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Multiple sleep dimensions and type 2 diabetes risk among women in the Sister Study: differences by race/ethnicity
  1. Ketrell L McWhorter1,
  2. Yong-Moon Park1,
  3. Symielle A Gaston1,
  4. Kacey B Fang2,
  5. Dale P Sandler1,
  6. Chandra L Jackson1
  1. 1 Epidemiology Branch, National Institute of Environmental Health Sciences, Research Triangle Park, North Carolina, USA
  2. 2 Department of Cognitive Science, Yale University, New Haven, Connecticut, USA
  1. Correspondence to Dr Chandra L Jackson; chandra.jackson{at}


Objective Poor sleep has been associated with type 2 diabetes. Since racial/ethnic minorities experience a disproportionately high prevalence of poor sleep and type 2 diabetes, we sought to determine the relationships between multiple sleep dimensions and incident type 2 diabetes and to investigate if these relationships vary by race/ethnicity.

Research design and methods Prospective data were analyzed from the Sister Study, which enrolled 50 884 women from 2003 to 2009. Participants self-reported sleep duration, sleep latency, night awakenings, and napping at baseline, and a physician’s diagnosis of type 2 diabetes at follow-up. Multivariable-adjusted HRs and 95% CIs were estimated using Cox proportional hazards models.

Results Among the 39 071 eligible participants, 87% self-identified as white, 8% black and 5% Hispanic/Latina. The mean follow-up period was 8.5±2.1 years and 1785 type 2 diabetes cases were reported. The incidence rate per 1000 person-years was 5.4 for whites, 13.3 for blacks and 11.6 for Hispanics/Latinas. There was a positive but non-significant increased risk of type 2 diabetes among women who reported short sleep, latency >30 min and frequent night awakenings. In fully-adjusted models, frequent napping was associated with a 19% (HR 1.19, 95% CI 1.04 to 1.37) higher type 2 diabetes risk in the overall sample. Poor sleep among racial/ethnic minorities ranged from a 1.4-fold to a 3.2-fold higher type 2 diabetes risk than whites with recommended sleep.

Conclusions Frequent napping was associated with higher type 2 diabetes risk. Racial/ethnic minorities with poor sleep had a higher type 2 diabetes risk than whites with recommended sleep.

  • sleep

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  • Presented at This research was presented, in part, at the 32nd Annual Meeting of the Associated Professional Sleep Societies in Baltimore, Maryland, from 2 June to 6 June 2018.

  • Contributors KLM, Y-MP, SAG, KBF, DPS, CLJ. Study concept and design: CLJ, KLM. Acquisition of data: DPS. Statistical analysis: KLM. Interpretation of data: KLM, YMP, SAG, KBF, DPS, CLJ. Drafting of the manuscript: KLM, KBF, CLJ. Critical revision of the manuscript for important intellectual content: KLM, YMP, SAG, KBF, DPS, CLJ. Administrative, technical, and material support: DPS. Obtaining funding and study supervision: CLJ. Final approval: KLM, YMP, SAG, KBF, DPS, CLJ.

  • Funding This work was funded by the Intramural Program at the National Institutes of Health, National Institute of Environmental Health Sciences (Z1A ES103325-01 (CLJ) and Z01 ES044005 (DPS)).

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval The study was approved by the institutional review boards of the National Institute of Environmental Health Sciences and the Copernicus Group.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data may be obtained from a third party and are not publicly available. All data relevant to the study are included in the article or uploaded as supplementary information.

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