Original Article
Association of Short and Long Sleep Durations with Insulin Sensitivity in Adolescents

https://doi.org/10.1016/j.jpeds.2010.09.080Get rights and content

Objective

To characterize the relationship between insulin sensitivity, assessed with the homeostasis model of insulin (HOMA), and objective measurements of sleep duration in adolescents.

Study design

We conducted a cross-sectional analysis from two examinations conducted in the Cleveland Children’s Sleep and Health Cohort (n = 387; 43% minorities). Biochemical and anthropometry measurements were made in a clinical research unit. Sleep duration was measured with actigraphy.

Results

Decreased sleep duration was associated with increased adiposity and minority race. Sleep duration had a quadratic “u-shape” association with HOMA. When adjusted for age, sex, race, preterm status, and activity, adolescents who slept 7.75 hours had the lowest predicted HOMA (1.96, 95% confidence interval [CI], 1.82-2.10), and adolescents who slept 5.0 hours or 10.5 hours had HOMA indices that were approximately 20% higher (2.36; 95% CI, 1.94-2.86; and 2.41; 95% CI, 1.93-3.01, respectively). After adjusting for adiposity, the association between shorter sleep and HOMA was appreciably attenuated, but the association with longer sleep persisted.

Conclusions

Shorter and longer sleep durations are associated with decreased insulin sensitivity in adolescents. Although the association between shorter sleep duration with insulin sensitivity likely is explained by the association between short sleep duration and obesity, the association between longer sleep and insulin sensitivity is independent of obesity.

Section snippets

Methods

This sample comprised adolescents participating in the Cleveland Children’s Sleep and Health Study (CCSHS), an ongoing longitudinal cohort study designed to evaluate sleep measures and their health outcomes. As previously described,27, 28, 29 the cohort was originally assembled by stratified sampling of full-term and preterm (<37 weeks gestational age) children born between 1988 and 1993 and was designed to over-represent African-American and preterm children. The first CCSHS examination

Results

Sample characteristics for the analytic sample and stratified by mean sleep duration category are shown in Table I. Consistent with the sampling strategy, approximately half the sample was male and had been born preterm, and 42.7% of the sample were minority race (predominantly African-American). Approximately 20% of the sample was obese, and approximately 26% had a G:I ratio <7. Mean weekday sleep duration was 7.63 ± 1.08 hours and was similar for participants in the early adolescent

Discussion

This study evaluated the relationship between an objective measure of habitual sleep duration (with actigraphy) and an index of insulin sensitivity in an adolescent population. In this sample, a birth cohort from an urban Midwestern area assembled to over-represent minorities and preterm children, we observed shorter sleep duration to be associated with minority race and indices of adiposity. As expected, increased HOMA levels were associated with adiposity, decreased physical activity,

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    Supported by grants from the National Institutes of Health (NIH HL07567, HL60957, UL1-RR024989, and 1U54CA116867). The authors declare no conflicts of interest.

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