FRI636 Sleep Architecture In Diabetic Patients With Sleep Apnea On Metformin

Abstract

Abstract Disclosure: M. Varma: None. M. Eghbali: None. D. Hung: None. A. Sahai: None. Background: Metformin, commonly used medication to treat Type II Diabetes Mellitus (DM) improves insulin sensitivity, reduces glucose production in liver and absorption by intestines. Type II DM patients often have higher BMI with increased incidence of sleep apnea. Metformin consuming patients sometimes report insomnia. Blood glucose levels affect sleep duration; therefore Metformin-related changes in blood glucose levels may affect sleep. Metformin prescriptions grew from 40 million in 2004 to 90 million in 2020. This has improved long term vascular complications outcomes in diabetics. Coincidentally the number of patients using sleeping aids has increased. Melatonin sales have doubled since 2004, approximating 821 million USD in sales in 2020. With diabetes and Metformin each causing significant changes in sleep, we aimed to examine sleep architecture in known diabetic patients on Metformin presenting with excessive daytime sleepiness and fatigue. Hypothesis: We hypothesize that Metformin affects sleep and influences sleep architecture in diabetic patients. Methods: Sleep architecture in 29 Type II DM patients taking Metformin, with symptoms of excessive daytime sleepiness, snoring, and fatigue was examined. Patients underwent overnight polysomnography which included six channel EEG, Electrooculogram, Electromyogram EKG, and pulse oximetry, respiratory and flow monitoring in a sleep lab. Sleep staging done using AASM guidelines. Data on age, gender, BMI, medications and sleep stages N1, N2, N3 and REM was collected. Data analyzed and shown as mean + SD, t test p<0.05 significant. Results: All patients had OSA diagnoses per AASM guidelines. The average age of patients with DM and OSA on Metformin therapy was 63 years, average BMI was 36. AASM stage distribution was N1 2.69 % + 0.02, N2 59.31% + 0.15, N3 12.22 % + 0.09, (Normal 25%) with 5.71% +0.06 REM sleep (normal 25%). All stages of sleep were reduced with significant reduction in deep sleep (N3) and REM sleep. Conclusion: Diabetic patients on Metformin had alterations in sleep architecture with significantly reduced restorative phases of deep and REM sleep. Sleep apnea reduces N3 and REM sleep, but diabetic pts had a more significant decrease. Although Metformin improves long term outcomes in diabetes associated complications, it alters sleep patterns. Altered sleep patterns further modify insulin release and over prolonged periods worsen glycemic control. Often patients on Metformin need additional medication like insulin for metabolic control. In part the progression of insulin resistance can be from altered sleep. Better understanding the effects of Metformin on sleep is needed to prevent long-term deteriorating effects on sleep while maintaining effective metabolic control. Presentation: Friday, June 16, 2023