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Short Duration of Sleep Increases Risk of Colorectal Adenoma

Insufficient sleep and chronic sleep deficits have been linked to poor performance and safety issues but can also affect health.1 Physiologic changes may occur in patients who experience acute sleep deficits.  Some of these changes include alterations in glucose tolerance, higher levels of cortisol in the evening and additional endocrine factors.2 Elevated blood pressure and negative effects on cognition have also been documented.3  Increased risk of cancer has been linked to disruptions in the circadian rhythm.  Although short sleep duration and increased risk of breast cancer has been reported, there is little information published on the effect on the risk of colorectal neoplasia.2 Thompson and colleagues2 recently published their findings on the short duration of sleep and its effect on formation of colorectal adenoma, precursor lesions to neoplasia.

The Pittsburgh Sleep Quality Index (PSQI) was administered to 1240 study participants before colonoscopy in a screening colonoscopy-based case-control study.  The researchers evaluated the associations of the duration and quality of sleep, including shift work and diagnosis of sleep apnea, with the development of colorectal adenoma.  All patients referred were asymptomatic, aged 50 years or older, and had had no colonoscopy exam within the last ten years or had a positive family history of colorectal cancer requiring a screening procedure at a younger age.  Participants did not have any inflammatory bowel disease and had never been diagnosed with CRC or polyps or other cancer. The study participants completed an interview over the phone or prior to the procedure.  The recruitment rate was 64.9% for all eligible patients.2


  • Of the 1240 participants, 338 were diagnosed with incident colorectal adenoma at the time of their colonoscopy
  • Generally, the diagnosed patients were older and more likely to be male
  • African Americans were more likely to be cases compared with Caucasians
  • No statistically significant difference in BMI was noted between cases and controls (P = .10)
  • Cases reporting current smoking were significantly higher compared to controls
  • Family history was reported in over 20% of the study population
  • On average, cases of positive adenoma findings scored higher (meaning poorer sleep quality) on the PSQI and more likely to average less than 6 hours of sleep per night (28.9% vs 22.1% in controls, P = .01)
  • The hours of sleep per night was statistically significantly different between cases and controls (P = .005), with cases reporting sleeping fewer hours on average versus controls (6.35 vs 6.54, P = .038)
  • Individuals averaging less than 6 hours per night of sleep had an almost 50% increase in risk of colorectal adenoma
The researchers reported that the increased risk found with sleep disturbance was comparable to the risk seen with having a first degree relative diagnosed with CRC and high red meat intake; it was also similar to the reported risk of breast cancer and short sleep duration.  The mechanism at work for this risk is not completely known. Suppression of nocturnal production of melatonin may be the key force at work; other causes may be that insulin resistance is connected between sleep disturbance and carcinogenesis.

ManageCRC.com Commentary

Although the focus of the previously reported research was on lack of sleep and formation of adenoma, the definitive answer on appropriate patterns of sleep for optimal health has not been reached.  There are a myriad of factors that can potentially affect sleep, including mechanical and physiologic factors.  Both “short” sleep (defined as less than 7 hours a night) and “long” sleep (defined as more than 9 hours of sleep a night) have been linked to higher all-cause mortality (including cardiovascular and cancer-related mortality). 4 The association between lack of sleep and the development of precancerous lesions found in the aforementioned study is intriguing; more research needs to be done to confirm the role of the lack of sleep and early colorectal neoplasia. 


  1. Lockley, SW, Barger, LK, Ayas, NT et al. Effects of health care provider work hours and sleep deprivation on safety and performance. Jt Comm J Qual Patient Saf. 2007;33(11 Suppl):7-18. Link to abstract at: http://www.ncbi.nlm.nih.gov/pubmed/18173162
  2. Thompson, CL, Larkin, EK, Patel, S et al. Short duration of sleep increases risk of adenoma. Cancer 2011;117:841-7. doi: 10.1002/cncr.25507  Link to abstract at:   http://www.ncbi.nlm.nih.gov/pubmed?term=thompson%2C%20larkin%2C%20patel         
  3. Tochikubo, O, Ikeda, A, Miyajima, E et al. Effects of insufficient sleep on blood pressure monitored by a new multibiomedical recorder. Hypertension 1996; 27: 1318-1324. Link to free full text at http://hyper.ahajournals.org/cgi/content/full/27/6/1318 
  4. Gallicchio, L & Kalesan, B. Sleep duration and mortality: a systematic review and meta-analysis. J Sleep Res. 2009; 18:148-158. doi:10.1111/j.1365-2869.2008.00732.x  Link to free full text at http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2869.2008.00732.x/pdf

Article Created On : 3/15/2011 9:01:22 AM             Article Updated On : 3/15/2011 9:01:22 AM