Abstract
Aims: To investigate the impact of thinning at individual grids of macular neuroretinal layers, clinical factors, and inadequate light exposure on the specific components of sleep disorder in patients with type 2 diabetes.Methods: One hundred twenty-four patients with type 2 diabetes without clinical evidences of diabetic retinopathy and neuropathy (HbA1c: 8.3%, diabetes duration; 8.7 years) and 54 age- and sex-matched control subjects (HbA1c: 5.6%) underwent detailed clinical, neurological, and ophthalmological examinations. The sleep disorder was assessed by the Pittsburgh Sleep Quality Index Japanese Version (PSQI-J). The temporal structures of daily life were assessed by the Munich Chronotype Questionnaire Japanese Version. The thickness at nine grids defined by the Early Treatment Diabetic Retinopathy Study of nine macular neuroretinal layers was determined by swept-source optical coherence tomography and OCT-Explorer. The associations between the individual components of sleep disorders and the thickness at each grid of macular neuroretinal layers, clinical factors, or the temporal structures of daily life were examined.Results: The prevalence of the sleep disorder, global score, and four individual PSQI-J scores in patients with type 2 diabetes were higher than control subjects. The thickness of two and five grids of two inner retinal layers and four to seven grids of four outer retinal layers in patients with type 2 diabetes was thinner than those in control subjects. The thickness at one to eight grids of four outer retinal layers in type 2 diabetic patients was inversely associated with global score and five individual scores of sleep disorder. The thinning at one to two grids of the inner plexiform layer was related to three high individual scores of sleep disorder. The inappropriate light exposure was associated with the sleep disorder and altered macular neuroretinal layers. The high HbA1c and LDL-cholesterol levels were related to the high global score and two individual scores of sleep disorder, respectively.Conclusion: In patients with type 2 diabetes, the thinning at grids of the inner plexiform layer and outer retinal layers was associated with the high scores of specific components of the sleep disorder. The sleep disorder was also related to hyperglycemia, dyslipidemia, and inappropriate light exposure.
Highlights
Sleep is essential for health, and people with diabetes are frequently beset with sleep disturbances
Sleep disorder is more prevalent in patients with diabetes than people without diabetes [1]
In order to exclude the potential impact of diabetic neuropathy on sleep disorder and the thickness of the macular neuroretinal layers, 17 patients with confirmed diabetic neuropathy defined by Toronto criteria were excluded, and further analyses were performed using 124 patients without diabetic neuropathy
Summary
Sleep is essential for health, and people with diabetes are frequently beset with sleep disturbances. According to the American Psychiatric Association, sleep disorder involves problems with the quality, timing, and amount of sleep, which cause problems with functioning and distress during the daytime. The concept of sleep disorder in people with diabetes has not been clearly defined and investigated. Sleep disorder is more prevalent in patients with diabetes than people without diabetes [1]. Sleep disorder increases the risk of insomnia, hyperglycemia, cardiovascular disease, and cancer [2, 3]. In the treatment of diabetes, less attention had been paid to sleep disorder than diet restriction and exercise
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