Expert commentary for PracticeUpdate on the Journal
Article: Singh P, Beyl RA, Stephens JM, Noland RC, Richard AJ, Boudreau Caitlin Hebert AR, Eric Ravussin, Broussard JL, St-Onge MP, Marlatt KL Effect of sleep restriction on insulin sensitivity and energy metabolism in postmenopausal women: A randomized crossover trial. Obesity 26 January 2023

Eve van Cauter, Karine Spiegel

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Eve van Cauter, Karine Spiegel. Expert commentary for PracticeUpdate on the Journal Article: Singh P, Beyl RA, Stephens JM, Noland RC, Richard AJ, Boudreau Caitlin Hebert AR, Eric Ravussin, Broussard JL, St-Onge MP, Marlatt KL Effect of sleep restriction on insulin sensitivity and energy metabolism in postmenopausal women: A randomized crossover trial. Obesity 26 January 2023. 2023. hal-04958263

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# Effect of Sleep Restriction on Insulin Sensitivity and Energy Metabolism in Postmenopausal Women

Obesity

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1 Expert Comment

## TAKE-HOME MESSAGE

* In this randomized crossover trial, 14 postmenopausal women underwent four nights of habitual sleep (100% normal sleep) and sleep restriction (SR; 60% of habitual sleep) to assess the effect of SR on insulin sensitivity and energy metabolism. SR reduced insulin sensitivity (measured by a hyperinsulinemic-euglycemic clamp) and fat oxidation (measured by indirect calorimetry).

* Sleep disturbances may be a component of metabolic dysfunction in postmenopausal women.

– Caitlin A. Colling, MD (/author/caitlin-colling/4300)

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## Diabetes

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Written by

Eve Van Cauter PhD (/author/eve-van-cauter/1958)

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Written by

Karine Spiegel PhD (/author/karine-spiegel/7450)

A 2022 meta-analysis has identified 26 randomized clinical trials that have described the metabolic consequences of partial sleep restriction. In total, to date, nearly 400 normal adults were studied under controlled laboratory conditions. Approximately 90% of the participants were under the age of 50, and only 125 were identified as women. Menopausal status was not considered in any of the trials. The meta-analysis concluded unambiguously that insufficient sleep results in a clinically significant decrease in whole body insulin sensitivity. The present study is the very first to assess the impact of sleep restriction in post-menopausal women and is thus addressing an important gap of knowledge. It provides strong evidence that the detrimental metabolic impact of sleep restriction also affects overweight and obese post-menopausal women, a population already at higher risk of diabetes and CVD.

Recent population studies have revealed that the proportion of US adults with chronic insufficient sleep (<6 hours per night) is around 30%. In contemporary society, post-menopausal women such as those included in the current study are increasingly part of the active working population and are exposed to the various socio-cultural risk factors inherent to the 24-hour "connected" society that promote insufficient sleep. The present study demonstrates that 4 days of restricted sleep to 5 hours per night results in a robust increase in insulin resistance, the initial step of the development of type 2 diabetes, with an effect size similar to that observed in young lean men and women.

The women who participated in the current trial had normal sleep duration and efficiency (based on actigraphy) and were good sleepers for their age range. The presence of insomnia and other sleep disorders, including sleep-disturbed breathing (SDB), was excluded using validated questionnaires. Of note, SDB is notoriously underreported and underdiagnosed in women because of a presentation distinct from that in men. In the Wisconsin sleep study, which used polysomnography, the prevalence of sleep apnea in overweight or obese women in the age range included in the present study was 20-40%.¹ Both insomnia and SDB are recognized risk factors for diabetes. Hot flashes, the most common cause of sleep disturbance in peri- and early menopause, are not mentioned in this article. Thus, the women who completed this trial were in the upper range of sleep quality in the post-menopausal age range and, nonetheless, a short-term exposure to insufficient sleep resulted in a marked increase in insulin resistance. Building on the present study, there is an urgent need to assess the impact of sleep restriction (a highly prevalent condition today) in post-menopausal women who present with the typical constellation of sleep disturbances.

The most important practical implication of the present study is that sleep duration and quality should be assessed in post-menopausal women using validated questionnaires.²⁻⁵ Women with scores suggestive of chronic insufficient sleep and/or clinically significant sleep disorders should be referred to a sleep specialist to determine whether a sleep intervention might mitigate the adverse cardiometabolic effects of menopause.

## References

1. Peppard PE, Young T, Barnet JH, Palta M, Hagen EW, Hla KM. Increased prevalence of sleep-disordered breathing in adults. *Am J Epidemiol*, 2013;177(9):1006-1014. https://academic.oup.com/aje/article/177/9/1006/145450?login=false (https://academic.oup.com/aje/article/177/9/1006/145450?login=false)

2. Johns MW. A new method for measuring daytime sleepiness: the Epworth sleepiness scale. *Sleep*. 1991;14(6):540-545. https://academic.oup.com/sleep/article/14/6/540/2742871/https://

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academic.oup.com/sleep/article/14/6/540/2742871

3. Bastien CH, Vallières A, Morin CM. Validation of the Insomnia Severity Index as an outcome measure for insomnia research. *Sleep Med.* 2001;2(4):297-307. https://www.sciencedirect.com/science/article/abs/pii/S1389945700000654?via%3Dihub

4. Buysse DJ, Reynolds CF 3rd, Monk TH, Berman SR, Kupfer DJ. The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research. *Psychiatry Res.* 1989;28(2):193-213. https://www.sciencedirect.com/science/article/abs/pii/S0165178189900474?via%3Dihub

5. Netzer NC, Stoohs RA, Netzer CM, Clark K, Strohl KP. Using the Berlin Questionnaire to identify patients at risk for the sleep apnea syndrome. *Ann Intern Med.* 1999;131(7):485-491. https://www.acpjournals.org/doi/10.7326/0003-4819-131-7-199910050-00002

Abstract

This abstract is available on the publisher's site.

Access this abstract now https://dx.doi.org/10.1002/oby.23739

OBJECTIVE

The aim of this study was to investigate the effect of sleep restriction (SR) on insulin sensitivity and energy metabolism in postmenopausal women.

METHODS

In a randomized crossover trial, 14 women underwent four nights of habitual sleep (HS, 100% normal sleep) and SR (60% of HS) while following a eucaloric diet. Outcomes included the following: (1) insulin sensitivity by hyperinsulinemic-euglycemic clamp, defined as the glucose infusion rate (GIR); (2) resting metabolism and substrate oxidation by indirect calorimetry; and (3) glucose, insulin, and C-peptide concentrations following a standard meal test.

RESULTS

Nine postmenopausal women (mean [SD], age 59 [4] years, BMI 28.0 [2.6] kg/m²) were analyzed. Accelerometer-determined total time in bed was 8.4 ± 0.6 hours during HS versus 5.0 ± 0.4 hours during SR (38% reduction, p < 0.0001). SR reduced low-dose insulin GIR by 20% (HS: 2.55 ± 0.22 vs. SR: 2.03 ± 0.20 mg/kg/min; p = 0.01) and high-dose insulin GIR by 12% (HS: 10.48 ± 0.72 vs. SR: 9.19 ± 0.72 mg/kg/min; p < 0.001). SR reduced fat oxidation during high-dose insulin infusion (p < 0.01), and it did not alter resting energy metabolism.

CONCLUSIONS

Four nights of SR reduced insulin sensitivity and fat oxidation in postmenopausal women. These findings underscore the role of insufficient sleep in metabolic dysfunction following menopause. Larger trials investigating how sleep disturbances cause metabolic dysfunction during menopause are needed across all stages of menopause.

Copyright © 2025 Elsevier Inc. All rights reserved.

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Karine Spiegel PhD (/author/karine-spiegel/7450)

Eve Van Cauter PhD (/author/eve-van-cauter/1958)

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