Healthy Sleep Behaviors Reduce the Risk of Microvascular and Cardiovascular Complications in Patients With Type 2 Diabetes and Are Associated With Potential Serum Biomarkers: A UK Biobank Observational Cohort Study

BACKGROUND: The association of sleep behaviors with microvascular complications and cardiovascular outcomes in diabetic patients is not clear. Furthermore, serum biomarkers that can be used to evaluate this association have not been characterized. Therefore, this study investigated the association of the overall sleep score with the diabetic complications and the potential underlying serum metabolic biomarkers in patients with type 2 diabetes mellitus (T2DM). METHODS: This prospective cohort study included 30 915 T2DM patients without complications from the UK Biobank. The sleep score of the participants was evaluated based on sleep behaviors such as sleep duration, insomnia, snoring, chronotype, and daytime sleepiness. The potential biomarkers, including cystatin C (Cys C), apolipoprotein A (Apo A), C-reactive protein (CRP), albumin, and γ-glutamyl transpeptidase (GGT), were also determined to evaluate their role as potential indicators of the association between the sleep score and the diabetic complications. RESULTS: Participants with a healthy sleep score of 4-5 had lower risks of microvascular complications (HR = 0.80 [95% CI: 0.72, 0.89]) and cardiovascular outcomes (HR = 0.70 [95% CI: 0.61, 0.81]) compared to those with a sleep score of 0-1. Furthermore, cys C showed the best effects by explaining the associations of overall healthy sleep behaviors with microvascular complications and cardiovascular outcomes by 30.36% and 14.36%, respectively. CONCLUSIONS: Our data showed that healthy sleep behaviors were associated with a reduced risk of diabetic complications. Moreover, serum biomarkers of renal function, lipids, systemic inflammation, and hepatic function partially mediated the relationship between sleep behaviors and diabetic complications.