Sleep Duration and Risks of Incident Cardiovascular Disease and Mortality Among People with Type 2 Diabetes

Objectives: People with type 2 diabetes may have insufficient or prolonged sleep which could accelerate cardiovascular disease (CVD) onset, but existing evidence from prospective studies has been limited. We aimed to examine the association of sleep duration with CVD incidence and mortality in this high-risk population.

Research Design and Methods: This prospective study included 18,876 participants with type 2 diabetes who were free of CVD and cancer at baseline from the UK Biobank. Habitual sleep duration was obtained using a baseline questionnaire. Cox proportional hazards regression models were used to examine the association between sleep duration and CVD events.

Results: During an average follow-up of 11.0-12.0 years, we documented 2,570 incident atherosclerotic cardiovascular disease (ASCVD) cases and 598 CVD deaths. Compared with sleeping for 7 h/day, the multivariable-adjusted hazard ratios (95% CIs) of ≤5 and ≥10 h/day were 1.26 (1.08, 1.48) and 1.41 (1.16, 1.70) for incident ASCVD, 1.22 (0.99, 1.50) and 1.16 (0.88, 1.52) for coronary artery disease, 1.70 (1.23, 2.35) and 2.08 (1.44, 3.01) for ischemic stroke, 1.02 (0.72, 1.44) and 1.45 (1.01, 2.10) for peripheral artery disease, and 1.42 (1.02, 1.97) and 1.85 (1.30, 2.64) for CVD mortality. Similar results were observed in most sensitivity analyses that aimed to address potential reverse causation and in the joint analysis of sleep duration and metabolic control or diabetes severity status.

Conclusions: Our findings showed short and long sleep durations were independently associated with increased risks of CVD onset and death among people with type 2 diabetes.