Sleep in diabetic patients: a focus on acute and chronic complications of diabetes mellitus affecting sleep

Abstract

In diabetes mellitus adherence to dietary measures is a cornerstone of therapy. Incompliance can favour acute or chronic complications impacting on the sleep of diabetic patients. Nocturnal hypoglycaemia is the most important acute complication affecting sleep, although it does not necessarily awake the patient. Effects of hypoglycaemia on sleep architecture and sleep quality are reported. Nycturia is one symptom of chronic hyperglycaemia obviously able to disturb sleep. It also occurs as a symptom of heart failure and its diuretic therapy, also a chronic complication of diabetes. Diabetic neuropathy is a further chronic complication with high prevalence in diabetic patients. It affects sleep in its manifestation as painful peripheral neuropathy. Mechanisms not completely understood associate diabetic neuropathy with central sleep apnoea, with the obstructive sleep apnoea syndrome and the restless legs syndrome, all impairing sleep architecture and sleep quality. Depression and diabetes promote each other via several mechanisms. Depression disturbs the circadian rhythm and sleep. Frequently used medications of diabetic patients such as antihypertensive or lipid-lowering drugs can also interfere with sleep.