Siswanto Agus, Asdie Ahmad Husain, Novyanto Rico, Kardin Laode, Sahara Yohana, Kaban David Yosua, Thahadian Harik Firman, Tajudin Rakhmat, Hidayat Heriyanto, Dwinata Michael
Psychosomatic Division, Department of Internal Medicine, Faculty of Medicine, Gadjah Mada University, Yogyakarta, Indonesia.
Endocrine & Metabolic Division, Department of Internal Medicine, Faculty of Medicine, Gadjah Mada University, Dr. Sardjito Central General Hospital, Yogyakarta, Indonesia.
Integr Med (Encinitas). 2024 Sep;23(4):16-22.
Insomnia is more frequent in type 2 diabetes mellitus (T2DM) patients. Both conditions are known to cause low-grade inflammation and an independent risk factor for cardio-cerebrovascular events (CCDs) and overall mortality. Relaxation, mindfulness, breath control, and spiritual-based therapies such as Latihan Pasrah Diri / Self Surrender Practice (LPD) have been known to induce relaxation, improve depressive symptoms and sleep quality, inflammatory markers, glycemic control, Daily Living Activities (DLA), and Quality of Life (QoL) in T2DM patients. It is currently unknown whether LPD can improve sleep quality in patients with T2DM without depression and its association with inflammation.
Determine the effect of LPD on sleep quality and inflammatory markers in T2DM patients without depression.
This is a prospective, single-blind, randomized controlled trial. Patients aged 30-60 years old, Muslim, diagnosed with type 2 diabetes mellitus and who were not currently experiencing depression (Beck Depression Inventory-II Score <17) were eligible to be included in the study. We assessed the changes in the value of the ΔInsomnia Severity Score (ΔISI) and inflammatory markers (Δhs-CRP, ΔMPV, and ΔNLR). The intervention group was the group with standard therapy of DM and LPD, while the control group was the group with standard therapy of DM without LPD. The intervention was carried out 2 times a day with 20 minutes for each session, for 8 weeks.
A total of 44 subjects were randomized 1: 1 into intervention (n = 22) and control (n = 22) groups. In the intervention group, only 12 subjects met the minimum frequency of intervention, thus being included in the statistical analysis. There was a statistically significant decrease of ΔISI score by 2.58 compared to 0.04 ( = .003; 95% CI -4.15, -0.92), decrease of ΔMPV by 0.41 and 0.03 ( = .001; 95% CI -0.59, -0.18), and change of ΔNLR by -0.4 compared to 0.15 ( = .035; 95% CI -0.93, -0.03) in the intervention group compared to the control group. There was no significant change in Δhs-CRP ( = .762; 95% CI -5.44, 4.02) in the intervention group compared to control.
Eight weeks of LPD improves sleep quality and reduces inflammatory markers (MPV and NLR) in T2DM patients without depression. Whether changes in inflammatory markers and insomnia are related and whether improvements in insomnia lead to improvements in inflammatory markers or vice versa requires further study.
Direct supervision on the diet and physical activity of the subjects was not done due to some obstacles in the field.
2型糖尿病（T2DM）患者中失眠更为常见。已知这两种情况都会导致低度炎症，并且是心脑血管事件（CCDs）和总体死亡率的独立危险因素。已知放松、正念、呼吸控制以及基于精神的疗法，如拉蒂汉·帕斯拉·迪里/自我臣服练习（LPD），可诱导T2DM患者放松、改善抑郁症状和睡眠质量、炎症标志物、血糖控制、日常生活活动能力（DLA）和生活质量（QoL）。目前尚不清楚LPD是否能改善无抑郁的T2DM患者的睡眠质量及其与炎症的关联。
确定LPD对无抑郁的T2DM患者睡眠质量和炎症标志物的影响。
这是一项前瞻性、单盲、随机对照试验。年龄在30 - 60岁、穆斯林、被诊断为2型糖尿病且目前未患抑郁症（贝克抑郁量表-II评分<17）的患者有资格纳入本研究。我们评估了失眠严重程度评分变化值（ΔISI）和炎症标志物（Δhs-CRP、ΔMPV和ΔNLR）的变化。干预组为接受糖尿病标准治疗和LPD的组，而对照组为仅接受糖尿病标准治疗而无LPD的组。干预每天进行2次，每次20分钟，共8周。
总共44名受试者按1:1随机分为干预组（n = 22）和对照组（n = 22）。在干预组中，只有12名受试者达到了最低干预频率，因此被纳入统计分析。与对照组相比，干预组的ΔISI评分有统计学意义地降低了2.58，而对照组降低了0.04（P = .003；95%CI -4.15，-0.92）；ΔMPV降低了0.41，而对照组降低了0.03（P = .001；95%CI -0.59，-0.18）；ΔNLR变化为-0.4，而对照组为0.15（P = .035；95%CI -0.93，-0.03）。干预组与对照组相比，Δhs-CRP无显著变化（P = .762；95%CI -5.44，4.02）。
八周的LPD可改善无抑郁的T2DM患者的睡眠质量并降低炎症标志物（MPV和NLR）。炎症标志物变化与失眠之间是否相关以及失眠改善是否会导致炎症标志物改善或反之是否成立，需要进一步研究。
由于实地存在一些障碍，未对受试者的饮食和身体活动进行直接监督。
