Effect of Metformin on Sleep Architecture in Diabetic Patients with Sleep Apnea

Background/ Objectives Patients with poor sleep are at high risk for developing diabetes (T2DM). Since T2DM is linked to increased risk of obstructive sleep apnea (OSA), and Metformin is commonly used to treat T2DM, we examined how Metformin affects sleep stages in patients with concurrent T2DM and OSA-related symptoms of snoring and fatigue. T2DM patients on Metformin, progressively develop increased insulin resistance associated with sleep disturbances, and poor glycemic control. We explored changes in sleep patterns in T2DM patients on Metformin. We explored if Metformin affects sleep Architecture in T2DM patients.MethodsEvaluate PSG (polysomnogram data from T2DM patients on Metformin along with data on age, BMI and sex. Data to be analyzed as mean +SE and linear regression, t test p<0.5 taken as significant. Results Non-obese patients taking Metformin experienced a significant decrease in REM duration compared to patients on alternative therapies (p = 0.036). There was no such change in REM for obese patients taking Metformin. While there was no change in N3 duration with Metformin use, linear regression identified a moderate negative correlation between N3 and age in patients taking non-Metformin therapies (R2 = 0.4555). No significant correlations between sleep stage duration and patient sex, smoking status, or body-mass index (BMI) were identified.Conclusion T2DM patients on Metformin had OSA with reduced deep sleep (N3) and REM (Rapid Eye Movement) sleep. These diabetic patients with OSA being treated with Metformin had decreased REM sleep, regardless of sex, smoking history, and BMI. N3 and REM sleep are needed for timely secretion of growth hormone and memory consolidation. Metformin affects sleep architecture and impacts N3 and REM sleep. This may contribute to the development of insulin resistance. Future studies are needed to explore potential causes for this decrease and how it may affect treatment of T2DM.