Longitudinal Sleep Patterns and Risk of Type 2 Diabetes Mellitus

Evidence relating sleep characteristics to type 2 diabetes mellitus (T2DM) has largely been based on single assessments. We examined whether transitions in a multidimensional healthy sleep score between two assessments were associated with incident T2DM and explored the relationship of the triglyceride-glucose (TyG) index to this association.

We conducted a landmark analysis among 60,249 UK Biobank participants with sleep assessed at visits 1 and 2. Visit 2 was defined as time zero for follow-up. Sleep pattern transitions were classified according to poor, intermediate, or healthy sleep status at each assessment. Cox proportional hazards models were used to estimate associations with incident T2DM. TyG analysis was treated as exploratory.

During a median follow-up of 4.2 years, 1284 incident T2DM cases occurred. Compared with stable healthy sleep, stable poor sleep was associated with higher risk (hazard ratio [HR], 2.07; 95% confidence interval [CI], 1.32-3.27). Baseline-stratified analyses did not show higher risk for improvement from poor or intermediate sleep relative to remaining in the same baseline category. The full-cohort spline showed evidence of nonlinearity (p for nonlinearity < 0.001), and TyG analyses were exploratory.

Sleep pattern transitions between the two assessments were associated with incident type 2 diabetes, and the association differed by baseline sleep status. Repeated sleep assessment may complement single-time-point evaluation in understanding the role of sleep in diabetes risk.