Sleep duration and cardiometabolic risk: A review of the epidemiologic evidence
Open accessAbstract
Laboratory studies have found that short-term sleep restriction is associated with impairments in glucose metabolism, appetite regulation and blood pressure regulation. This chapter reviews the epidemiologic evidence for an association between habitual sleep duration and quality and risk of cardiometabolic diseases including obesity, diabetes and hypertension. Multiple studies observed a cross-sectional association between short sleep duration (generally <6 h per night) and increased body mass index or obesity, prevalent diabetes and prevalent hypertension. Many studies also reported an association between self-reported long sleep duration (generally >8 h per night) and cardiometabolic disease. There have been a few prospective studies and several, but not all, have found an association between short sleep and incident diabetes, hypertension and markers of cardiovascular disease. Future prospective epidemiologic studies need to include objective measures of sleep, and intervention studies are needed in order to establish a causal link between impaired or insufficient sleep and cardiometabolic disease risk.
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Prospective epidemiologic studies indicate that insufficient sleep is associated with a higher risk of insulin resistance, obesity, and type 2 diabetes.
“Insufficient sleep increases the risk for insulin resistance, type 2 diabetes, and obesity, suggesting that sleep restriction may impair peripheral metabolic pathways.”
From Impaired Insulin Signaling in Human Adipocytes After Experimental Sleep Restriction: A Randomized, Crossover Study (2012) · cites this paper as [8]
The “Sleep and diabetes” section reports that prospective studies associate short sleep with incident diabetes, and “Sleep and BMI, obesity and appetite regulation” reports prospective associations with weight gain and childhood obesity. The paper discusses insulin resistance as a possible metabolic consequence in “Potential Mechanisms,” not as a risk established by prospective epidemiologic studies. It also cautions that observational evidence does not establish the causal claim that insufficient sleep increases these risks. Page numbers are unavailable in our copy. (LLM, conf=0.87)
Experimental — accuracy not yet measuredChronic sleep loss adversely affects glucose tolerance and cardiovascular function.
“Shift work is generally associated with chronic sleep loss, which adversely affects glucose tolerance and cardiovascular function (10–13).”
From Circadian Misalignment Augments Markers of Insulin Resistance and Inflammation, Independently of Sleep Loss (2014) · cites this paper as [11]
The Potential Mechanisms section links sleep loss to reduced glucose tolerance and describes changes in cardiac autonomic balance and blood pressure after sleep restriction. But the Introduction says laboratory studies were short-term, and the Summary treats the effects of insufficient sleep on cardiometabolic risk as suggestive; the paper does not establish that chronic sleep loss causes these effects. Page numbers were not provided. (LLM, conf=0.84)
Experimental — accuracy not yet measuredThe association of sleep duration with bodyweight appears to be best described by a U-shape, where long sleep durations may also be associated with increased bodyweight.
“We also note that the association of sleep duration with bodyweight appears to be best described by a U-shape, where long sleep durations may also be associated with increased bodyweight.108”
From The effects of sleep disruption on metabolism, hunger, and satiety, and the influence of psychosocial stress and exercise: A narrative review (2024) · cites this paper as [108]
Prospective epidemiologic studies strongly suggest that subjective short or long sleep duration and sleep disturbances predict the development of diabetes.
“Thus, taken together, prospective epidemiologic studies strongly suggest that subjective short or long sleep duration and sleep disturbances predict the development of diabetes.”
From Sleep and metabolic function (2012) · cites this paper as [80]
Short sleep duration predicted a higher incidence of diabetes in seven of nine prospective studies, while poor sleep quality was associated with increased risk in five of six studies.
“Short sleep duration (mostly ≤5and/or ≤6h) was found to predict a higher incidence of diabetes in seven of the nines studies, while poor sleep quality was associated with an increased risk of diabetes in five of the six studies [80].”
From Sleep and metabolic function (2012) · cites this paper as [80]
Some adult prospective studies report U- or L-shaped associations, so the link between longer sleep and BMI is conflicting in adults and absent in children.
“U- or L-shaped associations were reported in some adult prospective studies (reviewed in [80]; additional studies: [97, 202]); hence, the relationship between longer sleep and BMI is conflicting in adults and inexistent in children.”
From Sleep and metabolic function (2012) · cites this paper as [80]
Among 28 longitudinal studies on short sleep and later obesity risk in children and adults, 22 found that short sleep was linked to greater weight gain, obesity, or fat mass after a few years.
“Of the 28 longitudinal studies that examined the impact of short sleep on obesity risk in children and adults, 22 reported that short sleep is associated with an increased risk of weight gain or development of obesity and/or increased fat mass a few years later”
From Sleep and metabolic function (2012) · cites this paper as [80]
In pediatric populations, all 12 longitudinal studies found a positive association between short sleep and later obesity risk.
“This pattern is particularly consistent in pediatric populations (all 12 studies had positive findings; reviewed in [80]; additional references: [21, 38, 89, 150]).”
From Sleep and metabolic function (2012) · cites this paper as [80]
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“These findings have been summarized in reviews utilizing both quantitative [8,19,20,22,23] and narrative [3,16,17,24–28] approaches.”
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Self-citationSleep duration, cardiovascular disease, and proinflammatory biomarkers
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Sleep duration and risk of fatal and nonfatal stroke: A prospective study and meta-analysis
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Self-citationSleep duration versus sleep insufficiency as predictors of cardiometabolic health outcomes
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“Nine studies have examined the impact of self-reported sleep duration, and six studies have addressed the impact of sleep quality as determined by selfreport of sleep problems such as difficulty initiating or maintaining sleep or use of sleeping pills (reviewed in [80]).”
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Sleep: important considerations for the prevention of cardiovascular disease
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Addressing sleep disturbances: an opportunity to prevent cardiometabolic disease?
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“Many laboratory studies have demonstrated adverse effects of sleep deprivation that suggest mechanistic links between sleep loss and chronic disease (Grandner et al., 2010a; Knutson, 2010, 2012, 2013).”
BackgroundMethodThe Association of Sleep Duration and Quality with CKD Progression
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Self-citationExercise improves the quality of slow-wave sleep by increasing slow-wave stability
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Relation between sleep duration, overweight, and metabolic syndrome in Korean adolescents
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Sleep duration pattern and chronic diseases in Brazilian adults (ISACAMP, 2008/09)
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- Authors
- Knutson, K. L.
- Affiliations
- University of Chicago (US)
- Corresponding author
- Knutson, Kristen L.
- ORCID
- Knutson, Kristen L.
- Venue
- Best Practice & Research Clinical Endocrinology & Metabolism
- Publisher
- Elsevier BV
- Published
- 2010-10
- Volume
- 24
- Issue
- 5
- Pages
- 731-743
- ISSN
- 1521-690X (ISSN-L)
- PMC
- PMC3011978
- OpenAlex
- W2043746871
- Cited by
- 520
- References
- 94
- Citations by year
- 2026: 17 · 2025: 24 · 2024: 20 · 2023: 33 · 2022: 23 · 2021: 39 · 2020: 43 · 2019: 39 · 2018: 30 · 2017: 30 · 2016: 35 · 2015: 42 · 2014: 38 · 2013: 53 · 2012: 35
- FWCI
- 4.16
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Best Practice & Research Clinical Endocrinology & Metabolism (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Heart, Lung, and Blood Institute (P30HL101859)
- Topics
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and Work-Related Fatigue
- Life Sciences › Neuroscience › Endocrine and Autonomic Systems › Circadian rhythm and melatonin
- Keywords
- sleep duration, sleep quality, cardiometabolic risk, obesity, diabetes mellitus, hypertension, body mass index, glucose metabolism, blood pressure regulation, appetite regulation, cardiovascular disease, long sleep, short sleep duration
- MeSH terms
- Appetite Regulation, Cardiovascular Diseases, Diabetes Mellitus, Type 2, Humans, Metabolic Diseases, Models, Biological, Obesity, Risk Factors, Sleep, Sleep Deprivation, Body Mass Index
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