Department of Epidemiology and Biostatistics, School of Health Sciences, Wuhan University, 185 Donghu Road, Wuchang District, Wuhan, 430071, Hubei, China.
School of Nursing, Guangdong Pharmaceutical University, Guangzhou, China.
Diabetologia. 2020 Nov;63(11):2292-2304. doi: 10.1007/s00125-020-05214-4. Epub 2020 Jul 16.
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.
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.
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. Graphical abstract.
目的/假设：本研究旨在探讨睡眠时长的影响是否与糖尿病的存在有关。我们特别研究了睡眠时长与 2 型糖尿病患者全因和特定原因死亡率之间的关系，考虑了性别、诊断时的年龄、糖尿病病程和治疗类型的因素。
该样本包括 273029 名成年人，其中 248817 名无糖尿病，24212 名患有 2 型糖尿病。他们参加了 2004 年至 2013 年的全国健康访谈调查，并将其数据与截至 2015 年 12 月 31 日的死亡率数据库进行了关联。睡眠时长通过自我报告进行测量，参与者被问及“平均每天睡多长时间（≤5、6、7、8、9 或≥10 小时/天）？”使用 Cox 比例风险回归模型研究睡眠时长与死亡率风险之间的关系，调整了人口统计学、BMI、生活方式行为和临床变量。
糖尿病患者和睡眠时长极端（≤5 小时/天，215.0 人年；≥10 小时/天，363.5 人年）的成年人死亡率绝对更高。睡眠时长与糖尿病存在之间存在无统计学意义的交互作用（p 交互=0.08）。2 型糖尿病患者的睡眠时长与全因死亡率风险呈 J 形关系。与参考组（7 小时/天）相比，较短和较长的睡眠时长均与全因死亡率风险增加相关（≤5 小时/天，HR 1.24[95%CI 1.09，1.40]；6 小时/天，HR 1.13[1.01，1.28]；8 小时/天，HR 1.17[1.06，1.30]；≥10 小时/天，HR 1.83[1.61，2.08]）。同样观察到与心血管疾病、癌症、肾脏疾病、阿尔茨海默病和慢性下呼吸道疾病死亡率风险的相关关系。糖尿病发病年龄较小的患者中，较长的睡眠时长与全因和心血管疾病死亡率的风险增加相关。同时，接受胰岛素和口服降糖药物治疗的个体中，较短的睡眠时长也与全因和心血管疾病死亡率的风险增加相关。
结论/解释：睡眠时长与死亡率风险之间的关联在糖尿病患者和非糖尿病患者之间可能不同。在 2 型糖尿病患者中，每天睡眠不足 7 小时或超过 7 小时与全因和特定疾病死亡率风险增加相关。这种关联在糖尿病发病年龄较小和同时接受口服降糖药物和胰岛素治疗的患者中更为明显。这些人群可能受益于有针对性的睡眠相关干预措施，以降低不良健康结果的风险。
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