Abstract
BackgroundSleep disturbance has been significantly associated with the incidence of cardiovascular disease (CVD) in the general population. However, despite the common prevalence of sleep disturbance in patients with type 2 diabetes, its relationship with the risk of CVD remains unclear. Here, we have examined the association of sleep disturbance with the incidence of all CVD and all-cause mortality in patients with newly-diagnosed type 2 diabetes.MethodsWe used the Korean National Health Insurance Service–Health Screening Cohort data and included 36,058 patients with new-onset type 2 diabetes aged ≥ 40 years between 2004 and 2007, along with follow-up examinations to 2013. We used the ICD-10 code to measure sleep disturbance as a primary diagnosis and the multivariable Cox proportional hazards regression models to estimate the adjusted hazard ratio (AHR) and 95% confidence interval (CI) of all CVD, coronary heart disease (CHD), stroke, and all-cause mortality.ResultsWe identified 6897 cases of all CVD (CHD, n = 4138; stroke, n = 2759) and 2890 events of all-cause mortality during a mean follow-up period of 7.0 years. Sleep disturbance was associated with an increased risk of All CVD (AHR, 1.24; 95% CI, 1.06–1.46), CHD events (AHR, 1.24; 95% CI, 1.00–1.53), and all-cause mortality (AHR, 1.47; 95% CI, 1.15–1.87) in patients with new-onset type 2 diabetes. Furthermore, women (AHR, 1.33; 95% CI, 1.06–1.67) and middle-aged adults (AHR, 1.29; 95% CI, 1.02–1.64) with sleep disturbance had a significantly increased risk of CVD than those without; contrarily, men (AHR, 1.45; 95% CI, 1.09–1.95) and older adults (AHR, 1.51; 95% CI, 1.15–1.99) with sleep disturbance were associated with a significantly increased risk of all-cause mortality than those without.ConclusionsOur findings suggest that sleep disturbance is significantly associated with an increased risk of CVD and all-cause mortality in patients with new-onset type 2 diabetes.
Highlights
Sleep disturbance has been significantly associated with the incidence of cardiovascular disease (CVD) in the general population
Our findings indicated that sleep disturbance was associated with a higher risk of CVD in patients with type 2 diabetes, which was consistent with the outcomes of previous studies [18]
Our findings suggested that sleep disturbance was associated with higher risk of all-cause mortality in men and older adults with type 2 diabetes, which is consistent with previous study findings [35, 36]
Summary
Sleep disturbance has been significantly associated with the incidence of cardiovascular disease (CVD) in the general population. Despite the common prevalence of sleep disturbance in patients with type 2 diabetes, its relationship with the risk of CVD remains unclear. We have examined the association of sleep disturbance with the incidence of all CVD and all-cause mortality in patients with newly-diagnosed type 2 diabetes. CVD is considered to be the leading cause of premature mortality and accounts for more than 330 million years of life lost per year [5]. A recent global prospective cohort study reported a J-shaped association between the measured duration of total daily sleep and mortality and major cardiovascular events [10]. A number of meta-analyses demonstrated that sleep problems such as excessive (short or long) sleep durations or poor sleep quality may increase the overall risk of CVD and all-cause mortality [11,12,13,14,15] and the results suggest that sleep management may be essential in preventing CVD
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