Prevalence and Predictors of Excessive Daytime Sleepiness in Obese Type 2 Diabetic Patients – A Tertiary Centre Experience (original) (raw)
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Prevalence and Predictors of Excessive Daytime Sleepiness in Romanian Obese Type 2 Diabetic Patients
Aim: The objective of this study was to determine the prevalence and to evaluate factors associated with excessive daytime sleepiness as a symptom of sleep apnea (SAS) in a sample of Romanian type 2 diabetic patients. Material and Methods: The Epworth Sleepiness Scale was administered to 242 consecutive patients with type 2 diabetes and a body mass index (BMI) ≥30kg/m 2 . Score > 10 points was considered pathologic. Results: Twenty-two percent of diabetic obese patients had excessive daytime sleepiness. Compared with patients without daytime sleepiness, the median HbA1c was increased with 1.2% (p<0.001) in sleepy patients. Waist circumference (odds ratio: 1.04; 95%CI [1.01 -1.07]), BMI (odds ratio: 1.1; 95%CI [1.04 -1.18]) and HbA1c (odds ratio: 1.29; 95%CI [1.07 -1.56]) were significantly related to the presence of excessive daytime sleepiness. Conclusion: Excessive daytime sleepiness as a symptom of suspected SAS is highly prevalent in Romanian patients with type 2 diabetes and should be systematically screened for, especially among obese individuals with higher waist circumference, higher BMI and higher HbA1c values.
International Journal of Diabetes in Developing Countries, 2015
Obstructive sleep apnea (OSA) and excessive daytime sleepiness (EDS) are common in patients with type 2 diabetes mellitus (T2DM). This study was aimed to evaluate the prevalence and risk factors of the OSA and EDS among Iranian patients with T2DM. We conducted a cross-sectional study on randomly selected 173 patients with T2DM aged 30 to 65. We assessed daytime sleepiness using the Epworth sleepiness scale and risk of OSA using the STOP-BANG questionnaire. Further information was demographic and anthropometric characteristics plus metabolic profile. Of all, 122 (74 %) patients were at high risk for OSA and 78 (45 %) patients suffered from EDS. Patients at high risk for OSA were older and had higher BMI, waist circumference, neck circumference, systolic, and diastolic blood pressure. In addition, men were significantly at a higher risk for OSA than women. Logistic regression revealed that age, male sex, and neck circumference were independent predictors of risk for OSA. The only independent predictor of EDS was age. Patients with T2DM are at high risk for OSA; also, daytime sleepiness is highly prevalent in this population. Our results indicated that the evaluation of OSA, EDS, and their risk factors should be included in the clinical management of patients with T2DM.
Subjects with Type 2 Diabetes may have Obstructive Sleep Apnoea even at Lower BMI Values
Indian Journal of Sleep Medicine, 2012
Aim was to evaluate subjects with type 2 diabetes at risk of obstructive sleep apnoea (OSA) using Epworth Sleepiness Scale (ESS). A total of 436 subjects (M/F=273:163) were evaluated and categorised as those unlikely to have significant OSA (ESS score <10; absence of snoring) and likely to have significant OSA (ESS score >10; presence of snoring). Body mass index (BMI), HbA1c and micro-and macrovascular complications were recorded. Among 436 subjects, 242 were unlikely to have significant OSA, of which 20% were randomly selected (n=58; Group 1) and compared with subjects (8.3%) likely to have OSA (n=36; Group 2). In all, 50% in Group 2 and 36% in Group 1 had hypertension (P=0.27). In Group 2, 2.8% had BMI (kg/m 2) <23, 5.6% had 23-23.9, 19.4% had 24-24.9, 25% were between 25 and 26.9, and 47.2% had e"27. Diabetic subjects even with normal BMI were at risk of OSA and more likely to have macrovascular comorbidity.
Diabetes Care, 2013
OBJECTIVEdSleep-disordered breathing and sleepiness cause metabolic, cognitive, and behavioral disturbance. Sleep-disordered breathing is common in type 2 diabetes, a condition that requires adherence to complex dietary, behavioral, and drug treatment regimens. Hypoglycemia is an important side effect of treatment, causing physical and psychological harm and limiting ability to achieve optimal glycemic control. We hypothesized that sleep disorder might increase the risk of hypoglycemia through effects on self-management and glucose regulation.
Journal of Sleep Research, 2012
Obstructive sleep apnoea is common in patients with diabetes. Recently, it was reported that short sleep duration and sleepiness had deleterious effects on glucose metabolism. Thereafter, several reports showed relationships between glucose metabolism and obstructive sleep apnoea, sleep duration or sleepiness. But the interrelationships among those factors based on recent epidemiological data have not been examined. We analysed data on 275 male employees (age, 44 ± 8 years; body mass index, 23.9 ± 3.1 kg m)2) who underwent a cross-sectional health examination in Japan. We measured fasting plasma glucose, sleep duration using a sleep diary and an actigraph for 7 days, and respiratory disturbance index with a type 3 portable monitor for two nights. Fifty-four subjects (19.6%) had impaired glucose metabolism, with 21 having diabetes. Of those 21 (body mass index, 25.9 ± 3.8 kg m)2), 17 (81.0%) had obstructive sleep apnoea (respiratory disturbance index ‡ 5). Regarding the severity of obstructive sleep apnoea, 10, four and three had mild, moderate and severe obstructive sleep apnoea, respectively. The prevalence of obstructive sleep apnoea was greater in those with than without diabetes (P = 0.037). Multiple regression analyses showed that the respiratory disturbance index independently related to fasting plasma glucose only in the diabetic subjects. In patients with diabetes, after adjustment for age, waist circumference, etc. sleep fragmentation had a greater correlation with fasting plasma glucose than sleep duration, but without significance (P = 0.10). Because the prevalence of obstructive sleep apnoea is extremely high in patients with diabetes, sufficient sleep duration with treatment for obstructive sleep apnoea, which ameliorates sleep fragmentation, might improve fasting plasma glucose.
Study of Obstructive Sleep Apnea in Obese Patients with Type 2 Diabetes Mellitus
JOURNAL OF CLINICAL AND DIAGNOSTIC RESEARCH, 2020
This was a cross-sectional study carried out in patients attending the OutPatient Departments (OPDs) of TB and Respiratory Diseases and Endocrinology, from 1 st September 2017 to 31 st March 2019 after getting an approval from the Ethical Committee (Dean/2017/ EC/198). The consent was taken from participants. Inclusion criteria: Participants included in the study were obese adults with T2DM. Exclusion criteria: Pregnant females, participants taking treatment for OSA, having any chronic pulmonary condition, respiratory failure, or on domiciliary oxygen therapy, having any pre-existing cardiovascular disease, hepatic disease or neuromuscular/neurological disorders, having history of drug abuse or alcoholism (consumption of alcohol (ethanol) for more than 4 nights per week as per CAGE criteria) [4]. Data on demographic characteristics, medical history, medications, habits and sleep using Epworth Sleepiness Scale [5] were obtained before the initiation of overnight unattended polysomnography. Each patient's height, weight, neck circumference, waist circumference, abdominal girth and BMI were measured. Routine blood investigations like Complete Blood Count (CBC), Liver Function Test (LFT), Renal Function Test (RFT), blood sugar level i.e., fasting blood sugar and postprandial blood sugar and HbA1c were done. T2DM was diagnosed by using the following criteria [6] i.e., symptoms of diabetes plus random blood glucose concentration ≥200 mg/dL and/or Fasting plasma glucose ≥126 mg/dL, and/or Haemoglobin A1c (HbA1c) ≥6.5%, and/or 2-h plasma glucose ≥200 mg/dL. Obesity (BMI >30 Kg/m 2) was classified [7] using BMI into Class 1 (30-34.99 Kg/m 2), Class 2 (35-39.99 Kg/m 2) and Class 3 (≥40.0 Kg/m 2). Based on AHI, OSA was classified [8] into Mild (AHI 5 to <15), Moderate (AHI 15 to 30) and Severe (AHI >30) groups. STATISTICAL ANALYSIS The statistical analysis was done using statistical software SPSS for windows (version 16). Chi-square test was used for non-parametric variables. Student's t-test was used for comparing two groups. The p-value <0.05 was stated as statistically significant. RESULTS The baseline characteristics of the population are given in [Table/Fig-1].
Excessive daytime sleepiness in type 2 diabetes
Arquivos Brasileiros de Endocrinologia & Metabologia, 2013
OBJECTIVE: To examine excessive daytime sleepiness (EDS) in type 2 diabetes. SUBJECTS AND METHODS: Patients (N = 110) were evaluated regarding Epworth Sleepiness Scale (EDS), sleep quality (Pittsburgh Sleep Quality Index), depressive symptoms (Beck Depression Inventory), Restless Legs Syndrome (RLS), risk of obstructive sleep apnea (OSA) (Berlin questionnaire), and comorbidity severity (Charlson Comorbidity Index). Patients were compared with indivi-duals with arterial hypertension and without diabetes. RESULTS: Diabetic patients had more EDS, depressive symptoms, and higher comorbidity severity than hypertensive patients (p < 0.005). In diabetic patients, poor quality sleep (53.3%), and high risk of OSA (40.9%) and RLS (14.5%) were found; EDS (55.5%) was associated with depressive symptoms present in 44.5% indivi-duals (OR = 1.08; 95% CI: 1.01-1.15), and remained so after data were controlled for age, gender, body mass index, and glycated hemoglobin (OR = 2.27; 95% CI 1.03-5.03)...
PloS one, 2016
Type 2 diabetes (T2D) is an independent risk factor for sleep breathing disorders. However, it is unknown whether T2D affects daily somnolence and quality of sleep independently of the impairment of polysomnographic parameters. A case-control study including 413 patients with T2D and 413 non-diabetic subjects, matched by age, gender, BMI, and waist and neck circumferences. A polysomnography was performed and daytime sleepiness was evaluated using the Epworth Sleepiness Scale (ESS). In addition, 135 subjects with T2D and 45 controls matched by the same previous parameters were also evaluated through the Pittsburgh Sleep Quality Index (PSQI) to calculate sleep quality. Daytime sleepiness was higher in T2D than in control subjects (p = 0.003), with 23.9% of subjects presenting an excessive daytime sleepiness (ESS>10). Patients with fasting plasma glucose (FPG ≥13.1 mmol/l) were identified as the group with a higher risk associated with an ESS>10 (OR 3.9, 95% CI 1.8-7.9, p = 0.000...
General hospital psychiatry
There has been a growing recognition that obstructive sleep apnea (OSA) could increase the propensity for type 2 diabetes the metabolic syndrome. However, studies concerning about the impact of non-apnea sleep disorders (NSD) on diabetes control and metabolic outcomes are relatively scarce. Our aim is to investigate the impact of non-apnea sleep disorders (NSD) on diabetic control and associated metabolic outcomes in patients with type 2 diabetes. The data were obtained from two nationwide population-based databases for a period 2007 to 2012. A total 66,992 patients with type 2 diabetes were enrolled and divided into two cohorts based on comorbidity with or without a NSD diagnosis, and were followed up four years. The primary outcomes were to compare rate of change in HbA1c and associated metabolic outcomes during follow-up visits between patients with or without NSD. The secondary outcome is to examine whether NSD were associated with poor glycemic control of the last clinical reco...