Investigation of the Relationship between Sleep Quality and Nutritional Status in Individuals with Type 2 Diabetes

Yıl 2024, Cilt: 50 Sayı: 1, 61 - 68, 17.05.2024

Gökçe Günsel Yıldırım , Ezgi Bellikci Koyu , Zeynep Altın , Emine Dedeler , Deniz Çatar

https://doi.org/10.32708/uutfd.1452684

Öz

The aim of this study was to evaluate the relationship between sleep quality, dietary intake, anthropometric measurements and glycemic status in individuals with type 2 diabetes. The study was conducted on 190 participants with type 2 diabetes (65.3% women) who applied to HSU Izmir Tepecik Education and Research hospital in Izmir. The nutritional status of the participants was assessed by 24-hour dietary record, sleep quality was assessed by Pittsburgh Sleep Quality Index (PSQI), and glycaemic status was assessed by fasting blood glucose and Haemoglobin A1c (HbA1c). Body weight, height, waist and hip circumference were measured and waist/height ratio and body mass index were calculated. Half (n=95) of the individuals with diabetes had poor sleep quality and the rate of women with poor sleep quality was higher than men (p=0.015). No significant difference was found between macronutrient or micronutrient intakes of individuals according to the sleep quality. When the relationship between anthropometric measurements and PSQI components was analysed, positive correlations were found between BMI and sleep disorders (r=0.177, p=0.014), sleep medication use (r=0.183, p=0.012) and PSQI global score (r=0.153, p=0.035). In addition, there were weak positive correlations between waist circumference and sleep disorders (r=0.168, p=0.021) and sleep medication use (r=0.202, p=0.005) and between hip circumference and sleep medication use (r=0.155, p=0.033) and daytime dysfunction (r=0.154, p=0.034). Positive correlations were also found between waist/height ratio and sleep disorders (r=0.220, p=0.002), sleep medication use (r=0.207, p=0.004) and PSQI global score (r=0.160, p=0.028). No significant relationship was found between energy intake, fasting blood glucose and HbA1c values and sleep quality and its components. In this study, it was revealed that poor sleep quality is common in individuals with diabetes and obesity and abdominal obesity are associated with sleep quality.

Anahtar Kelimeler

type 2 diabetes, sleep quality, nutritional status, anthropometric measurements, glycemic control

Tip 2 Diyabetli Bireylerde Uyku Kalitesi ve Beslenme Durumu Arasındaki İlişkinin İncelenmesi

Öz

Bu araştırmanın amacı tip 2 diyabetli bireylerde uyku kalitesi, besin tüketimi, antropometrik ölçümler ve glisemik durum arasındaki ilişkinin değerlendirilmesidir. Araştırma SBÜ İzmir Tepecik Eğitim Araştırma hastanesine başvuran tip 2 diyabetli 190 birey (%65.3 kadın) ile yürütülmüştür. Katılımcıların beslenme durumları 24-saatlik geriye dönük besin tüketim kaydı, uyku kaliteleri Pittsburgh Uyku Kalitesi İndeksi (PUKİ), glisemik durumları ise açlık kan glukozu ve Hemoglobin A1c (HbA1c) ile değerlendirilmiştir. Katılımcıların vücut ağırlığı, boy uzunluğu, bel ve kalça çevresi ölçülmüş, bel/boy oranı ve beden kütle indeksi hesaplanmıştır. Araştırmaya katılan diyabetli bireylerin yarısının (n=95) kötü uyku kalitesine sahip olduğu ve uyku kalitesi kötü olan kadınların oranının erkeklere göre daha yüksek olduğu belirlenmiştir (p=0.015). Katılımcılar iyi ya da kötü uyku kalitesine göre sınıflandırıldığında, makro ya da mikro besin ögeleri alımları arasında anlamlı bir farklılık saptanmamıştır. Antropometrik ölçümlerin PUKİ ve bileşenleri ile ilişkisi incelendiğinde, BKİ ile uyku bozuklukları (r=0177, p=0.014), uyku ilacı kullanımı (r=0.183, p=0.012) ve PUKİ global skoru arasında (r=0.153, p=0.035), bel çevresi ile uyku bozuklukları (r=0.168, p=0.021) ve uyku ilacı kullanımı arasında (r=0.202, p=0.005), kalça çevresi ile uyku ilacı kullanımı (r=0.155, p=0.033) ve gündüz işlev bozukluğu arasında (r=0.154, p=0.034) zayıf pozitif korelasyon saptanmıştır. Bel/boy oranı ile uyku bozuklukları (r=0.220, p=0.002), uyku ilacı kullanımı (r=0.207, p=0.004) ve PUKİ global skoru (r=0.160, p=0.028) arasında da zayıf pozitif korelasyon belirlenmiştir. Enerji alımı, açlık kan glukozu ve HbA1c değerleri ile uyku kalitesi ve bileşenleri arasında anlamlı bir ilişki saptanmamıştır. Bu araştırmada, diyabetli bireylerde kötü uyku kalitesinin yaygın olduğu, obezitenin ve abdominal obezitenin uyku kalitesi ile ilişkili olduğu ortaya konulmuştur.

Anahtar Kelimeler

tip 2 diyabet, uyku kalitesi, beslenme durumu, antropometrik ölçüm, glisemik kontrol

Kaynakça

• 1. International Diabetes Federation. IDF Diabetes Atlas, 10th edn. Brussels, Belgium: 2021. Available at: https://www.diabetesatlas.org.
• 2. Satman I, Bayirlioglu S, Okumus F, Erturk N, Yemenici M, Cinemre S, et al. Estimates and Forecasts on the Burden of Prediabetes and Diabetes in Adult and Elderly Population in Turkiye. European Journal of Epidemiology. 2023;38(3):313-23.
• 3. World Health Organization. Fact Sheets: Diabetes. https://www.who.int/news-room/fact-sheets/detail/diabetes. 2023.
• 4. 5. Facilitating Positive Health Behaviors and Well-being to Improve Health Outcomes: Standards of Care in Diabetes—2024. Diabetes Care. 2024;47(Supplement_1):S77-S110.
• 5. Hirshkowitz M, Whiton K, Albert SM, Alessi C, Bruni O, DonCarlos L, et al. National Sleep Foundation's sleep time duration recommendations: methodology and results summary. Sleep Health. 2015;1(1):40-3.
• 6. Shan Z, Ma H, Xie M, Yan P, Guo Y, Bao W, et al. Sleep duration and risk of type 2 diabetes: A meta-analysis of prospective studies. Diabetes Care. 2015;38(3):529-37.
• 7. Tan NYQ, Chan J, Cheng C-Y, Wong TY, Sabanayagam C. Sleep duration and diabetic kidney disease. Frontiers in Endocrinology. 2019;9.
• 8. Jee D, Keum N, Kang S, Arroyo JG. Sleep and diabetic retinopathy. Acta Ophthalmol. 2017;95(1):41-7.
• 9. Brouwer A, Van Raalte DH, Rutters F, Elders PJ, Snoek FJ, Beekman AT, et al. Sleep and HbA1c in patients with type 2 diabetes: Which sleep characteristics matter most? Diabetes Care. 2020;43(1):235-43.
• 10. Barakat S, Abujbara M, Banimustafa R, Batieha A, Ajlouni K. Sleep quality in patients with type 2 diabetes mellitus. J Clin Med Res. 2019;11(4):261-6.
• 11. Suárez-Torres I, García-García F, Morales-Romero J, Melgarejo-Gutiérrez M, Demeneghi-Marini VP, Luna-Ceballos RI, et al. Poor quality of sleep in Mexican patients with type 2 diabetes and its association with lack of glycemic control. Prim Care Diabetes. 2023;17(2):155-60.
• 12. Surani S, Brito V, Surani A, Ghamande S. Effect of diabetes mellitus on sleep quality. World J Diabetes. 2015;6(6):868-73.
• 13. Association AD. Standards of care in diabetes—2023 abridged for primary care providers. Clinical Diabetes. 2023;41(1):4-31.
• 14. Laverty B, Puthezhath Jayanandan S, Smyth S. Understanding the relationship between sleep and quality of life in type 2 diabetes: A systematic review of the literature. J Health Psychol. 2023;28(8):693-710.
• 15. Türkiye Endokrinoloji ve Metabolizma Derneği. Diabetes mellitus ve komplikasyonlarının tanı, tedavi ve izlem kılavuzu. 2022.
• 16. Hashimoto A, Inoue H, Kuwano T. Low energy intake and dietary quality are associated with low objective sleep quality in young Japanese women. Nutrition Research. 2020;80:44-54.
• 17. Matsunaga T, Nishikawa K, Adachi T, Yasuda K. Associations between dietary consumption and sleep quality in young Japanese males. Sleep and Breathing. 2021;25(1):199-206.
• 18. Zuraikat FM, Makarem N, Liao M, St-Onge MP, Aggarwal B. Measures of poor sleep quality are associated with higher energy intake and poor diet quality in a diverse sample of women from the go red for women strategically focused research network. J Am Heart Assoc. 2020;9(4):e014587.
• 19. Fatima Y, Doi SA, Mamun AA. Sleep quality and obesity in young subjects: A meta-analysis. Obes Rev. 2016;17(11):1154-66.
• 20. Daneshzad E, Mansordehghan M, Larijani B, Heshmati J, Rouzitalab T, Pizarro AB, et al. Diet quality indices are associated with sleep and mental health status among diabetic women: A cross-sectional study. Eat Weight Disord. 2022;27(4):1513-21.
• 21. Azadbakht L, Bellissimo N, Daneshzad E, Keshavarz S-A, Larijani B, Qorbani M. Association of dietary acid load and plant-based diet index with sleep, stress, anxiety and depression in diabetic women. British Journal of Nutrition. 2020;123(8):901-12.
• 22. Rakıcıoğlu N, Acar Tek N, Ayaz A, Pekcan G. Yemek ve besin fotoğraf kataloğu, ölçü ve miktarlar. Ankara 2012.
• 23. Baysal A. Yemek Planlama. Beslenme. 12. Baskı. Ankara: Hatipoğlu Yayınları; 2009. p. 397-444.
• 24. Buysse DJ, Reynolds III CF, Monk TH, Berman SR, Kupfer DJ. The Pittsburgh Sleep Quality Index: A new instrument for psychiatric practice and research. Psychiatry research. 1989;28(2):193-213.
• 25. Ağargün MY, Kara H, Anlar Ö. The validity and reliability of the Pittsburgh Sleep Quality Index. Turk Psikiyatri Derg. 1996;7(2):107-15.
• 26. World Health Organization (WHO) Expert Committee on Physical Status. The Use and Interpretation of Anthropometry: Report of a WHO Expert Committee. 1995.
• 27. Bilsel BA. Uyku ve Bellek Konsolidasyonu Arasındaki İlişki. Journal of Turkish Sleep Medicine-Türk Uyku Tıbbı Dergisi. 2023.
• 28. Talaz D, KIZILCI S. Tip 2 diyabet riski ve hastalık sürecinde uykunun rolü. Dokuz Eylül Üniversitesi Hemşirelik Fakültesi Elektronik Dergisi. 2015;8(3):203-8.
• 29. Demir M. Quality of life and sleep in diabetes mellitus patients. Annals of Medical Research. 2021;26(12):2997-3000.
• 30. Zewdu D, Gedamu H, Beyene Y, Tadesse M, Tamirat M, Muluken S. Sleep quality and associated factors among type 2 DM patients and non-DM individuals in Bahir Dar governmental hospitals: comparative cross-sectional study. Sleep Science and Practice. 2022;6(1):10.
• 31. Lou P, Qin Y, Zhang P, Chen P, Zhang L, Chang G, et al. Association of sleep quality and quality of life in type 2 diabetes mellitus: A cross-sectional study in China. Diabetes Res Clin Pract. 2015;107(1):69-76.
• 32. Song Y, Ye X, Ye L, Li B, Wang L, Hua Y. Disturbed subjective sleep in Chinese females with type 2 diabetes on insulin therapy. PLoS One. 2013;8(1):e54951.
• 33. Madrid-Valero JJ, Martínez-Selva JM, Couto BRd, Sánchez-Romera JF, Ordoñana JR. Age and gender effects on the prevalence of poor sleep quality in the adult population. Gaceta sanitaria. 2017;31:18-22.
• 34. Tang J, Liao Y, Kelly BC, Xie L, Xiang Y-T, Qi C, et al. Gender and regional differences in sleep quality and insomnia: A general population-based study in human province of China. Scientific Reports. 2017;7(1):43690.
• 35. Mong JA, Cusmano DM. Sex differences in sleep: impact of biological sex and sex steroids. Philos Trans R Soc Lond B Biol Sci. 2016;371(1688):20150110.
• 36. Chaput JP. Sleep patterns, diet quality and energy balance. Physiol Behav. 2014;134:86-91.
• 37. Matsunaga T, Nishikawa K, Adachi T, Yasuda K. Associations between dietary consumption and sleep quality in young Japanese males. Sleep Breath. 2021;25(1):199-206.
• 38. Aslan Çin NN, Yardimci H. Association of total energy intake, diet quality and sleep disorders in university-term female students. Sleep and Biological Rhythms. 2021;19(3):313-23.
• 39. Daneshzad E, Mansordehghan M, Larijani B, Heshmati J, Rouzitalab T, Pizarro AB, et al. Diet quality indices are associated with sleep and mental health status among diabetic women: A cross-sectional study. Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity. 2022;27(4):1513-21.
• 40. Xiao Q, Gu F, Caporaso N, Matthews CE. Relationship between sleep characteristics and measures of body size and composition in a nationally-representative sample. BMC Obes. 2016;3:48.
• 41. Rahe C, Czira ME, Teismann H, Berger K. Associations between poor sleep quality and different measures of obesity. Sleep Med. 2015;16(10):1225-8.
• 42. Yoshikawa F, Kumashiro N, Shigiyama F, Miyagi M, Ando Y, Uchino H, et al. Changes in subjective sleep quality in patients with type 2 diabetes who did not use sleep agents: A cross-sectional study according to age and clinical background. Diabetol Int. 2022;13(1):142-7.
• 43. Narisawa H, Komada Y, Miwa T, Shikuma J, Sakurai M, Odawara M, et al. Prevalence, symptomatic features, and factors associated with sleep disturbance/insomnia in Japanese patients with type-2 diabetes. Neuropsychiatr Dis Treat. 2017;13:1873-80.
• 44. Campos-Romero S, Barrios Araya SC, Masalan-Apip MP, Guajardo Tobar V, Arias-Ortiz NE, Bobadilla-Beiza L. Sleep quality in people with type 2 diabetes controlled at the primary level and its association with sociodemographic and clinical characteristics. Enfermería Clínica. 2022;32(1):45-53.
• 45. Nasir NFM, Draman N, Zulkifli MM, Muhamad R, Draman S. Sleep quality among patients with type 2 diabetes: a cross-sectional study in the East Coast Region of Peninsular Malaysia. Int J Environ Res Public Health. 2022;19(9).
• 46. Shamshirgaran SM, Ataei J, Malek A, Iranparvar-Alamdari M, Aminisani N. Quality of sleep and its determinants among people with type 2 diabetes mellitus in Northwest of Iran. World journal of diabetes. 2017;8(7):358.
• 47. Feher M, Hinton W, Munro N, de Lusignan S. Obstructive sleep apnoea in type 2 diabetes mellitus: increased risk for overweight as well as obese people included in a national primary care database analysis. Diabet Med. 2019;36(10):1304-11.
• 48. Zheng C, Zheng X, Lin X, Ye J, Xu Z, Hu H, et al. Visceral adipose tissue indices independently correlated with obstructive sleep apnea in patients with type 2 diabetes. J Diabetes Res. 2022;2022:4950528.
• 49. Suárez-Torres I, García-García F, Morales-Romero J, Melgarejo-Gutiérrez M, Demeneghi-Marini VP, Luna-Ceballos RI, et al. Poor quality of sleep in Mexican patients with type 2 diabetes and its association with lack of glycemic control. Primary Care Diabetes. 2023;17(2):155-60.
• 50. Keskin A, Ünalacak M, Bilge U, Yildiz P, Güler S, Selçuk EB, et al. Effects of sleep disorders on hemoglobin A1c levels in type 2 diabetic patients. Chin Med J (Engl). 2015;128(24):3292-7.
• 51. Lee SWH, Ng KY, Chin WK. The impact of sleep amount and sleep quality on glycemic control in type 2 diabetes: A systematic review and meta-analysis. Sleep Med Rev. 2017;31:91-101.
• 52. Barikani A, Javadi M, Rafiei S. Sleep quality and blood lipid composition among patients with diabetes. Int J Endocrinol Metab. 2019;17(3):e81062.
• 53. Yang Y, Zhao L-h, Li D-d, Xu F, Wang X-h, Lu C-f, et al. Association of sleep quality with glycemic variability assessed by flash glucose monitoring in patients with type 2 diabetes. Diabetology & Metabolic Syndrome. 2021;13(1):102.