Global Assessment of the Impact of Type 2 Diabetes on Sleep through Specific Questionnaires. A Case-Control Study.
Type 2 diabetes (T2D) is an independent risk factor for sleep breathing disorders. However, it is unknown whether T2D affects daily somnolence and quality of sleep independently of the impairment of polysomnographic parameters.


METHODS
A case-control study including 413 patients with T2D and 413 non-diabetic subjects, matched by age, gender, BMI, and waist and neck circumferences. A polysomnography was performed and daytime sleepiness was evaluated using the Epworth Sleepiness Scale (ESS). In addition, 135 subjects with T2D and 45 controls matched by the same previous parameters were also evaluated through the Pittsburgh Sleep Quality Index (PSQI) to calculate sleep quality.


RESULTS
Daytime sleepiness was higher in T2D than in control subjects (p = 0.003), with 23.9% of subjects presenting an excessive daytime sleepiness (ESS>10). Patients with fasting plasma glucose (FPG ≥13.1 mmol/l) were identified as the group with a higher risk associated with an ESS>10 (OR 3.9, 95% CI 1.8-7.9, p = 0.0003). A stepwise regression analyses showed that the presence of T2D, baseline glucose levels and gender but not polysomnographic parameters (i.e apnea-hyoapnea index or sleeping time spent with oxigen saturation lower than 90%) independently predicted the ESS score. In addition, subjects with T2D showed higher sleep disturbances [PSQI: 7.0 (1.0-18.0) vs. 4 (0.0-12.0), p<0.001].


CONCLUSIONS
The presence of T2D and high levels of FPG are independent risk factors for daytime sleepiness and adversely affect sleep quality. Prospective studies addressed to demonstrate whether glycemia optimization could improve the sleep quality in T2D patients seem warranted.
Endocrinology and Nutrition Department, Hospital Universitari Arnau de Vilanova, Biomedical Research Institute of Lleida (IRBLLEIDA), Universitat de Lleida, Av Rovira Roure 80, 25198, Lleida, Spain.|CIBER de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Diabetes and Metabolism Research Unit, Institut de Recerca i Hospital Universitari Vall d'Hebron (VHIR), Universitat Autònoma de Barcelona, Pg Vall d'Hebron 119-129, 08035, Barcelona, Spain.
Albert
A
Lecube
Endocrinology and Nutrition Department, Hospital Universitari Arnau de Vilanova, Biomedical Research Institute of Lleida (IRBLLEIDA), Universitat de Lleida, Av Rovira Roure 80, 25198, Lleida, Spain.
Enric
E
Sánchez
Endocrinology and Nutrition Unit, Segovia General Hospital, C/Miguel Servet s/n, 40002, Segovia, Spain.
Fernando
F
Gómez-Peralta
Endocrinology and Nutrition Unit, Segovia General Hospital, C/Miguel Servet s/n, 40002, Segovia, Spain.
Cristina
C
Abreu
Biostatistics and Epidemiology Unit, Biomedical Research Institute of Lleida (IRBLLEIDA), Av Rovira Roure 80, 25198, Lleida, Spain.
Joan
J
Valls
CIBER de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Diabetes and Metabolism Research Unit, Institut de Recerca i Hospital Universitari Vall d'Hebron (VHIR), Universitat Autònoma de Barcelona, Pg Vall d'Hebron 119-129, 08035, Barcelona, Spain.
Olga
O
Mestre
CIBER Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III (ISCIII), Sleep Unit, Neurophysiology Department, Institut de Recerca i Hospital Universitari Vall d'Hebron (VHIR), Universitat Autònoma de Barcelona, Pg Vall d'Hebron 119-129, 08035, Barcelona, Spain.
Odile
O
Romero
Endocrinology and Nutrition Department, Hospital Universitari Arnau de Vilanova, Biomedical Research Institute of Lleida (IRBLLEIDA), Universitat de Lleida, Av Rovira Roure 80, 25198, Lleida, Spain.
María Dolores
MD
Martínez
CIBER Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III (ISCIII), Sleep Unit, Pneumology Department, Institut de Recerca i Hospital Universitari Vall d'Hebron (VHIR), Universitat Autònoma de Barcelona, Pg Vall d'Hebron 119-129, 08035, Barcelona, Spain.
Gabriel
G
Sampol
CIBER de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Diabetes and Metabolism Research Unit, Institut de Recerca i Hospital Universitari Vall d'Hebron (VHIR), Universitat Autònoma de Barcelona, Pg Vall d'Hebron 119-129, 08035, Barcelona, Spain.
Andreea
A
Ciudin
CIBER de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Diabetes and Metabolism Research Unit, Institut de Recerca i Hospital Universitari Vall d'Hebron (VHIR), Universitat Autònoma de Barcelona, Pg Vall d'Hebron 119-129, 08035, Barcelona, Spain.
Cristina
C
Hernández
CIBER de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Diabetes and Metabolism Research Unit, Institut de Recerca i Hospital Universitari Vall d'Hebron (VHIR), Universitat Autònoma de Barcelona, Pg Vall d'Hebron 119-129, 08035, Barcelona, Spain.
Rafael
R
Simó
D000368:Aged; D001786:Blood Glucose; D016022:Case-Control Studies; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000150:complications / Q000503:physiopathology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017286:Polysomnography; D012307:Risk Factors; D012890:Sleep / Q000502:physiology*; D012891:Sleep Apnea Syndromes / Q000097:blood / Q000150:complications / Q000503:physiopathology*; D007319:Sleep Initiation and Maintenance Disorders / Q000097:blood / Q000150:complications / Q000503:physiopathology*; D012894:Sleep Stages / Q000502:physiology; D011795:Surveys and Questionnaires
D001786:Blood Glucose