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Sleep Duration May Have Greater Cardiometabolic Impact on Women vs Men


Results of a new study that used early clinical surrogate markers of metabolic disease find women at greater risk related to suboptimal sleep.


Early intervention in sleep disturbance may play a significant role in decreasing risk for metabolic disease, particularly among women, according to a new study from Japan.

The suggestion is based on findings from the study, published online in Lipids in Health and Disease, that point to sex-specific associations between sleep duration and subclinical indicators of metabolic disease.

Study authors, led by Lili Huang of the School of Public Health, Shanghai Jiao Tong University School of Medicine, point to accumulating evidence for the role of sleep in metabolic regulation, particularly metabolic rhythm and glucose metabolism. They cite, too, existing epidemiologic data linking sleep quality and duration with chronic conditions including type 2 diabetes, hypertension, and cardiovascular disease. “However,” they write, “the short or long sleep duration may also be the consequence of comorbidities, such as depression, which may confound the relationship between sleep duration and outcomes.”

Their study was designed to avoid such potential confounding by exploring the relationship between early clinical surrogate markers of metabolic disease and sleep duration in asymptomatic patients.

The research team used data from the national China Health and Nutrition Survey, excluding from an original group of 10 286 adults aged ≥18 years those with diabetes, heart disease, history of stroke or other CVD, and hypertension. The final group for analysis numbered 4922 (men, 44.6%; mean age: men 48 years, women 46 years).

Early-stage metabolic disease was assessed using 3 proxies—triglyceride to high-density lipoprotein cholesterol ration (TG/HDL-C), the product of triglyceride and fasting glucose (TyG), and lipid accumulation product (LAP).

To gauge sleep duration, participants responded to a single question regarding “usual” hours of sleep per day. Fasting blood samples were collected and measures of height, weight, waist circumference, body mass index, and blood pressure recorded.

According to the joint consensus statement of the American Academy of Sleep Medicine and Sleep Research Society, sleep duration of 7-8 h per day is recommended for adults, and sleep duration <7 h or ≥9 h may increase the risk of adverse health conditions.

Sleep duration was classified into three groups: <7 h, 7-9 h, and ≥9 h.

Using multivariable linear and logistic regression models to evaluate associations between sleep duration and the 3 early-stage disease indicators, the investigators found that among women, sleep duration <7 hours/day vs 7-9 hours/day was associated with an increase in LAP of 25% (95% CI, 10.7-41.6%) and in TyG of 0.104 (95%CI: 0.024-0.185).

Although they were attenuated, the effects for LAP remiained signficant (11.4% [95% CI, 1.6-22.3%]) after adjusting for multiple covariates.

Of significant interest, there were no associations between sleep duration and elevation in any of the proxy indicators among men.

"Notably, the effects of short sleep duration on subclinical indicators were more likely to be found in females,” the authors write. “There is notable sex divergence in the risk of metabolic disease, which may be related to sex-specific hormonal and behavioral differences.

"In addition, the evidence indicated that sleep duration deficiency might be associated with an elevated inflammatory level in females but not in males. The sex differences need to be confirmed in further studies.”

Reference: Huang L, Long A, Xu G, et al. Sex-specific association of sleep duration with subclinical indicators of metabolic diseases among asymptomatic adults. Lipids Health and Dis. 2022;21.

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