title: Association between sleeping difficulty and type 2 diabetes in women.
abstract: OBJECTIVE
  Sleeping difficulty has been associated with type 2 diabetes in some prior studies. Whether the observed associations are independent of health behaviours, other cardiovascular risk factors or other sleep disorders is unclear.
  
  
  METHODS
  We analysed data from 133,353 women without diabetes, cardiovascular disease and cancer at baseline in the Nurses' Health Study (NHS, 2000-2010) and the NHSII (2001-2011). Sleeping difficulty was assessed as having difficulty falling or staying asleep 'all of the time' or 'most of the time' at baseline (2000 in NHS and 2001 in NHSII).
  
  
  RESULTS
  We documented 6,407 incident cases of type 2 diabetes during up to 10 years of follow-up. After adjustment for lifestyle factors at baseline, comparing women with and without sleeping difficulty, the multivariate-adjusted HR (95% CI) for type 2 diabetes was 1.45 (95% CI 1.33, 1.58), which changed to 1.22 (95% CI 1.12, 1.34) after further adjustment for hypertension, depression and BMI based on the updated repeated measurements. Women who reported all four sleep conditions (sleeping difficulty, frequent snoring, sleep duration ≤6 h and sleep apnoea in NHS or rotating shift work in NHSII) had more than a fourfold increased likelihood of type 2 diabetes (HR 4.17, 95% CI 2.93, 5.91).
  
  
  CONCLUSIONS
  Sleeping difficulty was significantly associated with type 2 diabetes. This association was partially explained by associations with hypertension, BMI and depression symptoms, and was particularly strong when combined with other sleep disorders. Our findings highlight the importance of sleep disturbance in the development and prevention of type 2 diabetes.
authors.affiliation: Department of Nutrition, Harvard T. H. Chan School of Public Health, 665 Huntington Ave, Boston, MA, 02115, USA.
authors.forename: Yanping
authors.initials: Y
authors.lastname: Li
authors.affiliation: Department of Nutritional Sciences, The Pennsylvania State University, University Park, PA, USA.
authors.forename: Xiang
authors.initials: X
authors.lastname: Gao
authors.affiliation: Department of Psychiatry, Harvard Medical School, Boston, MA, USA.|Departments of Psychiatry and Neurology, Sleep Disorders Clinical Research Program, Massachusetts General Hospital, Boston, MA, USA.
authors.forename: John W
authors.initials: JW
authors.lastname: Winkelman
authors.affiliation: Department of Nutrition, Harvard T. H. Chan School of Public Health, 665 Huntington Ave, Boston, MA, 02115, USA.|Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, USA.|Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA.
authors.forename: Elizabeth M
authors.initials: EM
authors.lastname: Cespedes
authors.affiliation: Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, USA.|Harvard Catalyst | Clinical and Translational Science Center, Boston, MA, USA.
authors.forename: Chandra L
authors.initials: CL
authors.lastname: Jackson
authors.affiliation: Vanderbilt University School of Medicine Medical Center, Nashville, TN, USA.
authors.forename: Arthur S
authors.initials: AS
authors.lastname: Walters
authors.affiliation: Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, USA.
authors.forename: Eva
authors.initials: E
authors.lastname: Schernhammer
authors.affiliation: Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, USA.|Brigham and Women's Hospital and Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
authors.forename: Susan
authors.initials: S
authors.lastname: Redline
authors.affiliation: Department of Nutrition, Harvard T. H. Chan School of Public Health, 665 Huntington Ave, Boston, MA, 02115, USA. nhbfh@channing.harvard.edu.|Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, USA. nhbfh@channing.harvard.edu.|Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA. nhbfh@channing.harvard.edu.
authors.forename: Frank B
authors.initials: FB
authors.lastname: Hu
mesh_terms: D000328:Adult; D015992:Body Mass Index; D003863:Depression / Q000453:epidemiology; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology* / Q000209:etiology; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000453:epidemiology; D008875:Middle Aged; D012307:Risk Factors; D012893:Sleep Wake Disorders / Q000150:complications / Q000453:epidemiology* / Q000503:physiopathology; D011795:Surveys and Questionnaires
keywords: Diabetes; Pathways; Sleeping difficulty
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