwent 2 admissions separated by a washout period. Each admission had 2 acclimatization nights followed by 5 nights of either SR (4 hours time in bed) or normal sleep (8 hours time in bed). MAIN OUTCOME MEASURE/METHODS: Insulin sensitivity (measured by hyperinsulinemic-euglycemic clamp) and hepatic insulin sensitivity (measured by stable isotope techniques) were measured. In addition, we assayed stress hormone (24-hour urine free cortisol, metanephrine, and normetanephrine), nonesterified fatty acid (NEFA), and β-hydroxybutyrate (β-OH butyrate) levels. Resting energy expenditure (REE) and respiratory quotient (RQ) were measured by indirect calorimetry. RESULTS: Compared to normal sleep, whole-body insulin sensitivity decreased by 25% (P = .008) with SR and peripheral insulin sensitivity decreased by 29% (P = .003). Whereas hepatic insulin sensitivity (endogenous glucose production) did not change significantly, percent gluconeogenesis increased (P = .03). Stress hormones increased modestly (cortisol by 21%, P = .04; metanephrine by 8%, P = .014; normetanephrine by 18%, P = .002). Fasting NEFA and β-OH butyrate levels increased substantially (62% and 55%, respectively). REE did not change (P = 0.98), but RQ decreased (0.81 ± .02 vs 0.75 ± 0.02, P = .045). CONCLUSION: Subchronic SR causes unique metabolic disturbances characterized by peripheral, but not hepatic, insulin resistance; this was associated with a robust increase in fasting NEFA levels (indicative of increased lipolysis), decreased RQ, and increased β-OH butyrate levels (indicative of whole-body and hepatic fat oxidation, respectively). We postulate that elevated NEFA levels are partially responsible for the decrease in peripheral sensitivity and modulation of hepatic metabolism (ie, increase in gluconeogenesis without increase in endogenous glucose production). Elevated cortisol and metanephrine levels may contribute to insulin resistance by increasing lipolysis and NEFA levels.
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The results are consistent with previous studies, including Rao et al. who reported a 25% decrease in whole-body insulin sensitivity following a similar sleep restriction protocol.
“These results are consistent with previous studies [[3], [4], [5]], including Rao et al. [2] who reported a 25% decrease in whole-body insulin sensitivity (measured with a hyperinsulinemic-euglycemic clamp) following a similar sleep restriction protocol [2].”
From Exercise mitigates sleep-loss-induced changes in glucose tolerance, mitochondrial function, sarcoplasmic protein synthesis, and diurnal rhythms (2021) · cites this paper as [2]
N3 sleep was preserved despite the reduced total sleep time.
“Thus, as reported previously [2], N3 sleep was preserved despite the reduced total sleep time.”
From Exercise mitigates sleep-loss-induced changes in glucose tolerance, mitochondrial function, sarcoplasmic protein synthesis, and diurnal rhythms (2021) · cites this paper as [2]
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- Authors
- Rao, M. N., Neylan, T. C., Grunfeld, C., Mulligan, K., Schambelan, M., & Schwarz, J.-M.
- Affiliations
- San Francisco VA Medical Center (US)
- Touro University California (US)
- Corresponding author
- Rao, Madhu N.
- Venue
- The Journal of Clinical Endocrinology & Metabolism
- Publisher
- The Endocrine Society
- Published
- 2015-04
- Volume
- 100
- Issue
- 4
- Pages
- 1664-1671
- ISSN
- 0021-972X (ISSN-L)
- 1945-7197
- PMC
- PMC4399283
- OpenAlex
- W2132612712
- Cited by
- 156
- References
- 40
- Citations by year
- 2026: 3 · 2025: 20 · 2024: 11 · 2023: 16 · 2022: 18 · 2021: 15 · 2020: 16 · 2019: 11 · 2018: 20 · 2017: 11 · 2016: 11 · 2015: 4
- FWCI
- 23.17
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- The Journal of Clinical Endocrinology & Metabolism (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institutes of Health (UL1TR000004)
- National Heart, Lung, and Blood Institute (K23HL096832)
- National Institute of Diabetes and Digestive and Kidney Diseases (P30DK063720, P30DK026743)
- National Center for Advancing Translational Sciences
- Topics
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and Work-Related Fatigue
- Life Sciences › Neuroscience › Endocrine and Autonomic Systems › Circadian rhythm and melatonin
- Keywords
- insulin resistance, peripheral insulin sensitivity, hepatic insulin sensitivity, gluconeogenesis, free fatty acids, lipolysis, beta-hydroxybutyrate, fat oxidation, respiratory quotient, resting energy expenditure, stress hormones, cortisol, metanephrine, normetanephrine, type 2 diabetes risk, substrate utilization, sleep
- MeSH terms
- Adult, Chronic Disease, Female, Glucose, Glucose Tolerance Test, Humans, Insulin Resistance, Liver, Male, Organ Specificity, Sleep, Sleep Deprivation, Glucose Clamp Technique, Cross-Over Studies, Young Adult
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