Wang T, Lu J, Wang W, Mu Y, Zhao J, Liu C, Chen L, Shi L, Li Q, Yang T, Yan L, Wan Q, Wu S, Liu Y, Wang G, Luo Z, Tang X, Chen G, Huo Y, Gao Z, Su Q, Ye Z, Wang Y, Qin G, Deng H, Yu X, Shen F, Chen L, Zhao L, Xu M, Sun J, Bi Y, Lai S, Bloomgarden Z T, Li D, Ning G
State Key Laboratory of Medical Genomics, Key Laboratory for Endocrine and Metabolic Diseases of Ministry of Health, National Clinical Research Center for Metabolic Diseases, Collaborative Innovation Center of Systems Biomedicine and Shanghai Clinical Center for Endocrine and Metabolic Diseases, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Chinese People's Liberation Army General Hospital, Beijing, China.
Diabet Med. 2015 Aug;32(8):1001-7. doi: 10.1111/dme.12809. Epub 2015 Jun 12.
Few studies have analysed the effect of sleep duration and snoring on hypertension and glycaemic control in patients with diabetes. This study aims to investigate the relationship of sleep duration and snoring on prevalent hypertension and glycaemic control in people with diabetes.
In the baseline survey of the REACTION study, 56 032 patients with diabetes were categorized into four groups according to self-reported sleep duration: < 6, 6-7.9, 8-8.9 and ≥ 9 h. Snoring frequency was evaluated as 'usually', 'occasionally' or 'never'. Hypertension was assessed by systolic blood pressure, diastolic blood pressure, self-reported previous diagnosis and antihypertensive medications. 'Good' glycaemic control was defined as HbA1c < 53 mmol/mol (7.0%) and 'poor' glycaemic control as HbA1c ≥ 53 mmol/mol (7.0%).
Controlling for potential confounders and intermediates, sleep ≥ 9 h relative to intermediate sleep (6-7.9 h) was significantly associated with prevalent hypertension (OR: 1.25, 95% CI: 1.18-1.32) and poor glycaemic control (OR: 1.11, 95% CI: 1.05-1.18), and a U-shaped association was found between sleep duration and prevalent hypertension (P for quadratic trend = 0.019). Usually snoring was positively associated with prevalent hypertension (OR: 1.30, 95% CI: 1.23-1.37), whereas the association between snoring and poor glycaemic control was only on the borderline of statistical significance.
Compared with a sleep duration of 6-7.9 h, longer sleep duration was associated with a higher prevalence of hypertension and poor glycaemic control in people with diabetes. Moreover, the relationship between sleep duration and prevalent hypertension was U-shaped. These findings may propose important public health implications for diabetes management.
很少有研究分析睡眠时间和打鼾对糖尿病患者高血压及血糖控制的影响。本研究旨在探讨睡眠时间和打鼾与糖尿病患者中高血压患病率及血糖控制之间的关系。
在REACTION研究的基线调查中，56032例糖尿病患者根据自我报告的睡眠时间分为四组：<6小时、6 - 7.9小时、8 - 8.9小时和≥9小时。打鼾频率评估为“经常”“偶尔”或“从不”。通过收缩压、舒张压、自我报告的既往诊断及降压药物来评估高血压。“良好”的血糖控制定义为糖化血红蛋白<53 mmol/mol（7.0%），“不佳”的血糖控制定义为糖化血红蛋白≥53 mmol/mol（7.0%）。
在控制潜在混杂因素和中介因素后，与中等睡眠时间（6 - 7.9小时）相比，睡眠时间≥9小时与高血压患病率显著相关（比值比：1.25，95%置信区间：1.18 - 1.32）以及血糖控制不佳相关（比值比：1.11，95%置信区间：1.05 - 1.18），并且发现睡眠时间与高血压患病率之间呈U型关联（二次趋势P值 = 0.019）。经常打鼾与高血压患病率呈正相关（比值比：1.30，95%置信区间：1.23 - 1.37），而打鼾与血糖控制不佳之间的关联仅处于统计学意义的临界值。
与6 - 7.9小时的睡眠时间相比，较长的睡眠时间与糖尿病患者中高血压患病率较高及血糖控制不佳相关。此外，睡眠时间与高血压患病率之间的关系呈U型。这些发现可能对糖尿病管理具有重要的公共卫生意义。
