Background: Sleep disturbances can be both a cause and consequence of circadian disruption resulting in cardiometabolic dysregulation. However, little is known about sleep debt, defined as the average sleep duration difference >=2 hours between weekend versus weekday and type II diabetes (T2D) mellitus particularly in older women.
Methods and Results: We analyzed 25,335 women free of cardiovascular disease (CVD) in the ongoing follow-up cohort from the Women’s Health Study (WHS). Utilizing the WHS stress questionnaire (2012-13) that assessed sleep duration among other chronic and acute stress measures, we computed sleep debt as the average sleep duration difference >=2 hours between weekend versus weekday. Of the 2539 women with physician confirmed T2D at the time of questionnaire administration, 216 women had sleep debt. Mean age for women with sleep debt and T2D versus no sleep debt and diabetes were 69.3 ± 4.4 and 72.7 +/- 6.1 years old respectively. Women with sleep debt and T2D were younger, more likely to have hypertension and hypercholesterolemia, use alcohol, be current smokers, had higher body mass index and be anxious or depressed. In logistic regression analyses, women with sleep debt had a 47% higher odds of T2D independent of age, race/ethnicity, and socioeconomic status (income and education) [odds ratio (OR): 1.47, 95% confidence interval (CI): 1.25 to 1.72, P<0.0001]. Adjustment for CVD risk factors, depression and anxiety symptoms resulted in attenuation of the relationship which maintained statistical significance [OR: 1.31, 95% CI: 1.10 to 1.55, P= 0.0002]. When cumulative psychological stress (combination of chronic and acute stressors: e.g., life events, job stress, discrimination) was accounted for, the observed relationship between sleep debt and T2D persisted [OR: 1.28, 95% CI 1.09 to 1.53, P= 0.004]. (Table 1)
Conclusion: Sleep debt was associated with higher odds of type 2 diabetes prevalence in middle-aged and older women.