Sleep disturbances in diabetic peripheral neuropathy patients: a clinical and polysomnographic study

Abstract

BackgroundDisordered sleep breathing is a common complication of diabetic peripheral neuropathy (DPN) manifested by excessive daytime sleepiness, morning headache, morning dizziness, cognitive decline, and mood changes.MethodsThis study was performed on 30 non-obese type 2 diabetic patients; 20 with clinically evident DPN and 10 without. Ten age-, sex-, and body mass index-matched healthy control subjects were also included. Patients and control were subjected to history taking, neurological examination, glycated hemoglobin, and clinical assessment of the sensori-motor manifestations by the neuropathy symptom score and neuropathy disability score. The autonomic nervous system was evaluated clinically by the systolic blood pressure response to standing and heart rate response to each of standing, Valsalva, and deep breath. Finally, sleep was assessed by one-night polysomnogram (PSG) followed by multiple sleep latency test in the next day.ResultsThe study showed significant increase in sleep apnea syndromes in diabetic peripheral neuropathy patients compared to diabetic neuropathy free patients and healthy control (p < 0.0001). The sleep apnea was mainly obstructive and to a little extent mixed (obstructive/central) sleep apnea. The severity of sleep PSG abnormalities was positively correlated with the severities of sensory, motor, and autonomic manifestations.ConclusionsNon-obese type 2 diabetic patients complicated by peripheral neuropathy especially those having dysautonomia are at increased risk of developing sleep disordered breathing resulting in their excessive daytime sleepiness, decreased productivity, and poor glycemic control.

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“…In cases of diabetes and arterial hypertension, it is expected that the entities may have disordered sleep breathing. 28 , 29 However, in the case of hypertension, only the pulmonary arterial hypertension was previously correlated to this disorder; therefore, we do not expect breathing anomalies during the video capture due to this condition.…”

Inspiratory Muscle Training in Obstructive Sleep Apnea Associating Diabetic Peripheral Neuropathy: A Randomized Control Study

“…Also previous patients with a diagnosis of type 1 diabetes or the presence of an acute illness at study enrollment, history of medication intake affecting sleep, and who are heavy smokers or drug abusers were excluded. In addition, patients underwent regular aerobic exercise were not included in this study as it improves inspiratory muscle strength so only sedentary patients were recruited [32,33].…”

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“…Diabetic autonomic dysfunction is a risk factor for OSA [ 20 ]. Diabetic patients with peripheral neuropathy, especially autonomic nerve dysfunction, have an increased risk of sleep and respiratory disorders [ 21 ]. Chronic hyperglycemia leads to structural damage and functional impairment of the divine meridian through oxidative stress, which leads to functional impairment of the divine meridian through impaired control function of the central axis of respiration, leading to sleep and sleep respiratory disorders [ 22 ].…”