Association between sleep duration and mortality risk among adults with type 2 diabetes: a prospective cohort study

Abstract

Aims/hypothesis This study aimed to investigate whether the effects of sleep duration interacted with the presence of diabetes. We specifically sought to examine the relationship between sleep duration and all-cause and cause-specific mortality in people with type 2 diabetes across sex, age at diagnosis, duration of diabetes and treatment type. Methods The sample consisted of 273,029 adults, including 248,817 without diabetes and 24,212 with type 2 diabetes, who participated in the National Health Interview Survey from 2004 to 2013 and whose data were linked to a mortality database up to 31 December 2015. Sleep duration was measured using self-report, whereby participants were asked ‘on average how long do you sleep each day (≤5, 6, 7, 8, 9 or ≥10 h/day)?’ The relationship between sleep duration and mortality risk was investigated using Cox proportional hazards regression model, with adjustments for demographics, BMI, lifestyle behaviours and clinical variables. Results Absolute mortality rate was higher in adults with diabetes and extremes of sleep duration (≤5 h/day, 215.0 per 10,000 person-years; ≥10 h/day, 363.5 per 10,000 person-years). There was a non-significant interaction between sleep duration and the presence of diabetes (p for interaction = 0.08). A J-shaped relationship existed between sleep duration and all-cause mortality risk in people with type 2 diabetes. Compared with the reference group (7 h/day), both shorter and longer sleep durations were associated with increased risk of all-cause mortality (≤5 h/day, HR 1.24 [95% CI 1.09, 1.40]; 6 h/day, HR 1.13 [1.01, 1.28]; 8 h/day, HR 1.17 [1.06, 1.30]; ≥10 h/day, HR 1.83 [1.61, 2.08]). Similar associations were also observed for mortality risk from CVD, cancer, kidney disease, Alzheimer’s disease and chronic lower respiratory diseases. Longer sleep duration in those with a younger age at diabetes onset was associated with greater risks of all-cause and CVD mortality. Shorter sleep duration in individuals treated with both insulin and oral glucose-lowering medication was also associated with higher risks of all-cause and CVD mortality. Conclusions/interpretation The associations between sleep duration and mortality risk may be different between diabetic and non-diabetic individuals. In people with type 2 diabetes, sleeping less or more than 7 h/day was associated with increased risk of all-cause and condition-specific mortality. The association was more prominent in those with a younger age at diabetes onset and receiving treatment with both oral glucose-lowering medication and insulin. This population may benefit from targeted sleep-related interventions to reduce the risks of adverse health outcomes.

Psychological Distress and All-Cause, Cardiovascular Disease, Cancer Mortality Among Adults with and without Diabetes

“…44 In addition, diabetic people with sleep disturbances have an increased all-cause and cause-specific mortality burden. 45 Among participants with diabetes, we found an association between levels of psychological distress and increased risk of CVD mortality. This finding is consistent with a previous study conducted in diabetic patients, indicating that patients with psychological distress (measured by Mental Health Inventory 5) were at increased risk of all-cause mortality and CVD events.…”

“… 44 In addition, diabetic people with sleep disturbances have an increased all-cause and cause-specific mortality burden. 45 …”

Associations between Intensity, Frequency, Duration, and Volume of Physical Activity and the Risk of Stroke in Middle- and Older-Aged Chinese People: A Cross-Sectional Study

“…Although housework activities may produce health benefits, women sleeping for a short or long duration have a higher possibility of poor health [ 38 ]. Additionally, women have many sleep problems in China [ 39 , 40 ]. Therefore, the association between MPA with a duration of ≥240 min/d and the risk of stroke in women was not found.…”

Effectiveness of a customised mobile phone text messaging intervention supported by data from activity monitors for improving lifestyle factors related to the risk of type 2 diabetes among women after gestational diabetes: protocol for a multicentre randomised controlled trial (SMART MUMS with smart phones 2)

“…There is increasing evidence that various parameters of sleep including duration, fragmentation, latency, regularity and chronotype are associated with T2DM, glycaemic control and mortality. [45][46][47][48] Sleep is also related to PA 49 and diet 50 which are two pillars in lifestyle interventions in management of T2DM. Activity monitors can provide greater granularity and duration of data than has been achieved in previous studies using clinically validated actigraphy.…”