School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan.
Department of Medical Research, China Medical University Hospital, Taichung, Taiwan.
Cardiovasc Diabetol. 2022 Apr 27;21(1):60. doi: 10.1186/s12933-022-01500-0.
Sleep duration is associated with mortality. However, prior studies exploring whether sleep duration predicts subsequent long-term mortality in patients with diabetes are limited. This study aims to examine whether metabolic factors affect the associations between baseline sleep duration and subsequent risks of all-cause, expanded, and non-expanded cardiovascular disease (CVD) mortalities among patients with type 2 diabetes (T2D).
A total of 12,526 T2D patients aged 30 years and older, with a follow-up period ≥ 3 years, were identified from the Diabetes Case Management Program of a medical center in Taiwan. Sleep duration was measured using computerized questionnaires by case managers, and the time frame for this question was 1 month prior to the interview date. Sleep duration in relation to subsequent mortality from all causes, expanded CVD, and non-expanded CVD was examined using Cox proportional hazard models.
Within 10 years of follow-up, 2918 deaths (1328 CVD deaths and 1590 non-CVD deaths) were recorded. A J-shaped association was observed for all-cause, expanded CVD, and non-expanded CVD mortalities, and the lowest risks were observed for patients with 5-7 h of sleep. The significant joint effects included sleep duration of more or less than 7 h with age ≥ 65 years [adjusted HRs: 4.00 (3.49-4.60)], diabetes duration ≥ 5 years [1.60 (1.40-1.84)], age at diabetes diagnosis ≤ 45 years [1.69 (1.38-2.07)], insulin use [1.76 (1.54-2.03)], systolic blood pressure/diastolic blood pressure > 130/85 mmHg [1.24 (1.07-1.43)], triglyceride ≥ 150 mg/dL [1.38 (1.22-1.56)], HbA1c ≥ 7% [1.31 (1.13-1.52)], and body mass index < 27 kg/m [1.31 (1.17-1.45)] for all-cause mortality.
A J-shaped association was observed between sleep duration and all-cause and expanded CVD mortality, and a sleep duration of 5-7 h had the lowest mortality risk. Sleep duration also showed significant synergistic interactions with diabetes duration but shared an antagonistic interaction with age and obesity.
睡眠时间与死亡率有关。然而，先前探索睡眠时间是否能预测糖尿病患者后续长期死亡率的研究有限。本研究旨在检验代谢因素是否会影响基线睡眠时间与 2 型糖尿病（T2D）患者全因、扩大和非扩大心血管疾病（CVD）死亡率之间的关联。
共纳入来自台湾某医疗中心糖尿病病例管理计划的 12526 名年龄在 30 岁及以上、随访时间≥3 年的 T2D 患者。通过病例管理者使用计算机化问卷测量睡眠时间，该问题的时间框架为访谈日期前 1 个月。使用 Cox 比例风险模型检验睡眠时间与全因、扩大 CVD 和非扩大 CVD 死亡率之间的关系。
在 10 年的随访期间，记录了 2918 例死亡（1328 例 CVD 死亡和 1590 例非 CVD 死亡）。全因、扩大 CVD 和非扩大 CVD 死亡率呈 J 形关联，睡眠时间为 5-7 小时的风险最低。显著的联合效应包括睡眠时间超过或少于 7 小时且年龄≥65 岁[校正 HR：4.00（3.49-4.60）]、糖尿病病程≥5 年[1.60（1.40-1.84）]、糖尿病诊断年龄≤45 岁[1.69（1.38-2.07）]、胰岛素使用[1.76（1.54-2.03）]、收缩压/舒张压>130/85mmHg[1.24（1.07-1.43）]、甘油三酯≥150mg/dL[1.38（1.22-1.56）]、HbA1c≥7%[1.31（1.13-1.52）]和体重指数<27kg/m[1.31（1.17-1.45）]。
睡眠时间与全因和扩大 CVD 死亡率呈 J 形关联，5-7 小时的睡眠时间具有最低的死亡率风险。睡眠时间还与糖尿病病程呈显著协同交互作用，但与年龄和肥胖呈拮抗交互作用。
