睡眠时间与2型糖尿病发病风险关系前瞻性研究的Meta分析

doi:10.3969/j.issn.1007-9572.2016.26.014

摘要/Abstract

摘要： 目的　探究睡眠时间与2型糖尿病发病风险的关系,分析睡眠时间与2型糖尿病发病风险的剂量反应关系。方法　计算机检索PubMed、Web of Science、中国知网、万方数据知识服务平台建库至2015-09-22有关睡眠时间与2型糖尿病发病风险的前瞻性研究，通过文献质量评价后，提取调整混杂因素后的相关数据，采用Stata 12.0和R 3.2.2软件分别对数据进行常规Meta分析和剂量反应Meta分析。结果　共纳入15个研究，睡眠时间与2型糖尿病发病风险关系的常规Meta分析结果显示，与正常组比较，睡眠时间过短组2型糖尿病发病风险增加36%〔RR=1.36，95%CI（1.23，1.50），P<0.001〕，睡眠时间过长组2型糖尿病发病风险增加23%〔RR=1.23，95%CI（1.09，1.39），P=0.001〕。亚组分析结果显示，睡眠时间过短组在除欧洲地区亚组的其他亚组中均增加了2型糖尿病的发病风险（PZ<0.05）；睡眠时间过长组在两种研究类型亚组、北美地区亚组及随访时间5～10年亚组中均增加了2型糖尿病的发病风险（PZ<0.05）。剂量反应Meta分析结果显示，睡眠时间与2型糖尿病发病风险呈非线性剂量反应关系，呈U型关系。与参照睡眠时间7.0 h/晚比较，睡眠时间5.5、6.0、6.5 h/晚2型糖尿病的发病风险为1.20〔95%CI（1.15，1.25）〕、1.10〔95%CI（1.08，1.13）〕、1.04〔95%CI（1.03，1.05）〕，睡眠时间7.5、8.0 h/晚2型糖尿病的发病风险为1.00〔95%CI（0.98，1.01）〕、1.02〔95%CI（0.99，1.06）〕，睡眠时间8.5、9.0、9.5 h/晚2型糖尿病的发病风险为1.07〔95%CI（1.01，1.14）〕、1.14〔95%CI（1.04，1.26）〕、1.23〔95%CI（1.07，1.40）〕。结论　睡眠时间过短和过长与2型糖尿病发病风险增加密切相关；睡眠时间<7.0 h/晚是2型糖尿病发病风险的危险因素，睡眠时间7.0～8.4 h/晚对2型糖尿病发病风险的影响不明显，而睡眠时间≥8.5 h/晚将导致2型糖尿病发病风险增加。因此，合理的睡眠时间有利于预防2型糖尿病。

关键词: 糖尿病, 2型, 睡眠时间, 前瞻性研究, Meta分析

Abstract: Objective　To investigate the relationship between length of sleep and incidence risk of type 2 diabetes and to analyze the dose-response relationship between these factors.Methods　PubMed,Web of Science,CNKI,and Wanfang Data Knowledge Service Platform were searched for prospective studies regarding the relationship between length of sleep and incidence risk of type 2 diabetes on September 22,2015.The quality of literature was evaluated,and relevant data were extracted after confounding factors were adjusted.Data were subjected to conventional meta-analysis and dose-response meta-analysis by using Stata 12.0 and R 3.2.2,respectively.Results　Fifteen studies were included.Conventional meta-analysis revealed that the incidence risk of type 2 diabetes group with very short sleep was 36%〔RR=1.36,95%CI（1.23,1.50）,P<0.001〕 higher than that of the normal group.The incidence risk of type 2 diabetes group with very long sleep was 23%〔RR=1.23,95%CI（1.09,1.39）,P=0.001〕 higher than that of the normal group.Subgroup analysis showed that all of the subgroups with very short sleep,except the subgroup in Europe,exhibited an increased risk of type 2 diabetes（PZ<0.05）.The group with very long sleep in two types of research subgroups,in subgroups in North America,and in 5-10 year’s follow up subgroups also experienced an increased risk of type 2 diabetes（PZ<0.05）.Dose-response meta-analysis demonstrated that the length of sleep and incidence risk of type 2 diabetes presented a nonlinear relationship,that was,a U-shaped relationship.Compared with the reference level of 7.0 h/night,the incidence risk of type 2 diabetes of 5.5,6.0,and 6.5 h/night were 1.20〔95%CI（1.15，1.25）〕,1.10〔95%CI（1.08，1.13）〕,and 1.04〔95%CI（1.03，1.05）〕,respectively.By comparison,the incidence risk of type 2 diabetes of 7.5 and 8.0 h/night were 1.00〔95%CI（0.98,1.01）〕 and 1.02〔95%CI（0.99,1.66）〕,respectively.Furthermore,the incidence risk of type 2 diabetes of 8.5,9.0,and 9.5 h/night were 1.07〔95%CI（1.01，1.14）〕,1.14〔95%CI（1.04，1.26）〕,and 1.23〔95%CI（1.07，1.40）〕,respectively.Conclusion　Extremely short or long sleep is closely associated with the increased risk of type 2 diabetes.Less than 7.0 h/night of sleep is a risk factor of type 2 diabetes.Approximately 7.0 to 8.4 h/night of sleep is unlikely a contributing factor of the risk of type 2 diabetes.More than 8.5 h/night of sleep possibly causes an increased risk of type 2 diabetes.Therefore,a reasonable length of sleep is beneficial for the prevention of type 2 diabetes.

Key words: Diabetes mellitus,type 2, Sleep duration, Prospective studies, Meta-analysis

查龙肖, 周权, 李风英, 胡波, 徐复朕, 刘静芳, 李菲, 朱秀丽. 睡眠时间与2型糖尿病发病风险关系前瞻性研究的Meta分析[J]. 中国全科医学, 2016, 19(26): 3196-3203.

ZHA Long-xiao, ZHOU Quan, LI Feng-ying, HU Bo, XU Fu-zhen, LIU Jing-fang, LI Fei, ZHU Xiu-li. Relationship between Length of Sleep and Incidence Risk of Type 2 Diabetes:A Meta-analysis of Prospective Studies[J]. Chinese General Practice, 2016, 19(26): 3196-3203.

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