title: Sleep quality and risk of diabetes and coronary artery disease among young men.
abstract: OBJECTIVE
  To assess the time-dependent effect of sleep quality on diabetes and coronary artery disease (CAD) incidence among young adults.
  
  
  METHODS
  Incident rates of diabetes and CAD during a mean follow-up of 6.4 ± 4.1 years were assessed among 26,023 men (mean age 30.9 ± 5.6 years) of the Metabolic Lifestyle and Nutrition Assessment in Young Adults stratified by sleep quality at baseline, as assessed by the Mini-Sleep Questionnaire (MSQ). Incident diabetes and CAD were analyzed using a Cox proportional hazard model.
  
  
  RESULTS
  There were 445 cases of diabetes and 92 cases of CAD during 151,312 person-years. An abnormal MSQ score was associated with a 53 % higher incidence of diabetes (95 % CI 1.22-1.94, p < 0.001) compared to those with a normal score, after adjustment for clinical and biochemical diabetes risk factors. The increased risk associated with abnormal sleep quality remained when MSQ was modeled as a continuous time-dependent variable in a multivariable model (HR = 1.036, 95 % CI 1.024-1.049, p < 0.001). The increased risk was higher among overweight or obese participants (BMI and MSQ interaction p = 0.046). Sustained abnormality in MSQ score resulted in higher HR for diabetes (2.35; 95 % CI 1.564-3.519, p < 0.001). In addition, abnormal sleep quality was associated with a 2.38 higher incidence of CAD (95 % CI 1.38-4.11, p = 0.002), after adjustment for traditional clinical and biochemical risk factors.
  
  
  CONCLUSIONS
  Sleep quality contributes to the development of diabetes and CAD in apparently healthy young adults in a time-dependent manner. The use of a simple questionnaire to assess sleep quality may be a useful tool for risk stratification in this population.
authors.affiliation: Department of Medicine B, Sheba Medical Center, 52621, Ramat Gan, Israel. Gilad.Twig@gmail.com.|The Dr. Pinchas Bornstein Talpiot Medical Leadership Program, Sheba Medical Center, Ramat Gan, Israel. Gilad.Twig@gmail.com.|The Israel Defense Forces Medical Corps, Ramat Gan, Israel. Gilad.Twig@gmail.com.
authors.forename: Gilad
authors.initials: G
authors.lastname: Twig
authors.affiliation: The Israel Defense Forces Medical Corps, Ramat Gan, Israel.|Department of Obstetrics and Gynecology, Sheba Medical Center, Ramat Gan, Israel.
authors.forename: Avi
authors.initials: A
authors.lastname: Shina
authors.affiliation: The Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.|Israel Ministry of Health, Jerusalem, Israel.
authors.forename: Arnon
authors.initials: A
authors.lastname: Afek
authors.affiliation: The Israel Defense Forces Medical Corps, Ramat Gan, Israel.|The Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Estela
authors.initials: E
authors.lastname: Derazne
authors.affiliation: The Israel Defense Forces Medical Corps, Ramat Gan, Israel.
authors.forename: Dorit
authors.initials: D
authors.lastname: Tzur
authors.affiliation: The Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.|The Center for Endocrinology, Diabetes and Metabolism, Sheba Medical Center, Ramat Gan, Israel.
authors.forename: Tali
authors.initials: T
authors.lastname: Cukierman-Yaffe
authors.affiliation: The Sleep Institute, Sheba Medical Center, Ramat Gan, Israel.
authors.forename: Dalia
authors.initials: D
authors.lastname: Shechter-Amir
authors.affiliation: Division of Endocrinology and Metabolism, and Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada.
authors.forename: Hertzel C
authors.initials: HC
authors.lastname: Gerstein
authors.affiliation: The Dr. Pinchas Bornstein Talpiot Medical Leadership Program, Sheba Medical Center, Ramat Gan, Israel.|The Center for Endocrinology, Diabetes and Metabolism, Sheba Medical Center, Ramat Gan, Israel.|The Division of Endocrinology, Diabetes and Hypertension, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
authors.forename: Amir
authors.initials: A
authors.lastname: Tirosh
mesh_terms: D000328:Adult; D015992:Body Mass Index; D003324:Coronary Artery Disease / Q000453:epidemiology*; D003920:Diabetes Mellitus / Q000453:epidemiology*; D005500:Follow-Up Studies; D006306:Health Surveys; D006801:Humans; D015994:Incidence; D008019:Life Style; D008297:Male; D015596:Nutrition Assessment; D009765:Obesity / Q000150:complications / Q000453:epidemiology; D050177:Overweight / Q000150:complications / Q000453:epidemiology; D012306:Risk; D012307:Risk Factors; D012890:Sleep; D011795:Surveys and Questionnaires; D055815:Young Adult
keywords: Body mass index; Coronary artery disease; Diabetes; Mini-Sleep Questionnaire; Sleep; Young adults