Association of Short and Long Sleep Durations with Insulin Sensitivity in Adolescents
Open accessAbstract
Objective To characterize the relationship between insulin sensitivity, assessed with the homeostasis model of insulin (HOMA), and objective measurements of sleep duration in adolescents.Study design We conducted a cross-sectional analysis from two examinations conducted in the Cleveland Children's Sleep and Health Cohort (n = 387; 43% minorities). Biochemical and anthropometry measurements were made in a clinical research unit. Sleep duration was measured with actigraphy.Results Decreased sleep duration was associated with increased adiposity and minority race. Sleep duration had a quadratic "u-shape" association with HOMA. When adjusted for age, sex, race, preterm status, and activity, adolescents who slept 7.75 hours had the lowest predicted HOMA (1.96, 95% confidence interval [CI], 1.82-2.10), and adolescents who slept 5.0 hours or 10.5 hours had HOMA indices that were approximately 20% higher (2.36; 95% CI, 1.94-2.86; and 2.41; 95% CI, 1.93-3.01, respectively). After adjusting for adiposity, the association between shorter sleep and HOMA was appreciably attenuated, but the association with longer sleep persisted.Conclusions Shorter and longer sleep durations are associated with decreased insulin sensitivity in adolescents. Although the association between shorter sleep duration with insulin sensitivity likely is explained by the association between short sleep duration and obesity, the association between longer sleep and insulin sensitivity is independent of obesity.
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There is strong evidence that short sleep duration is associated with greater insulin resistance and disrupted glucose metabolism.
“Taken together, there is strong evidence that short sleep duration is associated with greater insulin resistance and disrupted glucose metabolism.”
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 [14]
Among a more diverse sample (43% non-White) of adolescents, actigraphy-measured short sleep duration was associated with insulin resistance even after adjustment for age, sex, race, and activity levels.
“Among a more diverse samples (43% non-White) of adolescents, actigraphy-measured short sleep duration was associated with insulin resistance even after adjustment for age, sex, race, and activity levels.14”
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 [14]
Short sleep duration is associated with impaired insulin sensitivity and glucose metabolism.
“Data from both small and large cohort studies suggest that short sleep duration is associated with impaired insulin sensitivity and glucose metabolism (Table 1).”
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 [14]
The association between actigraphy-measured short sleep duration and insulin resistance in adolescents was attenuated but still significant following adjustment for adiposity.
“This association was attenuated but still significant following adjustment for adiposity.”
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 [14]
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Cites
Matthews, D. R., Hosker, J. P., Rudenski, A. S., Naylor, B. A., Treacher, D. F., & Turner, R. C. (1985) · Diabetologia · doi:10.1007/bf00280883 · Cited by 31,502 · see citing works
Impact of sleep debt on metabolic and endocrine function
Spiegel, K., Leproult, R., & Van Cauter, E. (1999) · The Lancet · doi:10.1016/s0140-6736(99)01376-8 · Cited by 3,668 · see citing works
Inflammation: the link between insulin resistance, obesity and diabetes
Dandona, P. (2004) · Trends in Immunology · doi:10.1016/j.it.2003.10.013 · Cited by 2,170 · see citing works
Meta-Analysis of Short Sleep Duration and Obesity in Children and Adults
Cappuccio, F. P., Taggart, F. M., Kandala, N.-B., Currie, A., Peile, E., Stranges, S., & Miller, M. A. (2008) · Sleep · doi:10.1093/sleep/31.5.619 · Cited by 2,076 · see citing works
Short Sleep Duration and Weight Gain: A Systematic Review
Patel, S. R., & Hu, F. B. (2008) · Obesity · doi:10.1038/oby.2007.118 · Cited by 1,505 · see citing works
The metabolic consequences of sleep deprivation
Knutson, K. L., Spiegel, K., Penev, P., & Van Cauter, E. (2007) · Sleep Medicine Reviews · doi:10.1016/j.smrv.2007.01.002 · Cited by 1,365 · see citing works
Sleep loss: a novel risk factor for insulin resistance and type 2 diabetes
Spiegel, K., Knutson, K., Leproult, R., Tasali, E., & Cauter, E. V. (2005) · Journal of Applied Physiology · doi:10.1152/japplphysiol.00660.2005 · Cited by 1,175 · see citing works
Keskin, M., Kurtoğlu, S., Kendırcı, M., Atabek, M. E., & Yazıcı, C. (2005) · PEDIATRICS · doi:10.1542/peds.2004-1921 · Cited by 1,089 · see citing works
Emerging epidemic of type 2 diabetes in youth
Rosenbloom, A. L., Joe, J. R., Young, R. S., & Winter, W. E. (1999) · Diabetes Care · doi:10.2337/diacare.22.2.345 · Cited by 1,019 · see citing works
Type 2 diabetes in children and adolescents. American Diabetes Association.
(2000) · Diabetes Care · doi:10.2337/diacare.23.3.381 · Cited by 936 · see citing works
Association of sleep time with diabetes mellitus and impaired glucose tolerance
Gottlieb, D. J., Punjabi, N. M., Newman, A. B., Resnick, H. E., Redline, S., Baldwin, C. M., & Nieto, F. J. (2005) · Archives of Internal Medicine · doi:10.1001/archinte.165.8.863 · Cited by 927 · see citing works
Self-citationA prospective study of self-reported sleep duration and incident diabetes in women
Ayas, N. T., White, D. P., Al-Delaimy, W. K., Manson, J. E., Stampfer, M. J., Speizer, F. E., Patel, S., & Hu, F. B. (2003) · Diabetes Care · doi:10.2337/diacare.26.2.380 · Cited by 883 · see citing works
<i>Associations between Sleep Loss and Increased Risk of Obesity and Diabetes</i>
Knutson, K. L., & Van Cauter, E. (2008) · Annals of the New York Academy of Sciences · doi:10.1196/annals.1417.033 · Cited by 810 · see citing works
Is Sleep Duration Associated With Childhood Obesity? A Systematic Review and Meta‐analysis
Chen, X., Beydoun, M. A., & Wang, Y. (2008) · Obesity · doi:10.1038/oby.2007.63 · Cited by 796 · see citing works
Sleep duration as a risk factor for the development of type 2 diabetes
Yaggi, H. K., Araujo, A. B., & McKinlay, J. B. (2006) · Diabetes Care · doi:10.2337/diacare.29.03.06.dc05-0879 · Cited by 790 · see citing works
ROSEN, C. L., Larkin, E. K., Kirchner, H. L., Emancipator, J. L., Bivins, S. F., Surovec, S. A., Martin, R. J., & Redline, S. S. (2003) · The Journal of Pediatrics · doi:10.1067/mpd.2003.28 · Cited by 742 · see citing works
Self-citationBastard, J., Maachi, M., Nhieu, J. T. V., Jardel, C., Bruckert, É., Grimaldi, A., Robert, J., Capeau, J., & Hainque, B. (2002) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jcem.87.5.8450 · Cited by 625 · see citing works
Sleep Duration as a Risk Factor for Diabetes Incidence in a Large US Sample
Gangwisch, J. E., Heymsfield, S. B., Boden-Albala, B., Buijs, R. M., Kreier, F., Pickering, T. G., Rundle, A. G., Zammit, G. K., & Malaspina, D. (2007) · Sleep · doi:10.1093/sleep/30.12.1667 · Cited by 573 · see citing works
Diabetes and Sleep Disturbances
Resnick, H. E., Redline, S., Shahar, E., Gilpin, A., Newman, A., Walter, R., Ewy, G. A., Howard, B. V., & Punjabi, N. M. (2003) · Diabetes Care · doi:10.2337/diacare.26.3.702 · Cited by 504 · see citing works
Self-citationGozal, D., Capdevila, Ó. S., & Gozal, D. (2008) · American Journal of Respiratory and Critical Care Medicine · doi:10.1164/rccm.200711-1670oc · Cited by 408 · see citing works
High Incidence of Diabetes in Men With Sleep Complaints or Short Sleep Duration
Mallon, L., Broman, J.-E., & Hetta, J. (2005) · Diabetes Care · doi:10.2337/diacare.28.11.2762 · Cited by 391 · see citing works
Lagathu, C., Bastard, J.-P., Auclair, M., Maachi, M., Capeau, J., & Caron, M. (2003) · Biochemical and Biophysical Research Communications · doi:10.1016/j.bbrc.2003.10.013 · Cited by 385 · see citing works
Adiponectin, the missing link in insulin resistance and obesity
GILCAMPOS, M. (2004) · Clinical Nutrition · doi:10.1016/j.clnu.2004.04.010 · Cited by 353 · see citing works
Impact of Sleep and Sleep Loss on Neuroendocrine and Metabolic Function
van Cauter, E., Holmbäck, U., Knutson, K., Leproult, R., Miller, A., Nedeltcheva, A., Pannain, S., Penev, P., Tasali, E., & Spiegel, K. (2007) · Hormone Research in Paediatrics · doi:10.1159/000097543 · Cited by 353 · see citing works
Incidence of Diabetes in Middle-Aged Men Is Related to Sleep Disturbances
Nilsson, P. M., Rööst, M., Engström, G., Hedblad, B., & Berglund, G. (2004) · Diabetes Care · doi:10.2337/diacare.27.10.2464 · Cited by 322 · see citing works
Sleep Quality and Elevated Blood Pressure in Adolescents
Javaheri, S., Storfer‐Isser, A., ROSEN, C. L., & Redline, S. S. (2008) · Circulation · doi:10.1161/circulationaha.108.766410 · Cited by 310 · see citing works
Self-citationAssociation between Metabolic Syndrome and Sleep-disordered Breathing in Adolescents
Redline, S. S., Storfer‐Isser, A., ROSEN, C. L., Johnson, N. L., Kirchner, H. L., Emancipator, J. L., & Kibler, A. M. (2007) · American Journal of Respiratory and Critical Care Medicine · doi:10.1164/rccm.200703-375oc · Cited by 300 · see citing works
Self-citationInsulin resistance and obesity in childhood
Chiarelli, F., & Marcovecchio, M. L. (2008) · European Journal of Endocrinology · doi:10.1530/eje-08-0245 · Cited by 285 · see citing works
Comparison of insulin sensitivity tests across a range of glucose tolerance from normal to diabetes
Hermans, M. P., Lévy, J., Morris, R. J., & Turner, R. C. (1999) · Diabetologia · doi:10.1007/s001250051215 · Cited by 260 · see citing works
Larkin, E. K., Rosen, C. L., Kirchner, H. L., Storfer-Isser, A., Emancipator, J. L., Johnson, N. L., Zambito, A. M. V., Tracy, R. P., Jenny, N. S., & Redline, S. (2005) · Circulation · doi:10.1161/01.cir.0000161819.76138.5e · Cited by 246 · see citing works
Self-citationStudy, T. M. A. C., Meisinger, C., Heier, M., & Loewel, H. (2005) · Diabetologia · doi:10.1007/s00125-004-1634-x · Cited by 234 · see citing works
Plat, L., Leproult, R., L’Hermite-Baleriaux, M., Fery, F., Mockel, J., Polonsky, K. S., & Van Cauter, E. (1999) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jcem.84.9.5978 · Cited by 225 · cited 1× · see citing works
“Sleep deprivation also causes an increase in counter-regulatory hormones such as cortisol and an increase in sympathetic nervous system activity, both of which can contribute to insulin resistance.(15,21,23,40) In our study, short sleep duration was strongly associated with indices of adiposity, and after adjusting fo…”
BackgroundMetabolic correlates with obstructive sleep apnea in obese subjects
Eva, R. C. D., Baur, L. A., Donaghue, K. C., & Waters, K. A. (2002) · The Journal of Pediatrics · doi:10.1067/mpd.2002.123765 · Cited by 213 · see citing works
Boyle, P. J., Scott, J. C., Krentz, A. J., Nagy, R. J., Comstock, E., & Hoffman, C. (1994) · Journal of Clinical Investigation · doi:10.1172/jci117003 · Cited by 202 · see citing works
Effects of a growth hormone pulse on total and forearm substrate fluxes in humans
Moller, N., Jorgensen, J. O., Schmitz, O., Moller, J., Christiansen, J., Alberti, K. G., & Orskov, H. (1990) · American Journal of Physiology-Endocrinology and Metabolism · doi:10.1152/ajpendo.1990.258.1.e86 · Cited by 194 · see citing works
Duncan, G. E. (2006) · Archives of Pediatrics & Adolescent Medicine · doi:10.1001/archpedi.160.5.523 · Cited by 183 · see citing works
Plat, L. (1999) · Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.84.9.3082 · Cited by 177 · see citing works
Association between Inadequate Sleep and Insulin Resistance in Obese Children
Flint, J. K., Kothare, S. V., Zihlif, M., Suarez, E. A., Adams, R., Legido, A., & Luca, F. D. (2007) · The Journal of Pediatrics · doi:10.1016/j.jpeds.2006.08.063 · Cited by 163 · see citing works
Perceived Insufficient Rest or Sleep Among Adults – United States, 2008
Nolan, B. (2010) · Yearbook of Neurology and Neurosurgery · doi:10.1016/s0513-5117(09)79157-4 · Cited by 146 · see citing works
Johnson, N. L., Kirchner, H. L., ROSEN, C. L., Storfer‐Isser, A., Cartar, L., Ancoli‐Israel, S., Emancipator, J. L., Kibler, A. M., & Redline, S. S. (2007) · SLEEP · doi:10.1093/sleep/30.7.899 · Cited by 129 · see citing works
Self-citationSchmid, S. M., Hallschmid, M., Jauch-Chara, K., Bandorf, N., Born, J., & Schultes, B. (2007) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2006-2788 · Cited by 115 · see citing works
Epidemiology of childhood type 2 diabetes and obesity
Shaw, J. E. (2007) · Pediatric Diabetes · doi:10.1111/j.1399-5448.2007.00329.x · Cited by 114 · see citing works
The Parable of Parabola: What the U-Shaped Curve Can and Cannot Tell Us about Sleep
Bliwise, D. L., & Young, T. B. (2007) · SLEEP · doi:10.1093/sleep/30.12.1614 · Cited by 111 · see citing works
Kitagawa, T., Ōwada, M., Urakami, T., & Tajima, N. (1994) · Diabetes Research and Clinical Practice · doi:10.1016/0168-8227(94)90221-6 · Cited by 103 · see citing works
Tuomilehto, H., Peltonen, M., Partinen, M., Seppä, J., Saaristo, T., Korpi-Hyövälti, E., Oksa, H., Puolijoki, H., Saltevo, J., Vanhala, M., et al. (2008) · Sleep Medicine · doi:10.1016/j.sleep.2007.04.015 · Cited by 103 · see citing works
Obstructive Sleep-Disordered Breathing and Fasting Insulin Levels in Nonobese Children
Kaditis, A. G., Alexopoulos, E. Ι., Damani, E., Καραδόντα, Ι., Kostadima, E., Tsolakidou, A., Gourgoulianis, K. I., & Syrogiannopoulos, G. A. (2005) · Pediatric Pulmonology · doi:10.1002/ppul.20306 · Cited by 93 · see citing works
Association between sleep duration and hemoglobin A1c level
Nakajima, H., Kaneita, Y., Yokoyama, E., Harano, S., Tamaki, T., Ibuka, E., Kaneko, A., Takahashi, I., Umeda, T., Nakaji, S., et al. (2007) · Sleep Medicine · doi:10.1016/j.sleep.2007.07.017 · Cited by 86 · see citing works
Hsia, Y., Neubert, A. C., Rani, F. A., Viner, R., Hindmarsh, P. C., & Wong, I. C. K. (2009) · British Journal of Clinical Pharmacology · doi:10.1111/j.1365-2125.2008.03347.x · Cited by 85 · see citing works
Perceived Insufficient Rest or Sleep Among Adults--United States, 2008
(2009) · PsycEXTRA Dataset · doi:10.1037/e552162010-003 · Cited by 76 · see citing works
Silverstein, J. H., & Rosenbloom, A. L. (2001) · Current Diabetes Reports · doi:10.1007/s11892-001-0006-x · Cited by 65 · see citing works
Epidemiology of Type 2 Diabetes in Children and Adolescents
Nadeau, K. J., & Dabelea, D. (2008) · Endocrine Research · doi:10.1080/07435800802080138 · Cited by 54 · see citing works
Lien entre syndrome métabolique et troubles respiratoires du sommeil chez les adolescents
Roisman, G. L. (2007) · Revue de Pneumologie Clinique · doi:10.1016/s0761-8417(07)78432-8 · Cited by 43 · see citing works
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Functional consequences of inadequate sleep in adolescents: A systematic review
Shochat, T., Cohen-Zion, M., & Tzischinsky, O. (2014) · Sleep Medicine Reviews · doi:10.1016/j.smrv.2013.03.005 · Cited by 837 · see citing works
Arslanian, S., Bacha, F., Grey, M., Marcus, M. D., White, N. H., & Zeitler, P. (2018) · Diabetes Care · doi:10.2337/dci18-0052 · Cited by 349 · see citing works
Sleep duration and insulin resistance in healthy black and white adolescents
Matthews, K. A., Dahl, R. E., Owens, J. F., Lee, L., & Hall, M. (2012) · SLEEP · doi:10.5665/sleep.2112 · Cited by 140 · see citing works
Sleep characteristics and cardiovascular risk in children and adolescents: an enumerative review
Matthews, K. A., & Pantesco, E. J. M. (2016) · Sleep Medicine · doi:10.1016/j.sleep.2015.06.004 · Cited by 136 · see citing works
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Klingenberg, L., Chaput, J.-P., Holmbäck, U., Visby, T., Jennum, P., Nikolic, M., Astrup, A., & Sjödin, A. (2013) · Sleep · doi:10.5665/sleep.2816 · Cited by 124 · see citing works
Addressing sleep disturbances: an opportunity to prevent cardiometabolic disease?
Grandner, M. A. (2014) · International Review of Psychiatry · doi:10.3109/09540261.2014.911148 · Cited by 88 · see citing works
“…2011; Kachi et al., 2012), insulin and/or glucose dysregulation (Beihl et al., 2009; Byberg et al., 2012; Chang et al., 2012b; Chaput et al., 2009; Javaheri et al., 2011; Liu et al., 2011; Lucassen et al., 2012; Zuo et al., 2012), and dysregulation of metabolic hormones (Chaput et al., 2007;…”
BackgroundProspective study of insufficient sleep and neurobehavioral functioning among school-age children
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Rogers, E. M., Banks, N. F., & Jenkins, N. D. M. (2024) · Diabetes/Metabolism Research and Reviews · doi:10.1002/dmrr.3667 · Cited by 62 · see citing works
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Boeke, C. E., Storfer-Isser, A., Redline, S., & Taveras, E. M. (2014) · Sleep · doi:10.5665/sleep.3510 · Cited by 57 · see citing works
Self-citationDe Bernardi Rodrigues, A. M., da Silva, C. D. C., Vasques, A. C. J., Camilo, D. F., Barreiro, F., Cassani, R. S. L., Zambon, M. P., Antonio, M. Â. R. D. G. M., Geloneze, B., & for the Brazilian Metabolic Syndrome Study (BRAMS) Investigators (2016) · JAMA Pediatrics · doi:10.1001/jamapediatrics.2015.4365 · Cited by 47 · see citing works
Short sleep duration is related to emerging cardiovascular risk factors in obese children
Navarro‐Solera, M., Carrasco‐Luna, J., Pin‐Arboledas, G., González‐Carrascosa, R., Soriano, J. M., & Codoñer‐Franch, P. (2015) · Journal of Pediatric Gastroenterology and Nutrition · doi:10.1097/mpg.0000000000000868 · Cited by 46 · see citing works
Zhu, Y., Li, A. M., Au, C. T., Kong, A. P. S., Zhang, J., Wong, C. K., Chan, J. C. N., & Wing, Y. K. (2015) · Journal of Diabetes · doi:10.1111/1753-0407.12138 · Cited by 42 · see citing works
Kim, T. H., Carroll, J. E., An, S. K., Seeman, T. E., Namkoong, K., & Lee, E. (2016) · Sleep Medicine · doi:10.1016/j.sleep.2016.07.023 · Cited by 39 · see citing works
- Authors
- Javaheri, S., Storfer-Isser, A., Rosen, C. L., & Redline, S.
- Affiliations
- Brigham and Women's Hospital (US)
- Rainbow Babies & Children's Hospital (US)
- Corresponding author
- Redline, Susan
- Venue
- The Journal of Pediatrics
- Publisher
- Elsevier BV
- Published
- 2011-04
- Volume
- 158
- Issue
- 4
- Pages
- 617-623
- ISSN
- 0022-3476 (ISSN-L)
- PMC
- PMC3076647
- OpenAlex
- W2046167435
- Cited by
- 139
- References
- 52
- Citations by year
- 2026: 1 · 2025: 3 · 2024: 5 · 2023: 9 · 2022: 6 · 2021: 10 · 2020: 8 · 2019: 8 · 2018: 17 · 2017: 9 · 2016: 19 · 2015: 13 · 2014: 11 · 2013: 13 · 2012: 7
- FWCI
- 8.37
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- The Journal of Pediatrics (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Heart, Lung, and Blood Institute (HL07567, HL60957, R01HL070916, T32HL007567, R01HL060957)
- National Cancer Institute (U54CA116867)
- National Center for Research Resources (M01RR000080, UL1RR024989)
- Topics
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
- Life Sciences › Neuroscience › Endocrine and Autonomic Systems › Circadian rhythm and melatonin
- Life Sciences › Neuroscience › Cognitive Neuroscience › Sleep and Wakefulness Research
- Keywords
- sleep duration, insulin sensitivity, adolescents, HOMA, adiposity, obesity, race, actigraphy, short sleep duration, long sleep, insulin resistance
- MeSH terms
- Adolescent, Blood Glucose, Cross-Sectional Studies, Fasting, Female, Homeostasis, Humans, Insulin, Insulin Resistance, Male, Obesity, Sleep, Sleep Deprivation, Time Factors
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