Sleep and Metabolic Health

Sleep and Metabolic Health

Both the quantity and quality of sleep play an important role in various aspects of health,1 with suboptimal sleep being associated with poorer health outcomes such as diabetes, cardiovascular disease, obesity, cancer, and premature mortality.2 

Diabetes – Sleep and Diabetes have a bidirectional relationship.3,4 Common sleep disorders such as obstructive sleep apnea (OSA), insomnia, and restless legs syndrome are more common in individuals with diabetes than the general population. On the other hand, poor sleep may independently be associated with the development of type 2 diabetes  through various mechanisms that accelerate the loss of pancreatic b-cell function, increase food consumption and weight, and decrease physical activity.  

Obesity – Studies have found short duration of sleep to be strongly associated with concurrent and future obesity.2 Sleep deprivation can alter the levels of hormone that regulate appetite (eg, ghrelin, leptin) and has been shown to be associated with increased eating, increased intake of total and saturated fats, greater snacking, and reward-seeking behaviors that contribute to increased caloric intake.5 One meta-analysis of 11 randomized controlled studies found that partial sleep deprivation (3.75-5.5 hours/night) was associated with an average 385 kcal/day increase in energy consumption compared to adequate sleep (7-9 hours/night).6 In addition, fatigue can lead to lower physical activity, exasperating obesity. 

Cardiovascular Disease – Studies have consistently shown that sleep deprivation is associated with a greater risk of developing cardiovascular disease (CVD).2,7 A meta-analysis of 15 prospective studies concluded that sleep and the risk of CVD have a U-shaped association, with both reduced and excessive sleep associated with increased risk of developing coronary heart disease and stroke.7 Epidemiological studies have also shown that sleep disorders (eg, OSA, insomnia) are significantly associated with increased risk or prevalence of hypertension, heart failure, coronary heart disease, and stroke.2

Changes in eating and physical activity patterns as well as the associated weight gain that result from sleep reduction may contribute to the increased risk of CVD.5 It is also hypothesized that sleep can also affect patterns of blood pressure, heart rate, insulin sensitivity, salt and fluid homeostasis, and activity of autonomous nervous system during the day.2 Intermittent low levels of oxygen that occur in OSA may lead to systemic inflammation, oxidative stress, and adverse cardiovascular health. 


1. Lao XQ, Liu X, Deng HB, et al. Sleep Quality, Sleep Duration, and the Risk of Coronary Heart Disease: A Prospective Cohort Study With 60,586 Adults. J Clin Sleep Med. 2018;14(1):109-117. doi:10.5664/jcsm.6894
2. Jackson CL, Redline S, Emmons KM. Sleep as a Potential Fundamental Contributor to Disparities in Cardiovascular Health. Annu Rev Public Health. 2015;36(1):417-440. doi:10.1146/annurev-publhealth-031914-122838
3. ElSayed NA, Aleppo G, Aroda VR, et al. 5. Facilitating Positive Health Behaviors and Well-being to Improve Health Outcomes: Standards of Care in Diabetes—2023. Diabetes Care. 2022;46(Supplement_1):S68-S96. doi:10.2337/dc23-S005
4. Schipper SBJ, Van Veen MM, Elders PJM, et al. Sleep Disorders in People With Type 2 Diabetes and Associated Health Outcomes: A Review of the Literature. Diabetologia. 2021;64(11):2367-2377. doi:10.1007/s00125-021-05541-0
5. St-Onge MP, Zuraikat FM. Reciprocal Roles of Sleep and Diet in Cardiovascular Health: a Review of Recent Evidence and a Potential Mechanism. Curr Atheroscler Rep. 2019;21(3):11. doi:10.1007/s11883-019-0772-z
6. Al Khatib HK, Harding SV, Darzi J, Pot GK. The Effects of Partial Sleep Deprivation on Energy Balance: A Systematic Review and Meta-Analysis. Eur J Clin Nutr. 2017;71(5):614-624. doi:10.1038/ejcn.2016.201
7. Cappuccio FP, Cooper D, D’Elia L, Strazzullo P, Miller MA. Sleep Duration Predicts Cardiovascular Outcomes: A Systematic Review and Meta-Analysis of Prospective Studies. Eur Heart J. 2011;32(12):1484-1492. doi:10.1093/eurheartj/ehr007



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