Abstract. Mallon L, Broman J-E, Hetta J (University Hospital, Uppsala, and Falun Hospital, Falun; and Institute of Clinical Neuroscience, Go Èteborg; Sweden). Sleep complaints predict coronary artery disease mortality in males: a 12-year follow-up study of a middle-aged Swedish population. J Intern Med 2002; 251: 207±216.Objectives. Only a few prospective surveys have been performed to investigate the relationship between sleep complaints and coronary artery disease (CAD) mortality. This study was conducted to determine whether sleep complaints in a middleaged population predicted total mortality and CAD mortality. Design. A population-based prospective study. Setting. The County of Dalarna, Sweden. Subjects and methods. In 1983, a random sample of 1870 subjects aged 45±65 years responded to a postal questionnaire (response rate 70.2%) including questions about sleep complaints and various diseases. Mortality data for the period 1983±95 were collected, and Cox proportional hazard analyses were used to examine the mortality risks. Results. At 12-year follow-up 165 males (18.2%) and 101 females (10.5%) had died. After adjustment for a wide range of important putative risk factors, dif®culties initiating sleep (DIS) were related to CAD death in males [relative risk (RR), 3.1; 95% con®d-ence interval (CI), 1.5±6.3; P < 0.01], but not in females. Short or long sleep duration did not in¯uence risk of CAD mortality or total mortality for either gender. Depression in males increased the risk of death attributed to CAD (RR, 3.0; 95% CI, 1.1±8.4; P < 0.05) and total mortality (RR, 2.2; 95% CI, 1.1±4.5; P < 0.05). Conclusion. These results provide evidence that there is an association between dif®culties falling asleep and CAD mortality in males.

A new English instrument for screening mental health in children and adolescents, the Strengths and Difficulties Questionnaire (SDQ), was translated into Swedish and used for parental ratings of 900 children aged 6-10 years from the general population. The SDQ which comprises 25 items, divided into 5 subscales (prosocial, hyperactivity, emotional symptoms, conduct problems, and peer problems) was developed from the Rutter scales. An earlier English validation study has shown the two instruments to have equal ability to identify child psychiatric cases, but the SDQ also provides screening on empathy and prosocial behaviour which are aspects of child development emphasized in current child psychiatry. The design of the SDQ with both strengths' and difficulties' items supposedly increases acceptability of the instrument on behalf of informants and makes the questionnaire especially suitable for studies of general population where the majority of children are healthy. Our results, which are novel findings on the instrument, confirmed the postulated factor structure and showed significant gender-differences in results on the total scale, prosocial and hyperactivity subscales and on some of the single items. Moreover, our investigation showed that a Swedish translation of the parental version of the SDQ worked well.

OBJECTIVE -The aim of this study was to investigate the possible relationship among sleep complaints, sleep duration, and the development of diabetes prospectively over a 12-year period in a middle-aged Swedish population. RESEARCH DESIGN AND METHODS-A random sample of 2,663 subjects aged 45-65 years living in mid-Sweden were sent a postal questionnaire including questions about sleep complaints, sleep duration, sociodemographic characteristics, behavioral risk factors, medical conditions, and depression (response rate 70.2%). Twelve years later, a new questionnaire with almost identical questions was sent to all the survivors (n ϭ 1,604) in 1995, and the questionnaire was answered by 1,244 subjects (77.6%).RESULTS -Men reporting new diabetes at follow-up more often reported short sleep duration (Յ5 h per night) (16.0 vs. 5.9%, P Ͻ 0.01), difficulties initiating sleep (16.0 vs. 3.1%, P Ͻ 0.001), and difficulties maintaining sleep (28.0 vs. 6.3%, P Ͻ 0.001) at baseline than men who did not develop diabetes. Women reporting new diabetes at follow-up reported long sleep duration (Ն9 h per night) more often at baseline than women not developing diabetes (7.9 vs. 2.4%, P Ͻ 0.05). In multiple logistic regression models, the relative risk (95% CI) for development of diabetes was higher in men with short sleep duration (2.8 [1.1-7.3]) or difficulties maintaining sleep (4.8 [1.9 -12.5]) after adjustment for age and other relevant risk factors. Short or long sleep duration or sleep complaints did not influence the risk of new diabetes in women.CONCLUSIONS -Difficulties maintaining sleep or short sleep duration (Յ5 h) are associated with an increased incidence of diabetes in men. Diabetes Care 28:2762-2767, 2005D iabetes is associated with increased frequency of sleep complaints (1-4), and this may be due to the disease itself as well as to physical complications of the disease (3,5). However, sleep disturbances may also play a primary role in the pathophysiology of diabetes. Data have demonstrated that individuals suffering from poor sleep have increased arousal and increased physiological activation (6 -13). Experimentally induced sleep debt has been found to be associated with increased activation in the hypothalamic-pituitary-adrenal axis as indexed by elevated evening cortisol levels and impaired glucose tolerance (14). These findings indicate that disturbance and curtailment of sleep may be risk factors for the development of insulin resistance. The insulin resistance syndrome, also known as the metabolic syndrome, is a cluster of risk factors for adult-onset diabetes, and it usually consists of obesity, dyslipidemia, hyperglycemia, and hypertension (15).In a sample of healthy middle-aged men in Sweden, Nilsson et al. (16) found that difficulties in falling asleep or regular use of hypnotic drugs was associated with development of diabetes when adjustment was made for several risk factors. A 10-year follow-up survey of women aged 30 -55 years enrolled in the Nurses Health Study in the U.S. has shown that both short ...

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