Association between Poor Glycemic Control, Impaired Sleep Quality, and Increased Arterial Thickening in Type 2 Diabetic Patients

Abstract

ObjectivePoor sleep quality is an independent predictor of cardiovascular events. However, little is known about the association between glycemic control and objective sleep architecture and its influence on arteriosclerosis in patients with type-2 diabetes mellitus (DM). The present study examined the association of objective sleep architecture with both glycemic control and arteriosclerosis in type-2 DM patients.DesignCross-sectional study in vascular laboratory.MethodsThe subjects were 63 type-2 DM inpatients (M/F, 32/31; age, 57.5±13.1) without taking any sleeping promoting drug and chronic kidney disease. We examined objective sleep architecture by single-channel electroencephalography and arteriosclerosis by carotid-artery intima-media thickness (CA-IMT).ResultsHbA1c was associated significantly in a negative manner with REM sleep latency (interval between sleep-onset and the first REM period) (β=-0.280, p=0.033), but not with other measurements of sleep quality. REM sleep latency associated significantly in a positive manner with log delta power (the marker of deep sleep) during that period (β=0.544, p=0.001). In the model including variables univariately correlated with CA-IMT (REM sleep latency, age, DM duration, systolic blood pressure, and HbA1c) as independent variables, REM sleep latency (β=-0.232, p=0.038), but not HbA1c were significantly associated with CA-IMT. When log delta power was included in place of REM sleep latency, log delta power (β=-0.257, p=0.023) emerged as a significant factor associated with CA-IMT.ConclusionsIn type-2 DM patients, poor glycemic control was independently associated with poor quality of sleep as represented by decrease of REM sleep latency which might be responsible for increased CA-IMT, a relevant marker for arterial wall thickening.

The relationship between sleep disturbance and glycaemic control in adults with type 2 diabetes: An integrative review

“…In the eight studies that examined the linear relationship between sleep duration and glycaemic control, six did not find a significant association. HbA1c or fasting glucose was not related to sleep duration measured by objective EEG (Yoda et al., ), actigraphy (Knutson et al., ; Kwan, ; Trento et al., ), or self‐reported questionnaire (Cho et al., ; Giacinto, ). Only in two studies was the relationship between sleep duration and HbA1c significant.…”

“…Sleep quality has been objectively measured by EEG, polysomnography (PSG) or actigraphy. Objective sleep latency ( r = −.342 to −.292, p < .05) (Yoda et al., ) and sleep efficiency ( r = −.29, p = .047) (Trento et al., ) was negatively correlated with glycaemic control. Greater sleep fragmentation was associated with higher fasting glucose (β = .089, p < .05) (Knutson et al., ) and HbA1c ( r = .31, p = .031) (Trento et al., ).…”

“…Additionally, the discrepancy between subjective and objective measures of sleep disturbance might account for the inconsistency between study findings. When sleep quality was objectively measured (Jennum et al., ; Knutson et al., ; Trento et al., ; Yoda et al., ), poor sleep quality was associated with poor glycaemic control. In contrast, subjectively measured sleep quality was not related to glycaemic control in several studies (Cho et al., ; Nefs et al., ; Rajendran et al., ; Reutrakul et al., ; Yagi et al., ).…”

Subjective sleep disturbances and glycemic control in adults with long-standing type 1 diabetes: The Pittsburgh’s Epidemiology of Diabetes Complications study

“…We used the standard cut-off point to define poor sleep quality (PSQI global score >5). As a proxy for disturbed rapid eye movement (REM) sleep, which has been linked to poor glycemic control in individuals with T1D [24] and type 2 diabetes [31], we defined the presence of bad dreams (any versus none) by utilizing the following PSQI item: “During the past month, how often have you had trouble sleeping because you had bad dreams?” Sleep duration in hours was quantified from PSQI, where participants reported self-perceived duration of actual sleep per night. We also categorized sleep duration by tertiles and by the National Sleep Foundation’s (NSF) [32] adult sleep guidelines (<7 hours=short sleep, 7–9 hours=normal sleep, and >9 hours=long sleep).…”

Relationship between Lifestyle, Quality of Sleep, and Daytime Drowsiness of Nursing Students of University A

“…Moreover, many patients with Type 2 diabetes have insomnia [13]. Analyzing the quality of sleep of hospitalized patients with Type 2 diabetes using electroencephalograph [14], has indicated that if HbA1c increased or worsened, poor glycemic control was independently associated with poor quality of sleep as represented by decrease of REM sleep latency.…”