Cross-sectional and prospective associations between sleep regularity and metabolic health in the Hispanic Community Health Study/Study of Latinos

Study Objectives: Sleep is an emergent, multi-dimensional risk factor for diabetes. Sleep duration, timing, quality, and insomnia have been associated with diabetes risk and glycemic biomarkers, but the role of sleep regularity in the development of metabolic disorders is less clear. Methods: We analyzed data from 2107 adults, aged 19-64 years, from the Sueño ancillary study of the Hispanic Community Health Study/Study of Latinos, followed over a mean of 5.7 years. Multivariable-adjusted complex survey regression methods were used to model cross-sectional and prospective associations between the sleep regularity index (SRI) in quartiles (Q1-least regular, Q4-most regular) and diabetes (either laboratory-confirmed or self-reported antidiabetic medication use), baseline levels of insulin resistance (HOMA-IR), beta-cell function (HOMA-β), hemoglobin A1c (HbA1c), and their changes over time. Results: Cross-sectionally, lower SRI was associated with higher odds of diabetes (odds ratio [OR]Q1 vs. Q4 = 1.64, 95% CI: 0.98-2.74, ORQ2 vs. Q4 = 1.12, 95% CI: 0.70-1.81, ORQ3 vs. Q4 = 1.00, 95% CI: 0.62-1.62, ptrend = 0.023). The SRI effect was more pronounced in older (aged ≥ 45 years) adults (ORQ1 vs. Q4 = 1.88, 95% CI: 1.14-3.12, pinteraction = 0.060) compared to younger ones. No statistically significant associations were found between SRI and diabetes incidence, as well as baseline HOMA-IR, HOMA-β, and HbA1c values, or their changes over time among adults not taking antidiabetic medication. Conclusions: Our results suggest that sleep regularity represents another sleep dimension relevant for diabetes risk. Further research is needed to elucidate the relative contribution of sleep regularity to metabolic dysregulation and pathophysiology.