The robust variance estimator was used in linear regression models to calculate confidence intervals and P values. The first regression model was unadjusted, and the second model was adjusted for age, race, sex, BMI, education, and income. Fasting glucose, fasting insulin, and HOMA-IR were all transformed using the natural log in the analyses because they were skewed to the right. Each of the four sleep measures-sleep duration, sleep fragmentation, insomnia, and frequent snoring-was entered into a separate regression model. Linear regression models were used to examine the cross-sectional association between the sleep measures and fasting glucose, fasting insulin, and HOMA of insulin resistance (HOMA-IR) at the 20-year examination. Differences in means between those with and without diabetes were tested using unpaired Student t tests, and differences in proportions were tested using χ 2 tests. Means (SD) of all continuous variables and proportions of categorical variables were calculated. Together, these studies suggest that glucose metabolism may be adversely affected by short sleep duration and poor sleep quality.īecause the mechanisms of glucose regulation are markedly different between people with and without diabetes, all analyses were stratified by diabetes status. A small Italian study did use wrist actigraphy to compare the sleep of patients with type 2 diabetes with healthy control subjects and found higher sleep fragmentation in the patients with diabetes ( 14). These observational studies all relied on self-reported sleep, which may not be very accurate ( 13). For example, a meta-analysis reported a pooled risk ratio of 1.28 (95% CI 1.03–1.60) associated with sleep duration ≤6 h compared with 7–8 h per night ( 12). Several prospective studies found higher rates of incident diabetes associated with shorter sleep durations. Many have found cross-sectional associations that indicated a higher prevalence of diabetes among short sleepers ( 7– 9) and among those with poor subjective sleep quality ( 10, 11). Observational studies have examined the association between self-reported habitual sleep and diabetes risk. These laboratory studies lasted only 1 to 2 weeks and the results may not reflect the effects of habitual short sleep. Laboratory studies that manipulated bedtimes observed impaired glucose metabolism after sleep restriction compared with sleep extension ( 4– 6).
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