Insufficient sleep has been recognized to underlie the epidemic of obesity, type 2 diabetes, hypertension, and cardiovascular diseases. Hirota T et al. of Osaka, Japan have conducted a study that indicates that not only short sleep duration, but also poor sleep quality is associated with obesity, type 2 diabetes, and metabolic syndrome. The study has been presented at the American Diabetic Association meeting 2018 in Orlando, Florida.
Most of the prior studies conducted in the past evaluated sleep quality subjectively by using a questionnaire. In the present study, the researchers objectively evaluated sleep quality and investigated its association with obesity in patients with type 2 diabetes. They included 182 patients with type 2 diabetes, of which 113 had obesity (BMI ≥ 25kg/m2). Objective sleep architecture was measured using single-channel electroencephalography, and slow-wave sleep (SWS) was evaluated as a marker of deep sleep. The researchers also measured the apnea-hypopnea index (AHI), and nocturnal blood pressure (BP) by 24-h ambulatory BP monitoring. In a total population, the mean value for age was 58 years, duration of diabetes was 12 years, BMI was 27.8 kg/m2, HbA1c was 8.5%, AHI was 15, total sleep time was 345 min, and SWS was 9.8 min. Subjects with obesity (mean BMI 31.2 kg/m2) were younger (56 vs. 62 years) and had higher AHI (18.3 vs. 9.5) than those without obesity (mean BMI 22.2 kg/m2). Neither total sleep time nor SWS was significantly different between the groups. In unadjusted analyses, BMI was significantly correlated with AHI, but not with SWS or total sleep time. Multivariate analysis revealed that AHI (β = 0.423, p < 0.001) was positively, while SWS (β = −0.146, p = 0.042), age, and male sex were negatively associated with BMI, after further adjustment for duration of diabetes, nocturnal systolic BP, serum creatinine, and HbA1c. On the other hand, no significant association was found between total sleep time and BMI. In conclusion, SWS is inversely associated with BMI, independently of AHI and other covariates, in patients with type 2 diabetes. This study indicates an adverse relationship between poor sleep quality and obesity, independent of sleep apnea, in patients with type 2 diabetes.
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