Insomnia symptoms as a cause of type 2 diabetes Incidence: a 20 year cohort study

BMC Psychiatry

Research Article

Tony Robertson¹  Michaela Benzeval²  Frank Popham³  Michael J Green³  Colin A Espie⁴ 

[1] Faculty of Health Sciences and Sport, University of Stirling, FK9 4LA, Stirling, UK;Institute for Social and Economic Research, University of Essex, CO4 3SQ, Colchester, UK;Institute of Health and Wellbeing, University of Glasgow, 1 Lilybank Gardens, G12 8RZ, Glasgow, UK;MRC/CSO Social & Public Health Sciences Unit, University of Glasgow, 200 Renfield Street, G2 3QB, Glasgow, UK;Nuffield Department of Clinical Neurosciences, Sleep & Circadian Neuroscience Institute, University of Oxford, OX3 9DU, Oxford, UK;

关键词: Insomnia;    Sleep;    Type 2 Diabetes;    Longitudinal;    Confounding;    Causal Effects;    Marginal Structural Models;   

DOI  :  10.1186/s12888-017-1268-4

 received in 2016-12-16, accepted in 2017-03-14,  发布年份 2017

来源: Springer

【 摘 要 】

BackgroundInsomnia symptoms are associated with type 2 diabetes incidence but are also associated with a range of potential time-varying covariates which may confound and/or mediate associations. We aimed to assess whether cumulative exposure to insomnia symptoms has a causal effect on type 2 diabetes incidence.MethodsA prospective cohort study in the West of Scotland, following respondents for 20 years from age 36. 996 respondents were free of diabetes at baseline and had valid data from up to four follow-up visits. Type 2 diabetes was assessed at the final visit by self-report, taking diabetic medication, or blood-test (HbA1c ≥ 6.5% or 48 mmol/mol). Effects of cumulative insomnia exposure on type 2 diabetes incidence were estimated with traditional regression and marginal structural models, adjusting for time-dependent confounding (smoking, diet, physical inactivity, obesity, heavy drinking, psychiatric distress) as well as for gender and baseline occupational class.ResultsTraditional regression yielded an odds ratio (OR) of 1.34 (95% CI: 1.06-1.70) for type 2 diabetes incidence for each additional survey wave in which insomnia was reported. Marginal structural models adjusted for prior covariates (assuming concurrently measured covariates were potential mediators), reduced this OR to 1.20 (95% CI: 0.98-1.46), and when concurrent covariates were also included (viewing them as potential confounders) this dropped further to 1.08 (95% CI: 0.85-1.37).ConclusionsThe association between cumulative experience of insomnia and type 2 diabetes incidence appeared confounded. Evidence for a residual causal effect depended on assumptions as to whether concurrently measured covariates were confounders or mediators.

【 授权许可】

CC BY   
© The Author(s). 2017