title: Joint associations of insomnia and sleep duration with prevalent diabetes: The Hispanic Community Health Study/Study of Latinos (HCHS/SOL).
abstract: BACKGROUND
  Inadequate sleep quantity and quality are associated with a higher risk of type 2 diabetes. This relationship is not well-examined in U.S. Hispanics/Latinos, and prior analyses may be confounded by sleep apnea. This cross-sectional study examined joint associations of sleep duration and insomnia with diabetes among diverse U.S. Hispanic/Latinos.
  
  
  METHODS
  Baseline data on sleep quantity and quality were obtained from 15,227 participants (mean age 41; range 18-74 years) from the Hispanic Community Health Study/Study of Latinos. Complex survey multinomial logistic regression was used to examine associations between prevalent diabetes and six phenotypes defined by cross-classifying sleep duration (short ≤6 h, average >6-9 h, long >9 h) and insomnia, adjusting for sex, age, site and Hispanic/Latino background interaction, education, physical activity, diet quality, and sleep apnea.
  
  
  RESULTS
  In the weighted population, 14% had diabetes, 28% had insomnia, 9% were short sleepers, and 19% were long sleepers. Compared with those with average sleep and no insomnia, those with short sleep and insomnia were more likely to have diabetes (odds ratio [OR] 1.46; 95% confidence interval [CI] 1.02, 2.11). Average sleepers with insomnia (1.28; 95% CI 1.02, 1.61) and long sleepers without insomnia (1.33; 95% CI 1.07, 1.65) also had elevated odds of diabetes. Further adjustment for body mass index attenuated associations, except with long sleep without insomnia.
  
  
  CONCLUSIONS
  Both decreased quantity and quality of sleep are associated with diabetes in Hispanic/Latinos, with the greatest odds among those with short sleep duration and insomnia. The association is largely explained by obesity.
authors.affiliation: Department of Nutrition, Harvard School of Public Health, Boston, Massachusetts, USA.|Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts, USA.
authors.forename: Elizabeth M
authors.initials: EM
authors.lastname: Cespedes
authors.affiliation: Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, Massachusetts, USA.
authors.forename: Katherine A
authors.initials: KA
authors.lastname: Dudley
authors.affiliation: Department of Biostatistics, Collaborative Studies Coordinating Center, University of North Carolina, Chapel Hill, North Carolina, USA.
authors.forename: Daniela
authors.initials: D
authors.lastname: Sotres-Alvarez
authors.affiliation: Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.|Institute for Minority Health Research, University of Illinois at Chicago, Chicago, Illinois, USA.
authors.forename: Phyllis C
authors.initials: PC
authors.lastname: Zee
authors.affiliation: Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.|Institute for Minority Health Research, University of Illinois at Chicago, Chicago, Illinois, USA.
authors.forename: Martha L
authors.initials: ML
authors.lastname: Daviglus
authors.affiliation: Montefiore Medical Center, Albert Einstein College of Medicine, Yeshiva University, Bronx, New York, USA.
authors.forename: Neomi A
authors.initials: NA
authors.lastname: Shah
authors.affiliation: Division of Health Promotion and Behavioral Science, Graduate School of Public Health, San Diego State University, San Diego, California, USA.
authors.forename: Gregory A
authors.initials: GA
authors.lastname: Talavera
authors.affiliation: Departments of Psychology, University of California San Diego, San Diego, California, USA.
authors.forename: Linda C
authors.initials: LC
authors.lastname: Gallo
authors.affiliation: Department of Nutrition, Harvard School of Public Health, Boston, Massachusetts, USA.
authors.forename: Josiemer
authors.initials: J
authors.lastname: Mattei
authors.affiliation: Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, USA.
authors.forename: Qibin
authors.initials: Q
authors.lastname: Qi
authors.affiliation: Department of Neurology, University of Miami Miller School of Medicine, Miami, Florida, USA.
authors.forename: Alberto R
authors.initials: AR
authors.lastname: Ramos
authors.affiliation: Department of Psychology, University of Miami, Coral Gables, Florida, USA.
authors.forename: Neil
authors.initials: N
authors.lastname: Schneiderman
authors.affiliation: Medicine, Division of Global Public Health, University of California San Diego, San Diego, California, USA.
authors.forename: Rebeca A
authors.initials: RA
authors.lastname: Espinoza-Giacinto
authors.affiliation: Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, Massachusetts, USA.
authors.forename: Sanjay R
authors.initials: SR
authors.lastname: Patel
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000453:epidemiology*; D005260:Female; D006630:Hispanic or Latino / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications; D015995:Prevalence; D012307:Risk Factors; D007319:Sleep Initiation and Maintenance Disorders / Q000175:diagnosis / Q000209:etiology*; D014481:United States / Q000453:epidemiology; D055815:Young Adult
keywords: 2型糖尿病; Hispanic Americans; acculturation; insomnia; sleep; type 2 diabetes mellitus; 失眠症; 文化适应; 睡眠; 西班牙裔美国人