Table 4.
A summary of prospective studies that have examined the relationship between sleep features and diabetes outcomes
| First author (year) | Sample/country | Study design | Sleep measure | Diabetes measure | Covariates | Findings |
|---|---|---|---|---|---|---|
| Gangwisch (2007) [21] | 8992; aged 32–86 years; US | Prospective cohort with 10-year follow-up data | Self-reported sleep duration (h) from questionnaire | IDM cases from physician/hospital diagnosis/T2DM death | Physical activity, depression, alcohol, ethnicity, education, marital status, age, overweight/obesity, hypertension | IDM ≤5 h 1.47*; IDM ≥9 h 1.52* |
| Ayas (2003) [24] | 70,026 (women) aged 30–55 years at baseline; US | Prospective cohort with 1-year follow-up IDM data | Self-reported sleep duration (h) from questionnaire | Self-reported by questionnaire (diagnosis/symptoms) | Age, smoking, hypertension, alcohol, physical activity, menopause, depression, family history of T2DM, hypercholesterolemia | IDM ≤5 h OR 1.29*; IDM ≥9 h OR 1.32*; adjustment for BMI resulted in nonsignificant association for short sleepers |
| Nilsson (2004) [59] | 6599 men; mean age 45 years; Sweden | Prospective cohort with mean follow-up of 15 years | Self-reported sleep difficulties from questionnaire (hypnotics/difficulty falling to sleep | Self-reported from questionnaire with objective verification in subsample (n = 1551) | Age, BMI, baseline glucose, length of follow-up, lifestyle, family history of diabetes, social | One of the two sleep features 1.52*; both sleep features 1.78 |
| Meisinger (2005) [53] | 4140 men; 4129 women; aged 25–74 years; Germany | Prospective cohort study with 7.5-year follow-up | Self-reported: (1) difficulty initiating sleep and (2) difficulty maintaining sleep | Self-reported from questionnaire and validated with hospital records | Age, survey, education, parental history, smoking, alcohol, hypertension, physical activity, dyslipidemia, history of angina, BMI | DIS in women OR 1.42, in men OR 1.10; DMS in women OR 1.98*, in men OR 1.60* |
| Yaggi (2006) [25] | 1139 men, aged 40–70 years; US | Prospective cohort with 15-year follow-up | Self-reported sleep duration | Self-reported physician diagnosis at follow-up to determine IDM | Age, hypertension, smoking, self-rated health, waist circumference, education | IDM ≤5 h OR 1.95; 6 h OR 1.95*; > 8 h OR 3.12* |
| Hayashino (2007) [26] | 6509 (26.1% women); aged 19–69 years; Japan | Prospective cohort study with median follow-up of 4.2 years | Self-reported sleep duration and difficulty initiating sleep from questionnaire | Fasted/non-fasted blood glucose level to determine IDM | Age, gender, smoking, hypertension, high cholesterol, potential history of T2DM, physical activity, intervention, BMI | No association with sleep duration; dose-dependent relationship between IDM and DIS |
| Beihl (2009) [29] | 390 men, 510 women; aged 40–69 years at baseline; US | Prospective study with 5-year follow-up | Researcher-led questionnaire with ≤7 h as ‘short sleep’ and ≥9 h as ‘long sleep’ | Fasted blood sample, OGTT and IVGTT to determine normal glucose, IGT or T2DM and insulin sensitivity as well as insulin response. IDM determined at 5-year follow-up | Age, sex, glucose tolerance at baseline, study site, hypertension, family history of diabetes, smoking, education, BMI, insulin sensitivity and acute insulin response | Non-Hispanic white/Hispanic ≤7 h OR 2.36* and ≥9 h OR 2.15; African Americans no significant association |
| Chaput (2009) [30] | 117 men, 159 women; aged 21–64 years; Canada | Prospective study with 6-year follow-up | Self-administered questionnaire with ≤6 h (short) 7–8 h (referent) and ≥9 h (long) | OGTT following overnight fast. AUC for glucose and insulin as well as HOMA-IR was calculated. T2DM and IGT determined using ADA/WHO criteria. IDM also determined | Age, smoking, employment status, income, shift-work history, resting metabolic rate, caffeine, physical activity, WC/BMI/BF% | IDM/IGT RR = 2.42* in those ≤6 h and RR = 2.31* in those ≥9 h |
| Olsson (2012) [107] | 53,394 without T2DM; aged ≥20 years; Norway | Prospective cohort followed for 11–22 years | Self-reported sleep disturbance, sleep initiation, sleep maintenance | IDM (n = 2344; n = 1895 T2DM) identified by follow-up questionnaire | Age, BMI | Men had 25% increased risk of incident T2DM with sleep disturbance |
| Boyko (2013) [22] | 47,093 (25.6% women); mean age 35 years; US | Prospective cohort study of US military with 6-year follow-up | Self-reported trouble sleeping, sleep duration | Self-reported IDM (n = 871) | Age, sex, race/ethnicity, education, BMI | Trouble sleeping at baseline had 45% increased risk of IDM; short sleep duration also associated with IDM |
| Holliday (2013) [23] | 192,728 sample; aged ≥45 years free of T2DM at baseline; Australia | Prospective cohort study | Self-reported sleep duration | Self-reported IDM, verified through medical records based on overnight hospital admission (n = 4648) | Age, sex, education, marital status, residential remoteness, alcohol, smoking, health insurance status, income, BMI, physical activity, baseline health status | HR = 1.23* for IDM with <6 h sleep duration |
| Heianza (2014) [20] | 38,987 without T2DM at baseline; aged 18–83 years; Japan | Prospective cohort study with 8-year follow-up | Self-reported sleep duration | Fasting blood sample to determine glucose and HbA1c; IDM after 8-year follow-up n = 2085 | Sex, physical activity, smoking, alcohol, occupation/shift work, BMI, dyslipidemia, hypertension, IFG | Short sleep (<5.5 h) duration for IDM OR 1.53* |
| Gutierrez-Repiso (2014) [28] | 1145; aged 18–65 years; Spain | Prospective cohort study with 6-year (n = 968) and 11-year (n = 673) follow-up | Self-reported sleep duration | OGTT in those unaware of T2DM status to determine HOMA-IR | Age, sex, physical activity, smoking, weight gain, abnormal glucose regulation at baseline | No association between sleep duration and IDM after adjustment at 6 or 11 years |
| Bjorkelund (2005) [27] | 1462 women born 1908–1930; Sweden | Prospective study with 32-year follow-up | Self-reported sleep duration, problems, medications | IDM determined by fasting blood/plasma glucose | Age, BMI, waist-hip ratio, subscapular skinfold, physical activity, triglycerides, blood pressure, socioeconomic group, education | No association between any sleep feature and IDM |
IDM incident diabetes mellitus, BMI body mass index, DIS difficulty initiating sleep, DMS difficulty maintaining sleep, OGTT oral glucose tolerance test, IVGTT intravenous glucose tolerance test, T2DM type 2 diabetes mellitus, OR odds ratio, IGT impaired glucose tolerance, RR relative risk, AUC area under curve, HOMA-IR homeostasis model assessment-insulin resistance, ADA American Diabetes Association, WHO World Health Organization, WC waist circumference, BF% body fat percent, HR hazard ratio
* p < 0.05