Short Sleep Duration is Associated with the Development of Impaired Fasting Glucose: The Western New York Health Study
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
References (30)
- et al.
Insufficient sleep in the general population
Neurophysiologie Clinique
(1996) - et al.
Alcohol drinking patterns differentially affect central adiposity as measured by abdominal height in women and men
J Nutr
(2003) - et al.
Impact of sleep debt on metabolic and endocrine function
Lancet
(1999) - et al.
Effect of sleep loss on C-reactive protein, an inflammatory marker of cardiovascular risk
J Am Coll Cardiol
(2004) Sleep deprivation and energy metabolism: to sleep, perchance to eat?
Curr Opin Endocrinol Diabetes Obes
(2007)National Sleep Foundation “Sleep in America” Poll
(2005)- et al.
Sleep duration in the United States: a cross-sectional population-based study
Am J Epidemiol
(2009) Knutson EVC. Associations between Sleep Loss and Increased Risk of Obesity and Diabetes
Ann New York Acad Sci
(2008)- et al.
Short sleep duration as a risk factor for hypertension: analyses of the first National Health and Nutrition Examination Survey. [see comment 47:816–817]
Hypertension
(2006) - et al.
A prospective study of sleep duration and coronary heart disease in women
Arch Intern Med
(2003)
Short and long sleep and sleeping pills. Is increased mortality associated?
Arch Gen Psychiatry
A prospective study of change in sleep duration: associations with mortality in the Whitehall II cohort. [see comment 30:1614–1615]
Sleep
Sleep duration as a risk factor for the development of type 2 diabetes
Diabetes Care
A prospective study of self-reported sleep duration and incident diabetes in women
Diabetes Care
Association of sleep duration with type 2 diabetes and impaired glucose tolerance
Diabetologia
Cited by (0)
Abstract published Circulation 119(10) March 17, 2009, p. 86.