Sleep duration, lifestyle intervention, and incidence of type 2 diabetes in impaired glucose tolerance: The Finnish Diabetes Prevention Study

Henri Tuomilehto, Markku Peltonen, Markku Partinen, Gilles Lavigne, Johan G Eriksson, Christian Herder, Sirkka Aunola, Sirkka Keinänen-Kiukaanniemi, Pirjo Ilanne-Parikka, Matti Uusitupa, Jaakko Tuomilehto, Jaana Lindström, Finnish Diabetes Prevention Study Group, Henri Tuomilehto, Markku Peltonen, Markku Partinen, Gilles Lavigne, Johan G Eriksson, Christian Herder, Sirkka Aunola, Sirkka Keinänen-Kiukaanniemi, Pirjo Ilanne-Parikka, Matti Uusitupa, Jaakko Tuomilehto, Jaana Lindström, Finnish Diabetes Prevention Study Group

Abstract

Objective: Both short and long sleep duration have frequently been found to be associated with an increased risk for diabetes. The aim of the present exploratory analysis was to examine the association between sleep duration and type 2 diabetes after lifestyle intervention in overweight individuals with impaired glucose tolerance in a 7-year prospective follow-up.

Research design and methods: A total of 522 individuals (aged 40-64 years) were randomly allocated either to an intensive diet-exercise counseling group or to a control group. Diabetes incidence during follow-up was calculated according to sleep duration at baseline. Sleep duration was obtained for a 24-h period. Physical activity, dietary intakes, body weight, and immune mediators (C-reactive protein and interleukin-6) were measured.

Results: Interaction between sleep duration and treatment group was statistically significant (P = 0.003). In the control group, the adjusted hazard ratios (HRs) (95% CI) for diabetes were 2.29 (1.38-3.80) and 2.74 (1.67-4.50) in the sleep duration groups 9-9.5 h and >or=10 h, respectively, compared with for that of the 7-8.5 h group. In contrast, sleep duration did not influence the incidence of diabetes in the intervention group; for sleep duration groups 9-9.5 h and >or=10 h, the adjusted HRs (95% CI) were 1.10 (0.60-2.01) and 0.73 (0.34-1.56), respectively, compared with that in the reference group (7-8.5 h sleep). Lifestyle intervention resulted in similar improvement in body weight, insulin sensitivity, and immune mediator levels regardless of sleep duration.

Conclusions: Long sleep duration is associated with increased type 2 diabetes risk. Lifestyle intervention with the aim of weight reduction, healthy diet, and increased physical activity may ameliorate some of this excess risk.

Trial registration: ClinicalTrials.gov NCT00518167.

Figures

Figure 1
Figure 1
The cumulative incidence of type 2 diabetes in follow-up time by sleep duration groups. A: Control group. B: Intervention group.

References

    1. Kripke DF, Garfinkel L, Wingard DL, Klauber MR, Marler MR: Mortality associated with sleep duration and insomnia. Arch Gen Psychiatry 2002;59:131–136
    1. Yaggi HK, Araujo AB, McKinlay JB: Sleep duration as a risk factor for the development of type 2 diabetes. Diabetes Care 2006;29:657–661
    1. Ayas NT, White DP, Al-Delaimy WK, Manson JE, Stampfer MJ, Speizer FE, Patel S, Hu FB: A prospective study of self-reported sleep duration and incident diabetes in women. Diabetes Care 2003;26:380–384
    1. Tuomilehto H, Peltonen M, Partinen M, Seppä J, Saaristo T, Korpi-Hyövälti E, Oksa H, Saltevo J, Puolijoki H, Vanhala M, Tuomilehto J: Sleep duration is associated with an increased risk for the prevalence of type 2 diabetes in middle-aged women: the FIN-D2D survey. Sleep Med 2008;9:221–227
    1. Spiegel K, Leproult R, Van Cauter E: Impact of sleep debt on metabolic and endocrine function. Lancet 1999;354:1435–1439
    1. Young T, Skatrud J, Peppard PE: Risk factors for obstructive sleep apnea in adults. JAMA 2004;291(16):2013–2016
    1. Capuron L, Su S, Miller AH, Bremner JD, Goldberg J, Vogt GJ, Maisano C, Jones L, Murrah NV, Vaccarino V: Depressive symptoms and metabolic syndrome: is inflammation the underlying link. Biol Psychiatry 2008;64:896–900
    1. Lindström J, Louheranta A, Mannelin M, Rastas M, Salminen V, Eriksson J, Uusitupa M, Tuomilehto J: The Finnish Diabetes Prevention Study Group: lifestyle intervention and 3-year results on diet and physical activity. Diabetes Care 2003;26:3230–3236
    1. Lindström J, Ilanne-Parikka P, Peltonen M, Aunola S, Eriksson JG, Hemiö K, Hämäläinen H, Härkönen P, Keinänen-Kiukaanniemi S, Laakso M, Louheranta A, Mannelin M, Paturi M, Sundvall J, Valle TT, Uusitupa M, Tuomilehto J: Finnish Diabetes Prevention Study Group. Sustained reduction in the incidence of type 2 diabetes by lifestyle intervention: the follow-up results of the Finnish Diabetes Prevention Study. Lancet 2006;368:1673–1679
    1. Lakka TA, Salonen JT: Intra-person variability of various physical activity assessments in the Kuopio Ischaemic Heart Disease Risk Factor Study. Int J Epidemiol 1992;21:467–472
    1. World Health Organization. Diabetes Mellitus: Report of a WHO Study Group. Geneva, World Health Org., 1985. (Tech. Rep. Ser., no. 727)
    1. Herder C, Peltonen M, Koenig W, Kräft I, Müller-Scholze S, Martin S, Lakka T, Ilanne-Parikka P, Eriksson JG, Hämäläinen H, Keinänen-Kiukaanniemi S, Valle TT, Uusitupa M, Lindström J, Kolb H, Tuomilehto J. for the Finnish Diabetes Prevention Study Group. Systemic immune mediators and lifestyle changes in the prevention of type 2 diabetes: results from the Finnish Diabetes Prevention Study. Diabetes 2006;55:2340–2346
    1. Kronholm E, Härmä M, Hublin C, Aro AR, Partonen T: Self-reported sleep duration in Finnish general population. J Sleep Res 2006;15:276–290
    1. Grandner MA, Drummond SPA: Who are long sleepers? Towards an understanding of the mortality relationship. Sleep Med Rev 2007;11:341–360
    1. Patel SR, Malhotra A, Gottlieb DJ, White DP, Hu FB: Correlates of long sleep duration. Sleep 2006;29:881–889
    1. Ip MS, Lam B, Ng MM, Lam WK, Tsang KW, Lam KS: Obstructive sleep apnea is independently associated with insulin resistance. Am J Respir Crit Care Med 2002;165:670–676
    1. Tuomilehto H, Seppä J, Partinen M, Peltonen M, Gylling H, Tuomilehto J, Vanninen E, Kokkarinen J, Sahlman J, Martikainen T, Randell J, Tukiainen H, Uusitupa M: Weight reduction is a curative treatment for patients with mild obstructive sleep apnea—a prospective, randomized study. Am J Respir Crit Care Med 2009;179:320–327
    1. Uusitupa M, Lindi V, Louheranta A, Salopuro T, Lindström J, Tuomilehto J: Long-term improvement in insulin sensitivity by changing lifestyles of people with impaired glucose tolerance: 4-year results from the Finnish Diabetes Prevention Study. Diabetes 2003;52:2532–2538
    1. Schweitzer PK: Drugs that disturb sleep and wakefulness. In Principles and Practice of Sleep Medicine. 4th ed. Kryger M, Roth Thomas, Dement W. Eds. New York, Elsevier, 2005, p. 499–518
    1. Vgontzas AN, Papanicolaou DA, Bixler EO, Kales A, Tyson K, Chrousos GP: Elevation of plasma cytokines in disorders of excessive daytime sleepiness: role of sleep disturbance and obesity. J Clin Endocrinol Metab 1997;82:1313–1316
    1. Williams CJ, Hu FB, Patel SR, Mantzoros CS: Sleep duration and snoring in relation to biomarkers of cardiovascular disease risk among women with type 2 diabetes. Diabetes Care 2007;30:1233–1240
    1. Herder C, Peltonen M, Koenig W, Sütfels K, Lindström J, Martin S, Ilanne-Parikka P, Eriksson JG, Aunola S, Keinänen-Kiukaanniemi S, Valle TT, Uusitupa M, Kolb H, Tuomilehto J. the Finnish Diabetes Prevention Study Group. Anti-inflammatory effect of lifestyle changes in the Finnish Diabetes Prevention Study. Diabetologia 2009;52:433–442
    1. Lockley SW, Skene DJ, Arendt J: Comparison between subjective and actigraphic measurement of sleep and sleep rhythms. J Sleep Res 1999;8:175–183

Source: PubMed

Sponzoři a spolupracovníci

Zdravotní podmínky

Drogové intervence

3
Předplatit