Bidirectional interactions between sleep and metabolism: mechanisms and therapeutic implications for insulin resistance

Sleep disturbances and metabolic dysfunctions are tightly interlinked through complex neuroendocrine and inflammatory pathways. Accumulating epidemiological, clinical, and experimental evidence indicates that insufficient sleep, poor sleep quality, circadian misalignment, and disorders such as obstructive sleep apnea (OSA) promote insulin resistance (IR) by disrupting the sleep–metabolic axis, thereby increasing the risk of obesity, type 2 diabetes mellitus (T2DM), and cardiovascular diseases. Conversely, IR and metabolic inflammation further impair sleep regulation, forming a self-reinforcing pathological cycle. This review synthesizes recent advances in understanding the bidirectional mechanisms connecting sleep and metabolism, emphasizing hormonal, inflammatory, and circadian regulation. Furthermore, we discuss the therapeutic potential of integrating sleep management into metabolic disorder treatment to break this vicious cycle and provide a framework for interdisciplinary research in neuroendocrine-sleep medicine.