Skip to main content
SpringerLink
Log in

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

  • Epidemiology • Original Article
  • Published:
Sleep and Breathing Aims and scope Submit manuscript

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.

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
Fig. 2

Similar content being viewed by others

Data availability

The data extracted was obtained from the HRS. The detailed information of HRS was shown at https://hrs.isr.umich.edu/.

Code availability

SPSS 24.0 and Stata 15.0 were used to process data.

References

  1. 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

    Article  PubMed  PubMed Central  Google Scholar 

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

    Article  PubMed  Google Scholar 

  3. 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

    Article  PubMed  Google Scholar 

  4. 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

    Article  PubMed  Google Scholar 

  5. 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

    Article  PubMed  Google Scholar 

  6. 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 34https://doi.org/10.1002/dmrr.2930

  7. 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

    Article  PubMed  PubMed Central  Google Scholar 

  8. 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

    Article  PubMed  PubMed Central  Google Scholar 

  9. 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

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  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

    Article  PubMed  Google Scholar 

  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

    Article  PubMed  PubMed Central  Google Scholar 

  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

    Article  PubMed  Google Scholar 

  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

    Article  PubMed  Google Scholar 

  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

    Article  PubMed  Google Scholar 

  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

    Article  PubMed  Google Scholar 

  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

    Article  CAS  PubMed  Google Scholar 

  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

    Article  PubMed  PubMed Central  Google Scholar 

  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

    Article  CAS  PubMed  Google Scholar 

  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

    Article  PubMed  PubMed Central  Google Scholar 

  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

    Article  CAS  PubMed  Google Scholar 

  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

    Article  PubMed  Google Scholar 

  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

    Article  PubMed  PubMed Central  Google Scholar 

  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

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  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

    Article  PubMed  Google Scholar 

  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

    Article  PubMed  PubMed Central  Google Scholar 

  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

    Article  PubMed  PubMed Central  Google Scholar 

  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

    Article  PubMed  PubMed Central  Google Scholar 

  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

    Article  PubMed  Google Scholar 

  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

    Article  PubMed  Google Scholar 

  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

    Article  CAS  PubMed  Google Scholar 

  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

    Article  PubMed  PubMed Central  Google Scholar 

  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

    Article  CAS  PubMed  Google Scholar 

  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

    Article  CAS  Google Scholar 

  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

    Article  PubMed  Google Scholar 

  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

    Article  PubMed  PubMed Central  Google Scholar 

  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

    Article  PubMed  Google Scholar 

  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

    Article  PubMed  Google Scholar 

  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

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgements

We thank all the staff who conducted and administered the HRS surveys and all the members who participated in the HRS study.

Author information

Authors and Affiliations

  1. Department of Epidemiology and Health Statistics, The School of Public Health of Qingdao University, No. 308 Ningxia Road, Qingdao, 266071, Shandong, China

    Wenqin Yao, Jia Luo, Xiaohui Yu, Wenjie Jiang & Dongfeng Zhang

Authors
  1. Wenqin Yao
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jia Luo
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Xiaohui Yu
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Wenjie Jiang
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Dongfeng Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

All the authors have contributed to the work: Wenqin Yao and Dongfeng Zhang conceived and designed the study; Wenqin Yao and Jia Luo analyzed the data; Wenqin Yao wrote the paper; Wenqin Yao, Xiaohui Yu, and Jia Luo revised the paper; Dongfeng Zhang and Wenjie Jiang reviewed the manuscript.

Corresponding author

Correspondence to Dongfeng Zhang.

Ethics declarations

Ethics approval and consent to participate

HRS was approved by the Institutional Review Board at the University of Michigan, and all participants provided informed consent. The detailed information of HRS was shown at https://hrs.isr.umich.edu/.

Consent for publication

All the authors have approved the final article and taken public responsibility for appropriate portions of the content.

Conflict of interest

The authors declare no competing interests.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (DOCX 141 KB)

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Yao, W., Luo, J., Yu, X. et al. Insomnia symptoms are associated with an increased risk of type 2 diabetes mellitus among adults aged 50 and older. Sleep Breath 26, 1409–1416 (2022). https://doi.org/10.1007/s11325-021-02497-8

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11325-021-02497-8

Keywords

Search

Navigation