The effect of glycemic control on sleep quality in type 2 diabetes mellitus

Abstract

Objectives: There are publications showing sleep quality is impacted in type 2 diabetes mellitus (T2DM) cases. In our study, we planned to assess the prevalence of sleep disorder in these patients compared to society, and investigate whether poor glycemic regulation and increased body mass index (BMI) caused disruption of sleep quality or not.

Methods: Sleep quality was compared between patients followed in our clinic with T2DM (n = 534) for minimum 5 years and a control group (n = 269). Assessment was performed for whether increased glycated haemoglobin (HbA1c) and increased BMI caused an increase in Pittsburgh Sleep Quality Index (PSQI) score or not. Cases with any comorbid disease or drug use affecting sleep quality were excluded from the study.

Results: T2DM patients had higher PSQI points compared to the control group. A statistically significant, very low-level positive correlation was identified between BMI measurements and PSQI scores (as BMI increased, PSQI increased). A statistically significant, very low-level positive correlation was identified between HbA1c measurements and PSQI scores (as HbA1c increased, PSQI increased). HbA1c measurements of those in the good sleep quality group were significantly lower compared to those in the moderate sleep quality and poor sleep quality groups. The BMI measurements in the poor sleep quality group were significantly higher than those in the good sleep quality group.

Conclusions: The sleep quality of T2DM cases was worse compared to the control group, while the increase in HbA1c level further disrupted sleep quality. The increase in BMI is another factor disrupting sleep quality in diabetic patients.

Keywords

• Glycemic control
• type 2 diabetes mellitus
• sleep quality
• glycated haemoglobin

References

1. 1. International Diabetes Federation. IDF Diabetes Atlas, 9th edn. Brussels, Belgium: International Diabetes Federation, 2019.
2. 2. Hiestand DM, Britz P, Goldman M, Phillips B. Prevalence of symptoms and risk of sleep apnea in the US population: Results from the national sleep foundation sleep in America 2005 poll. Chest 2006;130:780-6.
3. 3. İlhan Algın D, Akdağ G, Erdinç OO. [Quality sleep and sleep disorders]. Osmangazi J Med 2016;38 (Special Issue 1):29-34. [Article in Turkish]
4. 4. Depner CM, Stothard ER, Wright KP Jr. Metabolic consequences of sleep and circadian disorders. Curr Diab Rep 2014;14:507.
5. 5. Buysse DJ, Reynolds CF 3rd, Monk TH, Berman SR, Kupfer DJ. The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research. Psychiatry Res 1989;28:193-213.
6. 6. Rajendran A, Parthsarathy S, Tamilselvan B, Seshadri KG, Shuaib M. Prevalence and correlates of disordered sleep in South east asian indians with type 2 diabetes. Diabetes Metab J 2012;36:70-6.
7. 7. Cho EH, Lee H, Ryu OH, Choi MG, Kim SW. Sleep disturbances and glucoregulation in patients with type 2 diabetes. J Korean Med Sci 2014;29:243-7.
8. 8. Telford O, Diamantidis CJ, Bosworth HB, Patel UD, Davenport CA, Oakes MM, Crowley MJ. The relationship between Pittsburgh Sleep Quality Index subscales and diabetes control. Chronic Illn 2019;15:210-9.

9. 9. Tang Y, Meng L, Li D, Yang M, Zhu Y, Li C, et al. Interaction of sleep quality and sleep duration on glycemic control in patients with type 2 diabetes mellitus. Chin Med J (Engl). 2014;127:3543-7.
10. 10. Zhu B-Q, Li X-M, Wang D, Yu X-F. Sleep quality and its impact on glycemic control in patients with type 2 diabetes mellitus. Int J Nurs Sci 2014;1:260-5.
11. 11. Bener A, Al-Hamaq AOAA, Agan AF, Öztürk M, Ömer A. Sleeping disturbances and predictor risk factors among type 2 diabetic mellitus patients. Ann Afr Med 2020;19:230-6.
12. 12. Tsai YW, Kann NH, Tung TH, Chao YJ, Lin CJ, Chang KC, et al. Impact of subjective sleep quality on glycemic control in type 2 diabetes mellitus. Fam Pract 2012;29:30-5.
13. 13. Cappuccio FP, D’Elia L, Strazzullo P, Miller MA. Quantity and quality of sleep and incidence of type-2 diabetes: a meta-analysis of prospective studies. Diabetes Care 2010;33:414-20.
14. 14. Institute of Medicine (US) Committee on Sleep Medicine and Research. Sleep Disorders and Sleep Deprivation: An Unmet Public Health Problem. Colten HR, Altevogt BM, editors. Washington (DC): National Academies Press (US); 2006.
15. 15. Lucassen EA, Rother KI, Cizza G. Interacting epidemics? Sleep curtailment, insulin resistance, and obesity. Ann N Y Acad Sci 2012;1264:110-34.
16. 16. Yaggi HK, Araujo AB, McKinlay JB. Sleep duration as a risk factor for the development of type 2 diabetes. Diabetes Care 2006;29:657-61.
17. 17. Xu Q, Song Y, Hollenbeck A, Blair A, Schatzkin A, Chen H. Day napping and short night sleeping are associated with higher risk of diabetes in older adults. Diabetes Care 2010;33:78-83.
18. 18. Vetter C, Devore EE, Ramin CA, Speizer FE, Willett WC, Schernhammer ES. Mismatch of sleep and work timing and risk of type 2 diabetes. Diabetes Care 2015;38:1707-13.
19. 19. Buxton OM, Cain SW, O'Connor SP, Porter JH, Duffy JF, Wang W, Czeisler CA, Shea SA. Adverse metabolic consequences in humans of prolonged sleep restriction combined with circadian disruption. SciTransl Med 2012;4:129ra43.
20. 20. Koolhaas CM, Kocevska D, Te Lindert BHW, Erler NS, Franco OH, Luik AI, Tiemeier H. Objectively measured sleep and body mass index: a prospective bidirectional study in middle-aged and older adults. Sleep Med 2019;57:43-50.
21. 21. Vargas PA, Flores M, Robles E. Sleep quality and body mass index in college students: the role of sleep disturbances. J Am Coll Health 2014;62:534-41.
22. 22. Miller MA, Cappuccio FP. Inflammation, sleep, obesity and cardiovascular disease. Curr Vasc Pharmacol 2007;5:93-102.