Gender differences in the associations between insomnia and glycemic control in patients with type 2 diabetes: a cross-sectional study

Ding, Chenzhao; Zhang, Jihui; Lau, Eric S. H.; Luk, Andrea; So, Wing Yee; Ma, Rong; Choi, Kai Chow; Chan, Juliana C.N.; Wing, Yun Kwok; Kong, Alice Pik Shan

doi:10.1093/sleep/zsz014

Cited by 8 publications

(6 citation statements)

References 38 publications

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“…Ding et al similarly found that patients with insomnia and type 2 diabetes (compared to those with type 2 diabetes but without insomnia) had higher fasting glucose and HbA1c even after adjusting for diabetes and sleep-related confounders. 131 Furthermore, in the Multi-Ethnic Study of Atherosclerosis (MESA) cohort, among individuals with diabetes (20% of the population), those who slept <5 h per night had greater HbA1c than those who slept 7-8 h per night with no attenuation of the associations after adjusting for obstructive sleep apnea/hypoxemia. 132 Impaired sleep efficiency, defined as a low percentage of time spent asleep out of total time spent in bed, is another sleep parameter seen in insomnia that is associated with adverse glucose outcomes.…”

Section: Epidemiological Trendsmentioning

confidence: 99%

Connecting insufficient sleep and insomnia with metabolic dysfunction

Duan

Kim

Jun

et al. 2022

Annals of the New York Academy of Sciences

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The global epidemic of obesity and type 2 diabetes parallels the rampant state of sleep deprivation in our society. Epidemiological studies consistently show an association between insufficient sleep and metabolic dysfunction. Mechanistically, sleep and circadian rhythm exert considerable influences on hormones involved in appetite regulation and energy metabolism. As such, data from experimental sleep deprivation in humans demonstrate that insufficient sleep induces a positive energy balance with resultant weight gain, due to increased energy intake that far exceeds the additional energy expenditure of nocturnal wakefulness, and adversely impacts glucose metabolism. Conversely, animal models have found that sleep loss–induced energy expenditure exceeds caloric intake resulting in net weight loss. However, animal models have significant limitations, which may diminish the clinical relevance of their metabolic findings. Clinically, insomnia disorder and insomnia symptoms are associated with adverse glucose outcomes, though it remains challenging to isolate the effects of insomnia on metabolic outcomes independent of comorbidities and insufficient sleep durations. Furthermore, both pharmacological and behavioral interventions for insomnia may have direct metabolic effects. The goal of this review is to establish an updated framework for the causal links between insufficient sleep and insomnia and risks for type 2 diabetes and obesity.

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Section: Epidemiological Trendsmentioning

confidence: 99%

Connecting insufficient sleep and insomnia with metabolic dysfunction

Duan

Kim

Jun

et al. 2022

Annals of the New York Academy of Sciences

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“…The biological mechanisms of the relationship between sleep and diabetes are complicated, sleep habits and sleep disturbance, such as sleep duration, insomnia, and different kinds of circadian rhythms may act on T2DM through different biological mediations. Defining the relationship between these sleep traits and glycemic health is of great importance in understanding the detailed mechanisms and discovering potential treatment strategies for T2DM disease (Anothaisintawee et al, 2016;Ding et al, 2019). Therefore, we investigated the causality of different sleep traits with T2DM in this study and found significant evidence for an adverse effect of insomnia on T2DM risk.…”

Section: Discussionmentioning

confidence: 92%

Investigating Causal Relations Between Sleep-Related Traits and Risk of Type 2 Diabetes Mellitus: A Mendelian Randomization Study

et al. 2020

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ObjectiveExtensive literature put forward the link between sleep and type 2 diabetes mellitus (T2DM), however, little is known about the underlying causality of the associations. Here we aim to assess the causal relationships between five major sleep-related traits and T2DM.Design, Setting, and ParticipantsTwo-sample Mendelian randomization (MR) was utilized to investigate the potential causal relations. Independent genetic variants associated with five sleep-related phenotypes—insomnia, sleep duration, short sleep duration, long sleep duration, and morningness—were chosen as instrumental variables to estimate the causal associations with T2DM. Summary statistics were acquired from the genome-wide association studies of UK Biobank and 23andMe (for sleep-related measures), the DIAbetes Genetics Replication And Meta-analysis and the FinnGen (for T2DM).Main MethodsIndividual Cochran’s Q statistic was applied to remove the pleiotropic instruments, global Q statistics and MR-Egger regression were adopted to test for the global heterogeneity and horizontal pleiotropy of the screened instruments, respectively. Two T2DM cohorts were selected to analyze their associations with sleep traits. A modified inverse variance weighted (IVW) estimate was performed to combine the ratio estimators from each instrument and acquire the causal estimate, alternative methods including IVW with first-order weights, simple and weighted median estimations, and MR-Egger regression were conducted as sensitivity analyses, to ensure the robustness and solidity of the findings.ResultsTwo-sample MR supported findings for an adverse effect of genetically predicted insomnia on T2DM risk (odds ratio [OR] = 1.14, 95% confidence interval [CI]: 1.09–1.19, p = 1.29E–08) at the Bonferroni-adjusted level of significance (p < 0.005). We further investigated the causal role of T2DM on insomnia but obtained a non-significant estimation. There was also little evidence for the causal effect of other sleep-related measures on T2DM. Results were largely consistent when leveraging two different T2DM cohorts, and were robust among various sensitivity analyses.ConclusionFindings provide significant evidence for an adverse effect of insomnia on T2DM risk. The study extends fundamental knowledge to further understanding of the pathophysiological mechanisms of T2DM, and points out the non-negligible role of insomnia on epidemiologic intervention and clinical therapeutics of T2DM.

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“…A previous study reported that patients with both diabetes and insomnia tended to have worse glycaemic control than patients with diabetes who did not have insomnia. The effect of insomnia on glycaemic control was stronger in men than in women 45. Moreover, diabetes complications made insomnia more severe for patients with diabetes 43.…”

Section: Discussionmentioning

confidence: 95%

“…The effect of insomnia on glycaemic control was stronger in men than in women. 45 Moreover, diabetes complications made insomnia more severe for patients with diabetes. 43 HbA1c and diabetes complication may have a high impact on this association.…”

Section: Discussionmentioning

confidence: 99%

Accumulated unhealthy behaviours and insomnia in Japanese dwellers with and without cardiovascular risk factors: a cross-sectional study

et al. 2022

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ObjectivesTo date, the association between accumulated unhealthy behaviours and insomnia in individuals stratified according to the presence or absence of major cardiovascular risk factors is unclear. This study aimed to examine the effect of accumulated unhealthy behaviours on insomnia in Japanese dwellers.DesignCross-sectional study.SettingBaseline data between April 2012 and March 2015.ParticipantsOur study used cross-sectional data among Japanese aged 35–74 years in a rural community (N=9565), the attendees of annual municipal or work site health check-up programmes.Main outcome measuresInsomnia was assessed by Athens Insomnia Scale, which was set at 6 points and greater; other scales were given. Participants were categorised into three groups by their number of unhealthy behaviours (no exercise habit, smoking, alcohol drinking, skipping breakfast and obesity): 0–1, 2–3, 4 or more. The association between accumulated unhealthy behaviours and insomnia was estimated by logistic regression analysis. Further analysis was done after stratification of cardiovascular risk factors assessed by anthropometrics and clinical biochemistry measurements.ResultsThe overall prevalence of insomnia was 13.3% for men and 19.3% for women. Men with unhealthy behaviour factors were more likely to have insomnia after adjusting for potential confounders, compared with the least unhealthy group (trend p=0.013). Women with four or more unhealthy behaviour factors were more likely to have insomnia, compared with the lowest groups (OR 1.175, 95% CI 1.077 to 1.282). Insomnia has an association with the unhealthy behaviours among men without cardiovascular risk factors (lowest groups: OR 1.133, 95% CI 1.037 to 1.238, trend p=0.026). Women without hypertension were more likely to have suspected insomnia, compared with the lowest group (OR 1.215, 95% CI 1.101 to 1.341).ConclusionThe results showed accumulated unhealthy behaviours were associated with increased risk of insomnia in Japanese dwellers. For healthy population without cardiovascular risk factors, unhealthy behaviours should be considered as background conditions for insomnia.

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Gender differences in the associations between insomnia and glycemic control in patients with type 2 diabetes: a cross-sectional study

Cited by 8 publications

References 38 publications

Connecting insufficient sleep and insomnia with metabolic dysfunction

Connecting insufficient sleep and insomnia with metabolic dysfunction

Investigating Causal Relations Between Sleep-Related Traits and Risk of Type 2 Diabetes Mellitus: A Mendelian Randomization Study

Accumulated unhealthy behaviours and insomnia in Japanese dwellers with and without cardiovascular risk factors: a cross-sectional study

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