title: Sleep disturbances compared to traditional risk factors for diabetes development: Systematic review and meta-analysis.
abstract: Sleep disturbances [short (<6 h) and long (>8 h) sleeping time, insomnia (initiating or maintaining sleep), obstructive sleep apnea (OSA) and abnormal sleep timing] have been associated with increased diabetes risk but the effect size relative to that of traditional risk factors is unknown. We conducted a systematic review and meta-analysis to compare the risk associated with sleep disturbances to traditional risk factors. Studies were identified from Medline and Scopus. Cohort studies measuring the association between sleep disturbances and incident diabetes were eligible. For traditional risk factors (i.e., overweight, family history, and physical inactivity), systematic reviews with or without meta-analysis were included. Thirty-six studies (1,061,555 participants) were included. Pooled relative risks (RRs) of sleep variables were estimated using a random-effect model. Pooled RRs of sleeping ≤5 h, 6 h, and ≥9 h/d were respectively 1.48 (95%CI:1.25,1.76), 1.18 (1.10,1.26) and 1.36 (1.12,1.65). Poor sleep quality, OSA and shift work were associated with diabetes with a pooled RR of 1.40 (1.21,1.63), 2.02 (1.57, 2.61) and 1.40 (1.18,1.66), respectively. The pooled RRs of being overweight, having a family history of diabetes, and being physically inactive were 2.99 (2.42,3.72), 2.33 (1.79,2.79), and 1.20 (1.11,1.32), respectively. In conclusion, the risk of developing diabetes associated with sleep disturbances is comparable to that of traditional risk factors. Sleep disturbances should be considered in clinical guidelines for type 2 diabetes screening.
authors.affiliation: Department of Family Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; Section for Clinical Epidemiology and Biostatistics, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
authors.forename: Thunyarat
authors.initials: T
authors.lastname: Anothaisintawee
authors.affiliation: Division of Endocrinology and Metabolism, Department of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand. Electronic address: sreutrak10800@gmail.com.
authors.forename: Sirimon
authors.initials: S
authors.lastname: Reutrakul
authors.affiliation: Section of Adult and Pediatric Endocrinology, Diabetes, and Metabolism, and Sleep, Metabolism and Health Center, Department of Medicine, The University of Chicago, Chicago, IL, USA.
authors.forename: Eve
authors.initials: E
authors.lastname: Van Cauter
authors.affiliation: Section for Clinical Epidemiology and Biostatistics, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
authors.forename: Ammarin
authors.initials: A
authors.lastname: Thakkinstian
mesh_terms: D003924:Diabetes Mellitus, Type 2 / Q000209:etiology* / Q000503:physiopathology*; D006801:Humans; D012307:Risk Factors; D012890:Sleep; D020181:Sleep Apnea, Obstructive / Q000150:complications / Q000503:physiopathology; D012893:Sleep Wake Disorders / Q000150:complications* / Q000503:physiopathology*
keywords: Diabetes; Family history of diabetes; Insomnia; Obstructive sleep apnea; Overweight; Physical activity; Shift work; Sleep duration; Sleep quality