Assess Patients With Diabetes for Sleep Quality

Gregory A. Nichols, PhD


April 17, 2017

How Prevalent Are Sleep Problems in Diabetes?

Everyone loves a good night's sleep, and few of us are at our best without it. One night of sleep disruption can be bad enough, but when the nights string together, poor sleep can take a real toll on our daily lives.

The effects of sleep problems, however, extend beyond our mental and emotional states. Indeed, the cardiometabolic effects of sleep problems have become undeniable,[1] leading the American Heart Association (AHA) to issue a Scientific Statement reviewing the evidence and calling for health organizations to include evidence-based sleep recommendations in their guidelines for optimal health.[2]

Of note, sleep problems as reviewed by the AHA are not limited to obstructive sleep apnea, but also include short sleep duration.

A study by Gupta and Wang[3] suggests that sleep disturbances are remarkably common in diabetes. Using data from the 2012 National Health and Wellness Survey, the researchers identified 7239 respondents with self-reported diabetes. Respondents also self-reported physician-diagnosed sleep disorders (eg, insomnia, parasomnia, sleep apnea) and sleep symptoms (eg, difficulty falling or staying asleep, waking to go to the bathroom, difficulty staying awake during the day).

The investigators examined correlates of sleep disorders and symptoms with demographic and behavioral characteristics, univariately and in logistic regression models.

Nearly one quarter (24%) of respondents with diabetes were diagnosed with a sleep disorder, and 77% reported at least one sleep symptom. Of those with a sleep disorder, 70% were obese, as were 65% of those with a sleep problem. Female sex, white race, being single, low income, smoking, and not exercising were also associated with sleep disorders and symptoms.

Sleep loss appears to increase the risk of developing diabetes independent of obesity.

In multivariate analysis, probability of sleep disorders and symptoms increased across obesity classes, and smoking was a strong predictor of diagnosed sleep disorders as well as sleep symptoms.

However, because people without diabetes were not analyzed, it is impossible to discern whether the 24% with a diagnosed sleep disorder and the 77% with a sleep problem are proportions similar to, greater than, or even less than those in the general population. Nonetheless, considerable evidence suggests that these proportions are indeed greater than would be found among people without diabetes.

Because poor sleep is associated with obesity,[4] it is no surprise that it is also associated with diabetes. However, sleep loss appears to increase the risk of developing diabetes independent of obesity.[5,6] Once a person develops diabetes, poor sleep increases A1c levels,[7] although that effect might be mitigated by body mass index (BMI).[8]


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