Short Sleep Duration Is Associated with Risk of Future Diabetes but Not Cardiovascular Disease: a Prospective Study and Meta-Analysis

Holliday, Elizabeth G.; Magee, Christopher A.; Kritharides, Leonard; Banks, Emily; Attia, John

doi:10.1371/journal.pone.0082305

Cited by 146 publications

(103 citation statements)

References 36 publications

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“…The associations between sleep duration and incident CHD directly reflect the associations between sleep duration and incident diabetes, and when taken together with the strong association between sleep duration and diabetes-CHD, our study convincingly demonstrates that incident diabetes is the most probable explanatory biological mechanism for the positive associations found between sleep duration and CHD. The association between short sleep duration and incident diabetes in our study is consistent with previous prospective findings [1][2][3][4][5][6][7]. Although both BMI and hypertension have been mentioned as possible mediators [6] for the association between short sleep duration and incident diabetes, the association between short sleep duration and incident diabetes in our study persisted in both men and women despite BMIstratified analyses and adjustment for a large number of known diabetes risk factors and covariates, including hypertension.…”

Section: Discussionsupporting

confidence: 92%

Incident diabetes mellitus may explain the association between sleep duration and incident coronary heart disease

Svensson

Kitliński

et al. 2017

Diabetologia

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Aims/hypothesis Sleep duration is a risk factor for incident diabetes mellitus and CHD. The primary aim of the present study was to investigate, in sex-specific analyses, the role of incident diabetes as the possible biological mechanism for the reported association between short/long sleep duration and incident CHD. Considering that diabetes is a major risk factor for CHD, we hypothesised that any association with sleep duration would not hold for cases of incident CHD occurring before incident diabetes ('non-diabetes CHD') but would hold true for cases of incident CHD following incident diabetes ('diabetes-CHD'). Methods A total of 6966 men and 9378 women aged 45-73 years from the Malmö Diet Cancer Study, a populationbased, prospective cohort, who had answered questions on habitual sleep duration and did not have a history of prevalent diabetes or CHD were included in the analyses. Incident cases of diabetes and CHD were identified using national registers. Sex-specific Cox proportional hazards regression models were stratified by BMI and adjusted for known covariates of diabetes and CHD. Results Mean follow-up times for incident diabetes (n = 1137/ 1016 [men/women]), incident CHD (n = 1170/578), nondiabetes CHD (n = 1016/501) and diabetes-CHD (n = 154/ 77) were 14.2-15.2 years for men, and 15.8-16.5 years for women. In men, short sleep duration (< 6 h) was associated with incident diabetes (HR 1.35, 95% CI 1.01, 1.80), CHD (HR 1.41, 95% CI 1.06, 1.89) and diabetes-CHD (HR 2.34, 95% CI 1.20, 4.55). Short sleep duration was not associated with incident non-diabetes CHD (HR 1.35, 95% CI 0.98, 1.87). Long sleep duration (≥ 9 h) was associated with incident diabetes (HR 1.37, 95% CI 1.03, 1.83), CHD (HR 1.33, 95% CI 1.01, 1.75) and diabetes-CHD (HR 2.10, 95% CI 1.11, 4.00). Long sleep duration was not associated with incident non-diabetes CHD (HR 1.33, 95% CI 0.98, 1.80). In women, short sleep duration was associated with incident diabetes (HR 1.53, 95% CI 1.16, 2.01), CHD (HR 1.46, 95% CI 1.03, 2.07) and diabetes-CHD (HR 2.88, 95% CI 1.37, 6.08).Akiko Kishi Svensson and Thomas Svensson contributed equally to this study. Electronic supplementary materialThe online version of this article (https://doi.org/10.1007/s00125-017-4464-3) contains peer-reviewed but unedited supplementary material, which is available to authorised users.

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Section: Discussionsupporting

confidence: 92%

Incident diabetes mellitus may explain the association between sleep duration and incident coronary heart disease

Svensson

Kitliński

et al. 2017

Diabetologia

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“…Such high rates of insufficient sleep duration are of particular concern given increasing reports of prospective associations between short sleep duration and increased risk of adverse health outcomes, including cardiovascular diseases, diabetes, and mortality. [23][24][25] Roughly half of the population reported "fairly bad or very bad" sleep quality in the past month, suggesting that poor sleep quality is a highly salient problem in this population. Notably, poor sleep quality and insomnia-related symptoms have also been prospectively linked with adverse cardiometabolic outcomes in communitybased population studies.…”

Section: Discussionmentioning

confidence: 99%

Sleep Disturbances and Nocturnal Symptoms: Relationships with Quality of Life in a Population-Based Sample of Women with Interstitial Cystitis/Bladder Pain Syndrome

Troxel

Booth

Buysse

et al. 2014

Journal of Clinical Sleep Medicine

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Study Objectives: To characterize the nature and impact of sleep disturbances on quality of life (QOL) in women with interstitial cystitis/bladder pain syndrome (IC/BPS). Methods: Participants were 3,397 women from a telephone probability survey who met IC/BPS symptom criteria. Sleep quality, duration, and IC/BPS nocturnal symptoms (i.e., trouble sleeping due to bladder pain, urgency, or needing to use the bathroom), general QOL (mental and physical health and sexual functioning), and IC/BPS QOL impairment were assessed via self-report during telephone interview. Results: Over half of the sample reported poor sleep quality, sleep duration ≤ 6 hours, or trouble sleeping due to IC/BPS symptoms. After covariate adjustment, short sleep duration was signifi cantly associated with greater IC/BPS QOL impairment (β = -0.04; p < 0.001) and poorer self-reported physical health (β = 1.86; p < 0.001). Poor sleep quality was signifi cantly associated with greater IC/BPS QOL impairment (β = 0.06; p < 0.001), poorer self-reported physical health (β = -2.86; p < 0.001), and greater sexual dysfunction (β = -0.04; p < 0.05).IC/BPS nocturnal symptoms were signifi cantly associated with greater IC/BPS impairment (β = 0.14; p < 0.001), poorer physical health (β = -2.76; p < 0.001) and mental health (β = 0.52; p < 0.01), and greater sexual dysfunction (β = -0.10; p < 0.001), after covariate adjustment. After further adjustment for IC/BPS nocturnal symptoms, we found that poor sleep quality and short sleep duration were independent correlates of poor self-reported physical health. Conclusions: Poor sleep quality and short sleep duration, as well as disorder-specifi c sleep disturbances, are highly prevalent in women with IC/BPS and are associated with poorer disease-specifi c and general QOL. S C I E N T I F I C I N V E S T I G A T I O N SI nterstitial cystitis (IC)/ bladder pain syndrome (BPS) is a chronic pain syndrome which disproportionately affects women and is characterized by symptoms of urinary urgency and frequency, pelvic pain, and nocturia.1 The etiology and pathophysiology of IC/BPS are currently unknown; however, prevailing theories implicate chronic or subclinical infection, autoimmunity, neurogenic infl ammation, or bladder urothelial defects (i.e., epithelial lining of the urinary tract) as potential mechanisms. 2In the absence of known or measurable pathophysiological biomarkers, the clinical diagnosis of IC/BPS is based on patient-reported symptoms, and many cases remain undiagnosed. For instance, in the RAND Interstitial Cystitis Epidemiology (RICE) Study (from which the current data are drawn), a nationally representative population survey, up to 6.5% of US women reported experiencing IC/BPS symptoms according to established case criteria, but less than 10% of these women had an IC/BPS diagnosis.3 Adding to the diagnostic uncertainty is the considerable symptom overlap and comorbidity between IC/BPS and other chronic pain conditions, such as fi bromyalgia, chronic fatigue syndrome, and irritable bowel syndrome (IB...

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“…Whereas sleep duration is generally not considered a traditional risk factor for cardiovascular disease (CVD), growing evidence supports its association with cardiovascular risk (CVR) factors2, 3, 4, 5, 6, 7 and disease,8, 9, 10, 11 and quality of sleep appears to contribute to CVR 10, 12. Yet, current guidelines for the risk reduction of CVD make limited recommendations about quality or duration of sleep 13, 14…”

Section: Introductionmentioning

confidence: 99%

Self‐Reported Sleep Duration and Quality and Cardiovascular Disease and Mortality: A Dose‐Response Meta‐Analysis

Kwok

Kontopantelis

Kuligowski

et al. 2018

JAHA

331

227

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BackgroundThere is growing evidence that sleep duration and quality may be associated with cardiovascular harm and mortality.Methods and ResultsWe conducted a systematic review, meta‐analysis, and spline analysis of prospective cohort studies that evaluate the association between sleep duration and quality and cardiovascular outcomes. We searched MEDLINE and EMBASE for these studies and extracted data from identified studies. We utilized linear and nonlinear dose‐response meta‐analysis models and used DerSimonian–Laird random‐effects meta‐analysis models of risk ratios, with inverse variance weighting, and the I2 statistic to quantify heterogeneity. Seventy‐four studies including 3 340 684 participants with 242 240 deaths among 2 564 029 participants who reported death events were reviewed. Findings were broadly similar across both linear and nonlinear dose‐response models in 30 studies with >1 000 000 participants, and we report results from the linear model. Self‐reported duration of sleep >8 hours was associated with a moderate increased risk of all‐cause mortality, with risk ratio, 1.14 (1.05–1.25) for 9 hours, risk ratio, 1.30 (1.19–1.42) for 10 hours, and risk ratio, 1.47 (1.33–1.64) for 11 hours. No significant difference was identified for periods of self‐reported sleep <7 hours, whereas similar patterns were observed for stroke and cardiovascular disease mortality. Subjective poor sleep quality was associated with coronary heart disease (risk ratio, 1.44; 95% confidence interval, 1.09–1.90), but no difference in mortality and other outcomes.ConclusionsDivergence from the recommended 7 to 8 hours of sleep is associated with a higher risk of mortality and cardiovascular events. Longer duration of sleep may be more associated with adverse outcomes compared with shorter sleep durations.

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Short Sleep Duration Is Associated with Risk of Future Diabetes but Not Cardiovascular Disease: a Prospective Study and Meta-Analysis

Cited by 146 publications

References 36 publications

Incident diabetes mellitus may explain the association between sleep duration and incident coronary heart disease

Incident diabetes mellitus may explain the association between sleep duration and incident coronary heart disease

Sleep Disturbances and Nocturnal Symptoms: Relationships with Quality of Life in a Population-Based Sample of Women with Interstitial Cystitis/Bladder Pain Syndrome

Self‐Reported Sleep Duration and Quality and Cardiovascular Disease and Mortality: A Dose‐Response Meta‐Analysis

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