Insulin release is a complex oscillatory process with rapid pulses (10 min) superimposed on slower circhoral oscillations (50–100 min). The exact mechanism of the circhoral oscillations, which are probably in part the consequence of a negative feedback loop linking glucose and insulin secretion rate, remains unclear. Stimulatory effects of sleep on insulin secretion are achieved by an enhancement of the oscillation amplitude which could be partly mediated by GH. The different patterns observed after acute or chronic shift of sleep suggest however an interaction between sleep influence and circadian rhythmicity, as described for numerous pituitary hormones. The intra-sleep awakenings have a modulatory effect on glucose levels but no systematic relationship exists between glucose or insulin secretion rate oscillations and the REM-NREM sleep cycles. Irrespective of the mechanisms involved, sleep or GH stimulatory effects result from a modulation of the oscillation amplitude rather than of their frequency which is probably an important feature of insulin efficacy.

Keywords:
Glucose, Insulin secretion rate, Ultradian rhythm, Circadian rhythm, Sleep, EEG spectral analysis, Alpha slow-wave index, Delta relative power, Growth hormone
1.
Hansen KM: Investigations on the blood sugar in man – Condition of oscillations, rise and distribution. Acta Med Scand 1923;4(suppl):1–8.
2.
Goodner CJ, Walike BC, Koerker DJ, Ensick JW, Brown AC, Chideckel EW, Palmer J, Kalnasy L: Insulin, glucagon, and glucose exhibit synchronous, sustained oscillations in fasting monkeys. Science 1977;195:177–179.
3.
Lang DA, Matthews DR, Peto J, Turner RC: Cyclic oscillations of basal plasma glucose and insulin concentrations in human beings. N Engl J Med 1979;301:1023–1027.
4.
Koerker DJ, Goodner CJ, Hansen BW, Brown AC, Rubenstein AH: Synchronous, sustained oscillation of C-peptide and insulin in the plasma of fasting monkeys. Endocrinology 1978;102:1649–1652.
5.
Simon C, Follenius M, Brandenberger G: Postprandial oscillations of plasma glucose, insulin and C-peptide in man. Diabetologia 1987;30:769–773.
6.
Simon C, Brandenberger G, Follenius M: Ultradian oscillations of plasma glucose, insulin and C-peptide in man during continuous enteral nutrition. J Clin Endocrinol Metab 1987;64:669–674.
7.
Shapiro ET, Tillil H, Polonsky KS, Fang VS, Rubenstein AH, Van Cauter E: Oscillations in insulin secretion during constant glucose infusion in normal man: Relationship to changes in plasma glucose. J Clin Endocrinol Metab 1988;67:307–314.
8.
Sturis J, Polonsky KS, Shapiro ET, Blackman JD, O’Meara NM, Van Cauter E: Abnormalities in the ultradian oscillations of insulin secretion and glucose levels in type 2 (non-insulin-dependent) diabetic patients. Diabetologia 1992;35:681–689.
9.
Sturis J, O’Meara NM, Shapiro ET, Blackman JD, Tillil H, Polonsky KS, Van Cauter E: Differential effects of glucose stimulation upon rapid pulses and ultradian oscillations of insulin secretion. J Clin Endocrinol Metab 1993;76:895–901.
10.
Kern W, Born J, Fehm HL, Kerner W: Sustained oscillatory insulin secretion after pancreas transplantation. Horm Metab Res 1990;22:644–646.
11.
Polonsky KS, Given BD, Van Cauter E: Twenty-four-hour profiles and pulsatile patterns of insulin secretion in normal and obese subjects. J Clin Invest 1988;81:442–448.
12.
Sturis J, Polonsky KS, Mosekilde E, Van Cauter E: Computer model for mechanisms underlying ultradian oscillations of insulin and glucose. Am J Physiol 1991;260:E801–E809.
13.
Sturis J, Van Cauter E, Blackman JD, Polonsky KS: Entrainment of pulsatile insulin secretion by oscillatory glucose infusion. J Clin Invest 1991;87:439–445.
14.
Chou HF, Ipp E: Pulsatile insulin secretion in isolated rat islets. Diabetes 1990;39:112–117.
15.
Chou HF, Berman N, Ipp E: Evidence for pancreatic pacemaker for insulin oscillations in low-frequency range. Am J Physiol 1994;266:R1786–R1791.
16.
Simon C, Brandenberger G, Follenius M, Schlienger JL: Alteration in the temporal organisation of insulin secretion in type 2 (non-insulin-dependent) diabetic patients under continuous enteral nutrition. Diabetologia 1991;34:435–440.
17.
Simon C, Brandenberger G, Saini J, Ehrhart J, Follenius M: Slow oscillations of plasma glucose and insulin secretion rate are amplified during sleep in humans under continuous enteral nutrition. Sleep 1994;17:333–338.
18.
Van Cauter E, Blackman JD, Roland D, Spire JP, Refetoff S, Polonsky KS: Modulation of glucose regulation and insulin secretion by circadian rhythmicity and sleep. J Clin Invest 1991;88:934–942.
19.
Weibel L, Spiegel K, Gronfier C, Follenius M, Brandenberger G: Twenty-four-hour melatonin and core body temperature rhythms: Their adaptation in night workers. Am J Physiol 1997;272:R948–R954.
20.
Weibel L, Follenius M, Spiegel K, Gronfier C, Brandenberger G: Growth hormone secretion in night workers. Chronobiol Int 1997;14:49–60.
21.
Wehr TA: A brain-warming function for REM sleep. Neurosci Behav Rev 1992;16:379–397.
22.
Kern W, Offenheuser S, Born J, Fehm HL: Entrainment of ultradian oscillations in the secretion of insulin and glucagon to the nonrapid eye movement/rapid eye movement sleep rhythm in humans. J Clin Endocrinol Metab 1996;81:1541–1547.
23.
Scheen AJ, Byrne M, Plat L, Leproult R, Van Cauter E: Relationships between sleep quality and glucose regulation in normal man. Am J Physiol 1996;271:E261–E270.
24.
Jobert M, Schultz H, Tismer C, Bes F, Escola H: A computerized method for detection episodes of wakefulness during sleep based on the alpha-slow-wave index. Sleep 1994;17:37–46.
1998
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