title: The relationship between serum asymmetric dimethylarginine levels and subjective sleep quality in normotensive patients with type 2 diabetes mellitus.
abstract: OBJECTIVE
  Poor sleep quality (SQ) is associated with increased cardiovascular mortality and morbidity. Additionally, asymmetric dimethylarginine (ADMA) is an independent predictor of cardiovascular mortality and morbidity. However, no sufficient data regarding the relationship between ADMA levels and SQ have been reported. The goal of the current study was to evaluate the association between SQ and ADMA levels in normotensive patients with type 2 diabetes mellitus.
  
  
  METHODS
  The study participants consisted of 78 normotensive type 2 diabetics. The SQ of all participants was assessed using the Pittsburgh Sleep Quality Index (PSQI). Patients with a global PSQI score > 5 were defined as "poor sleepers." Factors associated with poor SQ were analyzed using a multiple regression model. Serum ADMA levels were measured using high performance liquid chromatography.
  
  
  RESULTS
  The median ADMA levels of the poor sleepers were increased compared with patients defined as good sleepers (5.5 [4.2 to 6.6] vs. 4.4 [2.9 to 5.4], p < 0.01, respectively). However, the L-arginine/ADMA ratio was decreased in poor sleepers (p < 0.01). Global PSQI scores were positively correlated with ADMA levels (p < 0.01) and negatively correlated with the L-arginine/ADMA ratio (p = 0.02). ADMA levels were correlated with sleep latency (p < 0.01) and sleep efficiency (p = 0.01). Logistic regression analysis showed that ADMA levels (odds ratio [OR], 1.68; 95% confidence interval [CI], 1.16 to 2.44; p = 0.01) and body mass index (OR, 1.15; 95% CI, 1.01 to 1.31; p = 0.04) were associated with poor SQ independently of glomerular filtration rate, sex, age, duration of diabetes, hemoglobin A1c, total cholesterol, and systolic blood pressure.
  
  
  CONCLUSIONS
  Self-reported SQ was independently associated with ADMA levels in normotensive patients with diabetes mellitus.
authors.affiliation: Department of Cardiology, Meram School of Medicine Hospital, Necmettin Erbakan University, Konya, Turkey.
authors.forename: Alpay
authors.initials: A
authors.lastname: Aribas
authors.affiliation: Department of Cardiology, Meram School of Medicine Hospital, Necmettin Erbakan University, Konya, Turkey.
authors.forename: Mehmet
authors.initials: M
authors.lastname: Kayrak
authors.affiliation: Cardiology Clinic, Kahramanmaras Necip Fazil City Hospital, Kahramanmaras, Turkey.
authors.forename: Mehmet
authors.initials: M
authors.lastname: Tekinalp
authors.affiliation: Department of Cardiology, Meram School of Medicine Hospital, Necmettin Erbakan University, Konya, Turkey.
authors.forename: Hakan
authors.initials: H
authors.lastname: Akilli
authors.affiliation: Cardiology Clinic, Lokman Hekim Van Hospital, Van, Turkey.
authors.forename: Hayrudin
authors.initials: H
authors.lastname: Alibasic
authors.affiliation: Department of Cardiology, Meram School of Medicine Hospital, Necmettin Erbakan University, Konya, Turkey.
authors.forename: Serkan
authors.initials: S
authors.lastname: Yildirim
authors.affiliation: Department of Cardiology, Ercis Government Hospital, Van, Turkey.
authors.forename: Mehmet
authors.initials: M
authors.lastname: Gunduz
authors.affiliation: Department of Biochemistry, Dr Faruk Sükan Maternity and Children's Hospital, Konya, Turkey.
authors.forename: Alpaslan
authors.initials: A
authors.lastname: Taner
authors.affiliation: Department of Biochemistry, Selcuk University School of Medicine, Konya, Turkey.
authors.forename: Ali
authors.initials: A
authors.lastname: Unlu
mesh_terms: D000328:Adult; D001120:Arginine / Q000031:analogs & derivatives* / Q000097:blood; D015415:Biomarkers / Q000097:blood; D002318:Cardiovascular Diseases / Q000097:blood / Q000209:etiology* / Q000503:physiopathology; D016009:Chi-Square Distribution; D002851:Chromatography, High Pressure Liquid; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D012307:Risk Factors; D012890:Sleep; D012893:Sleep Wake Disorders / Q000097:blood / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology; D011795:Surveys and Questionnaires
chemical_list: D015415:Biomarkers; C018524:N,N-dimethylarginine; D001120:Arginine
keywords: Asymmetric dimethylarginine; Diabetes mellitus; N,N-dimethylarginine; Sleep quality