Original ArticleSleep duration as a risk factor for the development of type 2 diabetes or impaired glucose tolerance: Analyses of the Quebec Family Study
Introduction
By 2010, diabetes is predicted to affect 221 million people globally, which would represent an increase of 46% from the year 2000 [1]. The continued rise in type 2 diabetes ensures that this metabolic disorder will remain of public health significance for decades to come. Patients with this condition require frequent contact with the health care system for effective management and prevention of complications, are at increased risk of hospitalization for conditions such as cardiovascular and kidney disease, and have 10 year reduction in life expectancy. Although lifestyle changes such as improving diet composition, increasing physical activity, and losing weight are the cornerstones of diabetes prevention, efforts are needed to better understand other determinants of the disease and to develop additional prevention strategies. Understanding the link between diabetes and sleep may represent an important part of that effort.
Chronic partial sleep deprivation as a consequence of voluntary bedtime restriction is an endemic condition in modern society. In 1960, the American Cancer Society conducted a survey study in adults that showed modal sleep duration to be 8.0–8.9 h [2]. In 1995, a survey conducted by the National Sleep Foundation revealed that mean sleep time had dropped to 7 h [3]. In 2004, more than 30% of adult men and women between the ages of 30 and 64 years reported sleeping less than 6 h per night [4]. Factors responsible for this situation include increases in environmental light, longer work days/longer commuting time, an increase in evening and night work, an increase in television use, and the advent of the personal computer and the Internet [5].
A rapidly growing body of laboratory [6], [7], [8] and epidemiological [9], [10], [11] evidence suggests that chronic partial sleep deprivation, a behavior that is specific to the human species and appears to have become more prevalent during the past few decades, may increase the risk of type 2 diabetes. However, the underlying mechanisms of this presumed adverse influence of sleep deprivation on glucose metabolism is not well understood. Some data suggest that short-term partial sleep restriction could lead to insulin resistance by increasing sympathetic tone [12], [13], raising evening cortisol concentrations [14], and decreasing cerebral glucose utilization [7], [8]. These findings suggest that long-term sleep deprivation may predispose individuals to overt clinical diabetes. In a recent cross-sectional study, we have shown that short-duration sleepers had significantly lower glucose concentrations towards the end of an oral glucose challenge compared to average- and long-duration sleepers [15]. According to the glucostatic theory of appetite control [16], this represents a stimulus that can trigger episodes of hunger and spontaneous food intake, which may explain at least in part the greater risk of becoming overweight displayed by short-duration sleepers, as shown in previous studies.
This study examines longitudinal associations between sleep duration and type 2 diabetes or impaired glucose tolerance (IGT) in the Quebec Family Study (QFS). Furthermore, this study aims at examining glucose homeostasis in relation to sleep time, as an increase in energy intake and weight gain might be an unfortunate solution to restore glucose homeostasis in a context where insufficient sleep time becomes ingrained in the lifestyle of an individual. In this regard, we hypothesize that short sleep duration mediates its effects on diabetes through obesity.
Section snippets
Subjects
The QFS was initiated at Laval University in 1978. The primary objective of this study was to investigate the role of genetics in the etiology of obesity, fitness, and cardiovascular and diabetes risk factors. In phase 1 of the study (1978–1981), a total of 1650 individuals from 375 families were recruited and measured. Recruitment was conducted irrespective of body weight during phase 1, which resulted in a cohort with a wide range of body mass index (BMI; in kg/m2), 13.8–64.9. In phases 2
Results
Regarding baseline characteristics of men and women in the study, men had higher body weight, waist circumference and waist-to-hip ratios than women, whereas women had greater percentage of body fat than men. However, age, BMI, body fat mass and total sleep duration were not significantly different between sexes. Table 1 presents baseline characteristics of subjects by sleep duration category. Short-duration sleepers presented higher body weight, BMI, percent body fat, abdominal circumference,
Discussion
The primary result of this study is that both short and long sleeping times are associated with a higher risk of developing type 2 diabetes/IGT. This finding is consistent with the majority of other studies investigating the association of sleep time with type 2 diabetes [10], [11], [27]. Furthermore, our results concur with a growing body of epidemiological evidence showing a U-shaped relationship between sleep duration and body weight [28], [29], type 2 diabetes [11], [27], coronary heart
Acknowledgements
The authors express their gratitude to the subjects for their participation and the staff of the Physical Activity Sciences Laboratory at Laval University for their contribution to this study. We especially thank Dr. Germain Thériault, Guy Fournier, Monique Chagnon, Lucie Allard and Claude Leblanc for their help in the collection and analysis of the data. The authors acknowledge the financial support over 20 years of the Medical Research Councils of Canada through several grants for the Quebec
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