title: Various patterns of disrupted daily rest-activity rhythmicity associated with diabetes.
abstract: Disruptions to sleep and circadian rhythms have now been recognized as common comorbidities in patients with medical illnesses. We aimed to determine if the diurnal rhythms for rest and activity were disrupted in parallel with the development of diabetic complications. Ninety outpatients in our diabetes clinic who had a body mass index <25 kg m(2) wore an actigraph for 7 consecutive days (42 men; mean age 68.7 ± 8.2 years). Patients with neuropsychiatric diseases, liver cirrhosis, renal failure, chronic obstructive pulmonary disease or blindness, or those who performed shiftwork were excluded. We grouped the actigraph recordings into 1-h periods and counted the number of minutes that showed activity. Stepwise regression analysis showed an association between a diabetic clinical background and measurements of circadian rhythms such as daytime activity, night-time activity, phase, interdaily stability, intradaily variability and relative amplitude. Higher age, body mass index, total cholesterol levels and insulin usage were associated with lower daytime activity and higher intradaily variability, whereas higher haemoglobin A1c levels and the presence of neuropathy were associated with greater daytime activity. The presence of proliferative retinopathy and increased levels of microalbuminuria were associated with higher intradaily variability and lower interdaily stability and amplitude. The presence of cardiovascular disease was associated with advanced phase, whereas painful neuropathy was associated with delayed phase. Our study demonstrated that different diabetic complications were associated independently with a variety of alterations in the circadian rest and activity rhythms. Our findings have provided novel insights that may be helpful in developing interventions for sleep-wake disorders associated with diabetes.
authors: Division of Metabolism, Nephrology and Rheumatology, Japanese Red Cross Kyoto Daini Hospital, Kyoto, Japan.|Department of Endocrinology and Metabolism, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan.
authors: Mayuko
authors: M
authors: Kadono
authors: Department of Endocrinology and Metabolism, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan.
authors: Naoko
authors: N
authors: Nakanishi
authors: Department of Endocrinology and Metabolism, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan.
authors: Masahiro
authors: M
authors: Yamazaki
authors: Division of Metabolism, Nephrology and Rheumatology, Japanese Red Cross Kyoto Daini Hospital, Kyoto, Japan.
authors: Goji
authors: G
authors: Hasegawa
authors: Division of Diabetes, Saiseikai Kyoto Hospital, Kyoto, Japan.
authors: Naoto
authors: N
authors: Nakamura
authors: Department of Endocrinology and Metabolism, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan.
authors: Michiaki
authors: M
authors: Fukui
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D000375:Aging; D000419:Albuminuria / Q000150:complications; D015992:Body Mass Index; D002318:Cardiovascular Diseases / Q000150:complications; D002784:Cholesterol / Q000097:blood; D002940:Circadian Rhythm; D003920:Diabetes Mellitus / Q000097:blood / Q000503:physiopathology*; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D008297:Male; D012146:Rest; D012890:Sleep; D012893:Sleep Wake Disorders / Q000209:etiology* / Q000503:physiopathology*; D018630:Vitreoretinopathy, Proliferative / Q000150:complications
chemical_list: D002784:Cholesterol; D006442:Glycated Hemoglobin
keywords: circadian rhythms; diabetes; diabetic complications; rest-activity rhythms; sleep