Sleep architecture, insulin resistance and the nasal cycle: Implications for positive airway pressure therapy

Catherine A.P. Crofts, Alister Neill, Angela Campbell, Jim Bartley, David E. White
Journal of Metabolic Health | Journal of Insulin Resistance: Vol 3, No 1, | a34 | DOI: | © 2018 Catherine A.P. Crofts, Alistair Neil, Angela Campbell, Jim Bartley, David E. White | This work is licensed under CC Attribution 4.0
Submitted: 09 January 2018 | Published: 28 March 2018

About the author(s)

Catherine A.P. Crofts, Faculty of Health and Environmental Sciences, Auckland University of Technology, New Zealand
Alister Neill, WellSleep Clinic, University of Otago, New Zealand
Angela Campbell, WellSleep Clinic, University of Otago, New Zealand
Jim Bartley, Department of Surgery, University of Otago, New Zealand
David E. White, BioDesign Lab, Auckland University of Technology, New Zealand


Background: The global pandemic of metabolic disease is worsening. The metabolic theory of obesity proposes that hormonal changes, especially hyperinsulinaemia, precede metabolic disease development. Although quality sleep is recognised as a key factor for good health, less is known about disrupted sleep as a risk factor for hyperinsulinaemia.


Aim: To explore the relationship between sleep, especially sleep architecture and the nasal cycle, on insulin secretion in obstructive sleep apnoea (OSA) with comorbid metabolic disease. This review includes a discussion of the potential role of Rest-Activity-Cycler positive airway pressure (RACer-PAP), a novel non-pharmacological OSA treatment strategy.


Methods: A narrative review of all the relevant papers known to the authors was conducted. This review also included results from a polysomnographic sleep clinic pilot study (n = 3) comparing sleep efficiency of RACer-PAP to nasal continuous positive airways pressure (n-CPAP) in OSA patients.


Results: Metabolic disease is strongly associated with disturbed sleep. Sleep architecture influences cerebral hormonal secretion, lateral shifts in the autonomic nervous system and nasal airflow dominance. Disturbed sleep shortens short-wave sleep periods, decreasing insulin sensitivity and glucose tolerance. Improvements to metabolic function during n-CPAP treatment are inconsistent. If RACer-PAP demonstrates superior effects on sleep architecture and autonomic function, it may offer advantages in OSA patients with comorbid metabolic disease.


Conclusion: Improving sleep architecture by maintaining the nasal cycle proposes a novel non-pharmacological treatment paradigm for treating OSA with comorbid metabolic disease. Research is required to demonstrate if RACer-PAP therapy influences whole night sleep architecture, sympathovagal balance and markers of metabolic disease.


sleep apnoea; metabolic disease; sympathovagal balance; sleep architecture; hyperinsulinaemia


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Crossref Citations

1. Repeatability characteristics of insulin response patterns and measures of insulin resistance
Catherine A.P. Crofts, Mark C. Wheldon, Caryn Zinn, Fabrice Merien, Grant Schofield
Journal of Metabolic Health  vol: 4  issue: 1  year: 2019  
doi: 10.4102/jir.v4i1.44