Abstract
Type 2 diabetes (T2D) is an independent risk factor for sleep breathing disorders. However, it is unknown whether T2D affects daily somnolence and quality of sleep independently of the impairment of polysomnographic parameters.Material and MethodsA case-control study including 413 patients with T2D and 413 non-diabetic subjects, matched by age, gender, BMI, and waist and neck circumferences. A polysomnography was performed and daytime sleepiness was evaluated using the Epworth Sleepiness Scale (ESS). In addition, 135 subjects with T2D and 45 controls matched by the same previous parameters were also evaluated through the Pittsburgh Sleep Quality Index (PSQI) to calculate sleep quality.ResultsDaytime sleepiness was higher in T2D than in control subjects (p = 0.003), with 23.9% of subjects presenting an excessive daytime sleepiness (ESS>10). Patients with fasting plasma glucose (FPG ≥13.1 mmol/l) were identified as the group with a higher risk associated with an ESS>10 (OR 3.9, 95% CI 1.8–7.9, p = 0.0003). A stepwise regression analyses showed that the presence of T2D, baseline glucose levels and gender but not polysomnographic parameters (i.e apnea-hyoapnea index or sleeping time spent with oxigen saturation lower than 90%) independently predicted the ESS score. In addition, subjects with T2D showed higher sleep disturbances [PSQI: 7.0 (1.0–18.0) vs. 4 (0.0–12.0), p<0.001].ConclusionThe presence of T2D and high levels of FPG are independent risk factors for daytime sleepiness and adversely affect sleep quality. Prospective studies addressed to demonstrate whether glycemia optimization could improve the sleep quality in T2D patients seem warranted.
Highlights
The well-known negative impact of sleep breathing disorders on glucose metabolism has switched to a bidirectional relationship during the last decade, in which type 2 diabetes (T2D) has appeared to be an independent risk factor for both nocturnal intermittent hypoxia and sleep fragmentation [1, 2]
Daytime sleepiness was higher in T2D than in control subjects (p = 0.003), with 23.9% of subjects presenting an excessive daytime sleepiness (ESS>10)
Patients with fasting plasma glucose (FPG 13.1 mmol/l) were identified as the group with a higher risk associated with an Epworth Sleepiness Scale (ESS)>10
Summary
The well-known negative impact of sleep breathing disorders on glucose metabolism has switched to a bidirectional relationship during the last decade, in which type 2 diabetes (T2D) has appeared to be an independent risk factor for both nocturnal intermittent hypoxia and sleep fragmentation [1, 2]. In this regard, the sleeping time spent with oxygen saturation lower than 90% (CT90) is three-fold higher among obese subjects with T2D in comparison with control subjects. Formal sleep studies in Sleep Units are time consuming and not economically viable for testing entire populations
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