Daytime sleepiness in patients with type 2 Diabetes Mellitus – a prospective cohort study

Abstract

Introduction: Daytime sleepiness is an independent factor for increased health care utilization and all cause mortality. Diabetic patients are more likely to be sleepy during the daytime than non-diabetics. Objectives:To examine factors influencing the evolution of daytime sleepiness in patients with type 2 diabetes (T2D) in a two-year followup study.Methods: Patients (N=145) aged from 40 to 60 of both genders were consecutively recruited and evaluated for comorbidity severity (Charlson Comorbidity Index), depressive symptoms (Beck Depression Inventory, BDI II), sleep quality (Pittsburgh Sleep Quality Index) and physical activity levels (International Physical Activity Questionnaire, IPAQ). Daytime sleepiness was assessed by the Epworth Sleepiness Scale (ESS).Results: Excessive daytime sleepiness (ESS>10) was found in 51 (35.2%) patients. At baseline, men had more excessive daytime sleepiness; however, women evolved with more sleepiness after two years. Levels of physical activity were independently associated with excessive daytime sleepiness: patients with a sedentary lifestyle developed worse levels of daytime sleepiness after two years. Active lifestyle was more beneficial for reducing daytime sleepiness in women. In this study, among all patients, levels of physical activity (IPAQ) improved after two years. Conclusion:Excessive daytime sleepiness affects approximately 1/3 of T2D patients and women evolve with more sleepiness. Better levels of physical activity are independently associated with less daytime sleepiness. Implementing physical exercise possibly break a chain involving sleep-wake alterations and comorbidites in T2D. Gender differences show that these effects are more important for women. IntroductionDaytime sleepiness is a major public health issue and is an independent factor for increased health care utilization and all cause mortality [1][2][3] . Previous studies suggest that diabetic patients are more likely to be sleepy during the daytime than non-diabetics [4][5][6] Patients with type 2 diabetes (T2D) commonly present with sleep abnormalities e.g. restless legs syndrome [7], obstructive sleep apnea [8], circadian alterations [9] and nervous system abnormalities [10,11]. Given these evidences, daytime sleepiness in diabetic patients are probably of multifactorial origin.Obesity and obstructive sleep apnea (OSA) cooccur frequently with T2D [12,13]. Furthermore, short sleep duration increases the risk for the development of obesity [14] and is associated with increased incidence of T2D [15]. Importantly, poor sleep quality affects more than half of patients with T2D and relates to depressive symptoms [16]. Arterial hypertension, cerebrovascular events, anxiety, depression, cognitive alterations and dementia are other comorbidities frequent in T2D that potentially influence daytime sleepiness [4,[17][18][19]. All this evidence demonstrate that these comorbid conditions are multilaterally related.In T2D, sedentary life contributes to worse anthropometric measures, worse quality of lif...

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“…The study by Cass et al (2013) revealed that 64.5% of type 2 diabetes patients with high risk of OSA had excessive daytime sleepiness. A prospective cohort study of type 2 diabetes patients found the prevalence of excessive daytime sleepiness to be 35% (Vasconcelos et al 2016), while in another study conducted on patients with type 1 and type 2 diabetes, the prevalence of excessive daytime sleepiness was 20.7% in the group with OSA (Vale et al 2015).…”

Effectiveness of Mediterranean Diet on Daytime Sleepiness among Individuals with Type 2 Diabetes Mellitus in Oman

“…Daytime sleepiness was prevalent in this study cohort, which is in accordance with the results of other studies. 34 35 On the other hand, there was a high proportion of participants who dozed when they were sitting, reading, watching TV, or lying down to rest in the afternoon when circumstances permitted. Previous studies have consistently reported that sleep disorders are not only a risk factor for the onset of diabetes but also have a great impact on individuals with T2DM.…”