Aims/hypothesisTo examine gender specific associations between sleep disturbance and incident type 2 diabetes mellitus in a representative population sample in Germany.MethodsThe study was based on 4,140 men and 4,129 women (aged 25–74 years) who participated in one of the three MONICA Augsburg surveys between 1984 and 1995, and who were free of diabetes at baseline. Incident cases of type 2 diabetes were assessed using a follow-up questionnaire in 1998. Gender specific hazard ratios were estimated from Cox proportional hazard models.ResultsA total of 119 cases of incident type 2 diabetes among men and 69 among women were registered during the mean follow-up period of 7.5 years. In both sexes, difficulty maintaining sleep was associated with a higher risk of type 2 diabetes. After adjustment for age, survey, hypertension, dyslipidemia, parental history of diabetes, history of angina pectoris, regular smoking, physical activity, alcohol intake, body mass index and education, the hazard ratio in men was 1.60 (95% CI: 1.05–2.45) and the hazard ratio in women was 1.98 (95% CI: 1.20–3.29). In contrast, difficulty initiating sleep was not associated with a significantly increased risk of developing type 2 diabetes mellitus after multivariable adjustment in both sexes in the present study.Conclusions/interpretationDifficulty maintaining sleep was associated with an increased risk of type 2 diabetes in men and women from the general population. Although, the causal pathway is not entirely clear, it seems that both insulin resistance and chronic low-grade systemic inflammation may be involved.