Changes before and after improvement of subjective sleep state of a man diagnosed with pre-diabetes and sleep disorder

Miki Sato, Yuko Yasuhara, Tetsuya Tanioka, Yukie Iwasa, Toshiyuki Yasui, Masafumi Miyake, Haruo Kobayashi, Waraporn Kongsuwan, Rozzano C. Locsin

Christine E. Lynn College of Nursing, Florida Atlantic University, Boca Raton, USA.
Department of Medical Nursing, Faculty of Nursing, Prince of Songkla University, Songkhla, Thailand.
Department of Nursing, Faculty of Nursing, Shikoku University, Tokushima, Japan.
Department of Nursing, Institute of Health Biosciences, The University of Tokushima Graduate School, Tokushima, Japan.
Faculty of Medical Welfare, Kawasaki University of Medical Welfare, Kurashiki, Japan.
Tokushima Prefectural Minami Health Care Center, Tokushima, Japan.

DOI: 10.4236/health.2013.53A069                

Abstract

The purpose of this case study was to examine the changes before and after improvements of the subjective sleep status of Mr A, a 40-year-old man diagnosed with pre-diabetes and a sleep disorder. Data were collected using a Holter monitor for 24 hours a day for 3 days to assess autonomic nervous activity by recording bed-time and waking time activity (activity counts: ACs). Mr. A kept a diary of activities and completed the Pittsburgh Sleep Quality Index (PSQI) questionnaire. The study revealed that subjective sleeping hours correlated almost precisely with those measured by the actigraph and as described in the diary. Both the parasympathetic and sympathetic nervous system activities were imbalanced. However, no correlation was observed between the ACs and autonomic nervous activity. Subjective sleep state according to the PSQI score improved remarkably by dietary and exercise therapy from 13 to 3 points, after six months, with corresponding high level sleep satisfaction level. Significant correlations were observed between ACs and high-frequency spectral power of R-R intervals, and between ACs and the low-frequency/high frequency ratio of spectral power of R-R intervals. Although Mr. A’s sleep satisfaction level has improved, the autonomic nervous system activity remained different from that of healthy people.

Keywords

Actigraphy; Heart Rate Variability; Autonomic Nervous System; Function; Disturbed sleep; Pre-Diabetes

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	Burgess, H.J., Trinder, J. and Kim, Y. (1999) Cardiac autonomic nervous system activity during presleep wakefulness and stage 2 NREM sleep. Journal of Sleep Research, 8, 113-122. doi:10.1046/j.1365-2869.1999.00149.x
[2]	Sherwood, A., Routledge, S., Wohlgemuth, W.K., Hinderliter, A.L., Kuhn, C.M. and Blumenthal, J.A. (2011) Blood pressure dipping: Ethnicity, sleep quality, and sympathetic nervous system activity, American Journal of Hypertension, 24, 982-988. doi:10.1038/ajh.2011.87
[3]	Niwa, F., Kuriyama, N., Nakagawa, M. and Imanishi, J. (2011) Circadian rhythm of rest activity and autonomic nervous system activity at different stages in Parkinson’s disease. Autonomic Neuroscience, 165, 195-200. doi:10.1016/j.autneu.2011.07.010
[4]	Gih, S.C., Byoung, H.C., Do-Un, J. and Park, K.S. (2007) Noninvasive heart rate variability analysis using load-cellinstalled bed during sleep. Proceedings of the 29th NNUAL International Conference of the IEEE EMBS, Lyon, 23-26 August 2007, 2357-2360.
[5]	Lewicke, A.T., Sazonov, E.S. and Schuckers, S.A. (2004) Sleep-wake identification in infants: Heart rate variability compared to actigraphy. Proceedings of the 26th NNUAL International Conference of the IEEE EMBS, San Francisco, 1-5 September 2004, 442-445.
[6]	Grap, M.J., Borchers, C.T., Munro, C.L., Elswick Jr., R.K. and Sessler, C.N. (2005) Actigraphy in the critically ill: Correlation with activity, agitation, and sedation. American Journal of Critical Care, 14, 52-60.
[7]	Budhiraja, R., Roth, T., Hudgel, D.W., Budhirai, P. and Drake, C.L. (2011) Prevalence and polysomnographic correlates of insomnia comorbid with medical disorders. Sleep, 34, 859-867.
[8]	Loredo, J.S., Ancoli-Israel, S. and Dimsdale, J.E. (2001) Sleep quality and blood pressure dipping in obstructive sleep apnea. American Journal of Hypertension, 14, 887892. doi:10.1016/S0895-7061(01)02143-4
[9]	Touma, C. and Pannain, S. (2011) Does lack of sleep cause diabetes? Cleveland Clinic Journal of Medicine, 78, 549-558. doi:10.3949/ccjm.78a.10165
[10]	Gangwisch, J.E., Malaspina, D., Boden-Albala, B. and HeymsField, S.B. (2005) Inadequate sleep as a risk factor for obesity: Analyses of the NHANES I. Sleep, 28, 12891296.
[11]	Penev, P.D. (2012) Update on energy homeostasis and insufficient sleep. Journal of Clinical Endocrinology and Metabolism, 97, 1792-1801. doi:10.1210/jc.2012-1067
[12]	Ewing, D.J., Campbell, I.W., Murray, A., Neilson, J.M. and Clake, B.F. (1978) Immediate heart-late response to standing simple test for autonomic neuropathy in diabetes. British Medical Journal, 1, 145-147. doi:10.1136/bmj.1.6106.145
[13]	Chun, M.Y., Park, H.K., Hwang, H.S., Han, J.I., Chee, Y.J. and Lee, J.S. (2011) The Association between symptoms of autonomic neuropathy and the heart rate variability in diabetics. Korean Journal of Family Medicine, 32, 292298. doi:10.4082/kjfm.2011.32.5.292
[14]	Nilsson, P.M., Rööst, M., Enqström, G., Hedblad, B. and Berglund, G. (2004) Incidence of diabetes in middle-aged men is related to sleep disturbances. Diabetes Care, 27, 2464-2469. doi:10.2337/diacare.27.10.2464
[15]	Kawakami, N., Takatsuka, N. and Shimizu, H. (2004) Sleep disturbance and onset of type 2 diabetes. Diabetes Care, 27, 282-283. doi:10.2337/diacare.27.1.282
[16]	Knutson, K.L., Ryden, A.M., Mander, B.A. and Van Cauter, E. (2006) Role of sleep duration and quality in the risk and severity of type 2 diabetes mellitus. Archives of Internal Medicine, 166, 1768-1774. doi:10.1001/archinte.166.16.1768
[17]	Doi, Y., Minowa, M., Uchiyama, M., Okawa, M., Kim, K., Shibui, K. and Kamei, Y. (2000) Psychometric assessment of subjective sleep quality using the Japanese version of the Pittsburgh Sleep Quality Index (PSQI-J) in psychiartric disordered and control subjects. Psychiatry Research, 97, 165-172. doi:10.1016/S0165-1781(00)00232-8
[18]	Shochat, T., Tzischinsky, O., Oksenberg, A. and Peled, R. (2007) Validation of the Pittsburgh Sleep Quality Index, Hebrew translation (PSQI-H) in a sleep clinic sample. Israel Medical Association Journal, 9, 853-856.
[19]	Buysse, D.J., Reynolde, C. F., Monk, T.H., Beman, S.R. and Kupfer, D.J. (1989) The Pittsburgh Sleep Quality Index: A new instrument for psychiatric practice and research. Psychiatry Research, 28, 198-213. doi:10.1016/0165-1781(89)90047-4
[20]	Lindholm, H., Sinisalo, J., Ahlberg, J., Hirvonen, A., Hublin, C., Partinen , M. and Savolainen, A. (2012) Attenuation of vagal recovery during sleep and reduction of cortisol/melatonin ratio in late afternoon associate with prolonged daytime sleepiness among media workers with irregular shift work. American Journal of Industrial Medicine, 55, 643-649. doi:10.1002/ajim.22042
[21]	Fang, S.C., Huang, C.J., Yang, T.T. and Tsai, P.S. (2008) Heart rate variability and daytime functioning in insomniacs and normal sleepers: preliminary results. Journal of Psychosomatic Research, 65, 23-30. doi:10.1016/j.jpsychores.2008.02.003
[22]	Malpas, S.C. and Purdie, G.L. (1990) Circadian variation of heart rate variability. Cardiovascular Research, 24, 210-213. doi:10.1093/cvr/24.3.210
[23]	Grossman, P., Karemaker, J. and Wieling, W. (1991) Prediction of tonic parasympathetic cardiac control using respiratory sinus arrhythmia: the need for respiratory control. Psychophysiology, 28, 201-216. doi:10.1111/j.1469-8986.1991.tb00412.x
[24]	Hall, M., Vaako, R., Buysse, D., Ombao, H., Chen, Q., Cashmere, J.D., Kupfer, D. and Thayer, J.F. (2004) Acute stress affects heart rate variability during sleep. Psychosomatic Medicine, 66, 56-62. doi:10.1097/01.PSY.0000106884.58744.09
[25]	Yaggi, H.K., Araujo, A.B. and McKinlay, J.B. (2006) Sleep duration as a risk factor for the development o type 2 diabetes. Diabetes Care, 29, 657-661. doi:10.2337/diacare.29.03.06.dc05-0879
[26]	Nakajima, H., Kaneita, Y., Yokoyama, E., Harano, S., Tamaki, T., Ibuka, E., Kaneko, A., Takahashi, I., Umeda, T., Nakaji, S. and Ohida, T. (2008) Association between sleep duration and hemoglobin A1c level. Sleep Medicine, 9, 745-752. doi:10.1016/j.sleep.2007.07.017
[27]	Tsujimura, T., Matsuo, Y., Keyaki, T., Sakurada, K. and Imanishi, J. (2009) Correlations of sleep disturbance with the immune system in type 2 diabetes mellitus. Diabetes Research and Clinical Practice, 85, 286-292. doi:10.1016/j.diabres.2009.07.001
[28]	Sato, M., Iwasa, Y., Yasuhara, Y., Fujimoto, A., Ikekita, Y., Manabe, M., Tanioka, T., Yasui, T. and Kobayashi, H. (in press) Characteristics of autonomic nervous system activity and daily activity of females with sleep disturbance, diabetes or dementia in their late middle to old age.
[29]	Fujibayashi, M., Umeda, Y., Matsumoto, T. and Moritani, T. (2011) Influence of physical exercise on psychosomatic health. Japanese Journal of Psychosomatic Medicine, 51, 336-344.