Relationship Between Sleep Fragmentation and Insulin Resistance in Adults With Metabolic Syndrome
DOI:
https://doi.org/10.61336/jdme.0401.03Keywords:
Sleep fragmentation, metabolic syndrome, insulin resistance, HOMA-IR, actigraphy, sleep efficiency, glucose metabolism, obesityAbstract
Sleep fragmentation is increasingly recognized as an important component of poor sleep quality, but its relationship with insulin resistance among adults with metabolic syndrome remains incompletely characterized. This study evaluated the association between objectively measured sleep fragmentation and insulin resistance in adults fulfilling diagnostic criteria for metabolic syndrome. A cross-sectional study was conducted among 176 adults aged 35–65 years with metabolic syndrome. Sleep characteristics were assessed using wrist actigraphy over 14 consecutive days, while nocturnal awakenings and sleep fragmentation index were derived from actigraphic recordings. Fasting glucose and insulin concentrations were measured after an overnight fast, and insulin resistance was estimated using the homeostatic model assessment of insulin resistance (HOMA-IR). Anthropometric measurements, blood pressure, lipid profile, high-sensitivity C-reactive protein, and physical activity were also assessed. Participants in the highest sleep-fragmentation tertile had significantly higher HOMA-IR values and fasting insulin concentrations than those in the lowest tertile. Sleep fragmentation index demonstrated a positive correlation with HOMA-IR (r = 0.41, p < 0.001) and fasting insulin (r = 0.36, p < 0.001), while sleep efficiency showed inverse associations with both measures. After adjustment for age, sex, body mass index, sleep duration, physical activity, waist circumference, and triglyceride concentration, sleep fragmentation remained independently associated with HOMA-IR. Participants with severe sleep fragmentation had approximately 2.6-fold greater odds of marked insulin resistance compared with those with lower fragmentation. These findings suggest that disrupted sleep continuity may represent an additional metabolic risk factor in adults with metabolic syndrome, independent of total sleep duration. Objective assessment of sleep fragmentation may therefore provide useful information when evaluating metabolic risk in this population.
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