Elsevier

Annals of Epidemiology

Volume 20, Issue 12, December 2010, Pages 883-889
Annals of Epidemiology

Short Sleep Duration is Associated with the Development of Impaired Fasting Glucose: The Western New York Health Study

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Purpose

To examine whether sleep duration was associated with incident-impaired fasting glucose (IFG) over 6 years of follow-up in the Western New York Health Study.

Methods

Participants (N = 1,455, 68% response rate) who were free of type 2 diabetes and known cardiovascular disease at baseline (1996–2001) were reexamined in the period 2003–2004. A nested case-control study was conducted. Cases had fasting plasma glucose (FPG) less than 100 mg/dL at baseline and 100 to 125 mg/dL at follow-up: controls (n = 272) had FPG less than 100 mg/dL at both exams. Cases (n = 91) were individually matched to three controls (n = 272) on sex, race, and year of study enrollment. Average sleep duration was categorized as short (<6 hours), mid-range (6 to 8 hours), and long (>8 hours).

Results

In multivariate conditional logistic regression after adjustment for several diabetes risk factors, the odds ratio (OR) of IFG among short sleepers was 3.0 (95% confidence limit [CL]: 1.05, 8.59) compared to mid-range sleepers. There was no association between long sleep and IFG: OR 1.6 (95% CL: 0.45, 5.42). Adjustment for insulin resistance attenuated the association only among short sleepers: OR 2.5 (95% CL: 0.83, 7.46).

Conclusions

Short sleep duration was associated with an elevated risk of IFG. Insulin resistance appears to mediate this association.

Introduction

Sleep is a restorative process required for metabolic homeostasis (1). Although sleep is necessary for normal homeostatic function, the amount one gets is in part discretionary. In the United States, the average number of hours of sleep for adults has declined since the mid-1900s from about 9 hours a night to current estimates of 7 hours a night 2, 3, 4. Observational epidemiologic studies have shown that inadequate sleep is associated with obesity (5), hypertension (6), coronary heart disease (7), and overall mortality 8, 9.

Prospective studies have demonstrated a U- or J-shaped association between sleep duration and incident type 2 diabetes mellitus. For example, after 12 years of follow-up in 1,100 men 40–70 years of age, the Massachusetts Male Aging Study reported the relative risk of developing type 2 diabetes; compared with men who slept 7 hours a night, participants who slept 6 hours had a relative risk (RR) of 1.95 (95% confidence interval [CI]: 1.06, 3.58) and those who slept more than 8 hours had an RR of 3.12 (95% CI: 1.53, 6.37) (10). In the 10-year follow-up, the Nurses' Health Study (N = 70,026 females, age 30–55 years) reported an elevated risk of developing type 2 diabetes among long sleepers (≥9 hours) (RR: 1.29; 95% CI: 1.05, 1.59) compared with sleeping 8 hours a night, but not among short sleepers (11). Cross-sectional studies have yielded similar results 12, 13.

The Western New York Health Follow-up Study is a prospective, community-based cohort of men and women that was designed to examine biomarkers that predicted incident type 2 diabetes mellitus. Within the prospective follow-up, we conducted an individually matched, nested, case-control study to test the hypothesis that short sleep duration at baseline would be associated with an increased likelihood of developing impaired fasting glucose (IFG) independent of diabetes risk factors and several confounding variables. We also examined the role of insulin resistance on this association.

Section snippets

Study Population

The study design and methodology of the original Western New York Health Study have been previously published (14). Participants in this report were originally enrolled as healthy control participants in the Western New York Health Study, an epidemiologic case–control investigation of patterns of alcohol intake and coronary heart disease in Erie and Niagara Counties, New York, conducted from 1996 to 2001. In brief, the initial control cohort was randomly selected from drivers' license and

Results

Table 1 presents the mean (standard deviation in parentheses) or number (percentage in parentheses) of selected baseline characteristics by IFG case/control status at follow-up. There were 91 cases of IFG matched to 272 control participants (one control was missing sleep data). At baseline, compared with controls, IFG cases were significantly older (58 years vs. 54 years, p = 0.005), had a larger abdominal height (21.3 vs. 20.1 cm, p = 0.005), and BMI (p = 0.04). Mean fasting glucose was higher

Discussion

In the present study after 6 years of follow-up, short sleep was associated with a significant, three-fold increased likelihood of developing IFG even after considering several putative diabetes risk factors. This estimate was slightly attenuated but no longer statistically significant when the role of insulin resistance on this observed association was examined, suggesting that insulin resistance explains some but not all of the association. To our knowledge, no other studies have reported

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