Vascular Complications in Diabetes Could Cause Sleep Problems

Highlights

• Diabetes mellitus is a metabolic/endocrine disorder characterized by elevated blood sugar levels (hyperglycemia).
• Type 2 diabetes is the more common type of diabetes, the hyperglycemia is caused by insulin resistance and a relative lack of insulin.
• Long-term complications of diabetes due to involvement of blood vessels (vascular complications) affect heart, kidney, eyes, brain and lower extremities with increased mortality and morbidity.
• This study determines the association between sleep-related complaints and vascular complications in type 2 diabetes.

Vascular complications in type 2 diabetes can lead to sleep problems, finds a study conducted in the Metabolic Diseases Hospital of Tianjin Medical University in China. Aim of the Study

Until now studies conducted have shown an association between diabetic microvessel disease such as peripheral neuropathy and obstructive sleep apnea (OSA).

Very few studies have focused on the incidence of sleep-related problems with the various complications systematically. The study hoped to find the association between sleep related issues and various diabetic vascular complications in a cross sectional population-based study.

Scientific Study from China

The study was conducted across a cross-section of the adult population in China with type 2 diabetes. Participants were selected between 2013 and 2016 using various inclusion and exclusion criteria.

Demographic information such as age and gender were also gathered and physical examinations such as body mass index (BMI) and blood pressure were done on the subjects. Glycosylated hemoglobin (HbA1C) was estimated employing standard high-performance liquid chromatography.

The various sleep-related complaints assessed in this study included difficulty falling asleep, short sleep, long sleep and early final awakening.

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Difficulty in falling asleep greater than thrice a week was defined as insomnia. Early final awakening was also defined using a similar criterion.Duration of sleep of less than 6 hours per night was defined as short sleep, and sleep duration more than 9 hours per night was taken to mean long sleep.

The various diabetic vascular complications assessed included microvessel disease (microangiopathy) such as diabetic kidney disease, diabetic retinopathy and diabetic neuropathy and macrovessel disease (macroangiopathy) such as heart disease and peripheral vascular disease involving the lower extremities.

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The various vascular complications in the participating patients were diagnosed using standard criteria.

Results of the Study

The findings of the study indicated the following

• Occurrence of short sleep was independently related to diabetic kidney disease (DKD) (OR > 1, P < 0.05) after due adjustments.
• Long sleep was independently related to diabetic retinopathy (DR) (OR > 1, P < 0.05)
• Early final awakening and short sleep were found to be independently associated with cardiovascular disease (OR > 1, P < 0.05);
• Incidence of short sleep was independently related to peripheral vascular disease (OR > 1, P < 0.05)
• There was no association between sleep complaints and neuropathy (P > 0.05).

Strengths and Limitations of the Study

• The authors claim that theirs is the first study to assess the connection between diabetic complications and poor sleep complaints employing a well-rounded validated questionnaire.
• Secondly, the population assessed was large and representative, making the results worthy enough to be relied on and extrapolated.

However, some limitations of this study should also be mentioned, admit the authors.

• Firstly, the adjusted-confounders were similar in the regression analysis, and this might lead to an incorrect adjustment for each diabetic complication.
• Secondly, an exact causal association between complications of diabetes and poor sleep complaints cannot be drawn because of the cross-sectional design of the study.
• Additionally, other sleep complaints such as daytime sleepiness and frequent awakening during night-time sleep were not assessed in this study, and should be addressed in a future study.

Lessons from the Study

• This study has provided evidence that poor sleep complaints might be associated with diabetic vascular complications.
• Nevertheless, bigger prospective studies employing the objective assessment by polysomnography are needed in the future to identify the underlying mechanisms.
• Clinicians should focus more on sleep-related complaints in order to improve the quality of life for patients with type 2 diabetes.

Strengths and Limitations of the Study

• The authors claim that theirs is the first study to assess the connection between diabetic complications and poor sleep complaints employing a well-rounded validated questionnaire.
• Secondly, the population assessed was large and representative, making the results worthy enough to be relied on and extrapolated.
• However there were some limitations of this study as mentioned by the authors.
• Firstly, the adjusted-confounders were similar in the regression analysis, and this might lead to an incorrect adjustment for each diabetic complication.
Secondly, an exact causal association between complications of diabetes and poor sleep complaints cannot be drawn because of the cross-sectional design of the study.
• Additionally, other sleep complaints such as daytime sleepiness and frequent awakening during night-time sleep were not assessed in this study, and should be addressed in a future study.

Importance of Diagnosing and Treating Sleep Disorders

The importance of detecting and treating sleep-related complaints cannot be overemphasized.

Sleep disorders have been found to cause various conditions such as diabetes, heart disease, hypertension and obesity and also an increased mortality.

Sleep disorders are widely prevalent globally and are only expected to rise in the future given factors such as the rapid pace of modern day life, increasing night-time use of smartphones and Internet surfing, and an increasing number of persons doing night shifts at work to mention a few.

Importantly, lack of sleep and fatigue can cause errors due to lapse in concentration and accidents at work or while operating machinery and vehicles.

The role of genetics in sleep and sleep disorders is being researched seriously worldwide and might provide answers to many yet unexplained mechanisms and phenomena related to sleep.

References:

1. Diabetes mellitus type 2 - (https://en.wikipedia.org/wiki/Diabetes_mellitus_type_2)
2. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3655374/ - (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3655374/)

Source-Medindia