title: Sleep Disturbances and Glucose Metabolism in Older Adults: The Cardiovascular Health Study.
abstract: OBJECTIVE
  We examined the associations of symptoms of sleep-disordered breathing (SDB), which was defined as loud snoring, stopping breathing for a while during sleep, and daytime sleepiness, and insomnia with glucose metabolism and incident type 2 diabetes in older adults.
  
  
  METHODS
  Between 1989 and 1993, the Cardiovascular Health Study recruited 5,888 participants ≥65 years of age from four U.S. communities. Participants reported SDB and insomnia symptoms yearly through 1989-1994. In 1989-1990, participants underwent an oral glucose tolerance test, from which insulin secretion and insulin sensitivity were estimated. Fasting glucose levels were measured in 1989-1990 and again in 1992-1993, 1994-1995, 1996-1997, and 1998-1999, and medication use was ascertained yearly. We determined the cross-sectional associations of sleep symptoms with fasting glucose levels, 2-h glucose levels, insulin sensitivity, and insulin secretion using generalized estimated equations and linear regression models. We determined the associations of updated and averaged sleep symptoms with incident diabetes in Cox proportional hazards models. We adjusted for sociodemographics, lifestyle factors, and medical history.
  
  
  RESULTS
  Observed apnea, snoring, and daytime sleepiness were associated with higher fasting glucose levels, higher 2-h glucose levels, lower insulin sensitivity, and higher insulin secretion. The risk of the development of type 2 diabetes was positively associated with observed apnea (hazard ratio [HR] 1.84 [95% CI 1.19-2.86]), snoring (HR 1.27 [95% CI 0.95-1.71]), and daytime sleepiness (HR 1.54 [95% CI 1.13-2.12]). In contrast, we did not find consistent associations between insomnia symptoms and glucose metabolism or incident type 2 diabetes.
  
  
  CONCLUSIONS
  Easily collected symptoms of SDB are strongly associated with insulin resistance and the incidence of type 2 diabetes in older adults. Monitoring glucose metabolism in such patients may prove useful in identifying candidates for lifestyle or pharmacological therapy. Further studies are needed to determine whether insomnia symptoms affect the risk of diabetes in younger adults.
authors.affiliation: Beth Israel Deaconess Medical Center, Department of Medicine, Boston, MA Department of Nutrition, Harvard School of Public Health, Boston, MA Department of Public Health and General Practice, Norwegian University of Science and Technology, Trondheim, Norway linn.b.strand@ntnu.no.
authors.forename: Linn Beate
authors.initials: LB
authors.lastname: Strand
authors.affiliation: Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL.
authors.forename: Mercedes
authors.initials: M
authors.lastname: Carnethon
authors.affiliation: Department of Biostatistics, University of Washington, Seattle, WA.
authors.forename: Mary Lou
authors.initials: ML
authors.lastname: Biggs
authors.affiliation: Department of Medicine, Division of Aging, Brigham and Women's Hospital, Harvard Medical School, and Boston Veterans Healthcare, Boston, MA.
authors.forename: Luc
authors.initials: L
authors.lastname: Djoussé
authors.affiliation: Department of Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, NY.
authors.forename: Robert C
authors.initials: RC
authors.lastname: Kaplan
authors.affiliation: Cardiovascular Health Research Unit, Departments of Medicine and Epidemiology, University of Washington, Seattle, WA.
authors.forename: David S
authors.initials: DS
authors.lastname: Siscovick
authors.affiliation: University of California, Davis, Sacramento, CA.
authors.forename: John A
authors.initials: JA
authors.lastname: Robbins
authors.affiliation: Beth Israel Deaconess Medical Center, Department of Medicine, Boston, MA Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, MA.
authors.forename: Susan
authors.initials: S
authors.lastname: Redline
authors.affiliation: Beth Israel Deaconess Medical Center, Department of Medicine, Boston, MA Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, MA.
authors.forename: Sanjay R
authors.initials: SR
authors.lastname: Patel
authors.affiliation: Department of Public Health and General Practice, Norwegian University of Science and Technology, Trondheim, Norway Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Imre
authors.initials: I
authors.lastname: Janszky
authors.affiliation: Beth Israel Deaconess Medical Center, Department of Medicine, Boston, MA Department of Nutrition, Harvard School of Public Health, Boston, MA.
authors.forename: Kenneth J
authors.initials: KJ
authors.lastname: Mukamal
mesh_terms: D000328:Adult; D000368:Aged; D001786:Blood Glucose / Q000378:metabolism*; D002319:Cardiovascular System / Q000503:physiopathology; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology*; D005215:Fasting; D005260:Female; D005951:Glucose Tolerance Test; D006801:Humans; D015994:Incidence; D007328:Insulin / Q000097:blood; D007333:Insulin Resistance; D008297:Male; D008875:Middle Aged; D012891:Sleep Apnea Syndromes / Q000453:epidemiology*; D007319:Sleep Initiation and Maintenance Disorders / Q000453:epidemiology / Q000378:metabolism; D012913:Snoring / Q000453:epidemiology / Q000378:metabolism; D014481:United States / Q000453:epidemiology
chemical_list: D001786:Blood Glucose; D007328:Insulin