Sleep duration as a risk factor for the development of type 2 diabetes.

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 Massachusetts Male Aging Study without diabetes at baseline (1987-1989) were followed until 2004 for the development of diabetes. Average number of hours of sleep per night was grouped into the following categories: < or =5, 6, 7, 8, and >8 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 (< or =5 and 6 h of sleep per night) were twice as likely to develop diabetes, and men reporting long sleep duration (>8 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 (RR 1.95 [95% CI 0.95-4.01] for < or =5 h and 3.12 [1.53-6.37] for >8 h). RRs were altered considerably for the two extreme sleep groups when adjusted for testosterone (1.51 [0.71-3.19] for < or =5 h and 2.81 [1.34-5.90] for >8 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.

[1]  P. D. Farber,et al.  A profile instrument for the quantification and assessment of alcohol consumption. The Khavari Alcohol Test. , 1978, Journal of studies on alcohol.

[2]  E. C. Hammond,et al.  Short and long sleep and sleeping pills. Is increased mortality associated? , 1979, Archives of general psychiatry.

[3]  W. Willett,et al.  Validation of a semi-quantitative food frequency questionnaire: comparison with a 1-year diet record. , 1987, Journal of the American Dietetic Association.

[4]  E. Barrett-Connor,et al.  Endogenous sex hormones and cardiovascular disease in men. A prospective population-based study. , 1988, Circulation.

[5]  M. Laakso,et al.  Insulin Resistance, Body Fat Distribution, and Sex Hormones in Men , 1994, Diabetes.

[6]  M. C. Leske,et al.  Comparing self-reported and physician-reported medical history. , 1994, American journal of epidemiology.

[7]  Sudhansu Chokroverty,et al.  Sleep Disorders Medicine. Basic Science, Technical Considerations and Clinical Aspects. , 1999 .

[8]  K. Patrick,et al.  Physical Activity and Public Health: A Recommendation From the Centers for Disease Control and Prevention and the American College of Sports Medicine , 1995 .

[9]  P. Mårin,et al.  Testosterone and regional fat distribution. , 1995, Obesity research.

[10]  M. Bonnet,et al.  We are chronically sleep deprived. , 1995, Sleep.

[11]  G. Reaven,et al.  Hypertension and associated metabolic abnormalities--the role of insulin resistance and the sympathoadrenal system. , 1996, The New England journal of medicine.

[12]  M. Laakso,et al.  Low levels of sex hormone-binding globulin and testosterone are associated with smaller, denser low density lipoprotein in normoglycemic men. , 1996, The Journal of clinical endocrinology and metabolism.

[13]  E. van Cauter,et al.  Sleep loss results in an elevation of cortisol levels the next evening. , 1997, Sleep.

[14]  R. Vettor,et al.  Effects of acute hyperinsulinemia on testosterone serum concentrations in adult obese and normal-weight men. , 1997, Metabolism: clinical and experimental.

[15]  K. Flegal,et al.  Prevalence of Diabetes, Impaired Fasting Glucose, and Impaired Glucose Tolerance in U.S. Adults: The Third National Health and Nutrition Examination Survey, 1988–1994 , 1998, Diabetes Care.

[16]  D. Skene,et al.  Comparison between subjective and actigraphic measurement of sleep and sleep rhythms , 1999, Journal of sleep research.

[17]  K. Spiegel,et al.  Impact of sleep debt on metabolic and endocrine function , 1999, The Lancet.

[18]  J. Mckinlay,et al.  US public health and the 21st century: diabetes mellitus , 2000, The Lancet.

[19]  J. Mckinlay,et al.  Testosterone, sex hormone-binding globulin, and the development of type 2 diabetes in middle-aged men: prospective results from the Massachusetts male aging study. , 2000, Diabetes care.

[20]  P. Lavie,et al.  Disruption of the nocturnal testosterone rhythm by sleep fragmentation in normal men. , 2001, The Journal of clinical endocrinology and metabolism.

[21]  F Vinicor,et al.  The continuing epidemics of obesity and diabetes in the United States. , 2001, JAMA.

[22]  J. Sorkin,et al.  Sleep-disordered breathing and insulin resistance in middle-aged and overweight men. , 2002, American journal of respiratory and critical care medicine.

[23]  J. Manson,et al.  Snoring as a risk factor for type II diabetes mellitus: a prospective study. , 2002, American journal of epidemiology.

[24]  Atul Malhotra,et al.  A prospective study of sleep duration and coronary heart disease in women. , 2003, Archives of internal medicine.

[25]  J. Manson,et al.  A prospective study of self-reported sleep duration and incident diabetes in women. , 2003, Diabetes care.

[26]  A. Araujo,et al.  The health of normally aging men: The Massachusetts Male Aging Study (1987–2004) , 2004, Experimental Gerontology.

[27]  E. Barrett-Connor,et al.  Interrelation between plasma testosterone and plasma insulin in healthy adult men: the Telecom Study , 1992, Diabetologia.