Women with sleep disorders have a significantly higher risk to develop diabetes
This finding can only be partially explained by associations with hypertension, BMI and depression, and supports the need to manage sleep disorders for the prevention of type 2 diabetes.
Association between sleeping difficulty and type 2 diabetes in womenLiterature - Li Y et al., Diabetologia 2016
Li Y, Gao X, Winkelman JW, et al.
Diabetologia 2016; published online ahead of print 2 February 2016
Background
Inadequate or fragmented sleep in healthy young adults has been associated with impaired glucose regulation [1, 2]. Sleep disturbance negatively affects metabolism and has been associated with type 2 diabetes (T2DM) risk factors, such as obesity [3], hypertension [4] and depression [5], as well as with increased risk T2DM itself [6-7]. However it is not clear whether the observed associations are independent of health behaviours, other cardiovascular risk factors or other sleep disorders.In this study, the association between sleeping difficulty and the risk of developing T2DM was examined, based on the extracted data from two independent cohorts of US women: the Nurses’ Health Study (NHS) [8] and NHSII [9]. Sleeping difficulty was defined as having difficulty initiating or maintaining sleep most of the time or all the time.
Data from 133,353 women were analysed with a follow-up of 10 years. Furthermore, the combined effect between sleeping difficulty and short sleep duration, frequent snoring, sleep apnoea and rotating shift work were assessed, and the extent to which the effects of sleeping difficulty on T2DM are mediated through BMI, hypertension and depression was quantified.
Main results
• At baseline, 5.9% in NHS and 4.8% in NHSII of women reported sleeping difficulty.• Women with sleeping difficulty had an increased risk of T2DM compared with women without sleeping difficulty, independent of a variety of risk factors. The multivariate-adjusted HR for T2DM comparing women with and without sleeping difficulty was:
- 1.45 (95% CI: 1.33 - 1.58) after adjustment for lifestyle factors at baseline,
- 1.22 (95% CI: 1.12 - 1.34) after further adjustment for hypertension, depression and BMI
(P for multiplicative interaction = 0.08, P for additive interaction= 0.04)
The multivariate-adjusted HRs
- of shift work only was 1.27 (95% CI: 1.14 - 1.42),
- of sleeping difficulty only was 1.40 (95% CI: 1.23 - 1.59)
- of both conditions was 2.30 (95% CI: 1.78 - 2.96)
• Women who reported all four sleep conditions (sleeping difficulty, frequent snoring, sleep duration ≤6 h and sleep apnoea in NHS or rotating shift work in NHSII) had more than a fourfold increased likelihood of T2DM (HR 4.17, 95% CI: 2.93 - 5.91)
Conclusion
In 2 large independent cohorts of females, sleeping difficulty, defined as having difficulty initiating or maintaining sleep most of the time or all the time, was significantly associated with T2DM. While this finding can be partially explained by associations with hypertension, BMI and depression symptoms, it was very powerful when combined with other sleep disorders. These findings support the need to manage sleep disturbance in the context of T2DM prevention.Find this article online at Diabetologia
References
1. Spiegel K, Leproult R, van Cauter E. Impact of sleep debt on metabolic and endocrine function. Lancet 1999;354:1435–1439
2. Stamatakis KA, Punjabi NM. Effects of sleep fragmentation on glucose metabolism in normal subjects. Chest 2010;137:95–101
3. Vorona RD, Winn MP, Babineau TW, et al. Overweight and obese patients in a primary care population report less sleep than patients with a normal body mass index. Arch Intern Med 2005;165:25–30
4. Meng L, Zheng Y, Hui R. The relationship of sleep duration and insomnia to risk of hypertension incidence: a meta-analysis of
prospective cohort studies. Hypertens Res 2013;36:985–995
5. Baglioni C, Battagliese G, Feige B, et al. Insomnia as a predictor of depression: a meta-analytic evaluation of longitudinal epidemiological studies. J Affect Disord 2011;135:10–19
6. Cappuccio FP, D'Elia L, Strazzullo P, et al. Quantity and quality of sleep and incidence of type 2 diabetes: a systematic review and meta-analysis. Diabetes Care 2010;33:414–420
7. Kawakami N, Takatsuka N, Shimizu H. Sleep disturbance and onset of type 2 diabetes. Diabetes Care 2004;27:282–283
8. Al-Delaimy WK, Manson JE, Willett WC, et al. Snoring as a risk factor for type II diabetes mellitus: a prospective study. Am J Epidemiol 2002;155:387–393
9. Pan A, Schernhammer ES, Sun Q, et al. Rotating night shift work and risk of type 2 diabetes: two prospective cohort studies in women. PLoS Med 2011;8: e1001141