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Diabetes Care 28:2739-2744, 2005
© 2005 by the American Diabetes Association, Inc.

Metabolic Syndrome/Insulin Resistance Syndrome/Pre-Diabetes
Original Article

Sleep Disturbances in Midlife Unrelated to 32-Year Diabetes Incidence

The prospective Population Study of Women in Gothenburg

Cecilia Björkelund, MD, PHD1, Dorota Bondyr-Carlsson, MD1, Leif Lapidus, MD, PHD1,2, Lauren Lissner, MD, PHD1,3, Jörgen Månsson, MD, PHD1,4, Ingmar Skoog, MD, PHD5 and Calle Bengtsson, MD, PHD1

1 Department of Primary Health Care, The Sahlgrenska Academy at Göteborg University, Göteborg, Sweden
2 Department of Internal Medicine, The Sahlgrenska Academy at Göteborg University, Göteborg, Sweden
3 Nordic School of Public Health, Göteborg, Sweden
4 Primary Health Care Centre "Husläkarna i Kungsbacka," Kungsbacka, Sweden
5 Institute of Clinical Neurosciences, The Sahlgrenska Academy at Göteborg University, Göteborg, Sweden

Address correspondence and reprint requests to Cecilia Björkelund, Professor, Department of Primary Health Care, P.O. Box 454, SE-405 30 Göteborg, Sweden. E-mail: cecilia.bjorkelund{at}allmed.gu.se

OBJECTIVE—To study the relation between diabetes incidence and sleep problems in a population-based sample of women followed for 32 years.

RESEARCH DESIGN AND METHODS—The researchers conducted a prospective population study initiated in 1968–1969, with follow-ups in 1974–1975, 1980–1981, 1992–1993, and 2000–2001 in Gothenburg, Sweden. A total of 1,462 women born in 1908, 1914, 1918, 1922, and 1930, representative of women of the same ages in the general population, initially participated (90% participation rate). Reported sleep duration, sleep problems, and use of sleeping medication were related to incident diabetes from 1968 to 2000. Associations between sleep problems and diabetes were corrected for waist-to-hip ratio (WHR), BMI, subscapular skinfold, fasting blood glucose and serum lipid concentrations, blood pressure, heart rate, smoking, physical activity, education, and socioeconomic status. Additionally, associations between BMI, WHR, and sleep problems were examined.

RESULTS—Over 32 years, 126 women (8.7%) developed diabetes. Associations between diabetes and initial sleep problems were tested in a Cox regression analysis, taking into consideration factors associated (P < 0.1) with diabetes. Sleep problems in 1968 did not increase risk of developing diabetes during the following 32 years. Obesity, particularly centralized, was associated with sleep problems.

CONCLUSIONS—No association between sleep problems and developing diabetes was seen in this 32-year follow-up of middle-aged women. Obesity, on the other hand, known to cause increased risk of diabetes, was associated with current sleep problems.

Abbreviations: HPA, hypothalamic-pituitary-adrenal • OSA, obstructive sleep apnea • WHR, waist-to-hip ratio


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