Browsing by Author "Naricha Chirakalwasan"
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Publication Metadata only Association between nocturnal hypoxemic burden and glucose metabolism(2021-01-01) Sikawat Thanaviratananich; Hao Cheng; Naricha Chirakalwasan; Sirimon Reutrakul; University of Illinois at Chicago; King Chulalongkorn Memorial Hospital; Faculty of Medicine Ramathibodi Hospital, Mahidol University; Miami VA Healthcare System; University of Iowa Carver College of Medicine; Faculty of Medicine, Chulalongkorn UniversityPurpose: To evaluate the association between a novel integrated event-based and hypoxemia-based parameter of polysomnography (PSG), hypoxemic load or HL100, and fasting blood glucose (FBG) and hemoglobin A1c (HbA1c) levels. Methods: Adult patients, who underwent an in-lab PSG at the University of Iowa Hospitals and Clinics with FBG or HbA1c levels, were included. Event-based parameter and hypoxemia-based parameter data were derived. HL100, defined as the integrated area of desaturation between the 100% oxygen saturation and the measured saturation levels during sleep divided by the total sleep time, was calculated by Python software. Demographic data and glycemic parameters within 1 year prior to PSG (FBG and HbA1c) were retrieved from chart review. Spearman correlation analysis and stepwise backward regression analysis were performed to determine independent predictors of FBG and HbA1c levels. Results: Of the 467 patients who underwent an in-lab PSG, 218 had FBG levels, 84 had HbA1c levels, and 118 had both values. All event-based and hypoxemia-based parameters, including HL100, were significantly correlated to FBG and HbA1c levels. Stepwise backward regression analyses, adjusted for age, sex, body mass index, and diabetes status, revealed that log HL100 was significantly related to FBG (B = 23.9, p = 0.010), but none of log event-based or hypoxemia-based parameters were found to be significantly related HbA1c levels. Conclusions: HL100 was shown to be an independent predictor of FBG in this cohort, implying that any degree of desaturation below 100% could adversely affect glucose metabolism. HL100 may be useful for interpretation of sleep studies, risk stratification, and patient management purposes in the future.Publication Metadata only Associations between nocturnal urinary 6-sulfatoxymelatonin, obstructive sleep apnea severity and glycemic control in type 2 diabetes(2017-03-16) Sirimon Reutrakul; Nantaporn Siwasaranond; Hataikarn Nimitphong; Sunee Saetung; Naricha Chirakalwasan; La or Chailurkit; Kriangsuk Srijaruskul; Boonsong Ongphiphadhanakul; Ammarin Thakkinstian; Mahidol University; Chulalongkorn University; King Chulalongkorn Memorial Hospital, Faculty of Medicine Chulalongkorn University© 2017, Published with license by Taylor & Francis Group, LLC. © 2017 Sirimon Reutrakul, Nantaporn Siwasaranond, Hataikarn Nimitphong, Sunee Saetung, Naricha Chirakalwasan, La-or Chailurkit, Kriangsuk Srijaruskul, Boonsong Ongphiphadhanakul, Ammarin Thakkinstian. Reduced nocturnal secretion of melatonin, a pineal hormone under circadian control, and obstructive sleep apnea have been both identified as risk factors for the development of type 2 diabetes mellitus. Whether they interact to impact glycemic control in patients with existing type 2 diabetes is not known. Therefore, this study explores the relationships between obstructive sleep apnea, melatonin and glycemic control in type 2 diabetes. As diabetic retinopathy may affect melatonin secretion, we also explore the relationship between retinopathy, melatonin and glycemic control. Fifty-six non-shift workers with type 2 diabetes, who were not using beta-blockers, participated. Most recent hemoglobin A1c (HbA1c) levels and the results of ophthalmologic examinations were obtained from medical records. Obstructive sleep apnea was diagnosed using an ambulatory device. Sleep duration and fragmentation were recorded by 7-day wrist actigraphy. The urinary 6-sulfatoxymelatonin/creatinine ratio, an indicator of nocturnal melatonin secretion, was measured in an overnight urine sample. Mediation analyses were applied to explore whether low nocturnal urinary 6-sulfatoxymelatonin/creatinine ratio could be a causal link between increasing obstructive sleep apnea severity [as measured by an Apnea Hypopnea Index (AHI)] and poorer glycemic control, and between the presence of retinopathy and glycemic control. AHI and HbA1c were log-scale (ln) transformed. Obstructive sleep apnea was found in 76.8%, and 25.5% had diabetic retinopathy. The median (interquartile range) of urinary 6-sulfatoxymelatonin/creatinine ratio was 12.3 (6.0, 20.1) ng/mg. Higher lnHbA1c significantly correlated with lower 6-sulfatoxymelatonin/creatinine ratio (p = 0.04) but was not directly associated with OSA severity. More severe obstructive sleep apnea (lnAHI, p = 0.01), longer diabetes duration (p = 0.02), retinopathy (p = 0.01) and insulin use (p = 0.03) correlated with lower urinary 6-sulfatoxymelatonin/creatinine ratio, while habitual sleep duration and fragmentation did not. A mediation analysis revealed that lnAHI negatively correlated with urinary 6-sulfatoxymelatonin/creatinine ratio (coefficient = −2.413, p = 0.03), and urinary 6-sulfatoxymelatonin/creatinine negatively associated with lnHbA1c (coefficient = −0.005, p = 0.02), after adjusting for covariates. Mediation analysis indicated that the effect of lnAHI on lnHbA1c was indirectly mediated by urinary 6-sulfatoxymelatonin/creatinine ratio (B = 0.013, 95% CI: 0.0006, 0.0505). In addition, having retinopathy was significantly associated with reduced nocturnal urinary 6-sulfatoxymelatonin/creatinine ratio, and an increase in HbA1c by 1.013% of its original value (B = −0.013, 95% CI: −0.038, −0.005). In conclusion, the presence and severity of obstructive sleep apnea as well as the presence of diabetic retinopathy were associated with lower nocturnal melatonin secretion, with an indirect adverse effect on glycemic control. Intervention studies are needed to determine whether melatonin supplementation may be beneficial in type 2 diabetes patients with obstructive sleep apnea.Publication Metadata only Continuous positive airway pressure therapy in gestational diabetes with obstructive sleep apnea: A randomized controlled trial(2018-03-15) Naricha Chirakalwasan; Somvang Amnakkittikul; Ekasitt Wanitcharoenkul; Suranut Charoensri; Sunee Saetung; Suwannee Chanprasertyothin; La Or Chailurkit; Panyu Panburana; Sommart Bumrungphuet; Ammarin Takkinstian; Sirimon Reutrakul; Chulalongkorn University; University of Illinois College of Medicine; King Chulalongkorn Memorial Hospital, Faculty of Medicine Chulalongkorn University; Faculty of Medicine, Ramathibodi Hospital, Mahidol University© 2018 American Academy of Sleep Medicine. All rights reserved. Study Objectives: Obstructive sleep apnea (OSA) is associated with gestational diabetes mellitus (GDM). This study assessed the effects of continuous positive airway pressure (CPAP) in obese pregnant females with GDM and OSA. Methods: A randomized controlled trial was conducted (April 2014-June 2016). Obese females at 24 to 34 weeks gestation and with diet-controlled GDM were screened for OSA. Those with OSA were randomly assigned to receive 2 weeks nightly CPAP or be part of a waitlist control group. After 2 weeks, all patients were offered CPAP. The primary outcome was glucose metabolism, obtained from an oral meal tolerance test (MTT) at baseline and 2 weeks. Pregnancy outcomes were collected. Results: Eighteen patients were randomized to CPAP and 18 to control groups. There were no significant changes between groups in fasting glucose, glucose response to MTT, and insulin sensitivity or secretion after 2 weeks. Those adherent to CPAP had significantly improved insulin secretion (P = .016) compared to the control group. When a counterfactual instrumental variable approach was applied to deal with nonadherence, the CPAP group had significantly improved insulin secretion (P = .002) and insulin sensitivity (P = .015). Lower rates of preterm delivery (P = .002), unplanned cesarean section (P = .005), and neonatal intensive care unit admissions (P < .001) were observed among those who used CPAP longer than 2 weeks. Conclusions: Two weeks of CPAP in females with GDM and OSA did not result in improved glucose levels, but insulin secretion improved in those adherent to CPAP. Continued CPAP use was possibly associated with improved pregnancy outcomes.Publication Metadata only The differences in the relationship between obstructive sleep apnea severity and trabecular bone score in men and women with type 2 diabetes(2019-06-01) Hataikarn Nimitphong; Nantaporn Siwasaranond; Chanika Sritara; Sunee Saetung; La or Chailurkit; Naricha Chirakalwasan; Boonsong Ongphiphadhanakul; Sirimon Reutrakul; Chulalongkorn University; University of Illinois at Chicago; King Chulalongkorn Memorial Hospital, Faculty of Medicine Chulalongkorn University; Faculty of Medicine, Ramathibodi Hospital, Mahidol University© 2019 The Authors Aims: Type 2 diabetes mellitus (T2DM)and obstructive sleep apnea (OSA)may adversely affect bone. Gender is a well-established factor influencing bone health. We investigated the impact of OSA on bone mineral density (BMD)and trabecular bone score (TBS)in T2DM. Methods: Eighty-one T2DM patients [33 men and 48 women]participated. OSA was diagnosed using an overnight monitor, with its severity assessed by an apnea hypopnia index (pAHI). The measurements of hypoxia, including the percentage of total sleep time in which oxygen saturation remains below 90% (pT90), the oxygen desaturation index (pODI)and minimum O2 (min O2), were reported. Lumbar spine (L1-4)and femoral neck (FN)BMD were measured using dual-energy X-ray absorptiometry (DXA). TBS was computed from DXA images. Results: Sixty-five patients (80.2%)had OSA. pAHI, pT90, pODI and min O2 were not correlated to L1-4 BMD, FN BMD or TBS in all participants by multiple regression analyses adjusting for age, gender and BMI. However, an interaction between gender and pAHI, and gender and pODI were significantly associated with TBS (b = 0.003, p = 0.034 and b = 0.004, p = 0.046, respectively). We therefore reassessed an association between pAHI or pODI and TBS separately between men and women. After adjusting for age and BMI, more severe OSA (higher pAHI)and higher pODI significantly associated with lower TBS (b = −0.002, p = 0.034 and b = −0.003, p = 0.021, respectively)in men. On the other hand, higher pAHI non-significantly associated with better trabecular microarchitecture as indicated by higher TBS (b = 0.002, p = 0.059)in women. When considered only postmenopausal (n = 33), higher pAHI and higher pODI were significantly associated with higher TBS (b = 0.004, p = 0.003 and b = 0.004, p = 0.008, respectively). Conclusions: In T2DM patients, there is a complex interrelationship among OSA severity, gender and TBS. More severe OSA predicted lower TBS in men, but predicted higher TBS in postmenopausal women.Publication Metadata only Effect of heated humidification on CPAP therapy adherence in subjects with obstructive sleep apnea with nasopharyngeal symptoms(2016-09-01) Chuleekorn Soudorn; Dittapol Muntham; Sirimon Reutrakul; Naricha Chirakalwasan; Chulalongkorn University; King Chulalongkorn Memorial Hospital, Faculty of Medicine Chulalongkorn University; Rajamangala University of Technology system; Mahidol University© 2016 Daedalus Enterprises. BACKGROUND: The addition of heated humidification to CPAP has been shown to improve nasal adverse effects in subjects with obstructive sleep apnea (OSA). However, current data regarding improvement in CPAP adherence is conflicting. Furthermore, there are no data from a tropical climate area with a high humidity level. METHODS: In this prospective randomized crossover study conducted in Thailand, subjects with moderate to severe OSA with nasopharyngeal symptoms post-split-night study were enrolled in the study. Subjects were randomly assigned to receive CPAP with or without heated humidification for 4 weeks and then crossed over. Information on CPAP adherence, quality of life assessed by the Functional Outcomes of Sleep Questionnaire, nasopharyngeal symptoms assessed by a modified XERO questionnaire, and bedroom ambient humidity and temperature data were obtained. RESULTS: Data were collected on 20 subjects with OSA during the period of January to December 2014. Although the addition of heated humidification appeared to improve average hours of use for all days when compared with conventional CPAP, the difference was not statistically significant (CPAP with heated humidification = 4.6 ± 1.7 h/night; conventional CPAP = 4.0 ± 1.7 h/night, P = .1). However, the addition of heated humidification improved CPAP adherence on the days of use (5.5 ± 1.5 h/night) compared with conventional CPAP (5.2 ± 1.4 h/night), P = .033. Quality of life was also improved according to the Functional Outcomes of Sleep Questionnaire score (median 17.6 [interquartile range 3.5]) in the heated humidification group compared with conventional CPAP group (median 17.6 [interquartile range 4.5]), P = .046. Significant reduction in the dry throat/sore throat symptom was noted only when CPAP with heated humidification was used. CONCLUSIONS: Even in a tropical climate area, CPAP adherence and quality of life appeared to improve when heated humidification was employed in subjects with moderate to severe OSA with nasopharyngeal symptoms post-split-night polysomnography. The improvement may be related to a reduction in the dry throat/sore throat symptom.Publication Metadata only Effects of bedroom environmental conditions on the severity of obstructive sleep apnea(2018-04-15) Sattamat Lappharat; Nutta Taneepanichskul; Sirimon Reutrakul; Naricha Chirakalwasan; Chulalongkorn University; University of Illinois at Chicago; King Chulalongkorn Memorial Hospital, Faculty of Medicine Chulalongkorn University; Faculty of Medicine, Ramathibodi Hospital, Mahidol University© 2018 American Academy of Sleep Medicine. All rights reserved. Study Objectives: Epidemiological associations have demonstrated the effects of long-term air pollution to obstructive sleep apnea (OSA) through a physiological mechanism linking particulate matter exposure to OSA. This study aimed to determine the relationship between bedroom environmental conditions, OSA severity, and sleep quality. Methods: Sixty-three participants were enrolled for an overnight polysomnography; OSA was diagnosed between May to August 2016. Personal characteristics and sleep quality were obtained by a face-to-face interview. Bedroom environments, including data on particulate matter with an aerodynamic diameter less than 10 μm (PM10), temperature, and relative humidity, were collected by personal air sampling and a HOBO tempt/RH data logger. Results: Sixty-eight percent of the participants experienced poor sleep. An elevation in 1-year mean PM10 concentration was significantly associated with an increase in apnea-hypopnea index (beta = 1.04, P =.021) and respiratory disturbance index (beta = 1.07, P =.013). An increase of bedroom temperature during sleep was significantly associated with poorer sleep quality (adjusted odds ratio 1.46, 95% confidence interval 1.01-2.10, P =.044). Associations between PM10 concentration and respiratory disturbance index were observed in the dry season (beta = 0.59, P =.040) but not in the wet season (beta = 0.39, P =.215). PM10 was not associated with subjective sleep quality. Conclusions: Elevation of PM10 concentration is significantly associated with increased OSA severity. Our findings suggest that reduction in exposure to particulate matter and suitable bedroom environments may lessen the severity of OSA and promote good sleep.Publication Metadata only Lack of associations between thyroid function and obstructive sleep apnea severity in adults with prediabetes and diabetes mellitus(2018-01-01) Chutintorn Sriphrapradang; Sittichai Pinyopodjanard; Onnicha Suntornlohanakul; Hataikarn Nimitphong; Naricha Chirakalwasan; Sunee Saetang; Thunyarat Anothaisintawee; Nantaporn Siwasaranond; Areesa Manodpitipong; La Or Chailurkit; Sirimon Reutrakul; Chulalongkorn University; University of Illinois at Chicago; King Chulalongkorn Memorial Hospital, Faculty of Medicine Chulalongkorn University; Faculty of Medicine, Ramathibodi Hospital, Mahidol University© 2018, Springer Nature Switzerland AG. Purpose: Hypothyroidism is associated with a high frequency of obstructive sleep apnea (OSA). However, the prevalence of OSA in hypothyroid patients is not different from the general population in many reports. The importance of thyroid function screening in sleep-disordered breathing is still controversial. This study aimed to explore the association between thyroid dysfunction and OSA in the adults with prediabetes or diabetes mellitus type 2, who have very high prevalence of OSA. Methods: OSA was assessed using an in-home monitoring device, WatchPAT200. OSA severity was measured using apnea-hypopnea index (AHI), oxygen desaturation index (ODI), minimum oxygen saturation (minO2), and time spent under oxygen saturation < 90% (T90). Patients with pre-existing thyroid dysfunction were excluded. Results: Participants included 70 men and 118 women with mean age 52.8 ± 10.9 years and body mass index 28.2 ± 4.9 kg/m 2 . One hundred forty participants (75%) had OSA, with a median AHI of 10.1 (interquartile range 4.8, 18.3). The percentage of positive thyroid autoantibody (thyroperoxidase and thyroglobulin antibody) was similar among the subjects with and without OSA. There was no correlation between the levels of thyroid function (TSH, FT3, FT4, TSH/FT3, and TSH/FT4 ratio) and the severity indices of OSA (AHI, ODI, minO2, and T90). Conclusions: These data do not support universal screening for thyroid dysfunction in OSA patients with diabetes or prediabetes.Publication Metadata only Metabolomic profile associated with obstructive sleep apnoea severity in obese pregnant women with gestational diabetes mellitus: A pilot study(2021-10-01) Sirimon Reutrakul; Hui Chen; Naricha Chirakalwasan; Suranut Charoensri; Ekasitt Wanitcharoenkul; Somvang Amnakkittikul; Sunee Saetung; Brian T. Layden; George E. Chlipala; Jesse Brown VA Medical Center; University of Illinois at Chicago; King Chulalongkorn Memorial Hospital; Faculty of Medicine Ramathibodi Hospital, Mahidol University; Faculty of Medicine, Chulalongkorn UniversityObstructive sleep apnoea (OSA) is prevalent in obese women with gestational diabetes mellitus (GDM). The present pilot study explored associations between OSA severity and metabolites in women with GDM. A total of 81 obese women with diet-controlled GDM had OSA assessment (median gestational age [GA] 29 weeks). The metabolic profile was assayed from fasting serum samples via liquid chromatography–mass spectrometry (LC-MS) using an untargeted approach. Metabolites were extracted and subjected to an Agilent 1,290 UPLC coupled to an Agilent 6,545 quadrupole time-of-flight (Q-TOF) MS. Data were acquired using electrospray ionisation in positive and negative ion modes. The raw LC-MS data were processed using the OpenMS toolkit to detect and quantify features, and these features were annotated using the Human Metabolite Database. The feature data were compared with OSA status, apnea–hypopnea index (AHI), body mass index (BMI) and GA using “limma” in R. Correlation analyses of the continuous covariates were performed using Kendall’s Tau test. The p values were adjusted for multiple testing using the Benjamini–Hochberg false discovery rate correction. A total of 42 women (51.8%) had OSA, with a median AHI of 9.1 events/hr. There were no significant differences in metabolomics profiles between those with and without OSA. However, differential analyses modelling in GA and BMI found 12 features that significantly associated with the AHI. These features could be annotated to oestradiols, lysophospholipids, and fatty acids, with higher levels related to higher AHI. Metabolites including oestradiols and phospholipids may be involved in pathogenesis of OSA in pregnant women with GDM. A targeted approach may help elucidate our understanding of their role in OSA in this population.Publication Metadata only No changes in gut microbiota after two-week sleep extension in chronically sleep-deprived individuals(2020-04-01) Sirimon Reutrakul; Apichart So-ngern; Naricha Chirakalwasan; Sunee Saetung; Suwannee Chanprasertyothin; Ammarin Thakkinstian; George E. Chlipala; Chulalongkorn University; University of Illinois at Chicago; Faculty of Medicine, Khon Kaen University; King Chulalongkorn Memorial Hospital, Faculty of Medicine Chulalongkorn University; Faculty of Medicine, Ramathibodi Hospital, Mahidol University© 2019 Elsevier B.V. Background: Gut microbiota has been linked to obesity and glucose metabolism. Insufficient sleep is also known to be associated with insulin resistance, and sleep extension was reported to improve glucose metabolism in short sleepers. This study aimed to explore whether sleep extension was associated with changes in gut microbiota and whether there was a relationship with glucose parameters. Methods: We performed a secondary analysis of eight short-seeping but otherwise healthy subjects who participated in a cross over study of two-week home sleep extension and two weeks of habitual sleep. After each sleep condition, stool samples were collected and glucose parameters were obtained. Stool DNA extraction was performed and 16S rRNA was sequenced by MiSeq™. The resulting sequence data were processed to infer relative abundances of taxa present and then analyzed to detect any differences in the abundances of the taxa or overall diversity of the microbiome. Results: Mean (SD) sleep duration during habitual sleep and sleep extension was 5.58 (0.53) and 6.60 (0.43) hours/night, respectively. Using the Bray–Curtis index, there was no significant dissimilarity of the genus-level microbial community between the two sleeping conditions (ADONIS, R2 = 0.017, p = 0.988 and ANOSIM, R = −0.131, p = 0.991). Within-sample microbial diversity (ie, the Shannon index) also did not find significant differences (p = 0.861). There was no significant relationship between per-individual dissimilarity and objective and subjective sleep variables, or glycemic parameters. Only higher sleep efficiency was related to higher abundance of the phyla Tenericutes. Conclusion: Two-week sleep extension in short sleepers was not associated with changes in gut microbiota.Publication Metadata only Postpartum resolution of obstructive sleep apnea in women with gestational diabetes and the relationship with glucose metabolism(2018-07-01) Somvang Amnakkittikul; Naricha Chirakalwasan; Ekasitt Wanitcharoenkul; Suranut Charoensri; Sunee Saetung; Suwannee Chanprasertyothin; La or Chailurkit; Panyu Panburana; Sommart Bumrungphuet; Sirimon Reutrakul; Chulalongkorn University; University of Illinois College of Medicine; King Chulalongkorn Memorial Hospital, Faculty of Medicine Chulalongkorn University; Faculty of Medicine, Ramathibodi Hospital, Mahidol UniversityPublication Metadata only Relationships among sleep timing, sleep duration and glycemic control in Type 2 diabetes in Thailand(2015-01-01) Sirimon Reutrakul; Nantaporn Siwasaranond; Hataikarn Nimitphong; Sunee Saetung; Naricha Chirakalwasan; Boonsong Ongphiphadhanakul; Ammarin Thakkinstian; Megan M. Hood; Stephanie J. Crowley; Faculty of Medicine, Ramathibodi Hospital, Mahidol University; Chulalongkorn University; King Chulalongkorn Memorial Hospital, Faculty of Medicine Chulalongkorn University; Mahidol University; Rush University Medical Center© 2015 Taylor & Francis Group, LLC. There is evidence that the sleep and circadian systems play a role in glucose metabolism. In addition to physiological factors, sleep is also affected by behavioral, environmental, cultural and social factors. In this study, we examined whether morning or evening preference, sleep timing and sleep duration are associated with glycemic control in patients with type 2 diabetes residing in Thailand. Two hundred and ten type 2 diabetes patients who were not shift workers completed an interview and questionnaires to collect information on diabetes history, habitual sleep duration and sleep timing. Chronotype, an individuals tendency for being a "morning" or "evening" person, was assessed using the Composite Score of Morningness (CSM), which reflects an individuals subjective preference for activities in the morning or evening, as well as mid-sleep time on weekend nights (MSF), which reflects their actual sleep behavior. Most recent hemoglobin A1c (HbA1c) values were retrieved from medical records. Evening preference (as indicated by lower CSM), later bedtime on weekends, and shorter sleep duration correlated with higher HbA1c (r = -0.18, p = 0.01; r = 0.17, p = 0.01 and r = -0.17, p = 0.01, respectively), while there was no association between MSF or wake up time and glycemic control. In addition, later bedtime on weekends significantly correlated with shorter sleep duration (r = -0.34, p < 0.001). Hierarchical regression analyses adjusting for age, sex, body mass index, insulin use and diabetes duration revealed that later bedtime on weekends was significantly associated with poorer glycemic control (B = 0.018, p = 0.02), while CSM was not. Mediation analysis revealed that this association was fully mediated by sleep duration. In summary, later bedtime on weekends was associated with shorter sleep duration and poorer glycemic control in patients with type 2 diabetes. It is likely that patients with later weekend bedtimes curtail their sleep by waking up earlier. Exploring the potential reasons for this phenomenon (e.g. cultural influences, metropolitan lifestyle, environmental factors, family and social obligations) specific to a Thai population may help identify behavioral modifications (i.e. earlier bedtime and/or sleep duration extension) that could possibly lead to improved glycemic control in this population.Publication Metadata only Sleep interventions and glucose metabolism: systematic review and meta-analysis(2021-02-01) Vallari Kothari; Zulma Cardona; Naricha Chirakalwasan; Thunyarat Anothaisintawee; Sirimon Reutrakul; Chulalongkorn University; University of Illinois at Chicago; King Chulalongkorn Memorial Hospital; Faculty of Medicine Ramathibodi Hospital, Mahidol UniversityObjective: Sleep disturbances (insufficient or poor sleep quality) have been linked to abnormal glucose metabolism. This systematic review and meta-analysis aimed to explore the effects of behavioral and pharmacological sleep interventions on glucose metabolism. Methods: Medline and Embase were used for systematic search. Studies reporting behavioral or pharmacological interventions in population with sleep disturbances, with measured outcomes of glucose metabolism and sleep parameters were selected. Results: Twenty two studies were eligible for review (eight were conducted in people with type 2 diabetes). Studies were grouped into three types of intervention: sleep extension (n = 6), sleep education or cognitive behavioral therapy for insomnia (CBT-I, n = 6) and pharmacological interventions (n = 10). CBT-I and sleep education resulted in significantly improved self-reported sleep quality (Pittsburgh Sleep Quality Index, mean difference, MD, −1.31, 95% confidence interval (CI) −1.83, −0.80), non-significant reduction in hemoglobin A1c level (MD -0.35%, 95% CI -0.84, 0.13), and non-significant reduction in fasting glucose levels (MD -4.76 mg/dL, 95% CI -14.19, 4.67). Other studies were not eligible for meta-analysis due to heterogeneity of interventions or outcomes. Sleep extension was able to increase sleep duration by varying degrees in short sleepers, and five of six studies demonstrated relationships between the intervention and measures of insulin resistance. A majority of pharmacological intervention studies showed improved sleep but the effects on glucose metabolism were mixed. Conclusions: Available sleep interventions were effective in improving sleep but the effects on glucose metabolism were inconclusive. Larger randomized studies with consistent outcome measurements are needed to demonstrate this potential causal relationship.Publication Metadata only Sleep medicine in Thailand(2020-03-15) Naricha Chirakalwasan; Aroonwan Preutthipan; Khun Nanta Maranetra; Prapan Yongchaiyudh; Naiphinich Kotchabhakdi; Chulalongkorn University; King Chulalongkorn Memorial Hospital, Faculty of Medicine Chulalongkorn University; Faculty of Medicine, Ramathibodi Hospital, Mahidol University; Mahidol University; Ramathibodi Hospital Sleep Disorder Center; Royal Society of ThailandPublication Metadata only Sleep variability, 6-sulfatoxymelatonin, and diabetic retinopathy(2021-06-01) Supamas Sirisreetreerux; Tharikarn Sujirakul; Hataikarn Nimitphong; Sittichai Pinyopodjanard; Sunee Saetung; La or Chailurkit; Naricha Chirakalwasan; Ben S. Gerber; Sirimon Reutrakul; University of Illinois at Chicago; University of Illinois College of Medicine; King Chulalongkorn Memorial Hospital; Faculty of Medicine Ramathibodi Hospital, Mahidol University; Mahidol University; Faculty of Medicine, Chulalongkorn UniversityPurpose: Recent evidence suggests that diabetic retinopathy (DR) is associated with abnormal melatonin regulation, possibly related to dysfunction of the melanopsin-expressing intrinsically photosensitive retinal ganglion cells. This study explored melatonin regulation in type 2 diabetes (T2D) patients with DR and its relation to sleep and circadian functioning. Methods: Thirty-five participants (10 non-diabetic controls, 10 T2D without DR, and 15 T2D with DR) were recruited. Overnight urine 6-sulfatoxymelatonin (aMT6s) and objective sleep and wrist activity (7-day actigraphy) were obtained. Results: After adjusting for covariates, having T2D with DR was significantly associated with lower urinary aMT6s (β = − 1.369, p = 0.004) compared with controls, while having T2D without DR was not (p = 0.418). T2D patients with DR reported poorer sleep quality (p = 0.014) and had greater variability of sleep duration (p = 0.017) than others, while no differences were found in sleep duration, efficiency, and rest-activity rhythm. After adjusting for covariates, lower nocturnal aMT6s was significantly associated with greater sleep variability. Conclusion: T2D patients with DR exhibited low overnight production of aMT6s which likely contributed to sleep irregularities possibly due to weak circadian signaling. Whether or not melatonin supplementation could improve health in T2D patients with DR remains to be explored.