The association of sleep duration and sleep quality with type 2 diabetes mellitus: The CARRS study Open Access

Ismaily, Sanober (2016)

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Objective: We sought to examine the association of night sleep duration and sleep quality (daytime napping, sleep apneas, habitual snoring, and daytime sleepiness, and overall sleep quality) with type 2 diabetes mellitus among adults in three large South Asian cities. Further, we assessed whether associations between sleep measures and type 2 diabetes mellitus varied by age, sex, or weight status.

Methods: We conducted a cross-sectional analysis of participants enrolled in the 2011 baseline survey of the Center for cArdiometabolic Risk Reduction in South Asia, a representative sample of non-pregnant adults in urban blocks of Chennai and Delhi, India and Karachi, Pakistan. The analytic sample consisted of n=11,351 with complete data on covariates of interest. We estimated odds ratios describing the association between measures of sleep duration and quality and diabetes using logistic regression models accounting for the survey design. Adjusted models included city, age, sex, religion, educational level, occupation, number of assets owned, time spent sedentary per day, and weight status measured as body mass index (BMI).

Results: We observed no association between duration of nightly sleep and prevalent diabetes in adjusted models. In contrast, four of five measures of sleep quality--daytime napping (aOR: 1.20, 95% CI: 1.02, 1.40), sleep apneas (aOR: 1.32, 95% CI: 1.06, 1.63), habitual snoring (aOR: 1.37, 95% CI: 1.14, 1.65), and overall sleep quality (aOR: 2.13, 95% CI: 1.24, 3.66) demonstrated moderate associations with prevalent diabetes in the overall sample. Point estimates of odds ratios were largely consistent in strata of sex, age group, and weight status.

Conclusion: While sleep duration was not associated with prevalent diabetes, we found that poor sleep quality was associated with prevalent diabetes. Specifically, daytime napping, observed apneas, habitual snoring, and overall poor sleep quality were significantly associated with higher prevalent type 2 diabetes. Of the indicators of poor sleep quality, overall poor sleep quality showed the strongest relationship with type 2 diabetes. Further investigation may probe the directionality of these associations to better understand the potential to mitigate diabetes risk by improving sleep quality among urban South Asians.

Table of Contents

Chapter I. Introduction. 8

Introduction and Rationale. 8

Problem Statement. 11

Purpose Statement. 12

Research Questions. 12

Significance Statement. 13

Chapter II. Literature Review. 15

Sleep duration and type 2 diabetes in the non-Asian population. 15

Sleep quality and type 2 diabetes in the non-Asian population. 17

Sleep duration and sleep quality and type 2 diabetes in the Asian population. 19

Sleep duration and sleep quality and type 2 diabetes in South Asia. 23

Chapter III. Manuscript. 26

Abstract. 29

Introduction. 30

Methods. 32

Study population. 32

Study measures and definitions. 33

Statistical analysis.. 36

Results. 38

Discussion. 45

Main findings. 45

Limitations and strengths. 46

References. 58

Chapter IV. Public Health Recommendations. 62

Conclusion. 62

Implications for the Future. 63

References. 66

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