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Effects of sleep deprivation on hypoglycemia-induced cognitive impairment and recovery in adults with type 1 diabetes

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  • Berit E Inkster
  • Nicola N Zammitt
  • Stuart J Ritchie
  • Ian J Deary
  • Ian Morrison
  • Brian M Frier

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    Rights statement: This is an author-created, uncopyedited electronic version of an article accepted for publication in Diabetes Care. The American Diabetes Care Association (ADA), publisher of Diabetes Care, is not responsible for any errors or omissions in this version of the manuscript or any version derived from it by third parties. The definitive publisher-authenticated version is available in print and online at 10.2337/dc15-2335.

    Accepted author manuscript, 155 KB, PDF-document

Original languageEnglish
JournalDiabetes Care
Volume39
Issue number5
DOIs
Publication statusPublished - 22 Mar 2016

Abstract

OBJECTIVE: To ascertain whether hypoglycemia in association with sleep deprivation causes greater cognitive dysfunction than hypoglycemia alone and protracts cognitive recovery after normoglycemia is restored.

RESEARCH DESIGN AND METHODS: Fourteen adults with type 1 diabetes underwent a hyperinsulinemic, hypoglycemic clamp on two separate occasions. Before one glucose clamp, the participants stayed awake overnight to induce sleep deprivation. Participants were randomized and counterbalanced to the experimental condition. Cognitive function tests were performed before and during hypoglycemia and for 90 min after restoration of normoglycemia.

RESULTS: Cognitive impairment during hypoglycemia did not differ significantly between the sleep-deprived and non-sleep-deprived conditions. However, in the sleep-deprived state, digit symbol substitution scores and choice reaction times were significantly poorer during recovery (P < 0.001) and hypoglycemia symptom scores were significantly higher (P < 0.001), even when symptoms that may have been caused by sleep deprivation, such as tiredness, were removed.

CONCLUSIONS: Hypoglycemia per se produced a significant decrement in cognitive function; coexisting sleep deprivation did not have an additive effect. However, after restoration of normoglycemia, preceding sleep deprivation was associated with persistence of hypoglycemic symptoms and greater and more prolonged cognitive dysfunction during the recovery period.

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