Abnormal sleep patterns in subjects with type II diabetes mellitus and its effect on diabetic microangiopathies: Sankara Nethralaya Diabetic Retinopathy Epidemiology and Molecular Genetic Study (SN-DREAMS, report 20)

Abstract

To study the prevalence of Abnormal Sleep Patterns (ASPs), gender-wise, in subjects with type II diabetes mellitus and its influence on diabetic microangiopathies. A population-based cross-sectional survey was conducted among 1,414 patients having type II diabetes mellitus. Diabetic retinopathy was graded using stereoscopic digital fundus photography. Neuropathy was assessed by measuring vibration perception threshold using a sensitometer. Nephropathy was diagnosed by the presence of microalbuminuria in the first morning urine sample. ASPs were defined as either short (less than 5 h) or long (more than 9 h) duration of sleep with excessive daytime sleepiness. The Epworth Sleepiness Scale (ESS) score was assessed to note excessive daytime sleepiness; a score of more than 10 was considered as abnormal. The prevalence of ASPs was more in subjects with diabetes than with those without diabetes (14.8 vs. 6.6%) (P = 0.009), especially in women (15.7 vs. 5.6%) (P = 0.021). Likewise, the prevalence of short duration of sleep was higher in subjects with diabetes compared to those without diabetes (6.6 vs. 2.2%) (P = 0.040). The mean age of women subjects with diabetes, having ASPs, was higher than those without diabetes (56.4 ± 8.9 years vs. 47.2 ± 5.9 years, P = 0.033). Women subjects with ASPs had a higher risk of diabetic neuropathy on both univariate and multivariate analysis. ASPs are not only related to diabetes but can also influence the microvascular complications arising due to diabetes, particularly diabetic neuropathy. Diabetology and sleep medicine specialists need to work together to prevent the negative interactions between these two groups.

The associations of objectively measured sleep duration and sleep disturbances with diabetic retinopathy

“…A high risk of insomnia was also associated with DME. Previous studies that have investigated the associations between sleep duration and DR were based on self-reported questionnaires ( Table 5) [9][10][11][12]. We were able to objectively confirm the association of short sleep duration with increased prevalence of moderate DR.…”

“…To this end, sleep and sleep disturbances such as obstructive sleep apnea (OSA) have recently surfaced as a potential modifiable risk factor for DR. While OSA has been relatively more established as a risk factor for DR [6][7][8], evidence on associations between sleep duration and DR have been lacking and inconsistent [9][10][11][12]. Furthermore, these four studies were based on self-reported sleep duration that is subject to recall bias.…”

Differences in the daily activity of patients with diabetic foot ulcers compared to controls in their free‐living environments

“…Last, our study found no differences for daily sleep duration or quality. This was in contrast to a previous study that found lower daily sleep duration and quality in DPN patients (12). Yet, unlike this previous study (12), we excluded patients with painful DPN (i.e.…”

“…• we suggest that this novel finding may be explained by an inefficient gait strategy or wound-healing requirements in DFU patients resulting in increased daily energy expenditure even though DFU patients performed less daily walking activity Those studies reporting low daily activity in the free-living environments of patients with DPN have mainly measured daily steps as their daily activity outcome of interest (3,4,7,8). However, laboratory-based studies that have measured other daily activity outcomes in laboratory-controlled environments have reported contrasting findings (8,(10)(11)(12)(13)(14). Some of the laboratory-based studies report patients with DPN have a low ability to perform short tasks representative of typical daily activity (10)(11)(12), whereas others report that patients with DPN have high standing durations (13) and high energy expenditure when performing other short tasks representative of typical daily activity (8,14).…”

Association of diabetic vascular complications with poor sleep complaints

“…Some literatures reported that sleep disturbances or obstructive sleep apnea is one of the risk factors causing CVD [9–11]. One study demonstrated that abnormal sleep patterns could influence the diabetic microvascular complications, in particular diabetic neuropathy [12]. Another study described a novel independent association between diabetic peripheral neuropathy and obstructive sleep apnea (OSA) [13].…”