Skip to main content
SpringerLink
Log in

Sleep Duration and the Risk of Diabetes Mellitus: Epidemiologic Evidence and Pathophysiologic Insights

  • Published:
Current Diabetes Reports Aims and scope Submit manuscript

Abstract

Evidence from well-defined cohort studies has shown that short sleep, through sleep fragmentation caused by obstructive sleep apnea (OSA) or behavioral sleep curtailment because of lifestyle choices, is associated with increased incidence of diabetes. In this report, we review epidemiologic and clinical data suggesting that OSA is involved in the pathogenesis of altered glucose metabolism. Evidence suggesting increased risk of developing diabetes resulting from curtailed sleep duration is also considered. Proposed mechanisms explaining associations between short sleep and diabetes are examined and clinical management of OSA among patients with diabetes is discussed.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as follows: • Of importance •• Of major importance

  1. Kripke DF, Garfinkel L, Wingard DL, et al.: Mortality associated with sleep duration and insomnia. Arch Gen Psychiatry 2002, 59:131–136.

    Article  PubMed  Google Scholar 

  2. Patel SR, Ayas NT, Malhotra MR, et al.: A prospective study of sleep duration and mortality risk in women. Sleep 2004, 27:440–444.

    PubMed  Google Scholar 

  3. Tamakoshi A, Ohno Y: Self-reported sleep duration as a predictor of all-cause mortality: results from the JACC study, Japan. Sleep 2004, 27:51–54.

    PubMed  Google Scholar 

  4. National Sleep Foundation: Sleep in American Poll. Washington, DC: National Sleep Foundation; 2008.

    Google Scholar 

  5. Jean-Louis G, Kripke DF, Ancoli-Israel S, et al.: Sleep duration, illumination, and activity patterns in a population sample: effects of gender and ethnicity. Biol Psychiatry 2000, 47:921–927.

    Article  CAS  PubMed  Google Scholar 

  6. Harris MI: Diabetes in America: epidemiology and scope of the problem. Diabetes Care 1998, 21(Suppl 3):C11–C14.

    PubMed  Google Scholar 

  7. Gottlieb DJ, Punjabi NM, Newman AB, et al.: Association of sleep time with diabetes mellitus and impaired glucose tolerance. Arch Intern Med 2005, 165:863–867.

    Article  PubMed  Google Scholar 

  8. Punjabi NM, Polotsky VY: Disorders of glucose metabolism in sleep apnea. Association of sleep time with diabetes mellitus and impaired glucose tolerance. J Appl Physiol 2005, 99:1998–2007.

    Article  CAS  PubMed  Google Scholar 

  9. Jemal A, Ward E, Hao Y, Thun M: Trends in the leading causes of death in the United States, 1970–2002. JAMA 2005, 294:1255–1259.

    Article  CAS  PubMed  Google Scholar 

  10. Young T, Finn L: Epidemiological insights into the public health burden of sleep disordered breathing: sex differences in survival among sleep clinic patients. Thorax 1998, 53(Suppl 3):S16–S19.

    Article  PubMed  Google Scholar 

  11. Young T, Peppard P: Sleep-disordered breathing and cardiovascular disease: epidemiologic evidence for a relationship. Sleep 2000, 23(Suppl 4):S122–S126.

    PubMed  Google Scholar 

  12. Young T, Peppard P, Palta M, et al.: Population-based study of sleep-disordered breathing as a risk factor for hypertension. Arch Intern Med 1997, 157:1746–1752.

    Article  CAS  PubMed  Google Scholar 

  13. Hiestand DM, Britz P, Goldman M, et al.: Prevalence of symptoms and risk of sleep apnea in the US population: results from the national sleep foundation sleep in America 2005 poll. Estimation of the clinically diagnosed proportion of sleep apnea syndrome in middle-aged men and women. Chest 2006, 130:780–786.

    Article  PubMed  Google Scholar 

  14. Hudgel DW: Mechanisms of obstructive sleep apnea. Chest 1992, 101:541–549.

    Article  CAS  PubMed  Google Scholar 

  15. Patil SP, Schneider H, Schwartz AR, Smith PL: Adult obstructive sleep apnea: pathophysiology and diagnosis. Chest 2007, 132:325–337.

    Article  PubMed  Google Scholar 

  16. Pinto JM, Garpestad E, Weiss JW, et al.: Hemodynamic changes associated with obstructive sleep apnea followed by arousal in a porcine model. J Appl Physiol 1993, 75:1439–1443.

    CAS  PubMed  Google Scholar 

  17. Somers VK, Dyken ME, Clary MP, Abboud FM: Sympathetic neural mechanisms in obstructive sleep apnea. J Clin Invest 1995, 96:1897–1904.

    Article  CAS  PubMed  Google Scholar 

  18. Johns MW: A new method for measuring daytime sleepiness: the Epworth sleepiness scale. Sleep 1991, 14:540–545.

    CAS  PubMed  Google Scholar 

  19. El Ad B, Lavie P: Effect of sleep apnea on cognition and mood. Int Rev Psychiatry 2005, 17:277–282.

    Article  PubMed  Google Scholar 

  20. Guilleminault C, Stoohs R, Clerk A, et al.: A cause of excessive daytime sleepiness. The upper airway resistance syndrome. Chest 1993, 104:781–787.

    Article  CAS  PubMed  Google Scholar 

  21. Kiely JL, McNicholas WT, Zgierska A, et al.: Cardiovascular risk factors in patients with obstructive sleep apnoea syndrome. Eur Respir J 2000, 16:128–133.

    Article  CAS  PubMed  Google Scholar 

  22. Wright J, Johns R, Watt I, et al.: Health effects of obstructive sleep apnoea and the effectiveness of continuous positive airways pressure: a systematic review of the research evidence. BMJ 1997, 314:851–860.

    CAS  PubMed  Google Scholar 

  23. Findley LJ, Weiss JW, Jabour ER: Drivers with untreated sleep apnea. A cause of death and serious injury. Arch Intern Med 1991, 151:1451–1452.

    Article  CAS  PubMed  Google Scholar 

  24. Newman AB, Nieto FJ, Guidry U, et al.: Relation of sleep-disordered breathing to cardiovascular disease risk factors: the Sleep Heart Health Study. Am J Epidemiol 2001, 154:50–59.

    Article  CAS  PubMed  Google Scholar 

  25. Stoohs RA, Guilleminault C, Itoi A, Dement WC: Traffic accidents in commercial long-haul truck drivers: the influence of sleep-disordered breathing and obesity. Sleep 1994, 17:619–623.

    CAS  PubMed  Google Scholar 

  26. Lavie P, Herer P, Peled R, et al.: Mortality in sleep apnea patients: a multivariate analysis of risk factors. Sleep 1995, 18:149–157.

    CAS  PubMed  Google Scholar 

  27. Spiegel R, Knudtson K, Leproult R, et al.: Sleep loss: a novel risk factor for insulin resistance and type II diabetes. J Appl Physiol 2005, 99:2008–2019.

    Article  CAS  PubMed  Google Scholar 

  28. Spiegel K, Leproult R, Van Cauter E: Impact of sleep debt on metabolic and endocrine function. Lancet 1999, 354:1435–1439.

    Article  CAS  PubMed  Google Scholar 

  29. Punjabi NM, Sorkin JD, Katzel LI, et al.: Sleep-disordered breathing and insulin resistance in middle-aged and overweight men. Am J Respir Crit Care Med 2002, 165:677–682.

    PubMed  Google Scholar 

  30. Vgontzas AN, Papanicolaou DA, Bixler EO, et al.: Sleep apnea and daytime sleepiness and fatigue: relation to visceral obesity, insulin resistance, and hypercytokinemia. J Clin Endocrinol Metab 2000, 85:1151–1158.

    Article  CAS  PubMed  Google Scholar 

  31. Young T, Peppard PE, Taheri S: Excess weight and sleep-disordered breathing. J Appl Physiol 2005, 99:1592–1599.

    Article  PubMed  Google Scholar 

  32. Shamsuzzaman AS, Winnicki M, Lanfranchi P, et al.: Elevated C-reactive protein in patients with obstructive sleep apnea. Circulation 2002, 105:2462–2464.

    Article  CAS  PubMed  Google Scholar 

  33. Punjabi NM, Ahmed MM, Polotsky VY, et al.: Sleep-disordered breathing, glucose intolerance, and insulin resistance. Respir Physiol Neurobiol 2003, 136:167–178.

    Article  CAS  PubMed  Google Scholar 

  34. Punjabi NM, Shahar E, Redline S, et al.: Sleep-disordered breathing, glucose intolerance, and insulin resistance: the Sleep Heart Health Study. Am J Epidemiol 2004, 160:521–530.

    Article  PubMed  Google Scholar 

  35. Reichmuth KJ, Austin D, Skatrud JB, Young T: Association of sleep apnea and type II diabetes: a population-based study. Am J Respir Crit Care Med 2005, 172:1590–1595.

    Article  PubMed  Google Scholar 

  36. Ayas NT, White DP, Al Delaimy WK, et al.: A prospective study of self-reported sleep duration and incident diabetes in women. Diabetes Care 2003, 26:380–384.

    Article  PubMed  Google Scholar 

  37. • Beihl DA, Liese AD, Haffner SM: Sleep duration as a risk factor for incident type 2 diabetes in a multiethnic cohort. Ann Epidemiol 2009, 19:351–357. This is a study that assessed associations between sleep duration and type 2 diabetes, considering insulin sensitivity and secretion, two important risk factors for diabetes.

  38. Ayas NT, White DP, Manson JE, et al.: A prospective study of sleep duration and coronary heart disease in women. Arch Intern Med 2003, 163:205–209.

    Article  PubMed  Google Scholar 

  39. Mallon L, Broman JE, Hetta J: 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 2005, 28:2762–2767.

    Article  PubMed  Google Scholar 

  40. Nilsson PM, Roost M, Engstrom G, et al.: Incidence of diabetes in middle-aged men is related to sleep disturbances. Diabetes Care 2004, 27:2464–2469.

    Article  PubMed  Google Scholar 

  41. •• Gangwisch JE, Heymsfield SB, Boden-Albala B, et al.: Sleep duration as a risk factor for diabetes incidence in a large U.S. sample. Sleep 2007, 30:1667–1673. This study explored relationships between sleep duration and diabetes incidence over an 8- to 10-year follow-up period in data from the First National Health and Nutrition Examination Survey.

  42. Sanders MH, Givelber R: Sleep disordered breathing may not be an independent risk factor for diabetes, but diabetes may contribute to the occurrence of periodic breathing in sleep. Sleep Med 2003, 4:349–350.

    Article  PubMed  Google Scholar 

  43. Zizi F, Jean-Louis G, Fernandez S, et al.: Sleep duration and risk of diabetes: analysis of the National Health Interview Survey [abstract]. Sleep 2009, 32:152.

    Google Scholar 

  44. Mezuk B, Eaton WW, Albrecht S, Golden SH: Depression and type 2 diabetes over the lifespan: a meta-analysis. Diabetes Care 2008, 31:2383–2390.

    Article  PubMed  Google Scholar 

  45. Anderson RJ, Freedland KE, Clouse RE, Lustman PJ: The prevalence of comorbid depression in adults with diabetes: a meta-analysis. Diabetes Care 2001, 24:1069–1078.

    Article  CAS  PubMed  Google Scholar 

  46. Knol MJ, Twisk JW, Beekman AT, et al.: Depression as a risk factor for the onset of type 2 diabetes mellitus. A meta-analysis. Diabetologia 2006, 49:837–845.

    Article  CAS  PubMed  Google Scholar 

  47. Edinger JD, Hoelscher TJ, Marsh GR, et al.: A cognitive-behavioral therapy for sleep-maintenance insomnia in older adults. Psychol Aging 1992, 7:282–289.

    Article  CAS  PubMed  Google Scholar 

  48. Edinger JD, Carwile S, Miller P, et al.: Psychological status, syndromatic measures, and compliance with nasal CPAP therapy for sleep apnea. Percept Mot Skills 1994, 78:1116–1118.

    CAS  PubMed  Google Scholar 

  49. The American Academy of Sleep Medicine: Practice Parameters. Available at http://www.aasmnet.org/PracticeParameters.aspx. Accessed August 24, 2002.

  50. • Dorkova Z, Petrasova D, Molcanyiova A, et al.: Effects of continuous positive airway pressure on cardiovascular risk profile in patients with severe obstructive sleep apnea and metabolic syndrome. Chest 2008, 134:686–692. This study examined the effects of 8 weeks of continuous positive airway pressure therapy on glucose and lipid profile, systemic inflammation, oxidative stress, and global cardiovascular disease risk among patients with OSA and metabolic syndrome.

  51. Babu AR, Herdegen J, Fogelfeld L, et al.: Type 2 diabetes, glycemic control, and continuous positive airway pressure in obstructive sleep apnea. Arch Intern Med 2005, 165:447–452.

    Article  PubMed  Google Scholar 

  52. McNicholas WT, Javaheri S: Pathophysiologic mechanisms of cardiovascular disease in obstructive sleep apnea. Sleep Med Clin 2007, 2:539–547.

    Article  Google Scholar 

  53. Jean-Louis G, Zizi F, Clark LT, Kossotis J: Associations of sleep apnea to cardiovascular diseases: role of diabetes and metabolic syndrome. In In Cardiovascular Disease and Diabetes: Contemporary Management. Edited by Clark LT. New York: McGraw-Hill; 2007:472–505.

    Google Scholar 

Download references

Disclosure

This research was supported by funding from the National Institutes of Health/National Center on Minority Health and Health Disparities (R01MD004113, P20MD005092). No other potential conflicts of interest relevant to this article were reported.

Author information

Authors and Affiliations

  1. Department of Medicine, SUNY Downstate Medical Center, Box 1199, 450 Clarkson Avenue, Brooklyn, NY, 11203-2098, USA

    Ferdinand Zizi, Girardin Jean-Louis, Clinton D. Brown, Gbenga Ogedegbe, Carla Boutin-Foster & Samy I. McFarlane

Authors
  1. Ferdinand Zizi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Girardin Jean-Louis
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Clinton D. Brown
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Gbenga Ogedegbe
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Carla Boutin-Foster
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Samy I. McFarlane
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Girardin Jean-Louis.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Zizi, F., Jean-Louis, G., Brown, C.D. et al. Sleep Duration and the Risk of Diabetes Mellitus: Epidemiologic Evidence and Pathophysiologic Insights. Curr Diab Rep 10, 43–47 (2010). https://doi.org/10.1007/s11892-009-0082-x

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11892-009-0082-x

Keywords

Search

Navigation