|
 |
|
|||||||
|
|||||||||
© 2004 by the American Diabetes Association, Inc.
Letters: Observations |
Sleep Disturbance and Onset of Type 2 Diabetes
1 Department of Hygiene and Preventive Medicine, Okayama University Graduate School of Medicine and Dentistry, Okayama, Japan
2 Department of Epidemiology and Preventive Medicine, Gifu University School of Medicine, Gifu, Japan
Address correspondence to Prof. Norito Kawakami, Hygiene and Preventive Medicine, Okayama University Graduate School of Medicine and Dentistry, 2-5-1 Shikata-cho, Okayama 700-8558, Japan. E-mail: norito{at}md.okayama-u.ac.jp
Sleep disturbance, which is often observed among patients with diabetes (1), is possibly caused by impaired glucose metabolism or physical and psychological discomfort due to the disorder. In addition, a recent prospective study of women has indicated an interesting association between sleep patterns and later-onset type 2 diabetes, with a greater incidence among both short-term (<6 h) and long-term (>8 h) sleepers (2). Disturbance in sleep quality may also affect the later onset of overt diagnosis of type 2 diabetes. We investigated the association between sleep disturbance and the subsequent onset of type 2 diabetes in a group of Japanese male employees.
We analyzed the database of an 8-year prospective study of male employees of an electrical company in Japan (3). We followed 2,649 male employees with no medical history of diabetes or other chronic illnesses at baseline for 8 years from 1984 to 1992. Data from 2,265 (86%) male respondents, who were thoroughly followed, were analyzed. All subjects received a medical checkup once a year during the follow-up to identify those with type 2 diabetes according to World Health Organization criteria (4). A mailed questionnaire was used to assess sleep disturbance in the previous month at baseline. Two single-item questions were asked concerning difficulty initiating sleep ("Did you have trouble falling asleep?") and difficulty maintaining sleep ("Did you often wake up in the middle of the night?"). The subjects were classified into one of two categories: low for those who indicated "seldom" or "sometimes" and high for those who indicated "often" or "almost everyday" in response to the questions.
During the 18,006 person-year observation, 38 incidents of type 2 diabetes were identified (an incidence rate of 1.68 per 1,000 person-years). Those who experienced a high frequency of difficulty initiating sleep had a significantly higher age-adjusted hazard ratio (2.98, 95% CI 1.36–6.53) for type 2 diabetes compared with those who experienced low-frequency difficulty initiating sleep. A similar hazard ratio was observed for difficulty maintaining sleep (2.23, 1.08–4.61). These hazard ratios were almost identical and were statistically significant after controlling for other factors relevant to type 2 diabetes (i.e., age, education, occupation, shift work, BMI, leisure-time physical activity, smoking, alcohol consumption, and family history of diabetes).
Our analysis demonstrated that those who had sleep disturbances showed a two- to threefold higher risk of later onset type 2 diabetes. The association was independent of known risk factors for type 2 diabetes and was not attributable to treatment for sleep disturbance. Sleep disturbance at baseline was unlikely due to complications or disability from the treatment of diabetes because we excluded subjects with known diabetes at baseline. A possible explanation is that an increased sympathetic nervous activity associated with sleep disturbance (5) causes glucose intolerance (6) and increases the risk of type 2 diabetes. Physicians may need to pay more attention to patients with sleep disturbance because it may indicate a higher risk for type 2 diabetes.
Acknowledgments
This study was supported in part by a grant-in-aid from the Japanese Ministry of Education, Science, and Culture.
References
- Resnick HE, Redline S, Shahar E, Gilpin A, Newman A, Walter R, Ewy GA, Howard BV, Punjabi NM: Diabetes and sleep disturbances: findings from the Sleep Heart Health Study. Diabetes Care 26:702–709, 2003
[Abstract/Free Full Text]
- Ayas NT, White DP, Al-Delaimy WK, Manson JE, Stampfer MJ, Speizer FE, Patel S, Hu FB: A prospective study of self-reported sleep duration and incident diabetes in women. Diabetes Care 26:380–384, 2003
[Abstract/Free Full Text]
- Kawakami N, Takatsuka N, Shimizu H, Ishibashi H: Depressive symptoms and occurrence of type 2 diabetes among Japanese men. Diabetes Care 22:1071–1076, 1999
[Abstract/Free Full Text]
- World Health Organization: WHO Expert Committee on Diabetes Mellitus, Second Report. Geneva, World Health Org., 1981 (Tech. Rep. Ser., no. 646)
- Bonnet MH, Arand DL: Heart rate variability in insomniacs and matched normal sleepers. Psychosom Med 60:610–615, 1998
[Abstract/Free Full Text]
- Gonzalez-Ortiz M, Martinez-Abundis E, Balcazar-Munoz BR, Pascoe-Gonzalez S: Effect of sleep deprivation on insulin sensitivity and cortisol concentration in healthy subjects. Diabetes Nutr Metab 13:80–83, 2000[Medline]
CiteULike 
Del.icio.us 
Digg 
Reddit 
Technorati What's this?
This article has been cited by other articles:
|
|
 |
|
  T. J. Balkin, T. Rupp, D. Picchioni, and N. J. Wesensten Sleep Loss and Sleepiness: Current Issues Chest, September 1, 2008; 134(3): 653 - 660. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 E. Tasali and M. S. M. Ip Obstructive Sleep Apnea and Metabolic Syndrome: Alterations in Glucose Metabolism and Inflammation Proceedings of the ATS, February 15, 2008; 5(2): 207 - 217. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
E. Tasali, B. Mokhlesi, and E. Van Cauter Obstructive Sleep Apnea and Type 2 Diabetes: Interacting Epidemics Chest, February 1, 2008; 133(2): 496 - 506. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 E. Tasali, R. Leproult, D. A. Ehrmann, and E. Van Cauter Slow-wave sleep and the risk of type 2 diabetes in humans PNAS, January 22, 2008; 105(3): 1044 - 1049. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 L.-F. M. Taub and N. S. Redeker Sleep Disorders, Glucose Regulation, and Type 2 Diabetes Biol Res Nurs, January 1, 2008; 9(3): 231 - 243. [Abstract] [PDF]
|
|
|
|
 |
|
 S. M. Schmid, M. Hallschmid, K. Jauch-Chara, N. Bandorf, J. Born, and B. Schultes Sleep Loss Alters Basal Metabolic Hormone Secretion and Modulates the Dynamic Counterregulatory Response to Hypoglycemia J. Clin. Endocrinol. Metab., August 1, 2007; 92(8): 3044 - 3051. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 Z. T. Bloomgarden Insulin Resistance Concepts Diabetes Care, May 1, 2007; 30(5): 1320 - 1326. [Full Text] [PDF]
|
|
|
|
 |
|
 K. L. Knutson, A. M. Ryden, B. A. Mander, and E. Van Cauter Role of sleep duration and quality in the risk and severity of type 2 diabetes mellitus. Arch Intern Med, September 18, 2006; 166(16): 1768 - 1774. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
L. A. Lopes, C. d. M.M. Lins, V. G. Adeodato, D. P. Quental, P. F.C. de Bruin, R. M. Montenegro Jr, and V. M.S. de Bruin Restless Legs Syndrome and Quality of Sleep in Type 2 Diabetes Diabetes Care, November 1, 2005; 28(11): 2633 - 2636. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
L. Mallon, J.-E. Broman, and J. Hetta High Incidence of Diabetes in Men With Sleep Complaints or Short Sleep Duration: A 12-year follow-up study of a middle-aged population Diabetes Care, November 1, 2005; 28(11): 2762 - 2767. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. M. Nilsson, M. Roost, G. Engstrom, B. Hedblad, and G. Berglund Incidence of Diabetes in Middle-Aged Men Is Related to Sleep Disturbances Diabetes Care, October 1, 2004; 27(10): 2464 - 2469. [Abstract] [Full Text] [PDF]
|
|
| |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
| Diabetes | Diabetes Care | Clinical Diabetes | Diabetes Spectrum |