The obstructive sleep apnea syndrome significantly increases the risk of stroke or death from any cause, and the increase is independent of other risk factors, including hypertension.

OBJECTIVE -Short-term partial sleep restriction results in glucose intolerance and insulin resistance. The purpose of this study was to assess the long-term relationship between sleep duration and the incidence of clinical diabetes. RESEARCH DESIGN AND METHODS -A cohort of men from the MassachusettsMale Aging Study without diabetes at baseline (1987)(1988)(1989) were followed until 2004 for the development of diabetes. Average number of hours of sleep per night was grouped into the following categories: Յ5, 6, 7, 8, and Ͼ8 h. Incidence rates and relative risks (RRs) were calculated for the development of diabetes in each sleep duration category. Those reporting 7 h of sleep per night served as the reference group. Multivariate analysis was performed using Poisson regression.RESULTS -Men reporting short sleep duration (Յ5 and 6 h of sleep per night) were twice as likely to develop diabetes, and men reporting long sleep duration (Ͼ8 h of sleep per night) were more than three times as likely to develop diabetes over the period of follow-up. Elevated risks remained essentially unchanged after adjustment for age, hypertension, smoking status, self-rated health status, education, and waist circumference .01] for Յ5 h and 3.12 [1.53-6.37] for Ͼ8 h). RRs were altered considerably for the two extreme sleep groups when adjusted for testosterone (1.51 [0.71-3.19] for Յ5 h and 2.81 [1. 34 -5.90] for Ͼ8 h), suggesting that the effects of sleep on diabetes could be mediated via changes in endogenous testosterone levels.CONCLUSIONS -Short and long sleep durations increase the risk of developing diabetes, independent of confounding factors. Sleep duration may represent a novel risk factor for diabetes. Diabetes Care 29:657-661, 2006D iabetes remains a critical public health challenge. The prevalence of diabetes continues to increase, and it affects an estimated 18 million people in the U.S. (1-3). Patients with diabetes require frequent contact with the health care system for effective management and prevention of complications, and they are at increased risk for premature mortality and hospitalization for conditions such as cardiovascular and kidney disease. Although lifestyle changes such as weight loss and increasing physical activity are the cornerstone of diabetes prevention, efforts are needed to better understand other determinants of the disease and to develop additional prevention strategies. Understanding the link between diabetes and sleep may represent one important part of that effort.Sleep loss is a common condition in modern society, with evidence showing that we are sleeping on average only 6.8 h per night, which is 1.5 h less than we did a century ago (4,5). Nearly one-third of adults report sleeping Ͻ6 h per night, leading some to suggest we live in a sleepdeprived society (6). Factors responsible for this change include increases in environmental light, longer work days/ commuting time, an increase in shift and night work, and the advent of television, radio, and the Internet (7).We are only beginning to reco...

PURPOSE-Cross-sectional studies have documented the co-occurrence of obstructive sleep apnea (hereafter sleep apnea) with glucose intolerance, insulin resistance, and type II diabetes mellitus (hereafter diabetes). It has not been determined, however, whether sleep apnea is independently associated with the subsequent development of diabetes, accounting for established risk factors. METHODS-This observational cohort study examined 1233 consecutive patients in the VeteranAffairs Connecticut Health Care System referred for evaluation of sleep-disordered breathing; 544 study participants were free of preexisting diabetes and completed a full, attended, diagnostic polysomnogram. The study population was divided into quartiles based on severity of sleep apnea as measured by the apnea-hypopnea index. The main outcome was incident diabetes defined as fasting glucose level > 126 mg/dL and a corresponding physician diagnosis. Compliance with positive airway pressure therapy, and its impact on the main outcome, was also examined.RESULTS-In unadjusted analysis, increasing severity of sleep apnea was associated with an increased risk of diabetes (P for linear trend < 0.001). After adjusting for age, sex, race, baseline fasting blood glucose, body mass index (BMI), and weight change, an independent association was found between sleep apnea and incident diabetes (hazard ratio per quartile 1.43; CI 1.10 -1.86). Among patients with more severe sleep apnea (upper two quartiles of severity), 60% had evidence of regular positive airway pressure use, and this treatment was associated with an attenuation of the risk of diabetes (log-rank test P=0.04).CONCLUSION-Sleep apnea increases the risk of developing diabetes, independent of other risk factors. Among patients with more severe sleep apnea, regular positive airway pressure use may attenuate this risk.

Among patients referred for OSA evaluation, routine polysomnographic data can identify physiological phenotypes that capture risk of adverse cardiovascular outcomes otherwise missed by conventional OSA severity classification.