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Sleep deprivation may not worsen hypoglycemia-induced cognitive impairment
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Cognitive impairment induced by hypoglycemia in adults with type 1 diabetes is not worsened with sleep deprivation; however, recovery after hypoglycemia takes longer with persistence of cognitive dysfunction and hypoglycemia symptoms, study data show.
“One possible explanation is that hypoglycemia, per se, exerts a ceiling effect on the degree of cognitive dysfunction as is possible to demonstrate with conventional tests,” the researchers wrote. “It is also possible that the mechanism causing cognitive dysfunction during sleep deprivation differs from that during hypoglycemia, so that no additive effect is evident.”
Berit E. Inkster, MBChB, of the department of diabetes at the Royal Infirmary of Edinburgh in Scotland, and colleagues evaluated 14 adults (median age, 27.5 years) to determine whether hypoglycemia linked to sleep deprivation causes greater cognitive dysfunction than hypoglycemia alone and delays recovery after normoglycemia is restored.
Participants underwent a hyperinsulinemic, hypoglycemic clamp on two separate occasions. Participants stayed awake over night to induce sleep deprivation before one clamp and had normal sleep before the other. Before and during hypoglycemia and for 90 minutes after restoration of normoglycemia, cognitive function tests were performed.
Compared with baseline, general cognitive test battery scores were deteriorated during hypoglycemia (P < .01). No significant differences were found between the two sleep conditions on cognitive tests during hypoglycemia.
During recovery, modified symptom scores were significantly higher during the sleep-deprived condition; however, time and condition did not interact, indicating that scores did not differ between the conditions.
During recovery, digit symbol substitution scores and choice reaction times were poorer (P < .001) and hypoglycemia scores were higher (P < .001) in the sleep-deprived condition compared with the normal-sleep condition, even when symptoms caused by sleep deprivation were removed.
“The current study in adults with type 1 diabetes has shown that although the cognitive impairment induced by hypoglycemia is not exacerbated by sleep deprivation, the posthypoglycemia recovery takes longer with persistence of both cognitive dysfunction and hypoglycemia symptoms,” the researchers wrote. “As these combined forms of stress may be encountered at some time in everyday life by people with insulin-treated diabetes, the delayed posthypoglycemia recovery could have importance consequences in situations such as driving. People with diabetes should be advised that exposure to hypoglycemia could prolong the impairment of cognitive function considerably, despite prompt restoration of normoglycemia.” – by Amber Cox
Disclosure: The researchers report no relevant financial disclosures.
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