Association between sleep duration and hemoglobin A1c level

doi:10.1016/j.sleep.2007.07.017

Sleep Medicine

Volume 9, Issue 7, October 2008, Pages 745-752

https://doi.org/10.1016/j.sleep.2007.07.017 Get rights and content

Abstract

Objective

The association between sleep habits and hemoglobin A_1c (HbA_1c) level has not been sufficiently examined. In the present study of residents in a local community, the associations between sleep duration and HbA_1c level were examined.

Methods

Self-administered questionnaires were mailed to 1062 residents in a rural community in Japan, and completed questionnaires were collected. At the time of collection, the fasting plasma glucose and HbA_1c levels were measured using peripheral blood samples. For the analyses, values that were considered to represent high levels were a fasting plasma glucose level of ⩾126 mg/dl and a HbA_1c level of ⩾6.5%. Logistic regression analyses were performed to examine the associations between sleep duration and high fasting plasma glucose or high HbA_1c levels.

Results

The prevalence of high fasting plasma glucose and high HbA_1c levels was significantly high (p < 0.01) in subjects with a short or a long sleep duration. Logistic regression analyses demonstrated a significant association between high HbA_1c level and sleep duration. The adjusted odds ratios for a high HbA_1c level showed high values with regard to both short and long sleep durations.

Conclusions

HbA_1c level showed a U-shaped association with sleep duration. These results suggest that there may be an appropriate range of sleep duration in individuals with glucose tolerance disorders. It is expected that the present findings will contribute to the treatment and prevention of diabetes mellitus.

Introduction

According to a fact-finding survey of diabetes mellitus conducted in 2002 by the Ministry of Health, Labour and Welfare in Japan, the number of people with a hemoglobin A_1c (HbA_1c) level of ⩾ 6.1% (those who were strongly suspected to have diabetes) and those currently receiving treatment for diabetes mellitus was approximately 7.4 million, and the number of people with an HbA_1c level of ⩾5.6% but <6.1% (those in whom the possibility of diabetes could not be ruled out) was approximately 8.8 million, giving an overall total of approximately 16.2 million [1]. These figures were higher than those reported in an earlier survey conducted in 1997. Diabetic nephropathy was ranked first (41.3%) among the diseases that necessitated dialysis. In addition, diabetic retinopathy-induced visual impairment is detected in approximately 3000 people annually [1]. Therefore, diabetes mellitus is currently recognized to be an important public health issue in Japan Fig. 1.

In addition to diet, exercise habits, alcohol consumption, and smoking habits, sleep habits are considered to be a particularly important factor associated with lifestyle-related diseases, including diabetes. Moreover, changes in social habits, as exemplified by the increase in the number of shops and restaurants that stay open until late at night, coupled with the increase in the number of people who stay up until late at night browsing the Internet (an outcome of the popularization of the Internet), have resulted in a new nightlife culture in Japanese society. Hence, an increase in the prevalence of sleep disturbance has been recognized as a social problem in recent years. According to large-scale epidemiological studies on sleep in Japan, approximately one out of five Japanese adults has some type of sleep problem [2], and sleep duration among Japanese adults tends to decrease year after year [3]. For example, in the general Japanese population, the average sleep duration on weekdays was reported to have decreased by more than 30 minutes over the 35 years between 1970 and 2005 [3].

With the increase in the number of studies on sleep, it has been revealed that sleep disturbance may cause various mental and physical problems [4], [5], [6], [7]. Various studies have reported associations between depression, a mental disease, and sleep disturbance [8], [9]. Several studies have also reported that sleep disturbances such as insomnia and short sleep duration impair glucose tolerance [4], [5], [10]. In addition, it is known that the complication rate of depression developed by diabetic patients is high because of their fear of developing complications [11]. Other contributing factors include stressful lifestyles that involve regular insulin injections, and strict diet and exercise therapies [12], [13].

For the prevention and treatment of diabetes, it is important to clarify the associations between sleep and both glucose tolerance and diabetes. In comparison with the plasma glucose level, the HbA_1c level shows less fluctuation and is less influenced by short-term lifestyle habits such as calorie intake. Therefore, the HbA_1c level is considered to be an important test parameter during the management of diabetes, a disease that has a prolonged course of development. However, to date, only a few large-scale studies have been conducted on the associations between sleep habits and HbA_1c. In the present study of residents in a rural community in Japan, the associations between sleep duration and fasting plasma glucose and HbA_1c level were examined under the situation in which depression was adjusted Fig. 2.

Section snippets

Subjects

We started a longitudinal survey in 2005 to collect and accumulate data on the lifestyle habits and health status of the residents of Iwaki-machi in order to contribute to the maintenance and promotion of their good health. To recruit the study participants, we mailed written notifications about the present longitudinal survey to residents aged 20 years or above as of March 31, 2005. Those interested in participating were requested to reply by mailing a consent letter. On the day of the survey,

Results

The distributions of the analyzed subjects based on gender and age classification are presented in Table 1. Among both men and women, participants aged 50 years and above accounted for approximately 70% of the study population.

The prevalence of high fasting plasma glucose and HbA_1c levels based on gender and age classification and the mean values and standard deviations of the fasting plasma glucose and HbA_1c levels are presented in Table 2. The prevalence of high plasma glucose and high HbA_1c

Discussion

This is the first report to demonstrate that the adjusted odds ratio for HbA_1c level is significantly high for both short and long sleep durations. Previous cross-sectional studies that examined the association between diabetes mellitus and sleep showed that the prevalences of DIS, DMS, and excessive daytime sleepiness were high among diabetics [6], [7]. In a prospective study of 8269 Germans, Meisinger et al. reported that DMS might be a risk factor for onset of Type 2 diabetes [19]. Similar

Conclusion

Sleep duration showed a U-shaped association with HbA_1c level. With regard to glucose metabolism, it is inferred that neither short nor long sleep duration is favorable, and that there may be an appropriate range of sleep duration.

Acknowledgement

We thank Ms. Hiromi Sekine for her help with this study.

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Original ArticleAssociation between sleep duration and hemoglobin A1c level

Abstract

Objective

Methods

Results

Conclusions

Introduction

Section snippets

Subjects

Results

Discussion

Conclusion

Acknowledgement

Lancet

J Clin Epidemiol

Diabetes Res Clin Pract

An epidemiological study of insomnia among the Japanese general population

Sleep

Role of sleep duration and quality in the risk and severity of Type 2 diabetes mellitus

Arch Intern Med

Somatic diseases and sleep complaints: an epidemiological study of 3201 Swedish men

Acta Med Scand

Epidemiology of insomnia,depression, and anxiety

Sleep

The relationship between depression and sleep disturbances; a Japanese nationwide general population survey

J Clin Psychiatr

Sleep duration as a risk factor for the development of type 2 diabetes

Diabetes Care

The prevalence of comorbid depression in adults with diabetes: a meta-analysis

Diabetes Care

Depressive symptoms and metabolic control in African-Americans with type2 diabetes

Diabetes Care

Clinical depression versus distress among patients with Type2 diabetes

Diabetes Care

The CES-D scale: a self-report depression scale for research in the general population

Appl Psychol Meas

A new self-rating scale for depression (in Japanese)

Clin. Psychiatry

Evaluation of hemoglobin A1c with a latex agglutination turbidimetric immunoassay and Adaptation to the autoanalyzer (in Japanese)

Rinsyokensakikisiyaku

Original Article
Association between sleep duration and hemoglobin A_1c level

Evaluation of hemoglobin A_1c with a latex agglutination turbidimetric immunoassay and Adaptation to the autoanalyzer (in Japanese)