High Incidence of Diabetes in Men With Sleep Complaints or Short Sleep Duration

Abstract

OBJECTIVE -The aim of this study was to investigate the possible relationship among sleep complaints, sleep duration, and the development of diabetes prospectively over a 12-year period in a middle-aged Swedish population. RESEARCH DESIGN AND METHODS-A random sample of 2,663 subjects aged 45-65 years living in mid-Sweden were sent a postal questionnaire including questions about sleep complaints, sleep duration, sociodemographic characteristics, behavioral risk factors, medical conditions, and depression (response rate 70.2%). Twelve years later, a new questionnaire with almost identical questions was sent to all the survivors (n ϭ 1,604) in 1995, and the questionnaire was answered by 1,244 subjects (77.6%).RESULTS -Men reporting new diabetes at follow-up more often reported short sleep duration (Յ5 h per night) (16.0 vs. 5.9%, P Ͻ 0.01), difficulties initiating sleep (16.0 vs. 3.1%, P Ͻ 0.001), and difficulties maintaining sleep (28.0 vs. 6.3%, P Ͻ 0.001) at baseline than men who did not develop diabetes. Women reporting new diabetes at follow-up reported long sleep duration (Ն9 h per night) more often at baseline than women not developing diabetes (7.9 vs. 2.4%, P Ͻ 0.05). In multiple logistic regression models, the relative risk (95% CI) for development of diabetes was higher in men with short sleep duration (2.8 [1.1-7.3]) or difficulties maintaining sleep (4.8 [1.9 -12.5]) after adjustment for age and other relevant risk factors. Short or long sleep duration or sleep complaints did not influence the risk of new diabetes in women.CONCLUSIONS -Difficulties maintaining sleep or short sleep duration (Յ5 h) are associated with an increased incidence of diabetes in men. Diabetes Care 28:2762-2767, 2005D iabetes is associated with increased frequency of sleep complaints (1-4), and this may be due to the disease itself as well as to physical complications of the disease (3,5). However, sleep disturbances may also play a primary role in the pathophysiology of diabetes. Data have demonstrated that individuals suffering from poor sleep have increased arousal and increased physiological activation (6 -13). Experimentally induced sleep debt has been found to be associated with increased activation in the hypothalamic-pituitary-adrenal axis as indexed by elevated evening cortisol levels and impaired glucose tolerance (14). These findings indicate that disturbance and curtailment of sleep may be risk factors for the development of insulin resistance. The insulin resistance syndrome, also known as the metabolic syndrome, is a cluster of risk factors for adult-onset diabetes, and it usually consists of obesity, dyslipidemia, hyperglycemia, and hypertension (15).In a sample of healthy middle-aged men in Sweden, Nilsson et al. (16) found that difficulties in falling asleep or regular use of hypnotic drugs was associated with development of diabetes when adjustment was made for several risk factors. A 10-year follow-up survey of women aged 30 -55 years enrolled in the Nurses Health Study in the U.S. has shown that both short ...

The metabolic consequences of sleep deprivation

“…37 Another prospective study conducted in Sweden followed 1,187 men and women free of diabetes at baseline for 12-years. 38 Men who reported difficulty maintaining sleep or who reported sleep duration of 5 hours or less had a significantly greater risk of developing diabetes, but no significant associations between sleep and diabetes risk was observed in women. 38 A third prospective study from Sweden followed over 600 women for 32 years beginning in 1968-69, but the incidence of diabetes over a 32-year period was not associated with the self-reported sleep problems, sleep medication use or sleep duration at baseline.…”

The association of sleep duration and type 2 diabetes in Korean male adults with abdominal obesity: The Korean National Health and Nutrition Examination Survey 2005

“…We included male adults aged 20-60 years (n = 2342) because of more consistent previous reports among male adults [3][4][5] and physiologic and pathologic changes of sleep with aging [7]. After excluding those with missing values, we obtained a final sample of 1652.…”

“…Sleep duration has recently been recognized as a novel risk factor for type 2 diabetes. Short or long sleep duration was associated with type 2 diabetes [2][3][4][5]. Obesity, in particular abdominal obesity, is also very strongly related to the development of type 2 diabetes [6].…”

The glucostatic theory of appetite control and the risk of obesity and diabetes

“…[54][55][56] A growing body of epidemiological evidence supports an association between short sleep duration and the risk of obesity [57][58][59][60][61] and type 2 diabetes. [62][63][64][65][66] The potential mechanisms by which sleep deprivation may predispose to obesity are: (1) an alteration of the neuroendocrine control of appetite characterized by a decrease in the levels of the anorexigenic hormone leptin and an increase in the levels of the orexigenic hormone ghrelin; (2) an increased opportunity to eat; (3) an altered thermoregulation; and (4) an increased fatigue leading to reductions in physical activity. 67 Furthermore, physiological data suggest that short-term partial sleep restriction leads to striking alterations in metabolic function including decreased carbohydrate tolerance and insulin resistance.…”