Sleep and HbA1c in Patients With Type 2 Diabetes: Which Sleep Characteristics Matter Most?

Brouwer, Annelies; Raalte, Daniël H. van; Rutters, Femke; Elders, Petra; Snoek, Frank J.; Beekman, Aartjan; Bremmer, Marijke A.

doi:10.2337/dc19-0550

Cited by 62 publications

(65 citation statements)

References 36 publications

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“…Using 7-day wrist actigraphy and sleep questionnaires, a previous study has investigated whether sleep characteristics may act in concert on HbA1c in patients with T2D (N=172). 4 In combination, variability in sleep duration, total sleep duration, and subjective sleep quality was most strongly associated with HbA1c (explaining 10.3% of the variance in HbA1c). 4 Extending these findings, in the present study, we observed a positive dose–response association between the number of sleep problems per subject and HbA1c.…”

Section: Discussionmentioning

confidence: 90%

“… 4 In combination, variability in sleep duration, total sleep duration, and subjective sleep quality was most strongly associated with HbA1c (explaining 10.3% of the variance in HbA1c). 4 Extending these findings, in the present study, we observed a positive dose–response association between the number of sleep problems per subject and HbA1c. However, no conclusions regarding causality can be drawn due to the cross-sectional study design.…”

Section: Discussionmentioning

confidence: 90%

“…1 This is worrisome as such sleep problems have been linked to impaired glycemic control in patients with T2D. [2][3][4][5][6] For example, a cross-sectional study involving 52 patients with T2D found that OSA was associated with higher hemoglobin A1c (HbA1c) values. 7 Long-term elevated blood glucose levels, as measured by the HbA1c level, have also been reported for patients with T2D suffering from poor sleep quality.…”

Section: Introductionmentioning

confidence: 99%

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Sleep characteristics and HbA1c in patients with type 2 diabetes on glucose-lowering medication

Tan

2020

BMJ Open Diab Res Care

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IntroductionTo examine the association of sleep duration, insomnia, and obstructive sleep apnea (OSA) with hemoglobin A1c (HbA1c) in a cohort of patients with type 2 diabetes (T2D) on glucose-lowering medications.Research design and methods13 346 patients with T2D were included in the present analysis (mean age: 60.2 years; 56.6% were on antidiabetic drug monotherapy; 43.4% received at least two glucose-lowering medications). Sleep duration (short: ≤6 hours/day; normal: 7–8 hours/day; long: ≥9 hours/day) and frequency of insomnia symptoms were self-reported. The risk of OSA was considered high if at least two of the following conditions were fulfilled: regular snoring, frequent daytime sleepiness, and either obesity (≥30 kg/m2) or hypertension (systolic blood pressure ≥140 mm Hg or diastolic blood pressure ≥90 mm Hg). Associations between sleep variables and HbA1c were investigated by analysis of covariance or linear regression (adjusted for, eg, participants’ age, sex, ethnic background, and systolic blood pressure).ResultsLong sleep duration and a high risk for OSA were independently associated with higher HbA1c values (long vs normal sleep duration: +0.10% (95% CI 0.03 to 0.18); high vs low risk for OSA: +0.07% (95% CI 0.02 to 0.11), both p=0.004). No robust association was found of short sleep duration and frequent insomnia symptoms with HbA1c. Finally, a positive dose–response association between the number of sleep problems per subject (range: 0–3) and HbA1c was observed (β=0.04% (0.02 to 0.06), p=0.002). However, all significant associations were small.ConclusionScreening for and treatment of sleep problems may help lower HbA1c levels in patients with T2D on glucose-lowering medications.

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Section: Discussionmentioning

confidence: 90%

Section: Discussionmentioning

confidence: 90%

Section: Introductionmentioning

confidence: 99%

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Sleep characteristics and HbA1c in patients with type 2 diabetes on glucose-lowering medication

Tan

2020

BMJ Open Diab Res Care

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“…Sleep disturbance is common in patients with type 2 diabetes [16] and a previous study reported the high prevalence of sleep dysfunction in patients with type 2 diabetes, and demonstrated that a high proportion (69%) of type 2 diabetics had a Pittsburgh sleep quality index score ≥ 5, suggesting reduced and disturbed sleep [17]. However, there is limited evidence on the association between sleep disturbance and the risk of incident CVD in patients with type 2 diabetes.…”

Section: Introductionmentioning

confidence: 99%

Association of sleep disturbance with risk of cardiovascular disease and all-cause mortality in patients with new-onset type 2 diabetes: data from the Korean NHIS-HEALS

Choi

2020

Cardiovasc Diabetol

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Background: Sleep disturbance has been significantly associated with the incidence of cardiovascular disease (CVD) in the general population. However, despite the common prevalence of sleep disturbance in patients with type 2 diabetes, its relationship with the risk of CVD remains unclear. Here, we have examined the association of sleep disturbance with the incidence of all CVD and all-cause mortality in patients with newly-diagnosed type 2 diabetes. Methods: We used the Korean National Health Insurance Service-Health Screening Cohort data and included 36,058 patients with new-onset type 2 diabetes aged ≥ 40 years between 2004 and 2007, along with follow-up examinations to 2013. We used the ICD-10 code to measure sleep disturbance as a primary diagnosis and the multivariable Cox proportional hazards regression models to estimate the adjusted hazard ratio (AHR) and 95% confidence interval (CI) of all CVD, coronary heart disease (CHD), stroke, and all-cause mortality. Results: We identified 6897 cases of all CVD (CHD, n = 4138; stroke, n = 2759) and 2890 events of all-cause mortality during a mean follow-up period of 7.0 years. Sleep disturbance was associated with an increased risk of All CVD (AHR, 1.24; 95% CI, 1.06-1.46), CHD events (AHR, 1.24; 95% CI, 1.00-1.53), and all-cause mortality (AHR, 1.47; 95% CI, 1.15-1.87) in patients with new-onset type 2 diabetes. Furthermore, women (AHR, 1.33; 95% CI, 1.06-1.67) and middle-aged adults (AHR, 1.29; 95% CI, 1.02-1.64) with sleep disturbance had a significantly increased risk of CVD than those without; contrarily, men (AHR, 1.45; 95% CI, 1.09-1.95) and older adults (AHR, 1.51; 95% CI, 1.15-1.99) with sleep disturbance were associated with a significantly increased risk of all-cause mortality than those without. Conclusions: Our findings suggest that sleep disturbance is significantly associated with an increased risk of CVD and all-cause mortality in patients with new-onset type 2 diabetes.

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“…Persistent sleep variability may result in poor sleep quality in individuals with T2D [ 29 ]. In addition, various T2D symptoms may explain the variation in sleep parameters including frequent nocturnal urination, hyperglycemia-related food consumption, hypoglycemia symptoms, obesity, pain, and distress [ 30 ].…”

Section: Introductionmentioning

confidence: 99%

Sleep Efficiency and Total Sleep Time in Individuals with Type 2 Diabetes with and without Insomnia Symptoms

et al. 2020

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There is increasing awareness of the high prevalence of insomnia symptoms in individuals with type 2 diabetes (T2D). Past studies have established the importance of measuring sleep parameters using measures of central tendency and variability. Additionally, subjective and objective methods involve different constructs due to the discrepancies between the two approaches. Therefore, this study is aimed at comparing the averages of sleep parameters in individuals with T2D with and without insomnia symptoms and comparing the variability of sleep parameters in these individuals. This study assessed the between-group differences in the averages and variability of sleep efficiency (SE) and total sleep time (TST) of 59 participants with T2D with and without insomnia symptoms. Actigraph measurements and sleep diaries were used to assess sleep parameter averages and variabilities calculated by the coefficient of variation across 7 nights. Mann–Whitney U tests were utilized to compare group differences in the outcomes. Validated instruments were used to assess the symptoms of depression, anxiety, and pain as covariates. Objective SE was found to be statistically lower on average (85.98±4.29) and highly variable (5.88±2.57) for patients with T2D and insomnia symptoms than in those with T2D only (90.23±6.44 and 3.82±2.05, respectively). The subjective average and variability of SE were also worse in patients with T2D and insomnia symptoms, with symptoms of depression, anxiety, and pain potentially playing a role in this difference. TST did not significantly differ between the groups on averages or in variability even after controlling for age and symptoms of depression, anxiety, and pain. Future studies are needed to investigate the underlying mechanisms of worse averages and variability of SE in individuals with T2D and insomnia symptoms. Additionally, prompting the associated risk factors of insomnia symptoms in individuals with T2D might be warranted.

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Sleep and HbA1c in Patients With Type 2 Diabetes: Which Sleep Characteristics Matter Most?

Cited by 62 publications

References 36 publications

Sleep characteristics and HbA1c in patients with type 2 diabetes on glucose-lowering medication

Sleep characteristics and HbA1c in patients with type 2 diabetes on glucose-lowering medication

Association of sleep disturbance with risk of cardiovascular disease and all-cause mortality in patients with new-onset type 2 diabetes: data from the Korean NHIS-HEALS

Sleep Efficiency and Total Sleep Time in Individuals with Type 2 Diabetes with and without Insomnia Symptoms

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