Heart rate variability in different sleep stages is associated with metabolic function and glycemic control in type 2 diabetes mellitus

Wenquan Cheng; Hongsen Chen; Leirong Tian; Zhimin Ma; Xingran Cui

doi:10.3389/fphys.2023.1157270

Heart rate variability in different sleep stages is associated with metabolic function and glycemic control in type 2 diabetes mellitus

Front Physiol. 2023 Apr 14:14:1157270. doi: 10.3389/fphys.2023.1157270. eCollection 2023.

Authors

Wenquan Cheng¹, Hongsen Chen¹, Leirong Tian¹, Zhimin Ma², Xingran Cui^{1

3}

Affiliations

¹ State Key Laboratory of Bioelectronics, School of Biological Science and Medical Engineering, Southeast University, Nanjing, China.
² Endocrinology Department, Suzhou Science and Technology Town Hospital, Suzhou, China.
³ Institute of Medical Devices (Suzhou), Southeast University, Suzhou, China.

Abstract

Introduction: Autonomic nervous system (ANS) plays an important role in the exchange of metabolic information between organs and regulation on peripheral metabolism with obvious circadian rhythm in a healthy state. Sleep, a vital brain phenomenon, significantly affects both ANS and metabolic function. Objectives: This study investigated the relationships among sleep, ANS and metabolic function in type 2 diabetes mellitus (T2DM), to support the evaluation of ANS function through heart rate variability (HRV) metrics, and the determination of the correlated underlying autonomic pathways, and help optimize the early prevention, post-diagnosis and management of T2DM and its complications. Materials and methods: A total of 64 volunteered inpatients with T2DM took part in this study. 24-h electrocardiogram (ECG), clinical indicators of metabolic function, sleep quality and sleep staging results of T2DM patients were monitored. Results: The associations between sleep quality, 24-h/awake/sleep/sleep staging HRV and clinical indicators of metabolic function were analyzed. Significant correlations were found between sleep quality and metabolic function (|r| = 0.386 ± 0.062, p < 0.05); HRV derived ANS function showed strengthened correlations with metabolic function during sleep period (|r| = 0.474 ± 0.100, p < 0.05); HRV metrics during sleep stages coupled more tightly with clinical indicators of metabolic function [in unstable sleep: |r| = 0.453 ± 0.095, p < 0.05; in stable sleep: |r| = 0.463 ± 0.100, p < 0.05; in rapid eye movement (REM) sleep: |r| = 0.453 ± 0.082, p < 0.05], and showed significant associations with glycemic control in non-linear analysis [fasting blood glucose within 24 h of admission (admission FBG), |r| = 0.420 ± 0.064, p < 0.05; glycated hemoglobin (HbA1c), |r| = 0.417 ± 0.016, p < 0.05]. Conclusions: HRV metrics during sleep period play more distinct role than during awake period in investigating ANS dysfunction and metabolism in T2DM patients, and sleep rhythm based HRV analysis should perform better in ANS and metabolic function assessment, especially for glycemic control in non-linear analysis among T2DM patients.

Keywords: T2DM; autonomic nervous system (ANS); glycemic control; heart rate variability (HRV); metabolic function; nonlinear analysis; sleep.

Grants and funding

This work was supported in part by National Key Research and Development Program of China under Grant 2018YFC2001100, in part by the National Natural Science Foundation of China under Grant 82274631, 61807007.