Combined effects of sleep quality and depression on quality of life in patients with type 2 diabetes

Abstract

BackgroundPoor sleep quality and depression negatively impact the health-related quality of life of patients with type 2 diabetes, but the combined effect of the two factors is unknown. This study aimed to assess the interactive effects of poor sleep quality and depression on the quality of life in patients with type 2 diabetes.MethodsPatients with type 2 diabetes (n = 944) completed the Diabetes Specificity Quality of Life scale (DSQL) and questionnaires on sleep quality and depression. The products of poor sleep quality and depression were added to the logistic regression model to evaluate their multiplicative interactions, which were expressed as the relative excess risk of interaction (RERI), the attributable proportion (AP) of interaction, and the synergy index (S).ResultsPoor sleep quality and depressive symptoms both increased DSQL scores. The co-presence of poor sleep quality and depressive symptoms significantly reduced DSQL scores by a factor of 3.96 on biological interaction measures. The relative excess risk of interaction was 1.08. The combined effect of poor sleep quality and depressive symptoms was observed only in women.ConclusionsPatients with both depressive symptoms and poor sleep quality are at an increased risk of reduction in diabetes-related quality of life, and this risk is particularly high for women due to the interaction effect. Clinicians should screen for and treat sleep difficulties and depressive symptoms in patients with type 2 diabetes.

Health and quality of life outcomes impairment of quality of life in type 2 diabetes mellitus: a cross-sectional study

“…Furthermore, the results of the present study suggest that depression is common among patients with DM2 and is associated with the perception of a poor QoL; depression should be screened for in these patients, especially older patients, who face greater risks related to the lack of motivation and emotional exhaustion [19, 37]. …”

“…Based on the results described with Zhang et al [19], who analyzed multiple factors associated with the QoL in subjects with DM2, including age, sex, marital status, duration of the disease, comorbidities and depression, all these variables impacted the QoL; however depression presented the smallest difference in proportions, (depression being in 27.9% of subjects with adequate QoL and in 38.4% of subjects with inadequate QoL); before this, the sample size was calculated by a difference of proportions with an alpha of 5% and a power of 80%, leaving a total of 334 subjects per group, i.e., with and without depression. A total of 1894 subjects were eligible to participate; however, only 1540 patients met the inclusion criteria, of whom 146 were excluded: 13 patients had a diagnosis of dementia; 48 patients had depression and were awaiting evaluation by a specialist for initiation of pharmacological treatment; and 85 patients did not agree to participate.…”

“…Multiple factors have been shown to modify the QoL in patients with DM2; the most prominent factors include the presence of diabetes distress, medication adherence, depression symptomatology, longer duration of diabetes, use of insulin, marital status, and comorbidities among others [16–19]. …”

Sleep complaints in early pregnancy. A cross-sectional study among women attending prenatal care in general practice

“…Nevertheless, some of the pregnant women may have been worried, because those who experienced poor sleep quality had a high use of health care [36]. Overall, GPs have a unique opportunity for reducing maternal distress by introducing sleep intervention, which represents a potential low-cost, nonpharmacological prevention and treatment strategy for postpartum mental illness, by articulating that the pregnant women should be aware of the connection between sleep and symptoms of depression and anxiety [13,37,38]. In addition, the women should be encouraged to engage in physical activity and exercise during pregnancy, as studies have shown that this has an overall beneficial effect on sleep characteristics and sleep continuity and on the woman's mental state [39,40].…”

Chinese Taoist Cognitive Therapy for Symptoms of Depression and Anxiety in Adults in China: A Systematic Review and Meta-Analysis

“…The risk of developing diabetes or macrovascular diseases is high in depressed individuals, whereas there is great risk of having comorbid depression in patients with DM2 and/or CHD (Anderson et al, 2001;Rudisch and Nemeroff, 2003;Mezuk et al, 2008;Roy and Lloyd, 2012;Gemeay et al, 2015). Furthermore, depression is responsible for lower quality of life, higher health economic burden, and reduced medication adherence and disease-related self-care activities (Gehi et al, 2005;Gonzalez et al, 2007;Nau et al, 2007;Rutledge et al, 2009;Katon et al, 2010;Chew et al, 2015;Mishra et al, 2015;Zhang et al, 2015Zhang et al, , 2016Mut-Vitcu et al, 2016). Evidence has underlined the need for early diagnosis and intervention of depression in patients with chronic physical diseases to improve the health outcomes of these people.…”