Sleep duration is a potential risk factor for newly diagnosed type 2 diabetes mellitus
Introduction
Humans spend nearly one third of each day sleeping, and it is a daily process of physiologic restitution and recovery. An epidemiologic study reported a decline in sleep duration over the past few decades by 1.5 to 2 hours [1], with about one third of adults reporting that they sleep less than 6 hours per night, meaning that we live in a sleep-deprived society. U-shaped patterns have been observed for the relationships between sleep duration and all-cause mortality [2], [3], [4], coronary heart disease [5], hypertension [6], [7], obesity [7], [8], and diabetes [9], [10], [11], [12], [13]. Sleep and sleep disturbance have a profound effect on many aspects of physiologic functions, including endocrinology, immunology, and metabolism; and decreased glucose tolerance and increased sympathetic tone are well-known risk factors for the development insulin resistance, obesity, and hypertension [14]. Therefore, we could speculate that chronic sleep loss would be a stress factor to promote weight gain and impair glycemic regulation, with a subsequently increased risk of diabetes.
Diabetes remains a critical public health problem because of its high prevalence rate and the fact that it increases the risk of cardiovascular-related mortality. There is growing evidence that sleep duration is a contributing factor toward the current diabetes epidemic [9], [10], [11], [12], [13]. An experimental study showed that acute deprivation of sleep, down to 4 hours per night for 6 nights, decreased glucose tolerance in healthy young adults. Therefore, the impact of sleep restriction on glucose regulation suggests a mechanism whereby short sleep time might increase the risk of diabetes [15]. Previous epidemiologic studies on the relationship between sleep duration and diabetes have shown varying results [9], [10], [11], [12], [13], [16], [17], [18], [19]. A cohort study of women in the Nurses Health Study showed that short (≤5 hours) and long sleepers (≥9 hours) had a significantly increased risk of diabetes, but the relationship remained significant only between long sleepers and diabetes after adjusting for body mass index (BMI) [9]. However, sleep disturbance in midlife was found to be unrelated to 32-year diabetes incidence in a Gothenburg study [17]. Mallon et al [18] found that short sleep duration was associated with diabetes incidence in men, but not in women. Furthermore, a prospective cohort study of middle-aged and elderly men showed a significant U-shaped relationship between self-reported sleep duration and incidence of diabetes [10]. Recent studies have found both short and long sleep duration to be associated with significantly increased risk of diabetes [12], [13]. In addition, prediabetes had been associated with the increased risk of cardiovascular diseases [20] and overt diabetes [21]. However, few studies investigate the relationship between sleep duration and newly diagnosed diabetes and prediabetes. Therefore, the aim of this study is to examine the potential effect of sleep duration on the risk of prediabetes and newly diagnosed diabetes, controlling for possible confounding factors.
Section snippets
Study subjects and data collection
The baseline data were collected from a health examination center in National Cheng Kung University Hospital from 2006 to 2007. All subjects received a health checkup and completed a structured questionnaire, which included demographic information; medical history; medication history; smoking, alcohol, and coffee drinking habits; and details of physical exercise. After excluding the subjects with high risk of obstructive sleep apnea (OSA), a total of 3470 adults without a history of diabetes or
Results
Table 1 summarizes the clinical characteristics of the 3470 subjects according to glycemic status. There were significant differences in sex, age, weight, education level, BMI, WHR, systolic and diastolic BP, alcohol and coffee drinking habits, family history of diabetes, and sleep duration among these 3 glycemic groups. Compared with the NGT group, both prediabetes and diabetes groups were older; had a higher BMI, WHR, body weight, systolic and diastolic BP, as well as a higher proportion of
Conclusions
Our study shows that both short and long sleep durations are associated with newly diagnosed diabetes after adjustments for the potential confounding factors of lifestyle and family history of diabetes. Furthermore, this association remained significant even after controlling for both general and central obesity indices (BMI and WHR). Thus, both short and long sleep durations independently increase the risk of newly diagnosed diabetes in a Taiwanese population.
Epidemiologic studies have
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