Improving Diabetes Outcomes Through Sleep Interventions

The primary goal of this project is to test the hypothesis that middle-aged adults who sleep fewer hours are at increased risk of gaining weight and developing type 2 diabetes, compared to adults who habitually sleep more hours. An alarming trend of increasing body mass index has been well documented since 1980 both from serial cross-sections of the population and from cohort studies. There is also evidence of decreasing sleep hours in adults of all ages in the US. This trend toward reduced sleep hours has received little attention: other than concern over accidents caused by sleepiness, there are no population data documenting adverse health consequences of reduced sleep. Are these two secular trends related? Prior work has shown that sleep restriction decreases glucose tolerance, reduces leptin levels and increases evening cortisol. Decreased carbohydrate tolerance and increased sympathetic tone are well-recognized risk factors for the development of insulin resistance, obesity and hypertension. S pecific aims are:

1. Does quantity of sleep predict change in weight among middle-aged adults over the course of 5 years?
2. Does quantity of sleep predict change in fasting glucose, fasting insulin, estimated insulin sensitivity, or resting blood pressure among middle-aged adults over the course of 5 years?
3. How does sleep duration vary by demographic, socioeconomic, health, psycho-social and lifestyle factors? Are sleep duration and quality related to socioeconomic status or race?

Should we find that there is a prospective association between sleep and weight gain or change in fasting insulin or fasting glucose among adults in early middle age, the significance would be great, because of the obvious implications for new types of public health interventions. This would be a previously unrecognized, prevalent, and modifiable social factor that is contributing to the obesity epidemic and increased diabetic risk in the US.