Interaction of sleep quality and sleep duration on glycemic control in patients with type 2 diabetes mellitus

Abstract

Background Copious evidence from epidemiological and laboratory studies has revealed that sleep status is associated with glucose intolerance, insulin resistance, thus increasing the risk of developing type 2 diabetes. The aim of this study was to reveal the interaction of sleep quality and sleep quantity on glycemic control in patients with type 2 diabetes mellitus. Methods From May 2013 to May 2014, a total of 551 type 2 diabetes patients in Tianjin Metabolic Diseases Hospital were enrolled. Blood samples were taken to measure glycosylated hemoglobin (HbA1c), and all the patients completed the Chinese version of the Pittsburgh Sleep Quality Index (PSQI) questionnaire to evaluate their sleep status. “Good sleep quality” was defined as PQSI <5, “average sleep quality” was defined as PQSI 6–8, and “poor sleep quality” was defined as PQSI >8. Poor glycemic control was defined as HbA1c ≥7%. Sleep quantity was categorized as <6, 6–8, and >8 hours/night. Short sleep time was defined as sleep duration <6 hours/night. Results In the poor glycemic control group, the rate of patients who had insufficient sleep was much higher than that in the other group (χ2=11.16, P=0.037). The rate of poor sleep quality in poor glycemic control group was much greater than that in the average control group (χ2=9.79, P=0.007). After adjusted by gender, age, body mass index, and disease duration, the adjusted PSQI score's OR was 1.048 (95% CI 1.007–1.092, P=0.023) for HbA1c level. The sleep duration's OR was 0.464 (95% CI 0.236–0.912, P=0.026) for HbA1c level. One-way analysis of variance showed that the poor sleep quality group had the highest homeostasis model assessment-insulin resistance (P <0.01). Conclusions Inadequate sleep, in both quality and quantity, should be regarded as a plausible risk factor for glycemic control in type 2 diabetes. Poor sleep might bring much more serious insulin resistance and could be the reason for bad glycemic control. A good night's sleep should be seen as a critical health component tool in the prevention and treatment of type 2 diabetes. It is important for clinicians to target the root causes of short sleep duration and/or poor sleep quality.