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26-09-2021 | Insomnia | Epidemiology • Original Article

Insomnia symptoms are associated with an increased risk of type 2 diabetes mellitus among adults aged 50 and older

Authors: Wenqin Yao, Jia Luo, Xiaohui Yu, Wenjie Jiang, Dongfeng Zhang

Published in: Sleep and Breathing | Issue 3/2022

Abstract

Purpose

To evaluate the association of the different degrees of insomnia symptoms with subsequent incidence of type 2 diabetes mellitus (T2DM).

Methods

The data were extracted from Health and Retirement Study 2006–2014 waves. The association of insomnia symptoms with T2DM incidence was evaluated by the competing risk model with cumulative incidence function (death was considered a competing event) and Cox proportional hazard model with the Kaplan–Meier method. Population attributable fraction (PAF) was calculated. All analyses related to our study were conducted between November 2020 and January 2021.

Results

A total of 14,112 patients were included in this study, with an average follow-up of 6.4 years, and the incidence density was 17.9 per 1000 person-years. Insomnia symptoms were positively associated with T2DM incidence compared with those with no insomnia symptoms, regardless of competing risk model (≥ 1 symptoms: sub-distribution hazard ratio (SHR) 1.13; 95% confidence interval (CI) 1.02–1.26; P-trend = 0.012) and Cox proportional hazard model (≥ 1 symptoms: hazard ratio (HR) 1.13; 95% CI 1.02–1.26; P-trend = 0.013). The cumulative incidence function (Gray’s test, p < 0.001) and Kaplan–Meier estimate (log-rank test, p < 0.001) also presented this positive relationship. This positive association was more apparent in women and participants with ages from 50 to 65 years. The PAF was 4.1% with 95% CI (0.7–7.9%).

Conclusions

Insomnia symptoms may be an important risk factor for the development of T2DM, which is unbiased by the death competing risk. These findings suggest that management of sleep problems may be an important part of strategies to prevent T2DM.

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Kaufmann CN, Canham SL, Mojtabai R, Gum AM, Dautovich ND, Kohn R, Spira AP (2013) Insomnia and health services utilization in middle-aged and older adults: results from the Health and Retirement Study. J Gerontol A Biol Sci Med Sci 68:1512–1517. https://doi.org/10.1093/gerona/glt050 CrossRefPubMedPubMedCentral

Morin CM, Benca R (2012) Chronic insomnia. Lancet 379:1129–1141. https://doi.org/10.1016/s0140-6736(11)60750-2 CrossRefPubMed

Wardle-Pinkston S, Slavish DC, Taylor DJ (2019) Insomnia and cognitive performance: a systematic review and meta-analysis. Sleep Med Rev 48:101205. https://doi.org/10.1016/j.smrv.2019.07.008 CrossRefPubMed

Shi T, Min M, Sun C, Zhang Y, Liang M, Sun Y (2020) Does insomnia predict a high risk of cancer? A systematic review and meta-analysis of cohort studies. J Sleep Res 29:e12876. https://doi.org/10.1111/jsr.12876 CrossRefPubMed

Sofi F, Cesari F, Casini A, Macchi C, Abbate R, Gensini GF (2014) Insomnia and risk of cardiovascular disease: a meta-analysis. Eur J Prev Cardiol 21:57–64. https://doi.org/10.1177/2047487312460020 CrossRefPubMed

Lin CL, Chien WC, Chung CH, Wu FL (2018) Risk of type 2 diabetes in patients with insomnia: a population-based historical cohort study. Diabetes Metab Res Rev 34 https://doi.org/10.1002/dmrr.2930

LeBlanc ES, Smith NX, Nichols GA, Allison MJ, Clarke GN (2018) Insomnia is associated with an increased risk of type 2 diabetes in the clinical setting. BMJ Open Diabetes Res Care 6:e000604. https://doi.org/10.1136/bmjdrc-2018-000604 CrossRefPubMedPubMedCentral

Green MJ, Espie CA, Popham F, Robertson T, Benzeval M (2017) Insomnia symptoms as a cause of type 2 diabetes Incidence: a 20 year cohort study. BMC Psychiatry 17:94. https://doi.org/10.1186/s12888-017-1268-4 CrossRefPubMedPubMedCentral

Li X, Sotres-Alvarez D, Gallo LC, Ramos AR, Aviles-Santa L, Perreira KM, Isasi CR, Zee PC, Savin KL, Schneiderman N, Wassertheil-Smoller S, Sofer T, Daviglus M, Redline S (2021) Associations of sleep-disordered breathing and insomnia with incident hypertension and diabetes. The Hispanic Community Health Study/Study of Latinos. Am J Respir Crit Care Med 203:356–365. https://doi.org/10.1164/rccm.201912-2330OC CrossRefPubMedPubMedCentral

10.

Kim HT (2007) Cumulative incidence in competing risks data and competing risks regression analysis. Clin Cancer Res 13:559–565. https://doi.org/10.1158/1078-0432.Ccr-06-1210 CrossRefPubMed

11.

Austin PC, Lee DS, Fine JP (2016) Introduction to the analysis of survival data in the presence of competing risks. Circulation 133:601–609. https://doi.org/10.1161/circulationaha.115.017719 CrossRefPubMedPubMedCentral

12.

Austin PC, Lee DS, D’Agostino RB, Fine JP (2018) Developing points-based risk-scoring systems in the presence of competing risks. Stat Med 37:1405. https://doi.org/10.1002/sim.7591 CrossRefPubMed

13.

Dong L, Agnew J, Mojtabai R, Surkan PJ, Spira AP (2017) Insomnia as a predictor of job exit among middle-aged and older adults: results from the Health and Retirement Study. J Epidemiol Community Health 71:750–757. https://doi.org/10.1136/jech-2016-208630 CrossRefPubMed

14.

Bardenheier BH, Gregg EW, Zhuo X, Cheng YJ, Geiss LS (2014) Association of functional decline with subsequent diabetes incidence in U.S. adults aged 51 years and older: the Health and Retirement Study 1998–2010. Diabetes Care 37:1032–1038. https://doi.org/10.2337/dc13-2216 CrossRefPubMed

15.

McGrath RP, Vincent BM, Lee IM, Kraemer WJ, Peterson MD (2018) Handgrip strength, function, and mortality in older adults: a time-varying approach. Med Sci Sports Exerc 50:2259–2266. https://doi.org/10.1249/mss.0000000000001683 CrossRefPubMed

16.

Zhang Y, Lin Y, Zhang J, Li L, Liu X, Wang T, Gao Z (2019) Association between insomnia and type 2 diabetes mellitus in Han Chinese individuals in Shandong Province, China. Sleep Breath 23:349–354. https://doi.org/10.1007/s11325-018-1687-6 CrossRefPubMed

17.

Gunderson EP, Hurston SR, Ning X, Lo JC, Crites Y, Walton D, Dewey KG, Azevedo RA, Young S, Fox G, Elmasian CC, Salvador N, Lum M, Sternfeld B, Quesenberry CP Jr (2015) Lactation and progression to type 2 diabetes mellitus after gestational diabetes mellitus: a prospective cohort study. Ann Intern Med 163:889–898. https://doi.org/10.7326/m15-0807 CrossRefPubMedPubMedCentral

18.

Spiegelman D, Hertzmark E, Wand HC (2007) Point and interval estimates of partial population attributable risks in cohort studies: examples and software. Cancer Causes Control 18:571–579. https://doi.org/10.1007/s10552-006-0090-y CrossRefPubMed

19.

Bhaskar S, Hemavathy D, Prasad S (2016) Prevalence of chronic insomnia in adult patients and its correlation with medical comorbidities. J Family Med Prim Care 5:780–784. https://doi.org/10.4103/2249-4863.201153 CrossRefPubMedPubMedCentral

20.

Rajaobelina K, Dow C, Romana Mancini F, Dartois L, Boutron-Ruault MC, Balkau B, Bonnet F, Fagherazzi G (2019) Population attributable fractions of the main type 2 diabetes mellitus risk factors in women: findings from the French E3N cohort. J Diabetes 11:242–253. https://doi.org/10.1111/1753-0407.12839 CrossRefPubMed

21.

Cespedes EM, Dudley KA, Sotres-Alvarez D, Zee PC, Daviglus ML, Shah NA, Talavera GA, Gallo LC, Mattei J, Qi Q, Ramos AR, Schneiderman N, Espinoza-Giacinto RA, Patel SR (2016) Joint associations of insomnia and sleep duration with prevalent diabetes: the Hispanic Community Health Study/Study of Latinos (HCHS/SOL). J Diabetes 8:387–397. https://doi.org/10.1111/1753-0407.12308 CrossRefPubMed

22.

Vgontzas AN, Liao D, Pejovic S, Calhoun S, Karataraki M, Bixler EO (2009) Insomnia with objective short sleep duration is associated with type 2 diabetes: a population-based study. Diabetes Care 32:1980–1985. https://doi.org/10.2337/dc09-0284 CrossRefPubMedPubMedCentral

23.

Suarez EC (2008) Self-reported symptoms of sleep disturbance and inflammation, coagulation, insulin resistance and psychosocial distress: evidence for gender disparity. Brain Behav Immun 22:960–968. https://doi.org/10.1016/j.bbi.2008.01.011 CrossRefPubMedPubMedCentral

24.

Prather AA, Epel ES, Cohen BE, Neylan TC, Whooley MA (2013) Gender differences in the prospective associations of self-reported sleep quality with biomarkers of systemic inflammation and coagulation: findings from the Heart and Soul Study. J Psychiatr Res 47:1228–1235. https://doi.org/10.1016/j.jpsychires.2013.05.004 CrossRefPubMed

25.

Amin A, Ali A, Altaf QA, Piya MK, Barnett AH, Raymond NT, Tahrani AA (2017) Prevalence and associations of obstructive sleep apnea in South Asians and white Europeans with type 2 diabetes: a cross-sectional study. J Clin Sleep Med 13:583–589. https://doi.org/10.5664/jcsm.6548 CrossRefPubMedPubMedCentral

26.

Cho YW, Kim KT, Moon HJ, Korostyshevskiy VR, Motamedi GK, Yang KI (2018) Comorbid insomnia with obstructive sleep apnea: clinical characteristics and risk factors. J Clin Sleep Med 14:409–417. https://doi.org/10.5664/jcsm.6988 CrossRefPubMedPubMedCentral

27.

Nagayoshi M, Punjabi NM, Selvin E, Pankow JS, Shahar E, Iso H, Folsom AR, Lutsey PL (2016) Obstructive sleep apnea and incident type 2 diabetes. Sleep Med 25:156–161. https://doi.org/10.1016/j.sleep.2016.05.009 CrossRefPubMedPubMedCentral

28.

Hiestand DM, Britz P, Goldman M, Phillips B (2006) Prevalence of symptoms and risk of sleep apnea in the US population: results from the national sleep foundation sleep in America 2005 poll. Chest 130:780–786. https://doi.org/10.1378/chest.130.3.780 CrossRefPubMed

29.

Irwin MR, Olmstead R, Carroll JE (2016) Sleep disturbance, sleep duration, and inflammation: a systematic review and meta-analysis of cohort studies and experimental sleep deprivation. Biol Psychiatry 80:40–52. https://doi.org/10.1016/j.biopsych.2015.05.014 CrossRefPubMed

30.

Calle MC, Fernandez ML (2012) Inflammation and type 2 diabetes. Diabetes Metab 38:183–191. https://doi.org/10.1016/j.diabet.2011.11.006 CrossRefPubMed

31.

Cole SW, Arevalo JM, Manu K, Telzer EH, Kiang L, Bower JE, Irwin MR, Fuligni AJ (2011) Antagonistic pleiotropy at the human IL6 promoter confers genetic resilience to the pro-inflammatory effects of adverse social conditions in adolescence. Dev Psychol 47:1173–1180. https://doi.org/10.1037/a0023871 CrossRefPubMedPubMedCentral

32.

Spiegel K, Leproult R, Van Cauter E (1999) Impact of sleep debt on metabolic and endocrine function. Lancet 354:1435–1439. https://doi.org/10.1016/s0140-6736(99)01376-8 CrossRefPubMed

33.

Spiegel K, Knutson K, Leproult R, Tasali E (1985) Van Cauter E (2005) Sleep loss: a novel risk factor for insulin resistance and type 2 diabetes. J Appl Physiol 99:2008–2019. https://doi.org/10.1152/japplphysiol.00660.2005 CrossRef

34.

McNeil J, Doucet É, Chaput JP (2013) Inadequate sleep as a contributor to obesity and type 2 diabetes. Can J Diabetes 37:103–108. https://doi.org/10.1016/j.jcjd.2013.02.060 CrossRefPubMed

35.

Lau B, Cole SR, Gange SJ (2009) Competing risk regression models for epidemiologic data. Am J Epidemiol 170:244–256. https://doi.org/10.1093/aje/kwp107 CrossRefPubMedPubMedCentral

36.

Logan BR, Zhang MJ, Klein JP (2006) Regression models for hazard rates versus cumulative incidence probabilities in hematopoietic cell transplantation data. Biol Blood Marrow Transplant 12:107–112. https://doi.org/10.1016/j.bbmt.2005.09.005 CrossRefPubMed

37.

Saydah SH, Geiss LS, Tierney E, Benjamin SM, Engelgau M, Brancati F (2004) Review of the performance of methods to identify diabetes cases among vital statistics, administrative, and survey data. Ann Epidemiol 14:507–516. https://doi.org/10.1016/j.annepidem.2003.09.016 CrossRefPubMed

38.

Kaufmann CN, Mojtabai R, Hock RS, Thorpe RJ Jr, Canham SL, Chen LY, Wennberg AM, Chen-Edinboro LP, Spira AP (2016) Racial/ethnic differences in insomnia trajectories among U.S. older adults. Am J Geriatr Psychiatry 24:575–584. https://doi.org/10.1016/j.jagp.2016.02.049 CrossRefPubMedPubMedCentral

Title: Insomnia symptoms are associated with an increased risk of type 2 diabetes mellitus among adults aged 50 and older
Authors: Wenqin Yao
Jia Luo
Xiaohui Yu
Wenjie Jiang
Dongfeng Zhang
Publication date: 26-09-2021
Publisher: Springer International Publishing
Keywords: Insomnia
Diabetes
Published in: Sleep and Breathing / Issue 3/2022
Print ISSN: 1520-9512
Electronic ISSN: 1522-1709
DOI: https://doi.org/10.1007/s11325-021-02497-8

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Abstract

Purpose

Methods

Results

Conclusions

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