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. 2023 Sep 18;108(10):e1044-e1055.
doi: 10.1210/clinem/dgad229.

Associations of Slow-Wave Sleep With Prevalent and Incident Type 2 Diabetes in the Multi-Ethnic Study of Atherosclerosis

Sina Kianersi  1 , Susan Redline  2   3 , Morgana Mongraw-Chaffin  4 , Tianyi Huang  1   2
Affiliations

Associations of Slow-Wave Sleep With Prevalent and Incident Type 2 Diabetes in the Multi-Ethnic Study of Atherosclerosis

Sina Kianersi et al. J Clin Endocrinol Metab. .

Abstract

Context: N3 sleep (i.e., slow-wave sleep), a marker of deep restorative sleep, is implicated in hormonal and blood pressure regulation and may impact cardiometabolic health.

Objective: We conducted cross-sectional and prospective analyses to test whether a higher proportion and longer duration of N3 sleep are associated with reduced type 2 diabetes risk.

Methods: A subsample of participants from the Multi-Ethnic Study of Atherosclerosis completed 1-night polysomnography at Exam 5 (2010-2013) and were prospectively followed until Exam 6 (2016-2018). We used modified Poisson regression to examine the cross-sectional associations of N3 proportion and duration with prevalent diabetes and Cox proportional hazards models to estimate risk of diabetes according to N3 measures.

Results: In cross-sectional analyses (n = 2026, mean age: 69 years), diabetes prevalence was 28% (n = 572). Compared with the first quartile (Q1) of the N3 proportion (<2.0%), participants in Q4 (≥15.4%) were 29% (95% CI 0.58, 0.87) less likely to have prevalent diabetes (P trend = .0016). The association attenuated after adjustment for demographics, lifestyles, and sleep-related factors (P trend = .3322). In prospective analyses of 1251 participants and 129 incident cases over 6346 person-years of follow-up, a curvilinear relationship was observed between N3 proportion and incident diabetes risk. In the fully adjusted model, the hazard ratio (95% CI) of developing diabetes vs Q1 was 0.47 (0.26, 0.87) for Q2, 0.34 (0.15, 0.77) for Q3, and 0.32 (0.10, 0.97) for Q4 (P nonlinearity = .0213). The results were similar for N3 duration.

Conclusion: Higher N3 proportion and longer N3 duration were prospectively associated with lower type 2 diabetes risk in a nonlinear fashion among older American adults.

Keywords: N3 sleep; deep sleep; diabetes mellitus; prospective studies; slow-wave sleep.

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Conflict of interest statement

Conflict of Interest: S.R. reports consulting fees from ApniMed Inc, Eli Lilly, and Jazz Pharma and receipt of equipment for use in multicenter NIH research from Philips Respironics and Nox Medical. Other authors report no conflicts of interest.

Figures

Figure 1.
Figure 1.
The association between N3 sleep and incident type 2 diabetes among diabetes free and diabetes untreated participants in prospective cohort analyses.
See this image and copyright information in PMC

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