Too Little or Too Much Sleep Linked to Diabetes
Sleeping less than 6 hours or 10 or more hours was linked to a greater risk for chronic diseases including diabetes, coronary heart disease, anxiety, and obesity in a study involving adults age 45 years and older. The findings were reported in the October issue of Sleep.
“Some of the relationships between unhealthy sleep durations and chronic diseases were partially explained by frequent mental distress and obesity,” said study co-author Janet B. Croft, PhD, senior chronic disease epidemiologist in Centers for Disease Control and Prevention’s Division of Population Health. “This suggests that physicians should consider monitoring mental health and body weight in addition to sleep health for patients with chronic diseases,” Dr. Croft said.
“There is a strong association between common sleep disorders and chronic disease, such as diabetes,” commented M. Safwan Badr, MD, President of the American Academy of Sleep Medicine. “The relationship is likely bidirectional; therefore, poor sleep may adversely affect diabetes control and vice versa. Optimal treatment of sleep disorders may significantly improve disease symptoms and quality of life,” Dr. Badr said.
U-Shaped Relationship Between Sleep and Chronic Disease Risk
The study involved more than 54,000 people age 45 years or older who completed the 2010 Behavioral Risk Factor Surveillance System survey. Nearly one third of participants (31.1%) were considered short sleepers (<6 hours on average), 64.8% were optimal sleepers, and 4.1% were long sleepers (>10 hours).
Both short and long sleepers reported a higher prevalence of coronary heart disease, stroke, diabetes, obesity, and frequent mental distress (ie, mental health was not good ≥ 14 days during the past 30 days) compared with optimal sleepers. The associations with coronary heart disease, stroke, and diabetes were even more pronounced among long sleepers than among short sleepers and were “moderately” attenuated by frequent mental distress, the researchers reported. The relationship between sleep duration and diabetes was “slightly” attenuated by obesity, according to the researchers.
Promoting Healthy Sleep Among Patients With Diabetes
“Optimal sleep duration is critical for patients with diabetes, who should obtain 7 to 9 hours of sleep per night,” said Dr. Badr, who is also Professor and Chief of the Division of Pulmonary, Critical Care, and Sleep Medicine at Wayne State University School of Medicine in Detroit, Michigan. “This is a universal recommendation that is even more critical for patients dealing with a chronic illness,” he explained.
Dr. Badr noted that sleep apnea is common in patients with type 2 diabetes. “In fact, four out of five patients with type 2 diabetes have sleep apnea; increasing severity of sleep apnea is associated with worsening glucose control. Therefore, primary care physicians need to be extremely vigilant in pursuing the diagnosis of sleep apnea in this population,” he said.
“Primary care physicians can play a major role in promoting and achieving healthy sleep and in the diagnosis and management of sleep disorders,” Dr. Badr suggested. “The first step is to inquire about sleep complaints during a routine doctor’s visit. A routine review of systems should include inquiry of sleep-related complaints including poor nocturnal sleep, frequent arousals, snoring, witnessed apnea, non-refreshing sleep, and daytime sleepiness,” he said.
“The physician may counsel the patient regarding optimal sleep or make the appropriate referral for an evaluation by a board-certified sleep specialist,” Dr. Badr added.