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Original Investigation
September 18, 2006

Role of Sleep Duration and Quality in the Risk and Severity of Type 2 Diabetes Mellitus

Author Affiliations

Author Affiliations: Department of Medicine, University of Chicago (Drs Knutson, Ryden, and Van Cauter, and Mr Mander); and Institute for Neuroscience, Northwestern University (Mr Mander); Chicago, Ill.

Arch Intern Med. 2006;166(16):1768-1774. doi:10.1001/archinte.166.16.1768

Background  Evidence from laboratory and epidemiologic studies suggests that decreased sleep duration or quality may increase diabetes risk. We examined whether short or poor sleep is associated with glycemic control in African Americans with type 2 diabetes mellitus.

Methods  We conducted a cross-sectional study of volunteers with type 2 diabetes interviewed at the University of Chicago Hospitals, Chicago, Ill. The final analysis included 161 participants. Glycemic control was assessed by hemoglobin A1c (HbA1c) level obtained from medical charts. Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI). Perceived sleep debt was calculated as the difference between preferred and actual weekday sleep duration.

Results  The mean ± SD sleep duration was 6.0 ± 1.6 hours, and 71% of the participants were classified as having poor quality sleep (PSQI score >5). We excluded patients with sleep frequently disrupted by pain (n = 39). In patients without diabetic complications, glycemic control was associated with perceived sleep debt but not PSQI score. The predicted increase in HbA1c level for a perceived sleep debt of 3 hours per night was 1.1% above the median. In patients with at least 1 complication, HbA1c level was associated with PSQI score but not perceived sleep debt. The predicted increase in HbA1c level for a 5-point increase in PSQI was 1.9% above the median.

Conclusions  In our sample, sleep duration and quality were significant predictors of HbA1c, a key marker of glycemic control. Combined with existing evidence linking sleep loss to increased diabetes risk, these data suggest that optimizing sleep duration and quality should be tested as an intervention to improve glucose control in patients with type 2 diabetes.