Associations between polysomnography and actigraphy-based sleep indices and glycemic control among those with and without type 2 diabetes: the Multi-Ethnic Study of Atherosclerosis

To examine the associations of sleep measures with hemoglobin A1c (HbA1c) among individuals with and without type 2 diabetes. Data were from 2049 Multi-Ethnic Study of Atherosclerosis participants taking part in a sleep ancillary study. Cross-sectional linear regression models examined associations...

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Published in:	Sleep (New York, N.Y.) Vol. 41; no. 11
Main Authors:	Whitaker, Kara M, Lutsey, Pamela L, Ogilvie, Rachel P, Pankow, James S, Bertoni, Alain, Michos, Erin D, Punjabi, Naresh, Redline, Susan
Format:	Journal Article
Language:	English
Published:	United States Oxford University Press 01.11.2018
Subjects:	Actigraphy - methods Aged Aged, 80 and over Atherosclerosis Atherosclerosis - blood Atherosclerosis - ethnology Atherosclerosis - physiopathology Blood Glucose - metabolism Cohort Studies Cross-Sectional Studies Diabetes Diabetes Mellitus, Type 2 - blood Diabetes Mellitus, Type 2 - ethnology Diabetes Mellitus, Type 2 - physiopathology Efficiency Ethnicity Female Glycated Hemoglobin - metabolism Humans Hypoxemia Male Middle Aged Polysomnography - methods Sleep - physiology Sleep apnea Sleep Apnea, Obstructive - blood Sleep Apnea, Obstructive - ethnology Sleep Apnea, Obstructive - physiopathology Sleep Initiation and Maintenance Disorders - blood Sleep Initiation and Maintenance Disorders - ethnology Sleep Initiation and Maintenance Disorders - physiopathology Sleep, Health and Disease Women
ISSN:	0161-8105, 1550-9109, 1550-9109
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Abstract	To examine the associations of sleep measures with hemoglobin A1c (HbA1c) among individuals with and without type 2 diabetes. Data were from 2049 Multi-Ethnic Study of Atherosclerosis participants taking part in a sleep ancillary study. Cross-sectional linear regression models examined associations of actigraphy estimates of sleep (sleep duration, variability, and maintenance efficiency) and polysomnography measures (obstructive sleep apnea [OSA] and hypoxemia) with HbA1c, stratified by diabetes status. Primary models were adjusted for demographics, lifestyle behaviors, and obesity. Among individuals with diabetes (20 per cent population), those who slept <5 hr/night had greater HbA1c than those who slept 7-8 hr/night (7.44 vs. 6.98 per cent, ptrend = 0.04), with no attenuation of associations after adjusting for OSA/hypoxemia. In women with diabetes, but not men, those in the lowest quartile of sleep maintenance efficiency had greater HbA1c than those in the highest quartile of sleep maintenance efficiency (7.60 vs. 6.97 per cent, ptrend < 0.01). Among those without diabetes, individuals with severe OSA or in the highest quartile of hypoxemia had significantly greater HbA1c than those without OSA or who were in the lowest quartile of hypoxemia (5.76 vs. 5.66 per cent, ptrend = 0.01; 5.75 vs. 5.66 per cent, ptrend < 0.01, respectively). Associations did not meaningfully differ by race/ethnicity. Among individuals with diabetes, HbA1c was significantly higher in men and women with short sleep duration and in women with poor sleep maintenance efficiency, suggesting a role for behavioral sleep interventions in the management of diabetes. Among individuals without diabetes, untreated severe OSA/hypoxemia may adversely influence HbA1c.
AbstractList	Study Objectives To examine the associations of sleep measures with hemoglobin A1c (HbA1c) among individuals with and without type 2 diabetes. Methods Data were from 2049 Multi-Ethnic Study of Atherosclerosis participants taking part in a sleep ancillary study. Cross-sectional linear regression models examined associations of actigraphy estimates of sleep (sleep duration, variability, and maintenance efficiency) and polysomnography measures (obstructive sleep apnea [OSA] and hypoxemia) with HbA1c, stratified by diabetes status. Primary models were adjusted for demographics, lifestyle behaviors, and obesity. Results Among individuals with diabetes (20 per cent population), those who slept <5 hr/night had greater HbA1c than those who slept 7–8 hr/night (7.44 vs. 6.98 per cent, ptrend = 0.04), with no attenuation of associations after adjusting for OSA/hypoxemia. In women with diabetes, but not men, those in the lowest quartile of sleep maintenance efficiency had greater HbA1c than those in the highest quartile of sleep maintenance efficiency (7.60 vs. 6.97 per cent, ptrend < 0.01). Among those without diabetes, individuals with severe OSA or in the highest quartile of hypoxemia had significantly greater HbA1c than those without OSA or who were in the lowest quartile of hypoxemia (5.76 vs. 5.66 per cent, ptrend = 0.01; 5.75 vs. 5.66 per cent, ptrend < 0.01, respectively). Associations did not meaningfully differ by race/ethnicity. Conclusions Among individuals with diabetes, HbA1c was significantly higher in men and women with short sleep duration and in women with poor sleep maintenance efficiency, suggesting a role for behavioral sleep interventions in the management of diabetes. Among individuals without diabetes, untreated severe OSA/hypoxemia may adversely influence HbA1c. To examine the associations of sleep measures with hemoglobin A1c (HbA1c) among individuals with and without type 2 diabetes.Study ObjectivesTo examine the associations of sleep measures with hemoglobin A1c (HbA1c) among individuals with and without type 2 diabetes.Data were from 2049 Multi-Ethnic Study of Atherosclerosis participants taking part in a sleep ancillary study. Cross-sectional linear regression models examined associations of actigraphy estimates of sleep (sleep duration, variability, and maintenance efficiency) and polysomnography measures (obstructive sleep apnea [OSA] and hypoxemia) with HbA1c, stratified by diabetes status. Primary models were adjusted for demographics, lifestyle behaviors, and obesity.MethodsData were from 2049 Multi-Ethnic Study of Atherosclerosis participants taking part in a sleep ancillary study. Cross-sectional linear regression models examined associations of actigraphy estimates of sleep (sleep duration, variability, and maintenance efficiency) and polysomnography measures (obstructive sleep apnea [OSA] and hypoxemia) with HbA1c, stratified by diabetes status. Primary models were adjusted for demographics, lifestyle behaviors, and obesity.Among individuals with diabetes (20 per cent population), those who slept <5 hr/night had greater HbA1c than those who slept 7-8 hr/night (7.44 vs. 6.98 per cent, ptrend = 0.04), with no attenuation of associations after adjusting for OSA/hypoxemia. In women with diabetes, but not men, those in the lowest quartile of sleep maintenance efficiency had greater HbA1c than those in the highest quartile of sleep maintenance efficiency (7.60 vs. 6.97 per cent, ptrend < 0.01). Among those without diabetes, individuals with severe OSA or in the highest quartile of hypoxemia had significantly greater HbA1c than those without OSA or who were in the lowest quartile of hypoxemia (5.76 vs. 5.66 per cent, ptrend = 0.01; 5.75 vs. 5.66 per cent, ptrend < 0.01, respectively). Associations did not meaningfully differ by race/ethnicity.ResultsAmong individuals with diabetes (20 per cent population), those who slept <5 hr/night had greater HbA1c than those who slept 7-8 hr/night (7.44 vs. 6.98 per cent, ptrend = 0.04), with no attenuation of associations after adjusting for OSA/hypoxemia. In women with diabetes, but not men, those in the lowest quartile of sleep maintenance efficiency had greater HbA1c than those in the highest quartile of sleep maintenance efficiency (7.60 vs. 6.97 per cent, ptrend < 0.01). Among those without diabetes, individuals with severe OSA or in the highest quartile of hypoxemia had significantly greater HbA1c than those without OSA or who were in the lowest quartile of hypoxemia (5.76 vs. 5.66 per cent, ptrend = 0.01; 5.75 vs. 5.66 per cent, ptrend < 0.01, respectively). Associations did not meaningfully differ by race/ethnicity.Among individuals with diabetes, HbA1c was significantly higher in men and women with short sleep duration and in women with poor sleep maintenance efficiency, suggesting a role for behavioral sleep interventions in the management of diabetes. Among individuals without diabetes, untreated severe OSA/hypoxemia may adversely influence HbA1c.ConclusionsAmong individuals with diabetes, HbA1c was significantly higher in men and women with short sleep duration and in women with poor sleep maintenance efficiency, suggesting a role for behavioral sleep interventions in the management of diabetes. Among individuals without diabetes, untreated severe OSA/hypoxemia may adversely influence HbA1c. To examine the associations of sleep measures with hemoglobin A1c (HbA1c) among individuals with and without type 2 diabetes. Data were from 2049 Multi-Ethnic Study of Atherosclerosis participants taking part in a sleep ancillary study. Cross-sectional linear regression models examined associations of actigraphy estimates of sleep (sleep duration, variability, and maintenance efficiency) and polysomnography measures (obstructive sleep apnea [OSA] and hypoxemia) with HbA1c, stratified by diabetes status. Primary models were adjusted for demographics, lifestyle behaviors, and obesity. Among individuals with diabetes (20 per cent population), those who slept <5 hr/night had greater HbA1c than those who slept 7-8 hr/night (7.44 vs. 6.98 per cent, ptrend = 0.04), with no attenuation of associations after adjusting for OSA/hypoxemia. In women with diabetes, but not men, those in the lowest quartile of sleep maintenance efficiency had greater HbA1c than those in the highest quartile of sleep maintenance efficiency (7.60 vs. 6.97 per cent, ptrend < 0.01). Among those without diabetes, individuals with severe OSA or in the highest quartile of hypoxemia had significantly greater HbA1c than those without OSA or who were in the lowest quartile of hypoxemia (5.76 vs. 5.66 per cent, ptrend = 0.01; 5.75 vs. 5.66 per cent, ptrend < 0.01, respectively). Associations did not meaningfully differ by race/ethnicity. Among individuals with diabetes, HbA1c was significantly higher in men and women with short sleep duration and in women with poor sleep maintenance efficiency, suggesting a role for behavioral sleep interventions in the management of diabetes. Among individuals without diabetes, untreated severe OSA/hypoxemia may adversely influence HbA1c.
Author	Whitaker, Kara M Lutsey, Pamela L Punjabi, Naresh Bertoni, Alain Michos, Erin D Redline, Susan Ogilvie, Rachel P Pankow, James S
AuthorAffiliation	2 Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, IA 4 Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA 6 Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 1 Department of Health and Human Physiology, College of Liberal Arts and Sciences, University of Iowa, Iowa City, IA 3 Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN 5 Department of Epidemiology and Prevention, Wake Forest School of Medicine, Wake Forest University, Winston-Salem, NC 7 Department of Medicine, Brigham and Women’s Hospital and Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
AuthorAffiliation_xml	– name: 1 Department of Health and Human Physiology, College of Liberal Arts and Sciences, University of Iowa, Iowa City, IA – name: 7 Department of Medicine, Brigham and Women’s Hospital and Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA – name: 4 Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA – name: 3 Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN – name: 2 Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, IA – name: 5 Department of Epidemiology and Prevention, Wake Forest School of Medicine, Wake Forest University, Winston-Salem, NC – name: 6 Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
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Snippet	To examine the associations of sleep measures with hemoglobin A1c (HbA1c) among individuals with and without type 2 diabetes. Data were from 2049 Multi-Ethnic... Study Objectives To examine the associations of sleep measures with hemoglobin A1c (HbA1c) among individuals with and without type 2 diabetes. Methods Data... To examine the associations of sleep measures with hemoglobin A1c (HbA1c) among individuals with and without type 2 diabetes.Study ObjectivesTo examine the...
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SubjectTerms	Actigraphy - methods Aged Aged, 80 and over Atherosclerosis Atherosclerosis - blood Atherosclerosis - ethnology Atherosclerosis - physiopathology Blood Glucose - metabolism Cohort Studies Cross-Sectional Studies Diabetes Diabetes Mellitus, Type 2 - blood Diabetes Mellitus, Type 2 - ethnology Diabetes Mellitus, Type 2 - physiopathology Efficiency Ethnicity Female Glycated Hemoglobin - metabolism Humans Hypoxemia Male Middle Aged Polysomnography - methods Sleep - physiology Sleep apnea Sleep Apnea, Obstructive - blood Sleep Apnea, Obstructive - ethnology Sleep Apnea, Obstructive - physiopathology Sleep Initiation and Maintenance Disorders - blood Sleep Initiation and Maintenance Disorders - ethnology Sleep Initiation and Maintenance Disorders - physiopathology Sleep, Health and Disease Women
Title	Associations between polysomnography and actigraphy-based sleep indices and glycemic control among those with and without type 2 diabetes: the Multi-Ethnic Study of Atherosclerosis
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