The Association of Sleep Disorder, Obesity Status, and Diabetes Mellitus among US Adults—The NHANES 2009-2010 Survey Results

To examine the association between sleep disorders, obesity status, and the risk of diabetes in adults, a total of 3668 individuals aged 40+ years from the NHANES 2009-2010 without missing information on sleep-related questions, measurements related to diabetes, and BMI were included in this analysis. Subjects were categorized into three sleep groups based on two sleep questions: (a) no sleep problems; (b) sleep disturbance; and (c) sleep disorder. Diabetes was defined as having one of a diagnosis from a physician; an overnight fasting glucose > 125 mg/dL; Glycohemoglobin > 6.4%; or an oral glucose tolerance test > 199 mg/dL. Overall, 19% of subjects were diabetics, 37% were obese, and 32% had either sleep disturbance or sleep disorder. Using multiple logistic regression models adjusting for covariates without including BMI, the odds ratios (OR, (95% CI)) of diabetes were 1.40 (1.06, 1.84) and 2.04 (1.40, 2.95) for those with sleep disturbance and with sleep disorder, respectively. When further adjusting for BMI, the ORs were similar for those with sleep disturbance 1.36 (1.06, 1.73) but greatly attenuated for those with sleep disorders (1.38 [0.95, 2.00]). In conclusion, the impact of sleep disorders on diabetes may be explained through the individuals' obesity status.

[1]  S. Yanovski,et al.  Obesity prevalence in the United States--up, down, or sideways? , 2011, The New England journal of medicine.

[2]  J. Pépin,et al.  Sleep deprivation, sleep apnea and cardiovascular diseases. , 2012, Frontiers in bioscience.

[3]  Claude Bouchard,et al.  Clinical guidelines on the identification, evaluation, and treatment of overweight and obesity in adults. , 1998, WMJ : official publication of the State Medical Society of Wisconsin.

[4]  David Kelley,et al.  Obstructive Sleep Apnea Among Obese Patients With Type 2 Diabetes , 2009, Diabetes Care.

[5]  K. Jones.  Role of Obesity in Complicating and Confusing the Diagnosis and Treatment of Diabetes in Children , 2008, Pediatrics.

[6]  Rachel Leproult,et al.  HIGHLIGHTED TOPIC Physiology and Pathophysiology of Sleep Apnea Sleep loss: a novel risk factor for insulin resistance and Type 2 diabetes , 2022 .

[7]  Role of Insulin Resistance in Human Disease , 1997 .

[8]  T. Murase,et al.  Association of short sleep duration with obesity, diabetes, fatty liver and behavioral factors in Japanese men. , 2011, Internal medicine.

[9]  D. Williamson,et al.  The relative contributions of different levels of overweight and obesity to the increased prevalence of diabetes in the United States: 1976-2004. , 2007, Preventive medicine.

[10]  K. Strohl,et al.  Physical Exercise as an Adjunct Therapy in Sleep Apnea—An Open Trial , 2000, Sleep and Breathing.

[11]  K. Rother,et al.  Annals of the New York Academy of Sciences Interacting Epidemics? Sleep Curtailment, Insulin Resistance, and Obesity , 2022 .

[12]  The association of sleep duration and type 2 diabetes in Korean male adults with abdominal obesity: the Korean National Health and Nutrition Examination Survey 2005. , 2009, Diabetes research and clinical practice.

[13]  Jing Zhao,et al.  Relation of sleep quality and sleep duration to type 2 diabetes: a population-based cross-sectional survey , 2012, BMJ Open.

[14]  G. Reaven.  Banting lecture 1988. Role of insulin resistance in human disease. , 1988, Diabetes.

[15]  S. Heymsfield,et al.  Waist circumference and obesity-associated risk factors among whites in the third National Health and Nutrition Examination Survey: clinical action thresholds. , 2002, The American journal of clinical nutrition.

[16]  E. van Cauter,et al.  Associations between Sleep Loss and Increased Risk of Obesity and Diabetes , 2008, Annals of the New York Academy of Sciences.

[17]  B. Mezuk,et al.  Association between duration and quality of sleep and the risk of pre‐diabetes: evidence from NHANES , 2013, Diabetic medicine : a journal of the British Diabetic Association.

[18]  B. A. Phillips.  Long-term Cardiovascular Outcomes in Men With Obstructive Sleep Apnoea-Hypopnoea With or Without Treatment With Continuous Positive Airway Pressure: An Observational Study , 2007 .

[19]  S. Tufik,et al.  Obesity, diabetes and OSAS induce of sleep disorders: Exercise as therapy , 2011, Lipids in Health and Disease.

[20]  D. Jacobs,et al.  Comparison of body mass index, waist circumference, and waist/hip ratio in predicting incident diabetes: a meta-analysis. , 2007, Epidemiologic reviews.

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

[22]  G. Reaven.  Role of Insulin Resistance in Human Disease , 1988, Diabetes.

[23]  G. Reaven.  Banting lecture 1988 , 1997 .

[24]  J. Broman,et al.  High incidence of diabetes in men with sleep complaints or short sleep duration: a 12-year follow-up study of a middle-aged population. , 2005, Diabetes care.

[25]  Nader Rifai,et al.  Effect of sleep loss on C-reactive protein, an inflammatory marker of cardiovascular risk. , 2004, Journal of the American College of Cardiology.

[26]  J. Cairney,et al.  Sleep difficulties and obesity among preadolescents. , 2011, Canadian journal of public health = Revue canadienne de sante publique.

[27]  Treatment of Obesity in Adults.  Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults--The Evidence Report. National Institutes of Health. , 1998, Obesity research.

[28]  Pasquale Strazzullo,et al.  Sleep duration predicts cardiovascular outcomes: a systematic review and meta-analysis of prospective studies. , 2011, European heart journal.

[29]  W. Mendelson,et al.  Sleep latency and duration estimates among sleep disorder patients: variability as a function of sleep disorder diagnosis, sleep history, and psychological characteristics. , 2000, Sleep.

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

[31]  Y. Saijo,et al.  Short Sleep Duration and Poor Sleep Quality Increase the Risk of Diabetes in Japanese Workers With No Family History of Diabetes , 2012, Diabetes Care.

[32]  S. Redline,et al.  Association of physical activity with sleep-disordered breathing , 2007, Sleep and Breathing.

[33]  P. O S I T I O N S T A T E M E N T,et al.  Diagnosis and Classification of Diabetes Mellitus , 2011, Diabetes Care.

[34]  T. Kitazono,et al.  Impact of Sleep Duration on Obesity and the Glycemic Level in Patients With Type 2 Diabetes , 2013, Diabetes Care.

[35]  M. Kenward,et al.  Multiple imputation for missing data in epidemiological and clinical research: potential and pitfalls , 2009, BMJ : British Medical Journal.

[36]  C. Björkelund,et al.  Sleep disturbances in midlife unrelated to 32-year diabetes incidence: the prospective population study of women in Gothenburg. , 2005, Diabetes care.