Association between long sleep duration and increased risk of obesity and type 2 diabetes: A review of possible mechanisms

Daily fruit and vegetable consumption and diabetes status in middle-aged females in the general US population

Objectives:

Fruit and vegetable consumption may impact development of diabetes, but limited research has addressed whether daily consumption of fruits and vegetables differs by those with and without diabetes, especially within high-risk groups. Thus, the purpose of this study was to determine whether daily fruit and vegetable consumption differs by diabetes status in middle-aged females in the general US population.

Methods:

This cross-sectional analysis used 2017 Behavioral Risk Factor Surveillance System data for females ages 45–64 years old in Arizona (n = 2609), Florida (n = 3768), Georgia (n = 1018), and Texas (n = 2092). Multiple logistic regression analysis by state assessed the relationship between the daily consumption of fruit (fruit, 100% fruit juice) and vegetables (green leafy or lettuce salad, potatoes, other vegetables) and diabetes status, while controlling for health status, health behaviors, demographic factors, and socioeconomic status.

Results:

Across states, relatively similar proportions of participants with and without diabetes reported daily fruit consumption (with: 58%–63%; without: 61%–68%) and daily vegetable consumption (with: 58%–63%; without: 61%–68%). The results of adjusted analyses indicated that daily fruit and vegetable consumption did not differ by diabetes status across states.

Conclusion:

Across states, daily fruit and vegetable consumption did not differ by diabetes status in middle-aged females. In the primary care setting, providers should educate all females ages 45–64 on the importance of eating fresh fruits and vegetables and may consider sharing information about flavonoid-rich fruit and vegetable consumption for diabetes.

Association of Self-Reported Sleep and Circadian Measures With Glycemia in Adults With Prediabetes or Recently Diagnosed Untreated Type 2 Diabetes

OBJECTIVE

Sleep disturbances and circadian misalignment (social jet lag, late chronotype, or shift work) have been associated with worse glycemic control in type 2 diabetes (T2D). Whether these findings apply to adults with prediabetes is yet unexplored. We hypothesized that self-reported short sleep, poor sleep quality, and/or circadian misalignment are associated with higher glycemia, BMI, and blood pressure (BP) in adults with prediabetes or recently diagnosed, untreated T2D.

RESEARCH DESIGN AND METHODS

Our cohort included 962 overweight/obese adults ages 20-65 years with prediabetes or recently diagnosed, untreated T2D who completed a 2-h oral glucose tolerance test and validated sleep questionnaires. Independent associations of sleep and circadian variables with glycemia, BMI, and BP were evaluated with regression models.

RESULTS

The multiethnic cohort was 55% men, with mean ± SD age 52.2 ± 9.5 years and BMI 34.7 ± 5.5 kg/m². Mean sleep duration was 6.6 ± 1.3 h. Poor sleep quality was reported by 54% and high risk for obstructive sleep apnea by 64%. HbA_1c was significantly higher in those reporting <5 or >8 h sleep per night. Sleep duration >8 h was also associated with higher fasting glucose and <6 h with higher BMI. Shift work was also associated with higher BMI. Social jet lag and delayed chronotype were associated with higher BP.

CONCLUSIONS

In our cohort, self-reported short and long sleep were both associated with adverse measures of glycemia, and short sleep and shift work were associated with higher BMI. Further research using objective measures of sleep is needed to better delineate the relationship between sleep and glycemia in adults with prediabetes or T2D.

Bridging the Reciprocal Gap between Sleep and Fruit and Vegetable Consumption: A Review of the Evidence, Potential Mechanisms, Implications, and Directions for Future Work

A substantial burden of disease and mortality globally is attributable to both sleep disruption and low intakes of fruit and vegetable (FV) and there is increasing mechanistic and epidemiological evidence to support a reciprocal relationship between the two. This review provides an overview of experimental and observational studies assessing the relations between sleep and FV consumption from 52 human adult studies. Experimental studies are currently limited and show inconsistent results. Observational studies support a non-linear association with adults sleeping the recommended 7–9 hours/day having the highest intakes of FV. The potential mechanisms linking sleep and FV consumption are highlighted. Disrupted sleep influences FV consumption through homeostatic and non-homeostatic mechanisms. Conversely, FV consumption may influence sleep through polyphenol content via several potential pathways. Few human experimental studies have examined the effects of FV items and their polyphenols on sleep and there is a need for more studies to address this. An appreciation of the relationship between sleep and FV consumption may help optimize sleep and FV consumption and may reduce the burden of chronic diseases. This review provides implications for public health and directions for future work.

Physical activity and sleep quality and duration among Hispanic postpartum women at risk for type 2 diabetes: Estudio PARTO

OBJECTIVES

Poor sleep among postpartum women is associated with adverse maternal outcomes. Physical activity (PA) is associated with better sleep. However, few studies have been conducted among postpartum Hispanic women. The objective of this study was to examine the association between PA and sleep quality and duration among postpartum Hispanic women.

DESIGN

A cross-sectional analysis using baseline data from Estudio PARTO, an ongoing randomized controlled trial aimed at reducing type 2 diabetes risk among Hispanic women.

SETTING

Baystate Medical Center, in Western Massachusetts, which serves an ethnically and socioeconomically diverse population.

PARTICIPANTS

Hispanic women, at elevated risk for type 2 diabetes, at a mean of 11 weeks (SD = 4.5) postpartum.

MEASUREMENTS

PA was measured with the Pregnancy Physical Activity Questionnaire (PPAQ), and sleep was measured with the Pittsburgh Sleep Quality Index (PSQI).

RESULTS

Mean sleep duration was 5.9 hour/night (SD = 1.7) and PSQI score was 6.5 (SD = 3.9). In multivariable logistic models, sports/exercise was associated with lower odds of very poor sleep quality (PSQI >10) (OR = 0.18, 95% CI = 0.05 to 0.69). Sports/exercise (OR = 0.05, 95% CI = 0.01 to 0.26) and vigorous intensity PA (OR = 0.13, 95% CI = 0.04 to 0.42) were associated with lower odds of short (vs normal) sleep duration. There were no statistically significant relationships between PA in any other domain or intensity and sleep quality or duration CONCLUSIONS: Findings can inform interventions designed to improve postpartum sleep via increasing opportunities for exercise among postpartum women.

Adverse childhood experiences affect sleep duration for up to 50 years later

Study Objectives

The main objective for this study was to assess the association of adverse childhood experiences (ACEs) and subsequent short sleep duration among adults.

Methods

This cross-sectional examination used data from the 2011 Behavioral Risk Factor Surveillance System, a nationwide telephone-administered survey. Participants completed a standardized questionnaire to report childhood experiences of abuse, neglect, household challenges, and sleep time. Multinominal logistic regression analyses included survey weighting procedures and adjusted for age, race, education, income, sex, and body mass index; associations were also examined by age strata, using age as a proxy for time since ACEs occurred.

Results

Complete data were available for 22 403 adults (mean age = 46.66 years) including 14 587 (65%) with optimum sleep duration (7–9 h/night) and 2069 (9%) with short sleep duration (<6 h/night). Compared with adults with optimum sleep duration, the number of ACEs was associated with the odds of short sleep duration (odds ratio [OR] = 1.22, 95% CI = 1.16 to 1.28), and the odds increased as the number of ACEs increased. The association held for each decade of age until the 60s, although the magnitude attenuated. Mental health challenges or poor physical health did not account for the association.

Conclusion

ACEs increased the odds of chronic short sleep duration during adulthood and showed both a time-dependent and dose–response nature. These associations were independent of self-reported mental health challenges or poor physical health. The association of ACEs with short sleep duration throughout the adult lifespan emphasizes the importance of child health and identifying underlying psychological challenges in adults with sleep difficulties.

Sleep and Resistant Hypertension

PURPOSE OF REVIEW

The goal of the present review is to describe the current findings on the association of sleep with resistant hypertension (hypertension that remains uncontrolled despite the use of three or more antihypertensive medications from different classes, including a diuretic).

RECENT FINDINGS

Sleep disturbances, particularly obstructive sleep apnea (OSA), are highly prevalent among adults who have resistant hypertension. Randomized controlled trials indicate that treating OSA has modest effects on blood pressure lowering among those with the highest initial blood pressure. There is a paucity of research on the association of habitual sleep and other sleep disturbances with resistant hypertension. Of note, the most recent observational studies describing the association of OSA with resistant hypertension are comprised primarily of non-white race/ethnic groups who are far more likely to have resistant hypertension. OSA is associated with resistant hypertension, but there is limited data on associations between sleep characteristics and resistant hypertension. Future studies should investigate whether treating OSA can reduce disparities in resistant hypertension and whether other aspects of sleep also contribute to resistant hypertension.

Lack of association between self-reported insomnia symptoms and clamp-derived insulin sensitivity in elderly men

Insomnia-related sleep disruptions, such as short and disturbed sleep, have been tied to systemic insulin resistance in young adult populations. We therefore sought to confirm these findings in a cohort of elderly men. To this aim, we utilized variables from 980 men who participated in the investigation at age 70 of the Uppsala Longitudinal Study of Adult Men. Self-reported insomnia symptoms were assessed by questions about difficulty initiating sleep, early final awakening, and regular use of hypnotics. All participants also underwent the gold-standard hyperinsulinemic-euglycemic clamp technique to assess the insulin sensitivity index (M/I). Finally, fasting blood was collected to measure free fatty acids (FFAs) and adiponectin. Differences in blood parameters between men with and those without insomnia were determined by ANCOVA, and were adjusted for lifestyle and cardio-metabolic risk factors. Our analysis yielded no differences in M/I, FFAs, and adiponectin between men with and those without insomnia symptoms. Analyses in non-diabetic and diabetic subsamples confirmed these negative findings. Our cross-sectional results therefore suggest that insomnia symptoms may have a minimal effect, if any, on measures of insulin sensitivity in elderly men. Given the observational design of our study, future studies are needed to determine whether experimental sleep manipulations influence systemic insulin sensitivity in elderly humans, as has previously been shown in young adult populations.

Association Between Self-Reported Sleep Duration and Body Composition in Middle-Aged and Older Adults

STUDY OBJECTIVES

The current study sought to examine whether self-reported sleep duration is linked to an adverse body composition in 19,709 adults aged 45 to 75 years.

METHODS

All variables used in the current study were derived from the Swedish EpiHealth cohort study. Habitual sleep duration was measured by questionnaires. Body composition was assessed by bioimpedance. The main outcome variables were fat mass and fat-free mass (in kg). Analysis of covariance adjusting for age, sex, fat mass in the case of fat-free mass (and vice versa), leisure time physical activity, smoking, and alcohol consumption was used to investigate the association between sleep duration and body composition.

RESULTS

Short sleep (defined as ≤ 5 hours sleep per day) and long sleep (defined as 8 or more hours of sleep per day) were associated with lower fat-free mass and higher fat mass, compared with 6 to 7 hours of sleep duration (P < .05).

CONCLUSIONS

These observations could suggest that both habitual short and long sleep may contribute to two common clinical phenotypes in middle-aged and older humans, ie, body adiposity and sarcopenia. However, the observational nature of our study does not allow for causal interpretation.

Association between Sleep Disturbances and Liver Status in Obese Subjects with Nonalcoholic Fatty Liver Disease: A Comparison with Healthy Controls

The relevance of sleep patterns in the onset or evolution of nonalcoholic fatty liver disease (NAFLD) is still poorly understood. Our aim was to investigate the association between sleep characteristics and hepatic status indicators in obese people with NAFLD compared to normal weight non-NAFLD controls. Ninety-four overweight or obese patients with NAFLD and 40 non-NAFLD normal weight controls assessed by abdominal ultrasonography were enrolled. Hepatic status evaluation considered liver stiffness determined by Acoustic Radiation Force Impulse elastography (ARFI) and transaminases. Additionally, anthropometric measurements, clinical characteristics, and biochemical profiles were determined. Sleep features were evaluated using the Pittsburgh Sleep Quality Index (PSQI). Hepatic status parameters, anthropometric measurements, and clinical and biochemical markers differed significantly in NAFLD subjects compared to controls, as well as sleep efficiency, sleep disturbance score, and sleep quality score. In the NAFLD group, a higher prevalence of short sleep duration (p = 0.005) and poor sleep quality (p = 0.041) were found. Multivariate-adjusted odds ratio (95% confidence interval) for NAFLD considering sleep disturbance was 1.59 (1.11–2.28). Regression models that included either sleep disturbance or sleep quality predicted up to 20.3% and 20.4% of the variability of liver stiffness, respectively, and after adjusting for potential confounders. Current findings suggest that sleep disruption may be contributing to the pathogenesis of NAFLD as well as the alteration of the liver may be affecting sleep patterns. Consequently, sleep characteristics may be added to the list of modifiable behaviors to consider in health promotion strategies and in the prevention and management of NAFLD.

Sleep and obesity: the mediating role of health behaviors among African Americans

OBJECTIVES

To examine the role of health behaviors (eg, physical activity, sedentary behaviors, and diet) in the relationship between sleep (ie, duration and quality) and BMI among African American adults.

DESIGN

A cross-sectional self-report questionnaire included questions related to health and health-related behaviors.

SETTING

This study was based on data from the CHURCH study, which aimed to address cancer health disparities among church-going African Americans in Houston, TX.

PARTICIPANTS

African American adults were recruited from three large community churches. The sample included a total of 1837 participants (75.2% female; mean age 48.2 ± 13.7y; mean BMI 32.0 ± 7.5 kg/m²).

MEASUREMENTS

Linear regression models and path analyses controlling for demographic characteristics and depression estimated the associations between sleep and BMI as well as the mediating roles of health behaviors.

RESULTS

The average self-reported sleep duration was 6.2 ± 1.5 h/night with 61%, 35.8%, and 1.6% reporting short (≤6 h/night), normal (7-9 h/night), and long sleep (≥10 h/night), respectively. Short sleep was related to greater BMI (b = 1.37, SE = 0.38, P = .01), and the relationship was mediated by sedentary behaviors (est. = 0.08, SE = 0.04, 95% CI: 0.02, 0.17).

CONCLUSIONS

Short sleep and poor quality sleep was related to poor diet and physical activity-related health behaviors, and BMI. The link between sleep and obesity is, in part, due to energy imbalance from increased sedentary behavior.

Real-World Data in Support of Short Sleep Duration with Poor Glycemic Control, in People with Type 2 Diabetes Mellitus

AIMS

Sleep duration (SD) has been associated with metabolic outcomes. Is there an independent association between short/long SD and glycemic control (GC) in type 2 diabetes mellitus (T2DM) outpatients, compared to intermediate SD? Employing up-to-date definitions of SD, we comprehensively considered, simultaneously, all known confounding/mediating factors that recently emerged in the literature: age, gender, diet, physical activity, obesity, night pain, nocturnal diuresis, sleep quality, chronotype, sleep apnea, depressive symptoms, alcohol, caffeine, tobacco, number of endocrinologist appointments, T2DM family history, and sleep medication.

METHODS

A cross-sectional study of 140 consecutive T2DM outpatients, ages 40-65, glycohemoglobin (HbA _1c ) goal ≤ 7. We searched for variables (including HbA_1c) significantly associated with short (<6 hours) or long (>8 hours) SD, in comparison to intermediate SD (6-8 hours).

RESULTS

Higher HbA_1c levels increased the chance of belonging to the group that sleeps <6 hours (p ≤ 0.001). Better sleep quality, nocturnal diuresis, and morningness increased the chance of belonging to the group that sleeps >8 hours (p < 0.05).

CONCLUSIONS

There is an independent association between short SD and elevated HbA_1c, in real-world T2DM outpatients. Future interventional studies could evaluate weather consistent, long-term sleep extension, from <6 hours to 7-9 hours per 24 hours, improves GC in T2DM outpatients.

Abnormal Global Brain Functional Connectivity in Primary Insomnia Patients: A Resting-State Functional MRI Study

Background: Resting-state functional magnetic resonance imaging (fMRI) studies have uncovered the disruptions of functional brain networks in primary insomnia (PI) patients. However, the etiology and pathogenesis underlying this disorder remains ambiguous, and the insomnia related symptoms are influenced by a complex network organization in the brain. The purpose of this study was to explore the abnormal intrinsic functional hubs in PI patients using a voxel-wise degree centrality (DC) analysis and seed-based functional connectivity (FC) approach. Methods: A total of 26 PI patients and 28 healthy controls were enrolled, and they underwent resting-state fMRI. Degree centrality was measured across the whole brain, and group differences in DC were compared. The peak points, which significantly altered DC between the two groups, were defined as the seed regions and were further used to calculate FC of the whole brain. Later, correlation analyses were performed between the changes in brain function and clinical features. Results: Primary insomnia patients showed DC values lower than healthy controls in the left inferior frontal gyrus (IFG) and middle temporal gyrus (MTG) and showed a higher DC value in the right precuneus. The seed-based analyses demonstrated decreased FC between the left MTG and the left posterior cingulate cortex (PCC), and decreased FC was observed between the right precuneus and the right lateral occipital cortex. Reduced DC in the left IFG and decreased FC in the left PCC were positively correlated with the Pittsburgh sleep quality index and the insomnia severity index. Conclusions: This study revealed that PI patients exhibited abnormal intrinsic functional hubs in the left IFG, MTG, and the right precuneus, as well as abnormal seed-based FC in these hubs. These results contribute to better understanding of how brain function influences the symptoms of PI.

Sleep duration and risk of incident stroke by age, sex, and race: The REGARDS study

OBJECTIVE

To investigate the association between reported sleep duration and incident stroke in a US cohort of black and white adults, and evaluate race, age, and sex as potential effect modifiers.

METHODS

From 2008 to 2010, 16,733 black and white adults, aged ≥45 years, without a history of stroke or sleep-disordered breathing from the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study, reported their habitual sleep duration (<6, 6.0-6.9, 7.0-8.9 [reference], ≥9 hours). Incident strokes were identified through biannual participant contact followed by physician adjudication of medical records. Cox proportional hazards analysis was conducted to calculate hazard ratios of interactions between sleep duration with race, age, sex, and 2-way combinations of these factors on incident stroke adjusting for stroke risk factors and sleep-disordered breathing risk.

RESULTS

The sample comprised 10.4% (n = 1,747) short sleepers (<6 hours) and 6.8% (n = 1,134) long sleepers (≥9 hours). Over an average 6.1 years follow-up, 460 strokes occurred. There were significant interactions between sleep duration and race (p = 0.018) and sleep duration and race-sex groups (p = 0.0023) in association with incident stroke. Short sleep duration was significantly associated with decreased risk for stroke among black participants (hazard ratio [HR] 0.49 [95% confidence interval (CI) 0.28-0.85]), particularly black men (HR 0.21 [95% CI 0.07-0.69]), whereas long sleep duration was significantly associated with increased risk for stroke among white men (HR 1.71 [95% CI 1.06-2.76]).

CONCLUSIONS

The association of sleep duration with incident stroke differs by race and sex, with short sleep duration among black men associated with decreased risk, whereas long sleep duration among white men associated with increased risk for stroke.

Impact of Poor Sleep on Physical and Mental Health in Older Women

Many aspects of sleep and circadian rhythms change as people age. Older adults usually experience decrease in sleep duration and efficiency, increase in sleep latency and fragmentation, high prevalence of sleep disorders, and weakened rest-activity rhythms. Research evidence suggests that women are more likely to report aging-related sleep problems. This review presents epidemiologic and clinical evidence on the relationships between sleep deficiency and physical and mental outcomes in older women, explores potential mechanisms underlying such relationships, points out gaps in the literature that warrant future investigations, and considers implications in clinical and public health settings.

Sleep duration, lifestyles and chronic diseases: a cross-sectional population-based study

Background

Adequate sleep is essential for health. Both, short and long sleep durations are associated to worse quality of life and poor health outcomes. Portugal represents a specific population model, since according to European statistics it has high rates of chronic diseases like depression, hypertension, diabetes and stroke; and low quality of life as well as low index of physical activity, while in parallel it has some other good health indicators such as: low age-standardized mortality for both genders, nutrition in terms of energy and fruit consumption, smoking and alcohol, obesity and overweight prevalence. The aim of this study was to characterize health and chronic diseases, lifestyles and quality of life in subjects with short and long sleep duration.

Methods

A population-based cross-sectional evaluation of the third wave of follow-up of the EpiDoC Cohort was carried between 2015-2016. A sample of 5,436 adults ≥18 years, representative of the national population, self-reported their daily total sleep time. Associations between short sleep duration (SSD ≤5h), long sleep duration (LSD≥9h) and independent variables were determined.

Results

The prevalence for SSD was high (20.7%) and the LSD (5.9%) was low. Being older, with lower education, retired and unemployed were associated to SSD and LSD (p<0.01). Being obese was associated to SSD as well as hypertension, gastrointestinal disease and hypercholesterolemia (p<0.01). SSD and LSD, were associated with diabetes (p<0.01 and p=0.03) and depression (p<0.01 and p=0.02) respectively. Cardiovascular disease (p<0.01) was associated to LSD. Multimorbidity (p<0.01) was associated to SSD. Worse quality of life and bad physical function were associated to SSD and LSD, as well as being hospitalized in the previous 12 months (p<0.01).

Conclusions

Socio-demographic, physical activity and chronic diseases were associated to reduction and extension of sleep duration. There was no association between rheumatic diseases and cancer with sleep duration, as found in other studies. This study emphasizes the burden of self-reported SSD for Portugal, its consequences to health and the need to increase sleep awareness campaigns enhancing the importance of sleep in health. Furthermore, it emphasizes that chronic diseases risks are dependent on multiple parameters which varying in different countries or regions, imply the need of regional studies and interventions.