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. 2013 Nov 25;8(11):e82305.
doi: 10.1371/journal.pone.0082305. eCollection 2013.

Short Sleep Duration Is Associated With Risk of Future Diabetes but Not Cardiovascular Disease: A Prospective Study and Meta-Analysis

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Short Sleep Duration Is Associated With Risk of Future Diabetes but Not Cardiovascular Disease: A Prospective Study and Meta-Analysis

Elizabeth G Holliday et al. PLoS One. .
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Epidemiologic studies have observed association between short sleep duration and both cardiovascular disease (CVD) and type 2 diabetes, although these results may reflect confounding by pre-existing illness. This study aimed to determine whether short sleep duration predicts future CVD or type 2 diabetes after accounting for baseline health. Baseline data for 241,949 adults were collected through the 45 and Up Study, an Australian prospective cohort study, with health outcomes identified via electronic database linkage. Cox proportional hazards models were used to estimate hazard ratios (HR) and 95% confidence intervals. Compared to 7h sleep, <6h sleep was associated with incident CVD in participants reporting ill-health at baseline (HR=1.38 [95% CI: 1.12-1.70]), but not after excluding those with baseline illness and adjusting for baseline health status (1.03 [0.88-1.21]). In contrast, the risk of incident type 2 diabetes was significantly increased in those with <6h versus 7h sleep, even after excluding those with baseline illness and adjusting for baseline health (HR=1.29 [1.08-1.53], P=0.004). This suggests the association is valid and does not simply reflect confounding or reverse causation. Meta-analysis of ten prospective studies including 447,124 participants also confirmed an association between short sleep and incident diabetes (1.33 [1.20-1.48]). Obtaining less than 6 hours of sleep each night (compared to 7 hours) may increase type 2 diabetes risk by approximately 30%.

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.


Figure 1
Figure 1. Hazard ratio for incident cardiovascular disease (CVD) and type 2 diabetes by sleep duration category in the 45 and Up Study.
The plots shows hazard ratios with 95% confidence intervals for the specified category of sleep duration, compared with 7 h, after adjusting for potential confounders. Analyses excluded individuals reporting any serious illness at baseline (cancer, heart disease, stroke or diabetes).
Figure 2
Figure 2. Forest plot showing the relationship between short sleep and incident diabetes in a meta-analysis of prospective studies including 447,124 total participants.
Point estimates and 95% confidence intervals are shown as black circles and solid lines, respectively. Grey rectangles indicate the relative weight assigned to individual studies reflecting sample size. Heterogeneity metrics and the summary estimate are shown in the final rows.

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Grant support

The Sax Institute; Cancer Council New South Wales; the National Heart Foundation of Australia (New South Wales Division); The New South Wales Ministry of Health; Beyondblue: the National Depression Initiative; Ageing, Disability and Home Care, New South Wales Family and Community Services; the Australian Red Cross Blood Service; Uniting Care Ageing; the Australian National Health and Medical Research Council. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.