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1
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Chen Y, Tong E, Rao Y, Yu EYW, Zeegers M, Wesselius A. The association between insomnia (related symptoms) and glycaemic control: a systematic review and meta-analysis. J Glob Health 2025; 15:04016. [PMID: 39916567 PMCID: PMC11803432 DOI: 10.7189/jogh.15.04016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2025] Open
Abstract
Background Insomnia characterised by difficulties in falling asleep and maintaining sleep, and early awaking, is a prevalent worldwide sleep disorder. While previous studies have suggested an association between insomnia and adverse glycaemic control, the evidence remains inconclusive. Therefore, this meta-analysis aims to explore this association. Methods Insomnia was assessed based on defined criteria, including related symptoms such as poor sleep quality and low sleep efficiency. Glycaemic control was evaluated using indicators such as fasting plasma glucose, haemoglobin A1c, and the presence of diabetes. A literature search was performed in PubMed, Web of Science, and Scopus. The quality of the included studied was assessed using The Newcastle-Ottawa Scale. Effect sizes, including odds ratio, relative risk, mean difference, and standard mean difference, were chosen based on data type. Forest plots visually displayed pooled effect sizes and corresponding 95% confidence intervals, while the I2 test calculated heterogeneity. Meta-regression and subgroup analysis explored potential sources of heterogeneity. Leave-one-out sensitivity analysis assessed result robustness, and Begg's and Egger's tests evaluated publication bias. Results Ninety-one articles, comprising 84 are cross-sectional studies, (five are case-control studies, and two are cohort studies) with 2 217 521 participants, were included. Ten separate meta-analyses were conducted based on variable type (binary/continuous), study design (cross-sectional, case-control, or cohort), and measurement of exposures/outcomes. All meta-analyses indicated a positive association between insomnia (related symptoms) and adverse glycaemic control. However, three meta-analyses showed significant heterogeneity, and three lacked robustness. No publication bias was detected across any of the analyses. Conclusions Insomnia is likely associated with adverse glycaemic control. As the included studies are observational, future research should prioritise diverse methodologies and robust study designs to further explore this complex relationship. Keywords insomnia, insomnia related symptoms, glycaemic control, systematic review, meta-analysis. Registration PROSPERO CRD42024491688.
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Affiliation(s)
- Yiming Chen
- School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, Limburg, the Netherlands
- Department of Epidemiology, Maastricht University, Maastricht, Limburg, the Netherlands
| | - Enyu Tong
- Department of Health, Ethics and Society, Maastricht University, Maastricht, Limburg, the Netherlands
| | - Yufeng Rao
- School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, Limburg, the Netherlands
- Department of Epidemiology, Maastricht University, Maastricht, Limburg, the Netherlands
| | - Evan YW Yu
- Key Laboratory of Environmental Medicine and Engineering of Ministry of Education, and Department of Epidemiology & Biostatistics, School of Public Health, Southeast University, Nanjing, Jiangsu, China
| | - Maurice Zeegers
- Department of Epidemiology, Maastricht University, Maastricht, Limburg, the Netherlands
| | - Anke Wesselius
- School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, Limburg, the Netherlands
- Department of Epidemiology, Maastricht University, Maastricht, Limburg, the Netherlands
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Vargas CA, Guzmán-Guzmán IP, Caamaño-Navarrete F, Jerez-Mayorga D, Chirosa-Ríos LJ, Delgado-Floody P. Syndrome Metabolic Markers, Fitness and Body Fat Is Associated with Sleep Quality in Women with Severe/Morbid Obesity. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18179294. [PMID: 34501884 PMCID: PMC8431712 DOI: 10.3390/ijerph18179294] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 08/26/2021] [Accepted: 08/30/2021] [Indexed: 12/15/2022]
Abstract
Background: Sleep is an important modulator of neuroendocrine function and glucose metabolism. Poor sleep quality is related to metabolic and endocrine alterations, including decreased glucose tolerance, decreased insulin sensitivity, and increased hunger and appetite. Objective: The aim of the present study was to determine the association between sleep quality with metabolic syndrome (MetS) markers, fitness and body fat of women with severe/morbid obesity. Methods: This cross-sectional study included 26 women with severe/morbid obesity. Fasting plasma glucose (FPG), high-density lipids (HDL-c), triglycerides (TGs), and the metabolic outcomes total cholesterol (Tc) and low-density lipids (LDL-c), systolic (SBP) and diastolic blood pressure (DBP), body composition and fitness were measured. Results: Poor sleep quality showed a positive association with body fat (%) ≥ 48.2 (OR; 8.39, 95% CI; 1.13–62.14, p = 0.037), morbid obesity (OR; 8.44, 95% CI; 1.15–66.0, p = 0.036), glucose ≥ 100 mg/dL (OR; 8.44, 95% CI; 1.15–66.0, p = 0.036) and relative handgrip strength ≤ 0.66 (OR; 12.2, 95% CI; 1.79–83.09, p = 0.011). Conclusion: sleep quality is associated with health markers in women with severe/morbid obesity.
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Affiliation(s)
- Claudia Andrea Vargas
- Department of Physical Education, Sport and Recreation, Universidad de La Frontera, Temuco 4780000, Chile;
| | - Iris Paola Guzmán-Guzmán
- Faculty of Chemical-Biological Sciences, Universidad Autónoma de Guerrero, Chilpancingo de los Bravo 39087, Mexico;
| | | | - Daniel Jerez-Mayorga
- Faculty of Rehabilitation Sciences, Universidad Andres Bello, Santiago 7591538, Chile;
| | - Luis Javier Chirosa-Ríos
- Department Physical Education and Sports, Faculty of Sport Sciences, University of Granada, 18011 Granada, Spain;
| | - Pedro Delgado-Floody
- Department of Physical Education, Sport and Recreation, Universidad de La Frontera, Temuco 4780000, Chile;
- Correspondence:
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Weschenfelder F, Lohse K, Lehmann T, Schleußner E, Groten T. Circadian rhythm and gestational diabetes: working conditions, sleeping habits and lifestyle influence insulin dependency during pregnancy. Acta Diabetol 2021; 58:1177-1186. [PMID: 33837820 PMCID: PMC8316165 DOI: 10.1007/s00592-021-01708-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Accepted: 03/16/2021] [Indexed: 11/02/2022]
Abstract
OBJECTIVE Management of gestational diabetes (GDM) is currently changing toward a more personalized approach. There is a growing number of GDM patients requiring only a single dose of basal insulin at night to achieve glucose control. Well-known risk factors like obesity, parity and family history have been associated with GDM treatment requirements. Sleep quality and lifestyle factors interfering with the circadian rhythm are known to affect glucose metabolism. The aim of this study was to investigate the impact of such lifestyle factors on insulin requirement in GDM patients, in particular on long-acting insulin to control fasting glucose levels. RESEARCH DESIGN AND METHODS A total of 805 patients treated for GDM between 2012 and 2016 received a study questionnaire on lifestyle conditions. Sleep quality and work condition categories were used for subgroup analysis. Independent effects on treatment approaches were evaluated using multivariate regression. RESULTS In total, 235 (29.2%) questionnaires returned. Women reporting poor sleep conditions had higher pre-pregnancy weight and BMI, heavier newborns, more large for gestational age newborns and higher rates of hyperbilirubinemia. Treatment requirements were related to sleep and work condition categories. Multivariate regression for 'Basal' insulin-only treatment revealed an adjOR 3.4 (CI 1.23-9.40, p < 0.05) for unfavorable work conditions and adjOR 4.3 (CI 1.28-14.50, p < 0.05) for living with children. CONCLUSIONS Our findings suggest that external stressors like unfavorable work conditions and living with children are independently associated with the necessity of long-acting insulin at night in GDM patients. Thus, fasting glucose levels of pregnant women presenting with such lifestyle conditions may be subject to close monitoring.
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Affiliation(s)
| | - Karolin Lohse
- Unit Neonatology, Department of Paediatrics, University Hospital Jena, Jena, Germany
| | - Thomas Lehmann
- Institute of Medical Statistics and Computer Science, University Hospital Jena, Friedrich Schiller University Jena, Jena, Germany
| | - Ekkehard Schleußner
- Department of Obstetrics, University Hospital Jena, Am Klinikum 1, 07747, Jena, Germany
| | - Tanja Groten
- Department of Obstetrics, University Hospital Jena, Am Klinikum 1, 07747, Jena, Germany.
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4
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Alshehri MM, Alenazi AM, Alothman SA, Rucker JL, Phadnis MA, Miles JM, Siengsukon CF, Kluding PM. Using Cognitive Behavioral Therapy for Insomnia in People with Type 2 Diabetes, Pilot RCT Part I: Sleep and Concomitant Symptom. Behav Sleep Med 2021; 19:652-671. [PMID: 33108932 DOI: 10.1080/15402002.2020.1831501] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
OBJECTIVE/BACKGROUND The primary aim of this study was to examine the effect of Cognitive Behavioral Therapy for Insomnia (CBT-I) on the severity of insomnia in people with Type 2 diabetes (T2D) compared to a health education (HE) control group. The secondary aim was to explore the effect of CBT-I on other sleep outcomes and concomitant symptoms. PARTICIPANTS Twenty-eight participants with T2D were randomly assigned to CBT-I (n = 14) or HE (n = 14). METHODS Validated assessments were used at baseline and post intervention to assess sleep outcomes and concomitant symptoms. In addition, actigraph and sleep diaries were used to measure sleep parameters. Independent sample t tests and Mann-Whitney U tests were utilized to measure between-group differences in the mean change scores. RESULTS Participants in the CBT-I group showed higher improvements in the following mean change scores compared to the HE group: insomnia symptoms (d = 1.78; p < .001), sleep quality (d = 1.53; p =.001), sleep self-efficacy (d = 1.67; p < .001). Both actigraph and sleep diary showed improvements in sleep latency and sleep efficiency in the CBT-I group as compared to the HE group. In addition, participants in the CBT-I group showed greater improvement in the mean change scores of depression symptoms (d = 1.49; p = .002) and anxiety symptoms (d = 0.88; p = .04) compared to the HE group. CONCLUSION This study identified a clinically meaningful effect of CBT-I on sleep outcomes and concomitant symptoms in people with T2D and insomnia symptoms. Further work is needed to investigate the long-term effects of CBT-I in people with T2D and insomnia symptoms.
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Affiliation(s)
- Mohammed M Alshehri
- Physical Therapy and Rehabilitation Science Department, University of Kansas Medical Center, Kansas City, Kansas.,Physical Therapy Department, Jazan University, Jazan, Saudi Arabia
| | - Aqeel M Alenazi
- Physical Therapy Department, Prince Sattam Bin Abdulaziz University, Alkharj, Saudi Arabia
| | - Shaima A Alothman
- Lifestyle and Health Research Center, Princess Nora Bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Jason L Rucker
- Physical Therapy and Rehabilitation Science Department, University of Kansas Medical Center, Kansas City, Kansas
| | - Milind A Phadnis
- Department of Biostatistics, University of Kansas Medical Center, Kansas City, Kansas
| | - John M Miles
- Endocrinology Department, University of Kansas Medical Center, Kansas City, Kansas
| | - Catherine F Siengsukon
- Physical Therapy and Rehabilitation Science Department, University of Kansas Medical Center, Kansas City, Kansas
| | - Patricia M Kluding
- Physical Therapy and Rehabilitation Science Department, University of Kansas Medical Center, Kansas City, Kansas
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5
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Adhikari P, Pradhan A, Zele AJ, Feigl B. Supplemental light exposure improves sleep architecture in people with type 2 diabetes. Acta Diabetol 2021; 58:1201-1208. [PMID: 33851274 DOI: 10.1007/s00592-021-01712-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 03/24/2021] [Indexed: 12/28/2022]
Abstract
AIMS People with type 2 diabetes (T2D) suffer from sleep disorders, with the mechanism not clearly understood. In T2D, the light transducing retinal photoreceptors that regulate sleep behaviours are dysfunctional; hence, we determine here whether supplemental light exposure ameliorates sleep quality and daytime sleepiness in T2D. METHODS Supplemental light (10,000 Lux, polychromatic) was self-administered for 30 min every morning for 14 days by ten participants with T2D with no diabetic retinopathy (DR). The effectiveness of supplemental light was assessed by comparing subjective sleep questionnaire (PSQI and ESS) scores and salivary dim light melatonin onset (DLMO) before and after the light exposure as well as with a self-maintained sleep diary during the light exposure. RESULTS Compared to the baseline, supplemental light significantly improved the excessive daytime sleepiness score (p = 0.004) and phase-advanced the DLMO on average by ~ 23 min. Sleep diary analyses showed that afternoon nap duration significantly shortened over the first week of supplemental light exposure (p = 0.019). Afternoon naps and midnight awakening were significantly longer in diabetic participants with thinner perifoveal retina. CONCLUSIONS In this case series, we provide initial evidence that supplemental bright light improves daytime sleepiness in T2D with no DR, with the critical period of light exposure showing a beneficial effect after one week. We infer that supplemental light augments photoreceptor signalling in T2D and therefore optimises circadian photoentrainment leading to improved sleep. Our findings inform the development of tailored light therapy protocols in future clinical trials for improving sleep architecture in diabetes.
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Affiliation(s)
- Prakash Adhikari
- Centre for Vision and Eye Research, Queensland University of Technology (QUT), Brisbane, QLD, 4059, Australia
- School of Optometry and Vision Science, Queensland University of Technology (QUT), Brisbane, QLD, 4059, Australia
| | - Asik Pradhan
- Centre for Vision and Eye Research, Queensland University of Technology (QUT), Brisbane, QLD, 4059, Australia
- School of Optometry and Vision Science, Queensland University of Technology (QUT), Brisbane, QLD, 4059, Australia
| | - Andrew J Zele
- Centre for Vision and Eye Research, Queensland University of Technology (QUT), Brisbane, QLD, 4059, Australia
- School of Optometry and Vision Science, Queensland University of Technology (QUT), Brisbane, QLD, 4059, Australia
| | - Beatrix Feigl
- Centre for Vision and Eye Research, Queensland University of Technology (QUT), Brisbane, QLD, 4059, Australia.
- School of Biomedical Sciences, Queensland University of Technology (QUT), Brisbane, QLD, 4059, Australia.
- Queensland Eye Institute, Brisbane, Australia.
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von Schantz M, Ong JC, Knutson KL. Associations between sleep disturbances, diabetes and mortality in the UK Biobank cohort: A prospective population-based study. J Sleep Res 2021; 30:e13392. [PMID: 34101927 PMCID: PMC8612946 DOI: 10.1111/jsr.13392] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 04/15/2021] [Accepted: 04/29/2021] [Indexed: 11/29/2022]
Abstract
Non-communicable diseases, including diabetes, are partly responsible for the deceleration of improvements of life expectancy in many countries. Diabetes is also associated with sleep disturbances. Our aim was to determine whether sleep disturbances, particularly in people with diabetes, were associated with increased mortality risk. Data from the UK Biobank were analysed (n = 487,728, mean follow-up time = 8.9 years). The primary exposure was sleep disturbances, assessed through the question: Do you have trouble falling asleep at night or do you wake up in the middle of the night? The primary outcome was mortality. We also dichotomized sleep disturbances into "never/sometimes" versus "usually" (frequently), and combined with the presence/absence of diabetes: 24.2% of participants reported "never/rarely" experiencing sleep disturbances, 47.8% "sometimes" and 28.0% "usually". In age- and sex-adjusted models, frequent sleep disturbances were associated with an increased risk of all-cause mortality (hazard ratio [HR], 1.31; 95% confidence interval [CI], 1.26-1.37), which remained significant in the fully adjusted model (HR 1.13, 95% CI 1.09-1.18). The presence of both diabetes and frequent sleep disturbances was associated with greater risk of all-cause mortality than either condition alone. In the fully adjusted model, the hazard ratio for all-cause mortality was 1.11 (95% CI, 1.07-1.15) for frequent sleep disturbances alone, 1.67 (95% CI, 1.57-1.76) for diabetes alone and 1.87 for both (95% CI, 1.75-2.01). Frequent sleep disturbances (experienced by more than one quarter of the sample) were associated with increased risk of all-cause mortality. Mortality risk was highest in those with both diabetes and frequent sleep disturbances. Complaints of difficulty falling or staying asleep merit attention by physicians.
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Affiliation(s)
| | - Jason C Ong
- Department of Neurology, Center for Circadian and Sleep Medicine, Northwestern University, Chicago, IL, USA
| | - Kristen L Knutson
- Department of Neurology, Center for Circadian and Sleep Medicine, Northwestern University, Chicago, IL, USA
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7
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Kuo CP, Lu SH, Huang CN, Liao WC, Lee MC. Sleep Quality and Associated Factors in Adults with Type 2 Diabetes: A Retrospective Cohort Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18063025. [PMID: 33804208 PMCID: PMC7999598 DOI: 10.3390/ijerph18063025] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 03/06/2021] [Accepted: 03/11/2021] [Indexed: 12/27/2022]
Abstract
Purpose: Sleep disturbance is one of the major complaints among patients with diabetes. The status of diabetes control and associated complications may contribute to sleep disturbance. This study explored night time sleep and excessive daytime sleepiness in adults with type 2 diabetes and examined the association of diabetes control and associated complications on their sleep quality. Methods: A retrospective cohort study design was used. Type 2 diabetic patients (87 females and 79 males, aged 63.1 ± 10.5 years) were recruited from the outpatient clinics of the endocrine department. Sleep quality was assessed by the Pittsburg Sleep Quality Index and the Epworth Sleepiness Scale. Diabetes control and complications were obtained by retrospectively reviewing patients' medical records over 1 year prior to study enrollment. Results: 72.3% of recruited patients had poor glycemic control, and 71.1% had at least one diabetic complication. 56.0% of patients experienced poor sleep quality, and 24.1% had excessive daytime sleepiness. Those who were female (OR = 3.45) and who had ophthalmological problems (OR = 3.17) were associated with poor night time sleep quality, but if they did exercise to the point of sweating (OR = 0.48) reduced the risk of poor sleep quality. Furthermore, poor sleep quality (OR = 4.35) and having nephropathy (OR = 3.78) were associated with a higher risk of excessive daytime sleepiness. Conclusions: Sex, ophthalmological problems, nephropathy, and no exercise to the point of sweating are associated with sleep problems in patients with type 2 diabetes. Both lifestyle behaviors and diabetic complications affect sleep disturbances in patients with diabetes.
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Affiliation(s)
- Ching-Pyng Kuo
- School of Nursing, Chung Shan Medical University, Taichung 40201, Taiwan;
- Department of Nursing, Chung Shan Medical University Hospital, Taichung 40201, Taiwan
| | - Shu-Hua Lu
- School of Nursing, China Medical University, Taichung 406040, Taiwan;
- Department of Nursing, China Medical University Hospital, Taichung 404332, Taiwan
| | - Chien-Ning Huang
- Department of Internal Medicine, Chung Shan Medical University Hospital, Taichung 40201, Taiwan;
- Institute of Medicine, Chung Shan Medical University, Taichung 40201, Taiwan
| | - Wen-Chun Liao
- School of Nursing, China Medical University, Taichung 406040, Taiwan;
- Department of Nursing, China Medical University Hospital, Taichung 404332, Taiwan
- Department of Nursing, Asia University, Taichung 41354, Taiwan
- Correspondence: (W.-C.L.); (M.-C.L.)
| | - Meng-Chih Lee
- Institute of Medicine, Chung Shan Medical University, Taichung 40201, Taiwan
- Department of Family Medicine, Taichung Hospital, Ministry of Health and Welfare, Taichung 40343, Taiwan
- Institute of Population Health Sciences, National Health Research Institutes, Miaoli 35053, Taiwan
- College of Management, Chaoyang University of Technology, Taichung 413310, Taiwan
- Correspondence: (W.-C.L.); (M.-C.L.)
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8
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Zhang HZ, Zhang P, Chang GQ, Xiang QY, Cao H, Zhou JY, Dong ZM, Qiao C, Xu CR, Qin Y, Lou PA. Effectiveness of cognitive behavior therapy for sleep disturbance and glycemic control in persons with type 2 diabetes mellitus: A community-based randomized controlled trial in China. World J Diabetes 2021; 12:292-305. [PMID: 33758648 PMCID: PMC7958479 DOI: 10.4239/wjd.v12.i3.292] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 12/09/2020] [Accepted: 12/23/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Poor sleep quality is a common clinical feature in patients with type 2 diabetes mellitus (T2DM), and often negatively related with glycemic control. Cognitive behavioral therapy (CBT) may improve sleep quality and reduce blood sugar levels in patients with T2DM. However, it is not entirely clear whether CBT delivered by general practitioners is effective for poor sleep quality in T2DM patients in community settings.
AIM To test the effect of CBT delivered by general practitioners in improving sleep quality and reducing glycemic levels in patients with T2DM in community.
METHODS A cluster randomized controlled trial was conducted from September 2018 to October 2019 in communities of China. Overall 1033 persons with T2DM and poor sleep quality received CBT plus usual care or usual care. Glycosylated hemoglobin A1c (HbAlc) and sleep quality [Pittsburgh Sleep Quality Index (PSQI)] were assessed. Repeated measures analysis of variance and generalized linear mixed effects models were used to estimate the intervention effects on hemoglobin A1c and sleep quality.
RESULTS The CBT group had 0.64, 0.50, and 0.9 lower PSQI scores than the control group at 2 mo, 6 mo, and 12 mo, respectively. The CBT group showed 0.17 and 0.43 lower HbAlc values than the control group at 6 mo and 12 mo. The intervention on mean ΔHbAlc values was significant at 12 mo (t = 3.68, P < 0.01) and that mean ΔPSQI scores were closely related to ΔHbAlc values (t = 7.02, P < 0.01). Intention-to-treat analysis for primary and secondary outcomes showed identical results with completed samples. No adverse events were reported.
CONCLUSION CBT delivered by general practitioners, as an effective and practical method, could reduce glycemic levels and improve sleep quality for patients with T2DM in community.
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Affiliation(s)
- Huai-Zhong Zhang
- Department of Psychiatry, Xuzhou Third People’s Hospital, Xuzhou 221000, Jiangsu Province, China
| | - Pan Zhang
- Department of Control and Prevention of Chronic Non-communicable Diseases, Xuzhou Center for Disease Control and Prevention, Xuzhou 221006, Jiangsu Province, China
| | - Gui-Qiu Chang
- Department of Control and Prevention of Chronic Non-communicable Diseases, Xuzhou Center for Disease Control and Prevention, Xuzhou 221006, Jiangsu Province, China
| | - Quan-Yong Xiang
- Department of Control and Prevention of Chronic Non-communicable Diseases, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing 210009, Jiangsu Province, China
| | - Huan Cao
- Department of Psychiatry, Xuzhou Third People’s Hospital, Xuzhou 221000, Jiangsu Province, China
| | - Jin-Yi Zhou
- Department of Control and Prevention of Chronic Non-communicable Diseases, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing 210009, Jiangsu Province, China
| | - Zong-Mei Dong
- Department of Control and Prevention of Chronic Non-communicable Diseases, Xuzhou Center for Disease Control and Prevention, Xuzhou 221006, Jiangsu Province, China
| | - Cheng Qiao
- Department of Control and Prevention of Chronic Non-communicable Diseases, Xuzhou Center for Disease Control and Prevention, Xuzhou 221006, Jiangsu Province, China
| | - Chun-Rong Xu
- Department of Psychiatry, Xuzhou Third People’s Hospital, Xuzhou 221000, Jiangsu Province, China
| | - Yu Qin
- Department of Control and Prevention of Chronic Non-communicable Diseases, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing 210009, Jiangsu Province, China
| | - Pei-An Lou
- Department of Control and Prevention of Chronic Non-communicable Diseases, Xuzhou Center for Disease Control and Prevention, Xuzhou 221006, Jiangsu Province, China
- Department of Epidemiology and Health Statistics, Xuzhou Medical University, Xuzhou 221006, Jiangsu Province, China
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Cheval B, Maltagliati S, Sieber S, Beran D, Chalabaev A, Sander D, Cullati S, Boisgontier MP. Why Are Individuals With Diabetes Less Active? The Mediating Role of Physical, Emotional, and Cognitive Factors. Ann Behav Med 2021; 55:904-917. [PMID: 33491067 DOI: 10.1093/abm/kaaa120] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Despite the key role of physical activity in the management of diabetes, many individuals with diabetes do not engage in the recommended levels of physical activity. However, our knowledge of the mechanisms underlying the relationship between diabetes and physical inactivity is limited. PURPOSE To investigate the associations between diabetes and the levels and evolution of physical activity across aging, and to determine whether physical, emotional, and cognitive factors mediate these associations. METHODS Data from 105,622 adults aged 50-96 years from the Survey of Health, Ageing and Retirement in Europe (SHARE) were used in adjusted linear mixed models to examine whether diabetes was associated with physical activity levels and variations across aging. The potential mediators were subjective energy, muscle strength, physical and cognitive disability, sleep problems, depressive symptoms, and cognitive functions. The variables were measured up to seven times over a 13-year period. RESULTS Individuals with diabetes demonstrated a lower level and a steeper decrease in physical activity across aging than individual without diabetes. Mediators explained ~53% and 94% of the association of diabetes with the level of physical activity and with the linear evolution of physical activity across aging, respectively. All mediators were significantly associated with physical activity. Physical and cognitive disability as well as depressive symptoms were the strongest mediators, while sleep was the lowest one. CONCLUSIONS These findings suggest that the etiology of physical inactivity in individuals with diabetes can result from several physical, emotional, and cognitive changes associated with the emergence of this disease.
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Affiliation(s)
- Boris Cheval
- Swiss Center for Affective Sciences, University of Geneva, Switzerland.,Laboratory for the Study of Emotion Elicitation and Expression (E3Lab), Department of Psychology, University of Geneva, Switzerland
| | | | - Stefan Sieber
- Swiss NCCR "LIVES - Overcoming Vulnerability: Life Course Perspectives," University of Geneva, Switzerland
| | - David Beran
- Division of Tropical and Humanitarian Medicine, University of Geneva and Geneva University Hospitals, Switzerland
| | | | - David Sander
- Swiss Center for Affective Sciences, University of Geneva, Switzerland.,Laboratory for the Study of Emotion Elicitation and Expression (E3Lab), Department of Psychology, University of Geneva, Switzerland
| | - Stéphane Cullati
- Population Health Laboratory, University of Fribourg, Switzerland.,Department of Readaptation and Geriatrics, University of Geneva, Switzerland
| | - Matthieu P Boisgontier
- School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada.,Bruyère Research Institute, Ottawa, ON, Canada
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10
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Farooque R, Herekar F, Iftikhar S, Patel MJ. The Frequency of Poor Sleep Quality in Patients With Diabetes Mellitus and Its Association With Glycemic Control. Cureus 2020; 12:e11608. [PMID: 33364126 PMCID: PMC7752787 DOI: 10.7759/cureus.11608] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background and objective Emerging evidence suggests that sleep problems are more common among individuals with diabetes mellitus (DM) than in the general population; these sleep issues are associated with poor glycemic control and they negatively affect the overall prognosis of the disease by increasing cardiometabolic risk. Our study aimed to determine the frequency of poor sleep quality and its association with glycemic control among Pakistani adult patients with DM. Methods This prospective cross-sectional study was conducted at the outpatient department (OPD) of The Indus Hospital (TIH), Karachi, and included 329 participants. To be eligible, participants had to be 14 years or older, should have been visiting the OPD at TIH for six months or more to seek treatment for DM, and had to give informed consent. Participants were assessed for poor sleep quality using the Pittsburgh Sleep Quality Index (PSQI) score and glycemic control using HbA1C levels ascertained through electronic health record review, with higher HbA1C levels reflecting poorer glycemic control. Results Two-thirds of the participants were females (n=212; 64.4%), and approximately 90% of the participants were married (n=292; 88.8%); 57% (n=188) of the participants were found to have poor sleep quality (PSQI of >5) and 233 (70.82%) had poor glycemic control (HbA1C of >7). Interestingly, no significant difference was observed in the PSQI scores between participants with controlled diabetes and those with uncontrolled diabetes. Conclusion Based on our findings, there is a high prevalence of sleep disturbance among Pakistani adults with DM, and we believe this necessitates the fostering of sleep-promoting interventional research in the country, as it might be highly rewarding and would positively affect the overall prognosis for diabetes by improving cardiometabolic risks. However, our results did not indicate any significant association between sleep quality and glycemic control. Further research should be conducted to explore the association between sleep disturbance and DM in Pakistani adults, by employing objective measures of sleep quality and involving a larger sample of individuals with DM to determine if these results hold true.
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Affiliation(s)
- Rabia Farooque
- Internal Medicine, Liaquat University of Medical and Health Sciences, Jamshoro, PAK
| | - Fivzia Herekar
- Internal Medicine and Infectious Diseases, The Indus Hospital, Karachi, PAK
| | - Sundus Iftikhar
- Maternal and Child Health Program, Interactive Research and Development, Karachi, PAK
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Sleep Efficiency and Total Sleep Time in Individuals with Type 2 Diabetes with and without Insomnia Symptoms. SLEEP DISORDERS 2020; 2020:5950375. [PMID: 32724680 PMCID: PMC7382760 DOI: 10.1155/2020/5950375] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 04/27/2020] [Accepted: 05/26/2020] [Indexed: 11/18/2022]
Abstract
There is increasing awareness of the high prevalence of insomnia symptoms in individuals with type 2 diabetes (T2D). Past studies have established the importance of measuring sleep parameters using measures of central tendency and variability. Additionally, subjective and objective methods involve different constructs due to the discrepancies between the two approaches. Therefore, this study is aimed at comparing the averages of sleep parameters in individuals with T2D with and without insomnia symptoms and comparing the variability of sleep parameters in these individuals. This study assessed the between-group differences in the averages and variability of sleep efficiency (SE) and total sleep time (TST) of 59 participants with T2D with and without insomnia symptoms. Actigraph measurements and sleep diaries were used to assess sleep parameter averages and variabilities calculated by the coefficient of variation across 7 nights. Mann-Whitney U tests were utilized to compare group differences in the outcomes. Validated instruments were used to assess the symptoms of depression, anxiety, and pain as covariates. Objective SE was found to be statistically lower on average (85.98 ± 4.29) and highly variable (5.88 ± 2.57) for patients with T2D and insomnia symptoms than in those with T2D only (90.23 ± 6.44 and 3.82 ± 2.05, respectively). The subjective average and variability of SE were also worse in patients with T2D and insomnia symptoms, with symptoms of depression, anxiety, and pain potentially playing a role in this difference. TST did not significantly differ between the groups on averages or in variability even after controlling for age and symptoms of depression, anxiety, and pain. Future studies are needed to investigate the underlying mechanisms of worse averages and variability of SE in individuals with T2D and insomnia symptoms. Additionally, prompting the associated risk factors of insomnia symptoms in individuals with T2D might be warranted.
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12
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Brindle RC, Yu L, Buysse DJ, Hall MH. Empirical derivation of cutoff values for the sleep health metric and its relationship to cardiometabolic morbidity: results from the Midlife in the United States (MIDUS) study. Sleep 2020; 42:5488780. [PMID: 31083710 DOI: 10.1093/sleep/zsz116] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Revised: 03/15/2019] [Indexed: 12/27/2022] Open
Abstract
STUDY OBJECTIVES Emerging evidence supports a multidimensional perspective of sleep in the context of health. The sleep health model, and composite sleep health score, are increasingly used in research. However, specific cutoff values that differentiate "good" from "poor" sleep, have not been empirically derived and its relationship to cardiometabolic health is less-well understood. We empirically derived cutoff values for sleep health dimensions and examined the relationship between sleep health and cardiometabolic morbidity. METHODS Participants from two independent Biomarker Studies in the MIDUS II (N = 432, 39.8% male, age = 56.92 ± 11.45) and MIDUS Refresher (N = 268, 43.7% male, age = 51.68 ± 12.70) cohorts completed a 1-week study where sleep was assessed with daily diaries and wrist actigraphy. Self-reported physician diagnoses, medication use, and blood values were used to calculate total cardiometabolic morbidity. Receiver operating characteristic (ROC) curves were generated in the MIDUS II cohort for each sleep health dimension to determine cutoff values. Using derived cutoff values, logistic regression was used to examine the relationship between sleep health scores and cardiometabolic morbidity in the MIDUS Refresher cohort, controlling for traditional risk factors. RESULTS Empirically derived sleep health cutoff values aligned reasonably well to cutoff values previously published in the sleep health literature and remained robust across physical and mental health outcomes. Better sleep health was significantly associated with a lower odds of cardiometabolic morbidity (OR [95% CI] = 0.901 [0.814-0.997], p = .044). CONCLUSIONS These results contribute to the ongoing development of the sleep health model and add to the emerging research supporting a multidimensional perspective of sleep and health.
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Affiliation(s)
- Ryan C Brindle
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA.,Department of Psychology and Neuroscience Program, Washington and Lee University, Lexington, VA
| | - Lan Yu
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Daniel J Buysse
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Martica H Hall
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA
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13
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Peleg O, Cohen A, Haimov I. Depressive symptoms mediate the relationship between sleep disturbances and type 2 diabetes mellitus. J Diabetes 2020; 12:305-314. [PMID: 31626387 DOI: 10.1111/1753-0407.12996] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Revised: 08/25/2019] [Accepted: 10/14/2019] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND The current study aimed at examining whether individuals diagnosed with type 2 diabetes mellitus (T2DM) have more severe sleep disturbances compared to individuals who are healthy or have prediabetes and whether depressive symptoms mediate the relationship between sleep disturbances and having T2DM. METHODS T2DM patients (n = 107) were compared to individuals with prediabetes (n = 48) and healthy individuals (n = 154) regarding the severity of depressive symptoms, measured via the Beck Depression Inventory-II (BDI-II), and sleep disturbances, measured via the Mini Sleep Questionnaire (MSQ). Mediation analysis examined whether depressive symptoms mediated the relationship between sleep disturbances and T2DM. RESULTS Compared to healthy individuals and individuals with prediabetes, T2DM patients had more depressive symptoms and higher levels of insomnia, hypersomnia, and overall more sleep disturbances. The prediabetes group did not differ from the healthy control group on these measures, and these groups were thus combined for further analysis. Sleep disturbances were correlated with severity of depressive symptoms (r =0.43). After controlling for age, gender, and ethnic background, both severity of sleep disturbances (odds ratio [OR]: 1.04; 95% CI: 1.01-1.07, P <.001) and severity of depressive symptoms (OR: 8.54, 95% CI: 3.37-21.69, P <.001) predicted T2DM. Depression symptoms mediated the relationship between sleep disturbances and T2DM, whereas the direct relationship between sleep disturbances and T2DM was nonsignificant. CONCLUSIONS The findings imply that sleep disturbances may contribute to the development and progression of T2DM by promoting depressive symptoms. Thus, treatments for the emotional distress associated with sleep disturbances may help reduce the risk for T2DM and the progression of the disease.
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Affiliation(s)
- Ora Peleg
- Department of Education, The Max Stern Yezreel Valley College, Emek Yezreel, Israel
| | - Ami Cohen
- Department of Psychology, The Max Stern Yezreel Valley College, Emek Yezreel, Israel
| | - Iris Haimov
- Department of Psychology, The Max Stern Yezreel Valley College, Emek Yezreel, Israel
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14
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Nocturia in Women With Type 2 Diabetes Mellitus: A Cross-sectional, Correlation Study. J Wound Ostomy Continence Nurs 2020; 47:265-272. [PMID: 32195774 DOI: 10.1097/won.0000000000000635] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
PURPOSE The first aim of this study was to compare nighttime voiding frequency (nocturia), serum hemoglobin A1c level, peripheral neuropathy score, and global sleep quality score in younger (>40 to <65 years) versus older (≥65 years) women with type 2 diabetes mellitus (DM). Additional aims were to identify factors associated with clinically relevant nocturia (≥2 episodes/night) and to analyze relationships between nocturia frequency, glycemic control, peripheral neuropathy, and sleep quality in these women. DESIGN Cross-sectional study. SETTING AND SUBJECTS Participants were 118 women older than 40 years and with type 2 DM. Their mean age was 65.25 (SD = 9.66) years; the mean duration since diagnosis of type 2 DM was 10.96 (SD = 7.66) years. The study setting was 2 metabolism and endocrinology outpatient departments located in Taipei City and Taoyuan, Taiwan. METHODS Data were collected using a questionnaire that queried sociodemographic information, lower urinary tract symptoms, and sleep quality. We also assessed peripheral neuropathy and lower extremity edema and obtained pertinent information from participants' medical records. Independent t tests, multivariate logistic regression analyses, Spearman's rank correlation coefficients, and one-way analysis of variance were used to address the 3 study aims. RESULTS Analyses found that older women (aged ≥65 years) had a significantly higher nighttime voiding frequency, a higher peripheral neuropathy score, and a higher sleep quality score than younger (>40 to <65 years) women. Multivariate logistic regression analyses identified 4 factors associated with clinically relevant nocturia advanced age, elevated hemoglobin A1c level, suspected peripheral neuropathy, and lower extremity edema. Significant correlation coefficients were found between nighttime voiding frequency and serum hemoglobin A1c levels, peripheral neuropathy scores, and sleep quality scores. Analyses also found that women with a greater nocturia frequency had higher hemoglobin A1c levels, peripheral neuropathy scores, and sleep quality scores. CONCLUSIONS Healthcare professionals should screen for nocturia in women with type 2 DM and provide appropriate management for those experiencing nocturia.
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Koopman ADM, Beulens JW, Dijkstra T, Pouwer F, Bremmer MA, van Straten A, Rutters F. Prevalence of Insomnia (Symptoms) in T2D and Association With Metabolic Parameters and Glycemic Control: Meta-Analysis. J Clin Endocrinol Metab 2020; 105:5585878. [PMID: 31603475 PMCID: PMC7110921 DOI: 10.1210/clinem/dgz065] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Accepted: 10/23/2019] [Indexed: 12/13/2022]
Abstract
OBJECTIVE We aimed to determine the prevalence of insomnia and insomnia symptoms and its association with metabolic parameters and glycemic control in people with type 2 diabetes (T2D) in a systematic review and meta-analysis. DATA SOURCES A systematic literature search was conducted in PubMed/Embase until March 2018. STUDY SELECTION Included studies described prevalence of insomnia or insomnia symptoms and/or its association with metabolic parameters or glycemic control in adults with T2D. DATA EXTRACTION Data extraction was performed independently by 2 reviewers, on a standardized, prepiloted form. An adaptation of Quality Assessment Tool for Quantitative Studies was used to assess the methodological quality of the included studies. DATA SYNTHESIS When possible, results were meta-analyzed using random-effects analysis and rated using Grading of Recommendations Assessment, Development and Evaluation (GRADE). RESULTS A total of 11 329 titles/abstracts were screened and 224 were read full text in duplicate, of which 78 studies were included. The pooled prevalence of insomnia (symptoms) in people with T2D was 39% (95% confidence interval, 34-44) with I2 statistic of 100% (P < 0.00001), with a very low GRADE of evidence. Sensitivity analyses identified no clear sources of heterogeneity. Meta-analyses showed that in people with T2D, insomnia (symptoms) were associated with higher hemoglobin A1c levels (mean difference, 0.23% [0.1-0.4]) and higher fasting glucose levels (mean difference, 0.40 mmol/L [0.2-0.7]), with a low GRADE of evidence. The relative low methodological quality and high heterogeneity of the studies included in this meta-analysis complicate the interpretation of our results. CONCLUSIONS The prevalence of insomnia (symptoms) is 39% (95% confidence interval, 34-44) in the T2D population and may be associated with deleterious glycemic control.
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Affiliation(s)
- Anitra D M Koopman
- Amsterdam UMC, location VUmc, Department of Epidemiology and Biostatistics, Amsterdam Public Health Research Institute, HV Amsterdam, the Netherlands
- Correspondence and Reprint Requests: Femke Rutters, Amsterdam UMC, location VUmc, Department of Epidemiology and Biostatistics, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands, De Boelelaan 1089a, 1081 HV Amsterdam, the Netherlands. E-mail:
| | - Joline W Beulens
- Amsterdam UMC, location VUmc, Department of Epidemiology and Biostatistics, Amsterdam Public Health Research Institute, HV Amsterdam, the Netherlands
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, GA Utrecht, the Netherlands
| | - Tine Dijkstra
- Amsterdam UMC, location VUmc, Department of Epidemiology and Biostatistics, Amsterdam Public Health Research Institute, HV Amsterdam, the Netherlands
| | - Frans Pouwer
- University of Southern Denmark, Department of Psychology, Odense, Denmark
- Deakin University, School of Psychology, Geelong, Australia
- STENO Diabetes Center Odense, Odense, Denmark
| | - Marijke A Bremmer
- Amsterdam UMC, location VUmc, Department of Psychiatry, Amsterdam Public Health Research Institute, HV Amsterdam, the Netherlands
| | - Annemieke van Straten
- Faculty of Behavioural and Movement Sciences & Amsterdam Public Health Research Institute, Vrije Universiteit, HV Amsterdam, the Netherlands
| | - Femke Rutters
- Amsterdam UMC, location VUmc, Department of Epidemiology and Biostatistics, Amsterdam Public Health Research Institute, HV Amsterdam, the Netherlands
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Brouwer A, van Raalte DH, Rutters F, Elders PJM, Snoek FJ, Beekman ATF, Bremmer MA. Sleep and HbA 1c in Patients With Type 2 Diabetes: Which Sleep Characteristics Matter Most? Diabetes Care 2020; 43:235-243. [PMID: 31719053 DOI: 10.2337/dc19-0550] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Accepted: 10/07/2019] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Poor sleep has been identified as a risk factor for poor glycemic control in individuals with type 2 diabetes (T2D). As optimal sleep can be characterized in several ways, we evaluated which sleep characteristics are most strongly associated with glycated hemoglobin A1c (HbA1c). RESEARCH DESIGN AND METHODS A total of 172 patients with T2D completed 7-day wrist-actigraphy and sleep questionnaires. Linear regression was used to evaluate associations between sleep measures (total sleep duration, variability in sleep duration, midsleep time, variability in midsleep time, sleep efficiency, subjective sleep quality, and subjective insomnia symptoms) and HbA1c, individually and in concert. RESULTS Variability in sleep duration was individually most strongly associated with HbA1c (β = 0.239; P = 0.002; R 2 = 4.9%), followed by total sleep duration (U-shaped: β = 1.161/β2 = 1.044; P = 0.017/0.032; R 2 = 4.3%), subjective sleep quality (β = 0.191; P = 0.012; R 2 = 3.6%), variability in midsleep time (β = 0.184; P = 0.016; R 2 = 3.4%), and sleep efficiency (β = -0.150; R 2 = 2.3%). Midsleep time and subjective insomnia symptoms were not associated with HbA1c. In combination, variability in sleep duration, total sleep duration, and subjective sleep quality were significantly associated with HbA1c, together explaining 10.3% of the variance in HbA1c. Analyses adjusted for covariates provided similar results, although the strength of associations was generally decreased and showing total sleep duration and subjective sleep quality to be most strongly associated with HbA1c, together explaining 6.0% of the variance in HbA1c. CONCLUSIONS Sleep in general may be a modifiable factor of importance for patients with T2D. The prevention of sleep curtailment may serve as a primary focus in the sleep-centered management of T2D.
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Affiliation(s)
- Annelies Brouwer
- Department of Psychiatry, Amsterdam UMC, Vrije Universiteit, and GGZ inGeest, Amsterdam Public Health research institute, Amsterdam, the Netherlands
| | - Daniel H van Raalte
- Department of Internal Medicine, Diabetes Center, Amsterdam UMC, Vrije Universiteit, Amsterdam, the Netherlands
| | - Femke Rutters
- Department of Epidemiology and Biostatistics, Amsterdam UMC, Vrije Universiteit, Amsterdam Public Health research institute, Amsterdam, the Netherlands
| | - Petra J M Elders
- Department of General Practice and Elderly Care Medicine, Amsterdam UMC, Vrije Universiteit, Amsterdam Public Health research institute, Amsterdam, the Netherlands
| | - Frank J Snoek
- Department of Medical Psychology, Amsterdam UMC, Vrije Universiteit and University of Amsterdam, Amsterdam Public Health research institute, Amsterdam, the Netherlands
| | - Aartjan T F Beekman
- Department of Psychiatry, Amsterdam UMC, Vrije Universiteit, and GGZ inGeest, Amsterdam Public Health research institute, Amsterdam, the Netherlands
| | - Marijke A Bremmer
- Department of Psychiatry, Amsterdam UMC, Vrije Universiteit, and GGZ inGeest, Amsterdam Public Health research institute, Amsterdam, the Netherlands
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Oda A, Inagaki M, Tasaki K, Matsui K, Horiguchi T, Koike M. The Concept of Sleep Ability and its Effect on Diabetes Control in Adults With Type 2 Diabetes. Can J Diabetes 2019; 43:329-335. [DOI: 10.1016/j.jcjd.2018.11.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Revised: 08/09/2018] [Accepted: 11/06/2018] [Indexed: 01/01/2023]
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Chattu VK, Chattu SK, Burman D, Spence DW, Pandi-Perumal SR. The Interlinked Rising Epidemic of Insufficient Sleep and Diabetes Mellitus. Healthcare (Basel) 2019; 7:E37. [PMID: 30841553 PMCID: PMC6473416 DOI: 10.3390/healthcare7010037] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Revised: 02/26/2019] [Accepted: 02/28/2019] [Indexed: 12/15/2022] Open
Abstract
For healthy existence, humans need to spend one-third of their time sleeping. Any qualitative or quantitative disturbances in sleep would result in an increased prevalence of obesity, metabolic disorders, diabetes, cardiovascular diseases, and hypertension. The paper aims to highlight the growing global problem of insufficient sleep and its significant impact on the rising incidence of diabetes mellitus. An extensive literature search was done in all major databases for "insufficient sleep" and "Diabetes Mellitus" for this review. Shorter (<6 h) and longer (>9 h) durations of sleep have been adversely related to insulin resistance. Though the relation between insufficient sleep and diabetes mellitus is more or less understood, little is known about how oversleeping or hypersomnia (10⁻12 h) increases the risk of diabetes. The relationship between sleep disturbances and diabetes is dual-sided, as chronic sleep disturbances would elevate the risk of developing insulin resistance, while diabetes would worsen the quality of sleep. Both the qualitative and quantitative disturbances in sleep significantly increase the risk of developing diabetes, which is supported by numerous community-based and hospital-based epidemiological studies discussed in this review. Obstructive sleep apnea is one of the most common sleep disorders and is characterized by chronic intermittent hypoxia and increased sympathetic activity, thus leading to a higher prevalence of diabetes. Sleep therapy may serve as a low-cost method for fighting against the rising epidemic of diabetes.
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Affiliation(s)
- Vijay Kumar Chattu
- Faculty of Medical Sciences, The University of the West Indies, St. Augustine, Trinidad and Tobago.
- Global Institute of Public Health, Thiruvananthapuram, Kerala 695024, India.
| | - Soosanna Kumary Chattu
- Faculty of Medical Sciences, The University of the West Indies, St. Augustine, Trinidad and Tobago.
| | - Deepa Burman
- School of Medicine, University of Pittsburgh, 4200 Fifth Ave, Pittsburgh, PA 15260, USA.
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Siegmann MJ, Athinarayanan SJ, Hallberg SJ, McKenzie AL, Bhanpuri NH, Campbell WW, McCarter JP, Phinney SD, Volek JS, Van Dort CJ. Improvement in patient-reported sleep in type 2 diabetes and prediabetes participants receiving a continuous care intervention with nutritional ketosis. Sleep Med 2019; 55:92-99. [PMID: 30772699 DOI: 10.1016/j.sleep.2018.12.014] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Revised: 12/11/2018] [Accepted: 12/17/2018] [Indexed: 10/27/2022]
Abstract
OBJECTIVE Sleep disruption is frequently associated with type 2 diabetes (T2D) and hyperglycemia. We recently reported the effectiveness of a continuous care intervention (CCI) emphasizing nutritional ketosis for improving HbA1c, body weight and cardiovascular risk factors in T2D patients. The present study assessed the effect of this CCI approach on sleep quality using a subjective patient-reported sleep questionnaire. METHODS A non-randomized, controlled longitudinal study; 262 T2D and 116 prediabetes patients enrolled in the CCI and 87 separately recruited T2D patients continued usual care (UC) treatment. Patients completed the Pittsburgh Sleep Quality Index (PSQI) questionnaire. A PSQI score of >5 (scale 0 to 21) was used to identify poor sleepers. RESULTS Global sleep quality improved in the CCI T2D (p < 0.001) and prediabetes (p < 0.001) patients after one year of intervention. Subjective sleep quality (component 1), sleep disturbance (component 5) and daytime dysfunction (component 7), also showed improvements in the CCI T2D (p < 0.01 for sleep quality and sleep disturbance; and p < 0.001 for daytime dysfunction) and prediabetes patients (p < 0.001 for all three components); compared to the UC T2D group after one year. The proportion of patients with poor sleep quality was significantly reduced after one year of CCI (T2D; from 68.3% at baseline to 56.5% at one year, p = 0.001 and prediabetes; from 77.9% at baseline to 48.7% at one year, p < 0.001). CONCLUSION This study demonstrates improved sleep quality as assessed by PSQI in patients with T2D and prediabetes undergoing CCI including nutritional ketosis but not in T2D patients receiving UC. The dietary intervention benefited both sleep quality and the severity of T2D symptoms suggesting that nutritional ketosis improves overall health via multiple mechanisms.
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Affiliation(s)
- Morgan J Siegmann
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA, USA; Division of Sleep Medicine, Harvard Medical School, Boston, MA, USA; Department of Brain and Cognitive Sciences, Massachusetts Institute of Technology, Cambridge, MA, USA
| | | | - Sarah J Hallberg
- Virta Health, 535 Mission Street, San Francisco, CA, USA; Indiana University Health Arnett, Lafayette, IN, USA
| | - Amy L McKenzie
- Virta Health, 535 Mission Street, San Francisco, CA, USA
| | | | - Wayne W Campbell
- Department of Nutrition Science, Purdue University, West Lafayette, IN, USA
| | - James P McCarter
- Virta Health, 535 Mission Street, San Francisco, CA, USA; Department of Genetics, Washington University School of Medicine, St Louis, MO, USA
| | | | - Jeff S Volek
- Virta Health, 535 Mission Street, San Francisco, CA, USA; Department of Human Sciences, The Ohio State University, Columbus, OH, USA
| | - Christa J Van Dort
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA, USA; Division of Sleep Medicine, Harvard Medical School, Boston, MA, USA; Department of Brain and Cognitive Sciences, Massachusetts Institute of Technology, Cambridge, MA, USA.
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Whitaker KM, Lutsey PL, Ogilvie RP, Pankow JS, Bertoni A, Michos ED, Punjabi N, Redline S. Associations between polysomnography and actigraphy-based sleep indices and glycemic control among those with and without type 2 diabetes: the Multi-Ethnic Study of Atherosclerosis. Sleep 2018; 41:5089925. [PMID: 30184232 PMCID: PMC6231520 DOI: 10.1093/sleep/zsy172] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Revised: 07/03/2018] [Indexed: 12/19/2022] Open
Abstract
Study Objectives To examine the associations of sleep measures with hemoglobin A1c (HbA1c) among individuals with and without type 2 diabetes. Methods Data were from 2049 Multi-Ethnic Study of Atherosclerosis participants taking part in a sleep ancillary study. Cross-sectional linear regression models examined associations of actigraphy estimates of sleep (sleep duration, variability, and maintenance efficiency) and polysomnography measures (obstructive sleep apnea [OSA] and hypoxemia) with HbA1c, stratified by diabetes status. Primary models were adjusted for demographics, lifestyle behaviors, and obesity. Results Among individuals with diabetes (20 per cent population), those who slept <5 hr/night had greater HbA1c than those who slept 7-8 hr/night (7.44 vs. 6.98 per cent, ptrend = 0.04), with no attenuation of associations after adjusting for OSA/hypoxemia. In women with diabetes, but not men, those in the lowest quartile of sleep maintenance efficiency had greater HbA1c than those in the highest quartile of sleep maintenance efficiency (7.60 vs. 6.97 per cent, ptrend < 0.01). Among those without diabetes, individuals with severe OSA or in the highest quartile of hypoxemia had significantly greater HbA1c than those without OSA or who were in the lowest quartile of hypoxemia (5.76 vs. 5.66 per cent, ptrend = 0.01; 5.75 vs. 5.66 per cent, ptrend < 0.01, respectively). Associations did not meaningfully differ by race/ethnicity. Conclusions Among individuals with diabetes, HbA1c was significantly higher in men and women with short sleep duration and in women with poor sleep maintenance efficiency, suggesting a role for behavioral sleep interventions in the management of diabetes. Among individuals without diabetes, untreated severe OSA/hypoxemia may adversely influence HbA1c.
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Affiliation(s)
- Kara M Whitaker
- Department of Health and Human Physiology, College of Liberal Arts and Sciences, University of Iowa, Iowa City, IA
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, IA
| | - Pamela L Lutsey
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN
| | - Rachel P Ogilvie
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA
| | - James S Pankow
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN
| | - Alain Bertoni
- Department of Epidemiology and Prevention, Wake Forest School of Medicine, Wake Forest University, Winston-Salem, NC
| | - Erin D Michos
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Naresh Punjabi
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Susan Redline
- Department of Medicine, Brigham and Women’s Hospital and Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
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Impact of non-apnea sleep disorders on diabetic control and metabolic outcome - A population-based cohort study. Gen Hosp Psychiatry 2018; 52:1-7. [PMID: 29448065 DOI: 10.1016/j.genhosppsych.2018.01.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Revised: 01/16/2018] [Accepted: 01/16/2018] [Indexed: 11/21/2022]
Abstract
OBJECTIVE There has been a growing recognition that obstructive sleep apnea (OSA) could increase the propensity for type 2 diabetes the metabolic syndrome. However, studies concerning about the impact of non-apnea sleep disorders (NSD) on diabetes control and metabolic outcomes are relatively scarce. Our aim is to investigate the impact of non-apnea sleep disorders (NSD) on diabetic control and associated metabolic outcomes in patients with type 2 diabetes. METHODS The data were obtained from two nationwide population-based databases for a period 2007 to 2012. A total 66,992 patients with type 2 diabetes were enrolled and divided into two cohorts based on comorbidity with or without a NSD diagnosis, and were followed up four years. The primary outcomes were to compare rate of change in HbA1c and associated metabolic outcomes during follow-up visits between patients with or without NSD. The secondary outcome is to examine whether NSD were associated with poor glycemic control of the last clinical records while controlling for the baseline HbA1c value. RESULTS Of the 66,992 patients with type 2 diabetes, 14.82% had comorbidity with a NSD. HbA1C decreases were significantly lower by 0.04% in the NSD group (P < 0.05), and triglyceride (TG) decreases remained significantly lower by 2.53% in the NSD group (P < 0.05). Furthermore, patients in the NSD group had an 8% higher risk of poor glycemic control (HbA1C >9) (OR = 1.08; 95%CI, 1.01-1.16). CONCLUSION Our findings indicated patients with type 2 diabetes comorbid with NSD had a slower improvement in HbA1c compared with the comparison cohort. It may because there may exist potential floor effect given those with NSD having significantly lower HbA1c values at baseline. On the other hand, the poor diabetic control among those with NSD may be also affected by other confounders such as medical treatment or interventions. Nevertheless, given the rapidly increasing prevalence of metabolic diseases and subsequent complications, the results may highlight the importance of sleep in the clinical management of type 2 diabetes.
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Association of usual sleep quality and glycemic control in type 2 diabetes in Japanese: A cross sectional study. Sleep and Food Registry in Kanagawa (SOREKA). PLoS One 2018; 13:e0191771. [PMID: 29364963 PMCID: PMC5783416 DOI: 10.1371/journal.pone.0191771] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Accepted: 12/13/2017] [Indexed: 12/16/2022] Open
Abstract
Objectives Excessively short and long sleep durations are associated with type 2 diabetes, but there is limited information about the association between sleep quality and diabetes. Accordingly, the present study was performed to investigate this relationship. Materials and methods The subjects were 3249 patients with type 2 diabetes aged 20 years or older. Sleep quality was assessed by using the Pittsburgh Sleep Quality Index (PSQI). A higher global PSQI score indicates worse sleep quality, and a global PSQI score >5 differentiates poor sleepers from good sleepers. Results The mean global PSQI score was 5.94 ± 3.33, and 47.6% of the patients had a score of 6 or higher. Regarding the components of the PSQI, the score was highest for sleep duration, followed by subjective sleep quality and then sleep latency in decreasing order. When the patients were assigned to HbA1c quartiles (≤ 6.5%, 6.6–7.0%, 7.1–7.8%, and ≥ 7.9%), the top quartile had a significantly higher global PSQI score than the other quartiles. The top HbA1c quartile had a sleep duration of only 6.23 ± 1.42 hours, which was significantly shorter than in the other quartiles. Also, sleep latency was 25.3 ± 31.8 minutes in the top quartile, which was significantly longer (by approximately 20 minutes) than in the other quartiles. When analysis was performed with adjustment for age, gender, BMI, smoking, and other confounders, the global PSQI score was still significantly higher and sleep duration was shorter in the top HbA1c quartile (HbA1c ≥ 7.9%). Conclusions Japanese patients with type 2 diabetes were found to have poor subjective sleep quality independently of potential confounders, especially those with inadequate glycemic control. Impairment of sleep quality was associated with both increased sleep latency and a shorter duration of sleep.
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Castonguay A, Miquelon P, Boudreau F. Self-regulation resources and physical activity participation among adults with type 2 diabetes. Health Psychol Open 2018; 5:2055102917750331. [PMID: 29372066 PMCID: PMC5774733 DOI: 10.1177/2055102917750331] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Physical activity plays a crucial role in the prevention and treatment of type 2 diabetes. Therefore, it is important to understand why so few adults with type 2 diabetes regularly engage in physical activity. The role of self-regulation in the context of health-related behavior adherence, especially in terms of physical activity engagement and adherence, has largely been reviewed based on the strength energy model. Building on this line of research, the aim of this theoretical work was to highlight how self-regulation and ego depletion can influence the lower rate of physical activity participation among adults with type 2 diabetes, compared to adults from the general population.
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Ho JM, Ducich NH, Nguyen NQK, Opp MR. Acute sleep disruption- and high-fat diet-induced hypothalamic inflammation are not related to glucose tolerance in mice. Neurobiol Sleep Circadian Rhythms 2018; 4:1-9. [PMID: 29732438 PMCID: PMC5931726 DOI: 10.1016/j.nbscr.2017.09.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Chronic insufficient sleep is a major societal problem and is associated with increased risk of metabolic disease. Hypothalamic inflammation contributes to hyperphagia and weight gain in diet-induced obesity, but insufficient sleep-induced neuroinflammation has yet to be examined in relation to metabolic function. We therefore fragmented sleep of adult male C57BL/6J mice for 18 h daily for 9 days to determine whether sleep disruption elicits inflammatory responses in brain regions that regulate energy balance and whether this relates to glycemic control. To additionally test the hypothesis that exposure to multiple inflammatory factors exacerbates metabolic outcomes, responses were compared in mice exposed to sleep fragmentation (SF), high-fat diet (HFD), both SF and HFD, or control conditions. Three or 9 days of high-fat feeding reduced glucose tolerance but SF alone did not. Transient loss of body mass in SF mice may have affected outcomes. Comparisons of pro-inflammatory cytokine concentrations among central and peripheral metabolic tissues indicate that patterns of liver interleukin-1β concentrations best reflects observed changes in glucose tolerance. However, we demonstrate that SF rapidly and potently increases Iba1 immunoreactivity (-ir), a marker of microglia. After 9 days of manipulations, Iba1-ir remains elevated only in mice exposed to both SF and HFD, indicating a novel interaction between sleep and diet on microglial activation that warrants further investigation.
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Affiliation(s)
- Jacqueline M. Ho
- Department of Anesthesiology & Pain Medicine, University of Washington, Seattle, WA, USA
| | - Nicole H. Ducich
- Department of Anesthesiology & Pain Medicine, University of Washington, Seattle, WA, USA
| | - Nhat-Quynh K. Nguyen
- Department of Anesthesiology & Pain Medicine, University of Washington, Seattle, WA, USA
| | - Mark R. Opp
- Department of Anesthesiology & Pain Medicine, University of Washington, Seattle, WA, USA
- Program in Neurobiology and Behavior, University of Washington, Seattle, Washington, USA
- Corresponding author. Present addrss: Department of Integrative Physiology, University of Colorado, UCB 354, 2860 Wilderness Place, 201K, Boulder, CO 80301, USA.
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Cavalcanti-Ferreira P, Berk L, Daher N, Campus T, Araujo J, Petrofsky J, Lohman E. A nonparametric methodological analysis of rest-activity rhythm in type 2 diabetes. ACTA ACUST UNITED AC 2018; 11:281-289. [PMID: 30746047 PMCID: PMC6361299 DOI: 10.5935/1984-0063.20180044] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The purpose of this study was to analyze the rest-activity rhythm of type 2
diabetics mellitus (T2DM) and compare it to healthy controls using the
nonparametric analytic approach. Twenty-one diabetics and 21 healthy subjects
matched for gender and age were recruited to participate in the study. Data were
analyzed using the Independent t-test, Mann-Whitney U test, and Spearmans
correlation. T2DM subjects demonstrate lower interdaily stability (IS)
(p=.03), higher intradaily variability
(p=.046) and lower rhythm amplitude (p=.02)
when compared to healthy controls. Also, there was a positive correlation
between IS and most active 10 hr (M10) in the average of 24 hours pattern (r
=.44; p=.046) in the diabetes group and a negative correlation
between IV and M10 in the healthy group (r =-.57; p=.007).
These data together suggest that T2DM exhibits a dysfunction in the
rest-activity rhythm due to alterations in the circadian function as well as in
the homeostatic capacity to maintain sleep; mainly characterized by less
consistency across days of the daily circadian signal, higher rhythm
fragmentation and lower rhythm amplitude. Future approaches may be developed
considering the influence of circadian glucose variations throughout the day on
the coupling of the rest-activity rhythm to zeitgeber and rhythm
fragmentation.
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Affiliation(s)
- Paula Cavalcanti-Ferreira
- Loma Linda University, Physical Therapy - Loma Linda - CA - United States.,California State University, Northridge - CA - United States
| | - Lee Berk
- Loma Linda University, Physical Therapy - Loma Linda - CA - United States
| | - Noha Daher
- Loma Linda University, Physical Therapy - Loma Linda - CA - United States
| | - Tania Campus
- Universidade Federal do Rio Grande do Norte, Physical Therapy - Natal - RN - Brazil
| | - John Araujo
- Universidade Federal do Rio Grande do Norte, Physical Therapy - Natal - RN - Brazil
| | - Jerrold Petrofsky
- Loma Linda University, Physical Therapy - Loma Linda - CA - United States
| | - Everett Lohman
- Loma Linda University, Physical Therapy - Loma Linda - CA - United States
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Zhu B, Hershberger PE, Kapella MC, Fritschi C. The relationship between sleep disturbance and glycaemic control in adults with type 2 diabetes: An integrative review. J Clin Nurs 2017; 26:4053-4064. [PMID: 28544107 PMCID: PMC5702275 DOI: 10.1111/jocn.13899] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/17/2017] [Indexed: 12/19/2022]
Abstract
AIMS AND OBJECTIVES To explore and synthesise current research to assess the state of science about the relationship between sleep disturbance and glycaemic control in adults with type 2 diabetes. BACKGROUND Sleep disturbance is suggested a risk factor for type 2 diabetes. Diabetes alone is a leading cause of death, but when coupled with sleep disturbance poses additional health risks. However, little is known about the relationship between sleep disturbance and glycaemic control in people with overt diabetes. DESIGN An integrative review. METHODS Whittemore and Knafl's methodology guided this integrative review. Original studies published before October 2016 were identified through systematic searches of seven databases using terms: diabet*; sleep or insomnia; glycem* or glucose or A1C or HbA1c or sugar; and their combinations. The matrix and narrative synthesis were employed to organise and synthesise the findings, respectively. The Crowe Critical Appraisal Tool was used to evaluate the study quality. RESULTS A total of 26 studies were identified; 17 of which reported significant relationships between sleep measures and glycaemic control. In 13 studies, sleep duration was associated with glycaemic control in both linear (n = 2) and nonlinear (n = 3) relationships; however, eight studies reported no significant relationships. Sleep quality was significantly related to glycaemic control in 14 of 22 studies. Nine studies found no relationship between any measure of sleep and glycaemic control. CONCLUSIONS There is strong evidence supporting the relationship between sleep quality and glycaemic control but further examination of the relationship between sleep duration and glycaemic control is warranted. Sleep disturbance, particularly impaired sleep quality, could potentially influence glycaemic control in adults with type 2 diabetes. RELEVANCE TO CLINICAL PRACTICE Nurses who treat patients with diabetes should include assessment of sleep, education for healthy sleep, and referral for treatment of sleep disturbance in order to maximise the potential for achieving good glycaemic control.
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Affiliation(s)
- Bingqian Zhu
- College of Nursing, University of Illinois at Chicago, Chicago, IL
| | - Patricia E. Hershberger
- College of Nursing, University of Illinois at Chicago, Chicago, IL
- College of Medicine, University of Illinois at Chicago, Chicago, IL
| | - Mary C. Kapella
- College of Nursing, University of Illinois at Chicago, Chicago, IL
| | - Cynthia Fritschi
- College of Nursing, University of Illinois at Chicago, Chicago, IL
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Makino S, Hirose S, Kakutani M, Fujiwara M, Nishiyama M, Terada Y, Ninomiya H. Association between nighttime sleep duration, midday naps, and glycemic levels in Japanese patients with type 2 diabetes. Sleep Med 2017. [PMID: 29530368 DOI: 10.1016/j.sleep.2017.11.1124] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVES To clarify the relationship between nighttime sleep duration, midday naps, and glycemic control in Japanese patients diagnosed with type 2 diabetes (n = 355) or impaired glucose tolerance (n = 43). METHODS A total of 398 patients completed a self-administered questionnaire on sleep duration/quality and were divided into five groups according to their self-reported nighttime sleep duration: <5 h, 5-6 h, 6-7 h, 7-8 h, and >8 h. Each group was further divided into two subgroups each according to the presence or absence of midday naps. Poor glycemic control was defined as HbA1c ≥ 7.0%. RESULTS Short nighttime sleep (<5 h), poor sleep induction, daytime sleepiness, and low sleep satisfaction were associated with high HbA1c levels. HbA1c was higher in the short nighttime sleep/no nap group than in non-nappers with different nighttime sleep duration, whereas the short nighttime sleep/nap group showed similar HbA1c levels to the other nap subgroups. In multivariate logistic regression models, after adjusting for a number of potential confounders, short (<5 h) nighttime sleep without nap was significantly associated with poor glycemic control compared with 6-7 h nighttime sleep without nap (OR [95% CI]: 7.14 [2.20-23.20]). However, taking naps reduced this risk for poor glycemic control in short sleepers. Other risk factors for poor glycemic control were low sleep satisfaction (1.73 [1.10-2.70]) and poor sleep induction (1.69 [1.14-2.50]). CONCLUSIONS Poor sleep quality and quantity could aggravate glycemic control in type 2 diabetes. Midday naps could mitigate the deleterious effects of short nighttime sleep on glycemic control. CLINICAL TRIALS REGISTRATION UMIN 000017887.
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Affiliation(s)
- Shinya Makino
- Department of Internal Medicine, Osaka Gyomeikan Hospital, 5-4-8 Nishikujo, Konohana-ku, Osaka, 554-0012, Japan.
| | - Sachie Hirose
- Department of Internal Medicine, Osaka Gyomeikan Hospital, 5-4-8 Nishikujo, Konohana-ku, Osaka, 554-0012, Japan
| | - Miki Kakutani
- Department of Internal Medicine, Osaka Gyomeikan Hospital, 5-4-8 Nishikujo, Konohana-ku, Osaka, 554-0012, Japan
| | - Masayoshi Fujiwara
- Department of Internal Medicine, Osaka Gyomeikan Hospital, 5-4-8 Nishikujo, Konohana-ku, Osaka, 554-0012, Japan
| | - Mitsuru Nishiyama
- Department of Endocrinology, Metabolism and Nephrology, Kochi Medical School, Okoh-cho, Nankoku-city, Kochi, 783-8505, Japan
| | - Yoshio Terada
- Department of Endocrinology, Metabolism and Nephrology, Kochi Medical School, Okoh-cho, Nankoku-city, Kochi, 783-8505, Japan
| | - Hitoshi Ninomiya
- Data Management Division, Integrated Center for Advanced Medical Technologies, Kochi Medical School, Okoh-cho, Nankoku-city, Kochi, 783-8505, Japan
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28
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Zhu B, Quinn L, Fritschi C. Relationship and variation of diabetes related symptoms, sleep disturbance and sleep-related impairment in adults with type 2 diabetes. J Adv Nurs 2017; 74:689-697. [DOI: 10.1111/jan.13482] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/04/2017] [Indexed: 01/12/2023]
Affiliation(s)
- Bingqian Zhu
- College of Nursing; the University of Illinois at Chicago; Chicago IL USA
| | - Laurie Quinn
- College of Nursing; the University of Illinois at Chicago; Chicago IL USA
| | - Cynthia Fritschi
- College of Nursing; the University of Illinois at Chicago; Chicago IL USA
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Reid KJ, Facco FL, Grobman WA, Parker CB, Herbas M, Hunter S, Silver RM, Basner RC, Saade GR, Pien GW, Manchanda S, Louis JM, Nhan-Chang CL, Chung JH, Wing DA, Simhan HN, Haas DM, Iams J, Parry S, Zee PC. Sleep During Pregnancy: The nuMoM2b Pregnancy and Sleep Duration and Continuity Study. Sleep 2017; 40:3089705. [PMID: 28369543 DOI: 10.1093/sleep/zsx045] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/23/2017] [Indexed: 12/14/2022] Open
Abstract
Study Objectives To characterize sleep duration, timing and continuity measures in pregnancy and their association with key demographic variables. Methods Multisite prospective cohort study. Women enrolled in the nuMoM2b study (nulliparous women with a singleton gestation) were recruited at the second study visit (16-21 weeks of gestation) to participate in the Sleep Duration and Continuity substudy. Women <18 years of age or with pregestational diabetes or chronic hypertension were excluded from participation. Women wore a wrist activity monitor and completed a sleep log for 7 consecutive days. Time in bed, sleep duration, fragmentation index, sleep efficiency, wake after sleep onset, and sleep midpoint were averaged across valid primary sleep periods for each participant. Results Valid data were available from 782 women with mean age of 27.3 (5.5) years. Median sleep duration was 7.4 hours. Approximately 27.9% of women had a sleep duration of <7 hours; 2.6% had a sleep duration of >9 hours. In multivariable models including age, race/ethnicity, body mass index, insurance status, and recent smoking history, sleep duration was significantly associated with race/ethnicity and insurance status, while time in bed was only associated with insurance status. Sleep continuity measures and sleep midpoint were significantly associated with all covariates in the model, with the exception of age for fragmentation index and smoking for wake after sleep onset. Conclusions Our results demonstrate the relationship between sleep and important demographic characteristics during pregnancy.
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Affiliation(s)
- Kathryn J Reid
- Department of Neurology and Center for Circadian and Sleep Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Francesca L Facco
- Department of Obstetrics and Gynecology, Magee-Womens Research Institute & Foundation, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - William A Grobman
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | | | - Marcos Herbas
- Department of Neurology and Center for Circadian and Sleep Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | | | - Robert M Silver
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Utah Health Sciences Center, Salt Lake City, UT
| | - Robert C Basner
- Department of Clinical Medicine, College of Physicians and Surgeons, Columbia University, New York, NY
| | - George R Saade
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Texas Medical Branch, Galveston, TX
| | - Grace W Pien
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Shalini Manchanda
- Indiana University Health Sleep Disorders Center, Indiana University School of Medicine, Indianapolis, IN
| | - Judette M Louis
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Case Western Reserve University School of Medicine, Cleveland, OH
| | - Chia-Lang Nhan-Chang
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, College of Physicians and Surgeons, Columbia University, New York, NY
| | - Judith H Chung
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of California, Irvine, School of Medicine, Irvine, CA
| | - Deborah A Wing
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of California, Irvine, School of Medicine, Irvine, CA
| | - Hyagriv N Simhan
- Department of Obstetrics and Gynecology, Magee-Womens Research Institute & Foundation, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - David M Haas
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Indiana University School of Medicine, Indianapolis, IN
| | - Jay Iams
- Department of Obstetrics and Gynecology, Ohio State University, Columbus, OH
| | - Samuel Parry
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Pennsylvania School of Medicine, Philadelphia, PA
| | - Phyllis C Zee
- Department of Neurology and Center for Circadian and Sleep Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
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Guedes LG, Abreu GDA, Rodrigues DF, Teixeira LR, Luiz RR, Bloch KV. Comparison between self-reported sleep duration and actigraphy among adolescents: gender differences. REVISTA BRASILEIRA DE EPIDEMIOLOGIA 2017; 19:339-47. [PMID: 27532757 DOI: 10.1590/1980-5497201600020011] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Accepted: 09/15/2015] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION There are only few agreement studies between subjective measures of sleep and actigraphy among adolescents. OBJECTIVE To compare self-reported sleep and actigraphy in this age group, by studying gender differences and, using a new graphical approach, the survival agreement plot. METHODS Thirty-seven subjects, aged 12 to 17 years, answered questions about nocturnal sleep duration and used actigraphy for seven days. The mean and median differences between the informed sleep and the recorded one, the intraclass correlation coefficient, the Bland-Altman plot and the survival-agreement plot were used. RESULTS A mean difference of about one hour (SD = 2.1; median = 0.5; p < 0.01) was found between both strategies, which was higher among boys, 1.9 hours (SD = 2.8; median = 1.6; p < 0.05), than among girls, 0.5 hours (SD = 1.4; median = 0.3; p = 0.11). The graphical evaluation showed similar results, as well as the intraclass correlation coefficient: 0.06 (95%CI = -0.33 - 0.46; p = 0.489) for boys and 0.43 (95%CI = 0.12 - 0.83; p < 0.001) for girls. CONCLUSIONS Our data are consistent with previous studies as to non-agreement between the two methods. These results are relevant because this is the first study of concordance between subjective measures of sleep and actigraphy among Brazilian adolescents, as far as we know. In addition, they reinforce the need of a careful use of nocturnal sleep measures among adolescents, mainly among boys.
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Affiliation(s)
- Luciane Gaspar Guedes
- Instituto de Puericultura e Pediatria Martagão Gesteira , Universidade Federal do Rio de Janeiro - Rio de Janeiro (RJ), Brazil
| | - Gabriela de Azevedo Abreu
- Instituto de Estudos em Saúde Coletiva , Universidade Federal do Rio de Janeiro - Rio de Janeiro (RJ), Brazil
| | - Daniel Frossard Rodrigues
- Instituto de Puericultura e Pediatria Martagão Gesteira , Universidade Federal do Rio de Janeiro - Rio de Janeiro (RJ), Brazil
| | - Liliane Reis Teixeira
- Escola Nacional de Saúde Pública , Fundação Oswaldo Cruz - Rio de Janeiro (RJ), Brazil
| | - Ronir Raggio Luiz
- Instituto de Estudos em Saúde Coletiva , Universidade Federal do Rio de Janeiro - Rio de Janeiro (RJ), Brazil
| | - Katia Vergetti Bloch
- Instituto de Estudos em Saúde Coletiva , Universidade Federal do Rio de Janeiro - Rio de Janeiro (RJ), Brazil
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31
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Full KM, Schmied EA, Parada H, Cherrington A, Horton LA, Ayala GX. The Relationship Between Sleep Duration and Glycemic Control Among Hispanic Adults With Uncontrolled Type 2 Diabetes. DIABETES EDUCATOR 2017; 43:519-529. [DOI: 10.1177/0145721717724564] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Purpose The purpose of this study was to examine the relationship between sleep duration and glycemic control in adult Hispanic patients with uncontrolled type 2 diabetes. Methods This cross-sectional study used baseline data from 317 Hispanic adults with uncontrolled type 2 diabetes who participated in a randomized controlled trial testing a peer support intervention to improve diabetes control. To be eligible, participants had to be 18 years or older and have A1C >7% in the 3 months prior to randomization. Glycemic control was assessed by A1C ascertained through medical chart review; higher A1C levels reflected poorer glycemic control. Sleep duration (hours/night), diabetes control behaviors, and demographics were obtained by interviewer-administered questionnaire. We used multivariable generalized linear models to estimate the association between sleep duration and glycemic control. Results Forty-three percent of participants reported sleeping fewer than 7 hours per night. Sleep duration (hours/night) was inversely associated with A1C levels; however, the relationship was no longer statistically significant after adjusting for insulin status. Conclusions Sleep duration was not significantly associated with glycemic control in this sample of Hispanic adults with uncontrolled type 2 diabetes when adjusting for insulin. Future research should continue to explore this relationship among Hispanic adults with diabetes using an objective measure of sleep duration and a larger sample of Hispanic adults with both controlled and uncontrolled type 2 diabetes to determine if these results hold true.
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Affiliation(s)
- Kelsie M. Full
- San Diego State University/University of California, San Diego Joint Doctoral Program in Public Health (Health Behavior), San Diego, California (Miss Full)
- Institute for Behavioral and Community Health, San Diego State University Research Foundation, San Diego, California (Miss Full, Dr Schmied, Miss Horton, Dr Ayala)
- University of North Carolina at Chapel Hill, Department of Epidemiology, Chapel Hill, North Carolina (Dr Parada)
- Department of Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama (Dr Cherrington)
- College of Health and Human Services, San Diego State University, San Diego, California (Dr Ayala)
| | - Emily A. Schmied
- San Diego State University/University of California, San Diego Joint Doctoral Program in Public Health (Health Behavior), San Diego, California (Miss Full)
- Institute for Behavioral and Community Health, San Diego State University Research Foundation, San Diego, California (Miss Full, Dr Schmied, Miss Horton, Dr Ayala)
- University of North Carolina at Chapel Hill, Department of Epidemiology, Chapel Hill, North Carolina (Dr Parada)
- Department of Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama (Dr Cherrington)
- College of Health and Human Services, San Diego State University, San Diego, California (Dr Ayala)
| | - Humberto Parada
- San Diego State University/University of California, San Diego Joint Doctoral Program in Public Health (Health Behavior), San Diego, California (Miss Full)
- Institute for Behavioral and Community Health, San Diego State University Research Foundation, San Diego, California (Miss Full, Dr Schmied, Miss Horton, Dr Ayala)
- University of North Carolina at Chapel Hill, Department of Epidemiology, Chapel Hill, North Carolina (Dr Parada)
- Department of Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama (Dr Cherrington)
- College of Health and Human Services, San Diego State University, San Diego, California (Dr Ayala)
| | - Andrea Cherrington
- San Diego State University/University of California, San Diego Joint Doctoral Program in Public Health (Health Behavior), San Diego, California (Miss Full)
- Institute for Behavioral and Community Health, San Diego State University Research Foundation, San Diego, California (Miss Full, Dr Schmied, Miss Horton, Dr Ayala)
- University of North Carolina at Chapel Hill, Department of Epidemiology, Chapel Hill, North Carolina (Dr Parada)
- Department of Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama (Dr Cherrington)
- College of Health and Human Services, San Diego State University, San Diego, California (Dr Ayala)
| | - Lucy A. Horton
- San Diego State University/University of California, San Diego Joint Doctoral Program in Public Health (Health Behavior), San Diego, California (Miss Full)
- Institute for Behavioral and Community Health, San Diego State University Research Foundation, San Diego, California (Miss Full, Dr Schmied, Miss Horton, Dr Ayala)
- University of North Carolina at Chapel Hill, Department of Epidemiology, Chapel Hill, North Carolina (Dr Parada)
- Department of Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama (Dr Cherrington)
- College of Health and Human Services, San Diego State University, San Diego, California (Dr Ayala)
| | - Guadalupe X. Ayala
- San Diego State University/University of California, San Diego Joint Doctoral Program in Public Health (Health Behavior), San Diego, California (Miss Full)
- Institute for Behavioral and Community Health, San Diego State University Research Foundation, San Diego, California (Miss Full, Dr Schmied, Miss Horton, Dr Ayala)
- University of North Carolina at Chapel Hill, Department of Epidemiology, Chapel Hill, North Carolina (Dr Parada)
- Department of Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama (Dr Cherrington)
- College of Health and Human Services, San Diego State University, San Diego, California (Dr Ayala)
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Relationships between lifestyle patterns and cardio-renal-metabolic parameters in patients with type 2 diabetes mellitus: A cross-sectional study. PLoS One 2017; 12:e0173540. [PMID: 28273173 PMCID: PMC5342268 DOI: 10.1371/journal.pone.0173540] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2016] [Accepted: 02/22/2017] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION While individuals tend to show accumulation of certain lifestyle patterns, the effect of such patterns in real daily life on cardio-renal-metabolic parameters remains largely unknown. This study aimed to assess clustering of lifestyle patterns and investigate the relationships between such patterns and cardio-renal-metabolic parameters. PARTICIPANTS AND METHODS The study participants were 726 Japanese type 2 diabetes mellitus (T2DM) outpatients free of history of cardiovascular diseases. The relationship between lifestyle patterns and cardio-renal-metabolic parameters was investigated by linear and logistic regression analyses. RESULTS Factor analysis identified three lifestyle patterns. Subjects characterized by evening type, poor sleep quality and depressive status (type 1 pattern) had high levels of HbA1c, alanine aminotransferase and albuminuria. Subjects characterized by high consumption of food, alcohol and cigarettes (type 2 pattern) had high levels of γ-glutamyl transpeptidase, triglycerides, HDL-cholesterol, blood pressure, and brachial-ankle pulse wave velocity. Subjects characterized by high physical activity (type 3 pattern) had low uric acid and mild elevation of alanine aminotransferase and aspartate aminotransferase. In multivariate regression analysis adjusted by age, gender and BMI, type 1 pattern was associated with higher HbA1c levels, systolic BP and brachial-ankle pulse wave velocity. Type 2 pattern was associated with higher HDL-cholesterol levels, triglycerides, aspartate aminotransferase, ɤ- glutamyl transpeptidase levels, and diastolic BP. CONCLUSIONS The study identified three lifestyle patterns that were associated with distinct cardio-metabolic-renal parameters in T2DM patients. TRIAL REGISTRATION UMIN000010932.
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Keskin A, Ünalacak M, Bilge U, Yildiz P, Güler S, Selçuk EB, Bilgin M. Effects of Sleep Disorders on Hemoglobin A1c Levels in Type 2 Diabetic Patients. Chin Med J (Engl) 2016; 128:3292-7. [PMID: 26668142 PMCID: PMC4797503 DOI: 10.4103/0366-6999.171415] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Background: Studies have reported the presence of sleep disorders in approximately 50–70% of diabetic patients, and these may contribute to poor glycemic control, diabetic neuropathy, and overnight hypoglycemia. The aim of this study was to determine the frequency of sleep disorders in diabetic patients, and to investigate possible relationships between scores of these sleep disorders and obstructive sleep apnea syndrome (OSAS) and diabetic parameters (fasting blood glucose, glycated hemoglobin A1c [HbA1c], and lipid levels). Methods: We used the Berlin questionnaire (BQ) for OSAS, the Epworth Sleepiness Scale (ESS), and the Pittsburgh Sleep Quality Index (PSQI) to determine the frequency of sleep disorders and their possible relationships with fasting blood glucose, HbA1c, and lipid levels. Results: The study included 585 type 2 diabetic patients admitted to family medicine clinics between October and December 2014. Sleep, sleep quality, and sleep scores were used as the dependent variables in the analysis. The ESS scores showed that 54.40% of patients experienced excessive daytime sleepiness, and according to the PSQI, 64.30% experienced poor-quality sleep. The BQ results indicated that 50.20% of patients were at high-risk of OSAS. HbA1c levels correlated significantly with the ESS and PSQI results (r = 0.23, P < 0.001 and r = 0.14, P = 0.001, respectively), and were significantly higher in those with high-risk of OSAS as defined by the BQ (P < 0.001). These results showed that HbA1c levels were related to sleep disorders. Conclusions: Sleep disorders are common in diabetic patients and negatively affect the control of diabetes. Conversely, poor diabetes control is an important factor disturbing sleep quality. Addressing sleep disturbances in patients who have difficulty controlling their blood glucose has dual benefits: Preventing diabetic complications caused by sleep disturbance and improving diabetes control.
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Affiliation(s)
| | | | - Uğur Bilge
- Department of Family Medicine, Faculty of Medicine, Eskişehir Osmangazi University, Eskişehir 9026100, Turkey
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Gozashti MH, Eslami N, Radfar MH, Pakmanesh H. Sleep Pattern, Duration and Quality in Relation with Glycemic Control in People with Type 2 Diabetes Mellitus. IRANIAN JOURNAL OF MEDICAL SCIENCES 2016; 41:531-538. [PMID: 27853334 PMCID: PMC5106569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Sleep disturbances have been shown to be associated with diabetes control, but the relation between planned wakings or napping with glycemic indices has not been evaluated yet. This study evaluated the relation between sleep quality, duration, and pattern, including daytime napping of people with diabetes and their glycemic control. A cross-sectional correlation research design was used for this study. We enrolled 118 people with type 2 diabetes receiving oral agents without major complications at the Shahid Bahonar Center, Kerman. The age, weight, height, serum HbA1c, as well as other glycemic indices and lipid profile were measured. BMI was also calculated. All participants were requested to fill in the Pittsburgh Sleep Quality Index (PSQI) questionnaire to evaluate their sleep quality. In addition, they were inquired about their sleep schedule during day and night. Pearson correlation and multiple regression analyses were conducted to examine the correlation between HbA1c and sleep pattern variables. The variables were also compared between participants with or without napping using t-test. All analyses were performed with the SPSS version 19 (SPSS, Chicago, IL, USA). The mean age was 58±11 years and mean HbA1c (%) was 7.8±11 (62±13 mmol/mol). Sleep duration and the number of sleep segments significantly predicted HbA1c (F (2,114)=5.232, P=0.007, R2=0.084). A one-hour increment in sleep duration was associated with a 0.174% (1.4 mmol/mol) decrement in HbA1c. PSQI score did not contribute to the regression model. Moreover, participants who napped (66%) had a lower HbA1c (7.6±1) compared to others (8.1±1.3) (P=0.04). We concluded that napping and segmented sleep are associated with a better glycemic control in type 2 diabetes and there is a linear correlation between sleep duration and better glycemic control.
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Affiliation(s)
- Mohammad Hossein Gozashti
- Department of Endocrinology, School of Medicine, Kerman University of Medical Sciences, Kerman, Iran,Endocrinology and Metabolism Research Center, Institute of Basic and Clinical Physiology Science, Kerman, Iran
| | - Nazanin Eslami
- Department of Internal Medicine, School of Medicine, Kerman University of Medical Sciences, Kerman, Iran
| | - Mohammad Hadi Radfar
- Department of Endourology, School of Medicine, Shahid Beheshti University Medical Sciences, Tehran, Iran
| | - Hamid Pakmanesh
- Department of Endourology, School of Medicine, Kerman University of Medical Sciences, Kerman, Iran,Correspondence: Hamid Pakmanesh, MD; Department of Endourology, Shahid Bahonar Hospital, Shahid Qarani Street, Kerman, Iran Tel: +98 913 3986871 Fax: +98 34 32235011
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Abstract
Sleep curtailment is common in the Westernised world and coincides with an increase in the prevalence of type 2 diabetes mellitus (T2DM). This review considers the recently published evidence for whether sleep duration is involved in the development of T2DM in human subjects and whether sleep has a role to play in glucose control in people who have diabetes. Data from large, prospective studies indicate a U-shaped relationship between sleep duration and the development of T2DM. Smaller, cross-sectional studies also support a relationship between short sleep duration and the development of both insulin resistance and T2DM. Intervention studies show that sleep restriction leads to insulin resistance, with recent sleep extension studies offering tantalising data showing a potential benefit of sleep extension on glucose control and insulin sensitivity. In people with established diabetes the published literature shows an association between poor glucose control and both short and long sleep durations. However, there are currently no studies that determine the causal direction of this relationship, nor whether sleep interventions are likely to offer benefit for people with diabetes to help them achieve tighter glucose control.
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Effects of sleep disruption and high fat intake on glucose metabolism in mice. Psychoneuroendocrinology 2016; 68:47-56. [PMID: 26943344 PMCID: PMC4851877 DOI: 10.1016/j.psyneuen.2016.02.024] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Revised: 02/22/2016] [Accepted: 02/22/2016] [Indexed: 11/23/2022]
Abstract
Poor sleep quality or quantity impairs glycemic control and increases risk of disease under chronic conditions. Recovery sleep may offset adverse metabolic outcomes of accumulated sleep debt, but the extent to which this occurs is unclear. We examined whether recovery sleep improves glucose metabolism in mice subjected to prolonged sleep disruption, and whether high fat intake during sleep disruption exacerbates glycemic control. Adult male C57BL/6J mice were subjected to 18-h sleep fragmentation daily for 9 days, followed by 1 day of recovery. During sleep disruption, one group of mice was fed a high-fat diet (HFD) while another group was fed standard laboratory chow. Insulin sensitivity and glucose tolerance were assessed by insulin and glucose tolerance testing at baseline, after 3 and 7 days of sleep disruption, and at the end of the protocol after 24h of undisturbed sleep opportunity (recovery). To characterize changes in sleep architecture that are associated with sleep debt and recovery, we quantified electroencephalogram (EEG) recordings during sleep fragmentation and recovery periods from an additional group of mice. We now report that 9 days of 18-h daily sleep fragmentation significantly reduces rapid eye movement sleep (REMS) and non-rapid eye movement sleep (NREMS). Mice respond with increases in REMS, but not NREMS, during the daily 6-h undisturbed sleep opportunity. However, both REMS and NREMS increase significantly during the 24-h recovery period. Although sleep disruption alone has no effect in this protocol, high fat feeding in combination with sleep disruption impairs glucose tolerance, effects that are reversed by recovery sleep. Insulin sensitivity modestly improves after 3 days of sleep fragmentation and after 24h of recovery, with significantly greater improvements in mice exposed to HFD during sleep disruption. Improvements in both glucose tolerance and insulin sensitivity are associated with NREMS rebound, raising the possibility that this sleep phase contributes to restorative effects of recovery sleep on glycemic control.
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Contributions of Comorbid Diabetes to Sleep Characteristics, Daytime Symptoms, and Physical Function Among Patients With Stable Heart Failure. J Cardiovasc Nurs 2016; 30:411-9. [PMID: 25078876 DOI: 10.1097/jcn.0000000000000183] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND Diabetes mellitus (DM) and heart failure (HF) are often comorbid. Sleep disturbances, poor physical functioning, and high levels of daytime symptoms are prevalent and contribute to poor quality of life in both populations. However, little is known about the independent and additive effects of comorbid DM on sleep, physical function, and daytime symptoms among patients with HF. OBJECTIVE The aim of this study was to investigate the extent to which comorbid DM confers independent and additive effects on sleep disturbance, physical functioning, and symptoms among patients with stable HF. METHODS This secondary analysis was conducted on a sample of 173 stable class II to IV HF patients. Self-report and polysomnography were used to measure sleep quality, objective sleep characteristics, and sleep-disordered breathing. Physical function measures included wrist actigraphy, the 6-minute walk test (6MWT), and the Medical Outcomes Study 36-item Short Form physical component summary score. Fatigue, sleepiness, and depression were also measured. Univariate analyses and hierarchical regression models were computed. RESULTS The sample included 173 (n = 119/68% HF and n = 54/32% HF plus DM) patients (mean [SD] age, 60.4 [16.1] years). In analyses adjusted for age, gender, body mass index, and New York Heart Association classification, the HF patients with DM had longer sleep latency and spent a greater percentage of time awake after sleep onset than the HF patients who did not have DM (all P < 0.05). There were no statistically significant differences in Respiratory Disturbance Index or self-reported sleep quality. Sleep duration was low in both groups. The patients with DM had shorter 6MWT distance, lower ratio of daytime to nighttime activity, as well as lower general health and self-reported physical function. Hierarchical regression models revealed that age and DM were the only significant correlates of the sleep variables, whereas age, gender, New York Heart Association class, and DM were all associated with 6MWT distance. CONCLUSIONS Comorbid DM contributes independent and additive effects on sleep disturbances and poor physical functioning in patients with stable HF.
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Rangaraj VR, Knutson KL. Association between sleep deficiency and cardiometabolic disease: implications for health disparities. Sleep Med 2016; 18:19-35. [PMID: 26431758 PMCID: PMC4758899 DOI: 10.1016/j.sleep.2015.02.535] [Citation(s) in RCA: 76] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2014] [Revised: 01/29/2015] [Accepted: 02/19/2015] [Indexed: 12/29/2022]
Abstract
BACKGROUND Cardiometabolic diseases, which include obesity, diabetes, hypertension, and cardiovascular disease, are associated with reduced quality of life and reduced life expectancy. Unfortunately, there are racial/ethnic and socioeconomic disparities associated with these diseases such that minority populations, such as African Americans and Hispanics, and those of lower socioeconomic status, experience a greater burden. Several reports have indicated that there are differences in sleep duration and quality that mirror the disparities in cardiometabolic disease. The goal of this paper is to review the association between sleep and cardiometabolic disease risk because of the possibility that suboptimal sleep may partially mediate the cardiometabolic disease disparities. METHODS We review both experimental studies that have restricted sleep duration or impaired sleep quality and examined biomarkers of cardiometabolic disease risk, including glucose metabolism and insulin sensitivity, appetite regulation and food intake, and immune function. We also review observational studies that have examined the association between habitual sleep duration and quality, and the prevalence or risk of obesity, diabetes, hypertension, and cardiovascular disease. CONCLUSION Many experimental and observational studies do support an association between suboptimal sleep and increased cardiometabolic disease risk.
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Abstract
Pre-diabetes and diabetes occur secondary to a constellation of pathophysiological abnormalities that culminate in insulin resistance, which results in reduced cellular glucose uptake and increased glucose production. Although pre-diabetes and diabetes have a strong genetic basis, they are largely environmentally driven through lifestyle factors. Traditional lifestyle factors such as diet and physical activity do not fully explain the dramatic rise in the incidence and prevalence of diabetes mellitus. Sleep has emerged as an additional lifestyle behavior, important for metabolic health and energy homeostasis. In this article, we review the current evidence surrounding the sleep-diabetes association.
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Affiliation(s)
- Teresa Arora
- Department of Medicine, Weill Cornell Medical College in Qatar, Room C008, Qatar Foundation, Education City, PO Box 24144, Doha, Qatar
- Department of Medicine, Weill Cornell Medical College, New York, USA
| | - Shahrad Taheri
- Department of Medicine, Weill Cornell Medical College in Qatar, Room C008, Qatar Foundation, Education City, PO Box 24144, Doha, Qatar.
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Disturbed sleep in type 2 diabetes mellitus independent of chronic complications, pain, and nocturia. Int J Diabetes Dev Ctries 2015. [DOI: 10.1007/s13410-015-0314-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Nefs G, Donga E, van Someren E, Bot M, Speight J, Pouwer F. Subjective sleep impairment in adults with type 1 or type 2 diabetes: Results from Diabetes MILES--The Netherlands. Diabetes Res Clin Pract 2015; 109:466-75. [PMID: 26264411 DOI: 10.1016/j.diabres.2015.07.008] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Revised: 07/12/2015] [Accepted: 07/24/2015] [Indexed: 10/23/2022]
Abstract
AIMS Despite growing recognition of the impact of sleep on diabetes, a clear profile of people with diabetes regarding subjective sleep impairment has yet to be established. This study examines: (1) subjective sleep characteristics in adults with type 1 and type 2 diabetes; (2) the relationship of poor subjective sleep quality with glycaemic control, self-care and daytime functioning; (3) possible risk markers for poor sleep quality. METHODS In a cross-sectional study, Dutch adults with type 1 (n=267) or type 2 diabetes (n=361) completed an online survey, including the Pittsburgh Sleep Quality Index (PSQI), socio-demographic, clinical, self-care and psychological measures. RESULTS Poor sleep quality (PSQI-score >5) was reported by 31% of adults with type 1 and 42% of adults with type 2 diabetes. Participants with good and poor sleep quality did not differ in self-reported HbA1c or the frequency of meeting lifestyle recommendations. Poor sleep quality was related to a higher self-care burden and higher levels of daytime sleepiness, fatigue, depressive and anxiety symptoms, and diabetes-specific distress. In multivariable logistic regression analyses examining risk markers, poor sleep quality was associated with depressive symptoms in adults with type 1 (OR=1.39, 95% CI 1.25-1.54) and type 2 diabetes (OR=1.31, 1.16-1.47), and with being female in those with type 2 diabetes (OR=2.72, 1.42-5.20). CONCLUSIONS Poor subjective sleep quality is prevalent both in adults with type 1 and type 2 diabetes, and is related to poor daytime functioning and higher self-care burden. The temporal relation with depression and merits of therapy should be explored.
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Affiliation(s)
- Giesje Nefs
- Center of Research on Psychology in Somatic diseases (CoRPS), Department of Medical and Clinical Psychology, Tilburg University, PO Box 90153, Tilburg, 5000 LE, The Netherlands.
| | - Esther Donga
- Department of Internal Medicine, St. Elisabeth Hospital, PO Box 90151, Tilburg, 5000 LC, The Netherlands
| | - Eus van Someren
- Department of Sleep and Cognition, Netherlands Institute for Neuroscience, Meibergdreef 47, Amsterdam, 1105 BA, The Netherlands; Departments of Integrative Neurophysiology and Medical Psychology, Center for Neurogenomics and Cognitive Research (CNCR), Neuroscience Campus Amsterdam, VU University and Medical Center, De Boelelaan 1085, Amsterdam, 1081 HV, the Netherlands
| | - Mariska Bot
- Center of Research on Psychology in Somatic diseases (CoRPS), Department of Medical and Clinical Psychology, Tilburg University, PO Box 90153, Tilburg, 5000 LE, The Netherlands; Department of Psychiatry, VU University Medical Center and EMGO Institute for Health and Care Research, A.J. Ernststraat 1187, Amsterdam, 1081 HL, The Netherlands
| | - Jane Speight
- The Australian Centre for Behavioural Research in Diabetes, Diabetes Australia, Vic, 570 Elizabeth Street, Melbourne, Victoria, 3000, Australia; Centre for Mental Health and Wellbeing Research, School of Psychology, Deakin University, 221 Burwood Highway, Burwood, Victoria, 3125, Australia; AHP Research, 16 Walden Way, Hornchurch, UK
| | - François Pouwer
- Center of Research on Psychology in Somatic diseases (CoRPS), Department of Medical and Clinical Psychology, Tilburg University, PO Box 90153, Tilburg, 5000 LE, The Netherlands
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Siwasaranond N, Nimitphong H, Saetung S, Chirakalwasan N, Ongphiphadhanakul B, Reutrakul S. Shorter sleep duration is associated with poorer glycemic control in type 2 diabetes patients with untreated sleep-disordered breathing. Sleep Breath 2015; 20:569-74. [PMID: 26298194 DOI: 10.1007/s11325-015-1243-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2015] [Revised: 07/20/2015] [Accepted: 08/11/2015] [Indexed: 01/29/2023]
Abstract
PURPOSE The purpose of this study is to explore the impact of sleep duration on glycemic control in type 2 diabetes patients with untreated sleep-disordered breathing (SDB). METHODS Ninety type 2 diabetes patients participated in the study. SDB was diagnosed using an overnight in-home monitoring device (WatchPAT200). Sleep duration was recorded by wrist actigraphy for 7 days. Medical records were reviewed for hemoglobin A1c (HbA1c) values. RESULTS Seventy-one patients (78.8 %) were diagnosed with SDB [apnea-hypopnea index (AHI) ≥ 5]. In patients with SDB, there was no significant relationship between AHI and glycemic control. In addition, oxygen desaturation index, minimum oxygen saturation, and time spent below oxygen saturation of 90 % were not significantly correlated with glycemic control. Sleep duration, however, was inversely correlated with HbA1c (r = -0.264, p 0.026). Multiple regression analysis adjusting for age, sex, body mass index, insulin use, diabetes duration, and AHI revealed that sleep duration was significantly associated with HbA1c (p = 0.005). Each hour reduction in sleep duration was associated with a 4.8 % increase in HbA1c of its original value (95 % CI 1.5-8.0). CONCLUSION In type 2 diabetes patients with untreated SDB, shorter sleep duration was independently associated with poorer glycemic control. Sleep duration optimization may lead to improved glycemic control in this population.
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Affiliation(s)
- Nantaporn Siwasaranond
- Section of Endocrinology, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 270 Rama VI Rd, Ratchathewi, Bangkok, 10400, Thailand
| | - Hataikarn Nimitphong
- Section of Endocrinology, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 270 Rama VI Rd, Ratchathewi, Bangkok, 10400, Thailand
| | - Sunee Saetung
- Section of Endocrinology, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 270 Rama VI Rd, Ratchathewi, Bangkok, 10400, Thailand
| | - Naricha Chirakalwasan
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.,Excellence Center for Sleep Disorders, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - Boonsong Ongphiphadhanakul
- Section of Endocrinology, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 270 Rama VI Rd, Ratchathewi, Bangkok, 10400, Thailand
| | - Sirimon Reutrakul
- Section of Endocrinology, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 270 Rama VI Rd, Ratchathewi, Bangkok, 10400, Thailand.
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Osonoi Y, Mita T, Osonoi T, Saito M, Tamasawa A, Nakayama S, Someya Y, Ishida H, Kanazawa A, Gosho M, Fujitani Y, Watada H. Poor sleep quality is associated with increased arterial stiffness in Japanese patients with type 2 diabetes mellitus. BMC Endocr Disord 2015; 15:29. [PMID: 26084960 PMCID: PMC4472398 DOI: 10.1186/s12902-015-0026-1] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2015] [Accepted: 06/01/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND While poor sleep quality can worsen cardiovascular risk factors such as glucose and lipid profiles in patients with type 2 diabetes mellitus (T2DM), the relationship between sleep quality and atherosclerosis remains largely unknown. The aim of this study was to examine this relationship. METHODS The study participants comprised 724 Japanese T2DM outpatients free of history of cardiovascular diseases. The relationships between sleep quality (assessed by the Pittsburgh Sleep Quality Index (PSQI)) and various clinical and laboratory parameters were investigated. RESULTS The mean PSQI was 5.1 ± 3.0 (±SD). Patients were divided into three groups based on the total PSQI score; subjects with good sleep quality (n = 462), average sleep quality (n = 185), and poor sleep quality (n = 77). In the age/gender-adjusted model, patients with poor sleep quality tended to be obese, evening type and depressed. However, other lifestyles showed no significant trends. Alanine aminotransferase, fasting blood glucose, HbA1c, systolic blood pressure, urinary albumin excretion, and brachial-ankle pulse wave velocity (baPWV) tended to be higher in patients with poor sleep quality. High baPWV was the only parameter that correlated with poor sleep in a model adjusted for several other lifestyle factors. CONCLUSIONS Our study indicates that poor sleep quality in T2DM patients correlates with increased arterial wall stiffness, a marker of atherosclerosis and a risk factor for cardiovascular diseases.
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Affiliation(s)
- Yusuke Osonoi
- Department of Metabolism and Endocrinology, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyoku, 113-8421, Tokyo, Japan.
| | - Tomoya Mita
- Department of Metabolism and Endocrinology, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyoku, 113-8421, Tokyo, Japan.
- Center for Molecular Diabetology, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyoku, 113-8421, Tokyo, Japan.
| | - Takeshi Osonoi
- Naka Memorial Clinic, 745-5, Nakadai, Naka City, 311-0113, Ibaraki, Japan.
| | - Miyoko Saito
- Naka Memorial Clinic, 745-5, Nakadai, Naka City, 311-0113, Ibaraki, Japan.
| | - Atsuko Tamasawa
- Naka Memorial Clinic, 745-5, Nakadai, Naka City, 311-0113, Ibaraki, Japan.
| | - Shiho Nakayama
- Department of Metabolism and Endocrinology, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyoku, 113-8421, Tokyo, Japan.
| | - Yuki Someya
- Department of Metabolism and Endocrinology, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyoku, 113-8421, Tokyo, Japan.
| | - Hidenori Ishida
- Naka Memorial Clinic, 745-5, Nakadai, Naka City, 311-0113, Ibaraki, Japan.
| | - Akio Kanazawa
- Department of Metabolism and Endocrinology, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyoku, 113-8421, Tokyo, Japan.
- Center for Therapeutic Innovations in Diabetes, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyoku, 113-8421, Tokyo, Japan.
| | - Masahiko Gosho
- Department of Clinical Trial and Clinical Epidemiology, Faculty of Medicine, University of Tsukuba, 1-1-1, Tennodai, Tsukuba, 305-8575, Ibaraki, Japan.
| | - Yoshio Fujitani
- Department of Metabolism and Endocrinology, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyoku, 113-8421, Tokyo, Japan.
| | - Hirotaka Watada
- Department of Metabolism and Endocrinology, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyoku, 113-8421, Tokyo, Japan.
- Center for Molecular Diabetology, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyoku, 113-8421, Tokyo, Japan.
- Center for Therapeutic Innovations in Diabetes, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyoku, 113-8421, Tokyo, Japan.
- Sportology Center, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyoku, 113-8421, Tokyo, Japan.
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Briançon-Marjollet A, Weiszenstein M, Henri M, Thomas A, Godin-Ribuot D, Polak J. The impact of sleep disorders on glucose metabolism: endocrine and molecular mechanisms. Diabetol Metab Syndr 2015. [PMID: 25834642 DOI: 10.1186/s13098- 015-0018-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Modern lifestyle has profoundly modified human sleep habits. Sleep duration has shortened over recent decades from 8 to 6.5 hours resulting in chronic sleep deprivation. Additionally, irregular sleep, shift work and travelling across time zones lead to disruption of circadian rhythms and asynchrony between the master hypothalamic clock and pacemakers in peripheral tissues. Furthermore, obstructive sleep apnea syndrome (OSA), which affects 4 - 15% of the population, is not only characterized by impaired sleep architecture but also by repetitive hemoglobin desaturations during sleep. Epidemiological studies have identified impaired sleep as an independent risk factor for all cause of-, as well as for cardiovascular, mortality/morbidity. More recently, sleep abnormalities were causally linked to impairments in glucose homeostasis, metabolic syndrome and Type 2 Diabetes Mellitus (T2DM). This review summarized current knowledge on the metabolic alterations associated with the most prevalent sleep disturbances, i.e. short sleep duration, shift work and OSA. We have focused on various endocrine and molecular mechanisms underlying the associations between inadequate sleep quality, quantity and timing with impaired glucose tolerance, insulin resistance and pancreatic β-cell dysfunction. Of these mechanisms, the role of the hypothalamic-pituitary-adrenal axis, circadian pacemakers in peripheral tissues, adipose tissue metabolism, sympathetic nervous system activation, oxidative stress and whole-body inflammation are discussed. Additionally, the impact of intermittent hypoxia and sleep fragmentation (key components of OSA) on intracellular signaling and metabolism in muscle, liver, fat and pancreas are also examined. In summary, this review provides endocrine and molecular explanations for the associations between common sleep disturbances and the pathogenesis of T2DM.
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Affiliation(s)
- Anne Briançon-Marjollet
- Université Grenoble Alpes, HP2, F-38041 Grenoble, Cedex France.,INSERM U1042, F-38041 Grenoble, Cedex France
| | - Martin Weiszenstein
- Centre for Research on Diabetes, Metabolism and Nutrition, Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Marion Henri
- Université Grenoble Alpes, HP2, F-38041 Grenoble, Cedex France.,INSERM U1042, F-38041 Grenoble, Cedex France
| | - Amandine Thomas
- Université Grenoble Alpes, HP2, F-38041 Grenoble, Cedex France.,INSERM U1042, F-38041 Grenoble, Cedex France
| | - Diane Godin-Ribuot
- Université Grenoble Alpes, HP2, F-38041 Grenoble, Cedex France.,INSERM U1042, F-38041 Grenoble, Cedex France
| | - Jan Polak
- Centre for Research on Diabetes, Metabolism and Nutrition, Third Faculty of Medicine, Charles University, Prague, Czech Republic.,2nd Internal Medicine Department, University Hospital Kralovske Vinohrady, Prague, Czech Republic.,Sports Medicine Department, Third Faculty of Medicine, Charles University in Prague, Ruska 87, Praha 10, 100 00 Czech Republic
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Zheng Y, Wang A, Pan C, Lu J, Dou J, Lu Z, Ba J, Wang B, Mu Y. Impact of night sleep duration on glycemic and triglyceride levels in Chinese with different glycemic status. J Diabetes 2015; 7:24-30. [PMID: 24981368 DOI: 10.1111/1753-0407.12186] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2013] [Revised: 05/28/2014] [Accepted: 06/09/2014] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND The aim of the present study was to assess the relationship between night sleep duration and glycemic and triglyceride (TG) levels among people with different glycemic status. METHODS In all, 18,121 subjects aged ≥40 years were enrolled in this cross-sectional study, including 4318 with impaired glucose regulation (IGR), 4225 with diabetes, and 9578 with normal glucose regulation (NGR). The IGR + diabetes and NGR groups were divided into three subgroups according to self-reported night sleep duration as follows: (i) <6 h; (ii) 6-9 h; and (iii) >9 h. The associations of sleep duration with HbA1c, fasting plasma glucose (FPG), 2-h post-load plasma glucose (PPG), and TG levels were examined. RESULTS Long night sleep duration (>9 h) was associated with higher HbA1c, FPG, PPG, and TG levels compared with sleep duration of 6-9 h (P < 0.01 for all) in the IGR + diabetes group, but not in the NGR group. This association was adjusted for potential confounders, including body mass index and depressive symptoms, and remained significant even after adjusting for snoring. A significant interaction between sleep duration and TG or snoring was observed for HbA1c levels, which attenuated the sleep-HbA1c association in the IGR + diabetes group. However, no significant association was observed between short night sleep duration and HbA1c levels. CONCLUSIONS Long night sleep duration is associated with higher HbA1c, FPG, PPG, and TG levels in IGR and diabetes patients, independent of potential confounders. This may be important in clinical management of IGR and diabetes patients.
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Affiliation(s)
- Yu Zheng
- Department of Endocrinology, Chinese PLA General Hospital, Beijing, China; School of Medicine, Nankai University, Tianjin, China
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Briançon-Marjollet A, Weiszenstein M, Henri M, Thomas A, Godin-Ribuot D, Polak J. The impact of sleep disorders on glucose metabolism: endocrine and molecular mechanisms. Diabetol Metab Syndr 2015; 7:25. [PMID: 25834642 PMCID: PMC4381534 DOI: 10.1186/s13098-015-0018-3] [Citation(s) in RCA: 161] [Impact Index Per Article: 16.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2014] [Accepted: 03/05/2015] [Indexed: 12/11/2022] Open
Abstract
Modern lifestyle has profoundly modified human sleep habits. Sleep duration has shortened over recent decades from 8 to 6.5 hours resulting in chronic sleep deprivation. Additionally, irregular sleep, shift work and travelling across time zones lead to disruption of circadian rhythms and asynchrony between the master hypothalamic clock and pacemakers in peripheral tissues. Furthermore, obstructive sleep apnea syndrome (OSA), which affects 4 - 15% of the population, is not only characterized by impaired sleep architecture but also by repetitive hemoglobin desaturations during sleep. Epidemiological studies have identified impaired sleep as an independent risk factor for all cause of-, as well as for cardiovascular, mortality/morbidity. More recently, sleep abnormalities were causally linked to impairments in glucose homeostasis, metabolic syndrome and Type 2 Diabetes Mellitus (T2DM). This review summarized current knowledge on the metabolic alterations associated with the most prevalent sleep disturbances, i.e. short sleep duration, shift work and OSA. We have focused on various endocrine and molecular mechanisms underlying the associations between inadequate sleep quality, quantity and timing with impaired glucose tolerance, insulin resistance and pancreatic β-cell dysfunction. Of these mechanisms, the role of the hypothalamic-pituitary-adrenal axis, circadian pacemakers in peripheral tissues, adipose tissue metabolism, sympathetic nervous system activation, oxidative stress and whole-body inflammation are discussed. Additionally, the impact of intermittent hypoxia and sleep fragmentation (key components of OSA) on intracellular signaling and metabolism in muscle, liver, fat and pancreas are also examined. In summary, this review provides endocrine and molecular explanations for the associations between common sleep disturbances and the pathogenesis of T2DM.
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Affiliation(s)
- Anne Briançon-Marjollet
- />Université Grenoble Alpes, HP2, F-38041 Grenoble, Cedex France
- />INSERM U1042, F-38041 Grenoble, Cedex France
| | - Martin Weiszenstein
- />Centre for Research on Diabetes, Metabolism and Nutrition, Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Marion Henri
- />Université Grenoble Alpes, HP2, F-38041 Grenoble, Cedex France
- />INSERM U1042, F-38041 Grenoble, Cedex France
| | - Amandine Thomas
- />Université Grenoble Alpes, HP2, F-38041 Grenoble, Cedex France
- />INSERM U1042, F-38041 Grenoble, Cedex France
| | - Diane Godin-Ribuot
- />Université Grenoble Alpes, HP2, F-38041 Grenoble, Cedex France
- />INSERM U1042, F-38041 Grenoble, Cedex France
| | - Jan Polak
- />Centre for Research on Diabetes, Metabolism and Nutrition, Third Faculty of Medicine, Charles University, Prague, Czech Republic
- />2nd Internal Medicine Department, University Hospital Kralovske Vinohrady, Prague, Czech Republic
- />Sports Medicine Department, Third Faculty of Medicine, Charles University in Prague, Ruska 87, Praha 10, 100 00 Czech Republic
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Kubota Y, Iso H, Ikehara S, Tamakoshi A. Relationship between sleep duration and cause-specific mortality in diabetic men and women based on self-reports. Sleep Biol Rhythms 2014. [DOI: 10.1111/sbr.12091] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Yasuhiko Kubota
- Public Health; Department of Social and Environmental Medicine; Osaka University Graduate School of Medicine; Osaka Japan
| | - Hiroyasu Iso
- Public Health; Department of Social and Environmental Medicine; Osaka University Graduate School of Medicine; Osaka Japan
| | - Satoyo Ikehara
- Public Health; Department of Social and Environmental Medicine; Osaka University Graduate School of Medicine; Osaka Japan
| | - Akiko Tamakoshi
- Department of Public Health; Hokkaido University Graduate School of Medicine; Hokkaido Japan
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Cooper AJM, Westgate K, Brage S, Prevost AT, Griffin SJ, Simmons RK. Sleep duration and cardiometabolic risk factors among individuals with type 2 diabetes. Sleep Med 2014; 16:119-25. [PMID: 25439076 DOI: 10.1016/j.sleep.2014.10.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2014] [Accepted: 10/15/2014] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To examine the association between sleep duration and cardiometabolic risk factors among individuals with recently diagnosed type 2 diabetes (n = 391). METHODS Sleep duration was derived using a combination of questionnaire and objective heart rate and movement sensing in the UK ADDITION-Plus study (2002-2007). Adjusted means were estimated for individual cardiometabolic risk factors and clustered cardiometabolic risk (CCMR) by five categories of sleep duration. RESULTS We observed a J-shaped association between sleep duration and CCMR - individuals sleeping 7 to <8 h had a significantly better CCMR profile than those sleeping ≥9 h. Independent of physical activity and sedentary time, individuals sleeping 7 to <8 h had lower triacylglycerol (0.62 mmol/l (0.29, 1.06)) and higher high-density lipoprotein (HDL)-cholesterol levels (0.23 mmol/l (0.16, 0.30)) compared with those sleeping ≥9 h, and a lower waist circumference (7.87 cm (6.06, 9.68)) and body mass index (BMI) (3.47 kg/m(2) (2.69, 4.25)) than those sleeping <6 h. Although sleeping 7 to <8 h was associated with lower levels of systolic and diastolic blood pressure, HbA1c, total cholesterol, and low-density lipoprotein (LDL)-cholesterol, these associations were not statistically significant. CONCLUSIONS Sleep duration has a J-shaped association with CCMR in individuals with diabetes, independent of potential confounding. Health promotion interventions might highlight the importance of adequate sleep in this high-risk population.
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Affiliation(s)
- Andrew J M Cooper
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Institute of Metabolic Science, Cambridge Biomedical Campus, Cambridge, CB2 0QQ, UK.
| | - Kate Westgate
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Institute of Metabolic Science, Cambridge Biomedical Campus, Cambridge, CB2 0QQ, UK
| | - Søren Brage
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Institute of Metabolic Science, Cambridge Biomedical Campus, Cambridge, CB2 0QQ, UK
| | - A Toby Prevost
- Department of Primary Care and Public Health Science, King's College London, London, SE1 3QD, UK
| | - Simon J Griffin
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Institute of Metabolic Science, Cambridge Biomedical Campus, Cambridge, CB2 0QQ, UK; The Primary Care Unit, Institute of Public Health, University of Cambridge, Cambridge, UK
| | - Rebecca K Simmons
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Institute of Metabolic Science, Cambridge Biomedical Campus, Cambridge, CB2 0QQ, UK
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Zhu BQ, Li XM, Wang D, Yu XF. Sleep quality and its impact on glycaemic control in patients with type 2 diabetes mellitus. Int J Nurs Sci 2014. [DOI: 10.1016/j.ijnss.2014.05.020] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Reutrakul S, Van Cauter E. Interactions between sleep, circadian function, and glucose metabolism: implications for risk and severity of diabetes. Ann N Y Acad Sci 2014; 1311:151-73. [PMID: 24628249 DOI: 10.1111/nyas.12355] [Citation(s) in RCA: 216] [Impact Index Per Article: 19.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Sleep disturbances, including sleep insufficiency and sleep fragmentation, have been linked to abnormal glucose metabolism and increased diabetes risk. Well-controlled laboratory studies have provided insights regarding the underlying mechanisms. Several large prospective studies suggest that these sleep disturbances are associated with an increased risk of incident diabetes. Obstructive sleep apnea, which combines sleep fragmentation and hypoxemia, is a major risk factor for insulin resistance and possibly diabetes. Whether glycemic control in type 2 diabetes patients can be improved by treating sleep apnea remains controversial. Recently, sleep disturbances during pregnancy and their relationship to gestational diabetes and hyperglycemia have received considerable attention owing to potential adverse effects on maternal and fetal health. Additionally, evidence from animal models has identified disruption of the circadian system as a putative risk factor for adverse metabolic outcomes. The purpose of this review is to provide an update on the current state of knowledge linking sleep disturbances, circadian dysfunction, and glucose metabolism. Experimental, prospective, and interventional studies are discussed.
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Affiliation(s)
- Sirimon Reutrakul
- Division of Endocrinology and Metabolism, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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