Sleep Duration as a Risk Factor for the Development of Type 2 Diabetes

Abstract

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...

Gender and socio-economic patterning of self-reported sleep problems in Britain

“…However, increasing evidence from prospective studies shows that disrupted sleep and short sleep duration (under 6.5 hours) are implicated in higher levels of diabetes, obesity, hypertension and mortality (Ayas, White, Al-Delaimy, Manson, Stamfer, Speizer et al, 2003;Ferrie, Shipley, Cappuccio, Brunner, Miller, Kumari et al, 2007;Gangwisch, Heymsfield, Boden-Albala, Buijs, Kreier, Pickering et al, 2007;Patel, Ayas, Malhotra et al, 2004;Tamakoshi & Ohno, 2004;Yaggi, Araujo & McKinlay, 2006). Experimental laboratory research has also shown that chronic sleep deprivation (restricted to 4 hours of sleep for 6 nights) results in significant changes in carbohydrate metabolism, decreased glucose tolerance, elevated evening cortisol levels and increased sympathetic activity, indicating that sleep loss can increase 'allostatic load', facilitating the development of chronic conditions, such as obesity, diabetes and hypertension .…”

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.…”

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

“…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].…”