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Quantity and Quality of Nocturnal Sleep Affect Morning Glucose Measurement in Acutely Burned Children

Mayes, Theresa BS, RD, CCRC*; Gottschlich, Michele M. PhD, RD, CNSD†§; Khoury, Jane PhD; Simakajornboon, Narong MD; Kagan, Richard J. MD‡§

doi: 10.1097/BCR.0b013e3182a2a89c
Original Articles

Hyperglycemia after severe burn injury has long been recognized, whereas sleep deprivation after burns is a more recent finding. The postburn metabolic effects of poor sleep are not clear despite reports in other populations demonstrating the association between sleep insufficiency and deleterious endocrine consequences. The aim of this study was to determine whether a relationship between sleep and glucose dynamics exists in acutely burned children. Two overnight polysomnography runs (2200 to 0600) per subject were conducted in 40 patients with a mean (± SEM) age of 9.4 ± 0.7 years, 50.1 ± 2.9% TBSA burn, and 43.2 ± 3.6% full-thickness injury. Serum glucose was drawn in the morning (0600) immediately after the sleep test. Insulin requirements during the 24-hour period preceding the 0600 glucose measurement were recorded. Generalized linear models were used by the authors to evaluate percent time in each stage of sleep, percent wake time, total sleep time, sleep efficiency, and morning serum glucose, accounting for insulin use. Increased time awake (P = .04, linear; P = .02, quadratic) and reduced time spent in stage 1 sleep (P = .03, linear) were associated with higher glucose levels. Sleep efficiency (P = .01, linear; P = .02, quadratic) and total sleep time (P = .01 linear; P = .02, quadratic) were inversely associated with glucose level. Morning glucose levels appear to be affected by the quality and quantity of overnight sleep in children who have sustained extensive burn injuries. Future research is needed to elucidate the metabolic and neuroendocrine consequences of sleep deprivation on metabolism after burns.

From the Departments of *Nutrition, Research, and Surgery, Shriners Hospitals for Children, Cincinnati, Ohio; §Department of Surgery, University of Cincinnati College of Medicine, Ohio; and Cincinnati Children’s Hospital Medical Center, Ohio.

Supported in part by Shriners Hospitals for Children research grants #70096 and 70097. No external funding was received.

Presented at the Annual Meeting of the American Burn Association, Palm Springs, California, April 23–26, 2013.

Address correspondence to Theresa Mayes, BS, RD, CCRC, Department of Nutrition, Shriners Hospitals for Children, 3229 Burnet Avenue, Cincinnati, Ohio 45229.

© 2013 The American Burn Association