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Sleep Duration Linked to Diabetes Risk

Posted: Thursday, December 27, 2007

Too little sleep or too much may increase the risk of type 2 diabetes, according to the results of a new study.

James E. Gangwisch, Ph.D., of Columbia, and colleagues reported in the December issue of Sleep that, sleeping an average of five hours or less or nine hours or longer increased the odds for diabetes onset by about 50% compared with seven hours.

Shorter and longer sleep duration remained significant predictors of diabetes even after controlling for more conventional risks, such as older age and higher body mass index.

The findings are consistent with evidence suggesting that short sleep duration increases insulin resistance and decreases glucose tolerance, the authors noted. However, the association between diabetes and longer sleep duration has no obvious explanation.

"We are not aware of any plausible physiologic explanations whereby long sleep duration could play a role in the pathogenesis of diabetes," the authors concluded. "It is more likely that long sleep duration occurs in parallel to, and as a consequence of, diabetes and other conditions associated with chronic inflammation."

Modern lifestyle factors may play a role. For example, the average sleep duration has decreased from an estimated nine hours in 1910 to seven hours in 2003, the authors noted.

To examine the association between sleep duration and diabetes more closely, Dr. Gangwisch and colleagues performed multivariate longitudinal analyses of data from the first National Health and Nutrition Examination Survey (NHANES I). The analysis included 8,992 non-institutionalized persons ages 32 to 86 who were followed from 1982 to 1992.

The analysis showed that 430 (4.8%) of the NHANES I sample developed diabetes during the follow-up period. Dr. Gangwisch and colleagues examined the association between sleep duration and diabetes by means of three logistic regression models: an unadjusted model and two different models adjusted for a variety of confounding variables.

In the unadjusted model, comparison of diabetes cases and reported sleep duration showed that participants reporting five or fewer hours of sleep had an odds ratio for diabetes of 1.91 (95% CI: 1.37 to 2.67) compared with participants who averaged seven hours of sleep. Those who reported averaging nine or more hours of sleep had an unadjusted diabetes risk of 1.85 (95% CI: 1.32 to 2.60).

In the fully adjusted model, participants reporting five or fewer hours of sleep had a diabetes odds ratio of 1.47 (95% CI: 1.03 to 2.09), and participants reporting nine or more hours of sleep had an odds ratio of 1.52 (95% CI: 1.06 to 2.17).

Acknowledging the study's limitations, estimated sleep duration was self-reported, not objectively measured. Finally, the investigators had no way to assess the influence of a diabetes diagnosis and treatment on subsequent sleep patterns.

Source: Diabetes In Control: Gangwisch JE, et al "Sleep duration as a risk facto for diabetes incidence in a large U.S. sample" Sleep 2007; 30: 1667-1673.