Chronic sleep disturbances are associated with the development and progression of chronic conditions such as cardiovascular disease, hypertension and obesity. Sleep disturbances are categorized as short or long sleep duration as well as difficulty falling asleep or maintaining sleep. The prevalence and incidence of type II diabetes increased three-fold in the United States between 1980 and 2012. The goals of this research are to assess the bidirectional association between chronic sleep disturbances and diabetes among older adults, by gender, as well as the joint association of diabetes and chronic sleep disturbances on healthy dietary consumption. Participants were selected from the Health and Retirement Study, a longitudinal, nationally representative sample of individuals over the age of 50 in the U.S.. Multivariate Cox-proportional hazard models were used to assess the association between chronic sleep disturbances and development of diabetes within eight years. Women who reported chronic sleep disturbances at baseline had a 27% greater hazard of developing diabetes within eight years than those without chronic sleep disturbances (OR 1.37; 95% CI 1.17-1.60). The association was attenuated after multivariable adjustment for time-varying covariates yet was still significant (OR 1.27; 95% CI 1.08-1.50). While the association was in the same direction in men, it was not statistically significant (adjusted for time-varying covariates OR 1.14; 95%CI 0.88-1.48). Women with newly reported diabetes were 80% more likely to develop a chronic sleep disturbances after four years than those without diabetes (OR 1.80, 95% CI 1.01-3.20). However, the association was attenuated and no longer significant after multivariable adjustment (OR 1.63; 95% CI 0.86-3.12). Men with newly reported diabetes had a slightly higher odds of developing chronic sleep disturbances, yet the results did not reach statistical significance (multivariable adjusted OR 1.14; 95%CI 0.69-1.90). In assessing the associations between the comorbidity of chronic sleep disturbances and diabetes on consumption of a healthy diet, defined as a Mediterranean diet, men with diabetes appear to consume a healthier diet unless they have a chronic sleep disturbance. Women with diabetes do not appear to consume a healthier diet and those with diabetes and chronic sleep disturbances are 20% less likely to consume a healthy diet than those without diabetes or chronic sleep disturbances. Sleep disturbances appear to have an antagonistic association with diabetes and adherence to a healthy diet in both women and men. In conclusion, our research shows that chronic sleep disturbances, specifically trouble falling asleep or staying asleep, are associated with the onset of diabetes in women, women with diabetes are somewhat more likely to develop chronic sleep disturbances within four years of receiving a diagnosis of diabetes, and that chronic sleep disturbances have a negative association with healthy dietary intake among those with diabetes. Additionally, our research shows that women report greater rates of sleep disturbances and the relationship between sleep disturbances and diabetes varies by gender as well as by race and ethnicity. Novel aspects of this research include the findings related to self-reported sleep quality, rather than sleep duration, as well as the quantification of differences by gender and race/ethnicity. In an increasingly aging, diverse population, understanding the impact of sleep disturbances in the onset and progression of diabetes elucidates an important area for prevention as well as detection and treatment at the individual level as well as the population-level.
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Chronic Sleep Disturbances, Type II Diabetes and Dietary Intake; an Assessment of Gender-Based Differences.
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