Study identifies sleep duration associated with lowest death rate in patients with T2D

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A recent study found a J-shaped association between sleep duration and mortality in people with type 2 diabetes (T2D), with a duration of 5-7 hours associated with the lowest mortality risk.

A study published in Cardiovascular diabetes found that sleep duration was associated with cardiovascular disease (CVD) mortality risk in participants with type 2 diabetes (T2DM). The aim of the study was to examine associations between baseline sleep duration and subsequent risks of all-cause mortality, extensive CVD, and non-extensive CVD.

The retrospective cohort study took place at the Diabetes Care Management Program (DCMP) of China Medical University Hospital in Taiwan. The participants all had a diagnosis of T2D, and all those enrolled in the DCMP registry between November 2001 and April 2016 were eligible for the study. Participants were excluded if they had gestational diabetes, were younger than 30, or had less than 3 years of follow-up. A total of 12,526 patients were included in the study.

All participants underwent medical testing for vital signs, blood, urine, anthropometric measurements, and lifestyle behaviors; medical history was also acquired. All measurements were recorded annually. Sleep duration was determined by a questionnaire; participants were asked to record their typical sleep hours one month before the interview. The thresholds for the 6 groups were: 4 hours of sleep or less, 5 to 6 hours, 7 hours, 8 hours, 9 to 10 hours and more than 10 hours.

All patients were followed from the index date in the DCMP to August 2021, the date of DCMP withdrawal or death.

There were 2918 patients who died during the mean (SD) follow-up of 10.82 (3.90) years, including 1328 extensive CVD deaths and 1590 non-extensive CVD deaths. Expanded cardiovascular mortality was defined as death due to cardiovascular disease, diabetes, or kidney disease, as defined by International Classification of Diseases codes, while non-expanded CVD deaths were from CVD only.

Patients who slept more than 10 hours a day were more likely to be female, non-alcohol drinkers, physically inactive, and older than 45 at diagnosis of diabetes and were more likely to have hypertension , higher risk of stroke, coronary artery disease, peripheral neuropathy and cardiovascular drug use than patients who slept 7 hours a day.

Patients who slept more than 10 hours a day also had lower mean body mass index (BMI) and estimated glomerular filtration rate values, but higher mean age and diabetes duration than patients who slept 7 hours. per day. The proportions of participants with sleep durations of 4 hours or less, 5 to 6 hours, 7 hours, 8 hours, 9 to 10 hours and more than 10 hours were 1.64%, 16.04%, 26.15 %, 29.32%, 23.23% and 3.62%, respectively.

A multivariate Cox regression model demonstrated that patients with sleep durations of 4 hours or less, 9-10 hours, and more than 10 hours had higher mortality risks than patients with sleep durations of 7 hours (≤4 hours: HR, 1.41; 95% CI, 1.06-1.86; 9-10 hours: HR, 1.37; 95% CI, 1.23-1.52; > 10 hours: HR, 1.82; 95% CI, 1.54-2.14).

Patients who slept 4 hours or less, 9-10 hours, and more than 10 hours per day had a higher risk of mortality from enlarged CVD (≤ 4 hours: RR, 1.54; 95% CI, 1. 04-2.28, 9-10 hours: HR, 1.34, 95% CI, 1.15-1.57, >10 hours: HR, 1.88, 95% CI, 1.49-2 ,37). Excessive risks of non-extensive CVD mortality were found in patients with sleep durations of 8 hours, 9-10 hours, and more than 10 hours (8 hours: RR, 1.16; 95% CI, 1.01-1.34, 9-10 hours: RR, 1.39, 95% CI, 1.20-1.60, >10 hours: HR, 1.77, 95% CI, 1.41 -2.23).

When the analysis included patients younger than 30 years, patients with sleep duration of 4 hours or less, 9-10 hours, and more than 10 hours had a higher risk of all-cause mortality and mortality cardiovascular extent than those with a sleep duration of 7 hours.

Adjusted RRs of sleep duration greater or less than 7 hours with age, duration of diabetes, age at diagnosis of diabetes, insulin use, and BMI were all significant for all-cause mortality, extensive cardiovascular disease and non-extensive cardiovascular disease. Significant interactions were found between sleep duration and obesity on all-cause mortality, sleep duration and age on broad cardiovascular mortality, and sleep duration and diabetes duration and obesity. on unexpanded cardiovascular mortality.

There were some limitations to this study. The sleep measure was reported by a questionnaire and not by an objective measure, meaning it lacks information about sleep quality and depression. Only 1.6% of patients had a sleep time of 4 hours or less, so the results should be taken with caution.

The researchers concluded that sleep duration is a predictor of extensive and non-extensive CVD mortality in patients with T2DM, and those with sleep duration of 5 to 7 hours have the greatest mortality risk. weak.

Reference

Li CI, Lin CC, Liu CS, Lin CH, Yang SY, Li TC. Sleep duration predicts long-term mortality in patients with type 2 diabetes: a large single-center cohort study. Cardiovascular diabetes. 2022;21:60. doi:10.1186/s12933-022-01500-0

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