Role of Sleep Duration and Quality in the Risk and Severity of Type 2 Diabetes Mellitus
Abstract
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.
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Short sleep (fewer than five to six hours) may qualify as an additional clinical factor in the development of insulin resistance and diabetes.
“We suggest that short sleep (fewer than five to six hours) may now qualify as an additional clinical factor in the development of insulin resistance and diabetes, as shown in several cross-sectional studies.27–29”
From Interacting epidemics? Sleep curtailment, insulin resistance, and obesity (2012) · cites this paper as [27]
Among persons with type 2 diabetes, poorer glycemic control is associated with worse sleep quality and increased sleep disordered breathing.
“Furthermore, among persons with T2DM, poorer glycemic control is associated with worse sleep quality and increased sleep disordered breathing [179–181].”
From Association between sleep deficiency and cardiometabolic disease: implications for health disparities (2016) · cites this paper as [179]
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Morjaria, R., Alexander, I., Purbrick, R. M. J., Safa, R., Chong, N. V., Wulff, K., Foster, R. G., Downes, S. M., & for the SOMNUS Study Group (2019) · Investigative Opthalmology & Visual Science · doi:10.1167/iovs.18-26108 · Cited by 35 · see citing works
Lack of sleep in the workplace: What the psychologist-manager should know about sleep.
Gaultney, J. F., & Collins-McNeil, J. (2009) · The Psychologist-Manager Journal · doi:10.1080/10887150902905454 · Cited by 20 · see citing works
Dumitrescu, A. M., Hanlon, E. C., Arosemena, M., Duchon, O., Ettleson, M., Giurcanu, M., & Bianco, A. C. (2022) · Thyroid · doi:10.1089/thy.2021.0304 · Cited by 20 · see citing works
- Authors
- Knutson, K. L.
- Affiliations
- University of Chicago (US)
- Corresponding author
- Knutson, Kristen L.
- ORCID
- Knutson, Kristen L.
- Venue
- Archives of Internal Medicine
- Publisher
- American Medical Association (AMA)
- Published
- 2006-09-18
- Volume
- 166
- Issue
- 16
- Pages
- 1768
- ISSN
- 0003-9926 (ISSN-L)
- OpenAlex
- W2035143857
- Cited by
- 641
- References
- 36
- Citations by year
- 2026: 13 · 2025: 13 · 2024: 25 · 2023: 28 · 2022: 43 · 2021: 41 · 2020: 37 · 2019: 40 · 2018: 37 · 2017: 43 · 2016: 35 · 2015: 43 · 2014: 46 · 2013: 34 · 2012: 36
- FWCI
- 27.64
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Archives of Internal Medicine (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institute on Aging (P01-AG11412., P01AG011412)
- National Institute of Diabetes and Digestive and Kidney Diseases (R01 DK-41814, R01DK041814)
- Topics
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
- Life Sciences › Neuroscience › Endocrine and Autonomic Systems › Circadian rhythm and melatonin
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and Work-Related Fatigue
- Keywords
- type 2 diabetes, sleep duration, sleep quality, glycemic control, HbA1c, sleep debt, African Americans, diabetes complications, Pittsburgh Sleep Quality Index
- MeSH terms
- Black or African American, Cross-Sectional Studies, Diabetes Mellitus, Type 2, Female, Glycated Hemoglobin, Humans, Male, Middle Aged, Surveys and Questionnaires, Regression Analysis, Risk Factors, Severity of Illness Index, Sleep, Time Factors, Black People
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