Lecube Albert, Sánchez Enric, Gómez-Peralta Fernando, Abreu Cristina, Valls Joan, Mestre Olga, Romero Odile, Martínez María Dolores, Sampol Gabriel, Ciudin Andreea, Hernández Cristina, Simó Rafael
Endocrinology and Nutrition Department, Hospital Universitari Arnau de Vilanova, Biomedical Research Institute of Lleida (IRBLLEIDA), Universitat de Lleida, Av Rovira Roure 80, 25198, Lleida, Spain.
CIBER de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Diabetes and Metabolism Research Unit, Institut de Recerca i Hospital Universitari Vall d'Hebron (VHIR), Universitat Autònoma de Barcelona, Pg Vall d'Hebron 119-129, 08035, Barcelona, Spain.
PLoS One. 2016 Jun 17;11(6):e0157579. doi: 10.1371/journal.pone.0157579. eCollection 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 = 0.0003). A stepwise regression analyses showed that the presence of T2D, baseline glucose levels and gender but not polysomnographic parameters (i.e apnea-hyoapnea index or sleeping time spent with oxigen saturation lower than 90%) independently predicted the ESS score. In addition, subjects with T2D showed higher sleep disturbances [PSQI: 7.0 (1.0-18.0) vs. 4 (0.0-12.0), p<0.001].
The presence of T2D and high levels of FPG are independent risk factors for daytime sleepiness and adversely affect sleep quality. Prospective studies addressed to demonstrate whether glycemia optimization could improve the sleep quality in T2D patients seem warranted.
2型糖尿病（T2D）是睡眠呼吸障碍的独立危险因素。然而，T2D是否独立于多导睡眠图参数受损而影响日常嗜睡和睡眠质量尚不清楚。
一项病例对照研究，纳入413例T2D患者和413例非糖尿病受试者，根据年龄、性别、BMI、腰围和颈围进行匹配。进行多导睡眠图检查，并使用爱泼华嗜睡量表（ESS）评估白天嗜睡情况。此外，还通过匹兹堡睡眠质量指数（PSQI）对135例T2D受试者和45例按上述相同参数匹配的对照进行评估，以计算睡眠质量。
T2D患者的白天嗜睡程度高于对照受试者（p = 0.003），23.9%的受试者存在过度白天嗜睡（ESS>10）。空腹血糖（FPG≥13.1 mmol/l）的患者被确定为与ESS>10相关风险较高的组（OR 3.9，95%CI 1.8 - 7.9，p = 0.0003）。逐步回归分析显示，T2D的存在、基线血糖水平和性别而非多导睡眠图参数（即呼吸暂停 - 低通气指数或血氧饱和度低于90%的睡眠时间）可独立预测ESS评分。此外，T2D受试者的睡眠障碍更高[PSQI：7.0（1.0 - 18.0）对4（0.0 - 12.0），p<0.001]。
T2D的存在和高FPG水平是白天嗜睡的独立危险因素，并对睡眠质量产生不利影响。进行前瞻性研究以证明血糖优化是否能改善T2D患者的睡眠质量似乎是必要的。
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