Patients with Diabetes at Increased Risk of Sleep Disorders, Could Increase Complications Risk

A recent review is underlining the prevalence of sleep disorders among patients with type 2 diabetes and the impact it can have on health outcomes in this patient population.

A review of the PubMed database from inception through January 2021, results suggest patients with type 2 diabetes had greater prevalence of sleep disorders, including insomnia OSA, and restless legs syndrome, than the general population and multiple studies demonstrated presence of these disorders negatively impacted health outcomes.

“With this review, we aim to highlight the importance of targeted diagnosis and treatment of sleep disorders in people with type 2 diabetes,” wrote investigators.

To further inform clinicians on the role of sleep disorders in progression of type 2 diabetes and development of diabetic complications, a team of investigators from the Netherlands conducted a literature review to describe current treatment options and provide an updated overview of associations with diabetic complications from available data. An 11-page document with almost 80 references, the review highlights current data as well as detailing pharmacological and non-pharmacological treatments, implications for diabetes management, and priorities for future research.

For their review, investigators performed a search of PubMed form inception through January 2021 using type 2 diabetes and the following terms: sleep disorders, sleep wake disorders, sleep deprivation, circadian, sleep arousal, insomnia, obstructive sleep apnea, and restless legs syndrome. For the purpose of the review, investigators included all relevant English or Dutch language original and review studies. Investigators pointed out observational and experimental studies were included in the review and no quality or risk of bias assessments were made.

Analysis of data from studies included in the review suggested insomnia (34-44%), OSA (55-86%), and restless legs syndrome (8-45%) appeared to be more prevalent in patients with type 2 diabetes than among the general population, which was based on data from the ICSD-3 third edition. Investigators pointed out they were unable to identify any studies reporting on prevalence of circadian rhythm sleep–wake disorders, central disorders of hypersomnolence, or parasomnias.

Multiple cross-sectional and prospective studies suggested presence of sleep disorders was associated with negative health outcomes, specifically in glycemic control. Investigators highlighted insomnia was associated with increased HbA1c levels (2.51 mmol/mol [95% CI, 1.1-4.4]; 0.23% [95% CI, 0.1-0.4]) and fasting glucose (0.4 mmol/l [95% CI, 0.2-0.7]). Investigators also pointed out presence of insomnia was associated with increased risk of depressive symptoms (OR, 1.31; 95% CI, 1.16-1.47) in patients with type 2 diabetes.

“Sleep disorders are highly prevalent in people with type 2 diabetes, negatively affecting health outcomes. Since treatment of the sleep disorder could prevent diabetes progression, efforts should be made to diagnose and treat sleep disorders in people with type 2 diabetes in order to ultimately improve health and therefore quality of life,” wrote investigators.

After providing a summary of guideline-directed treatments for sleep disorders in patients with type 2 diabetes, investigators drew attention to the apparent lack of randomized controlled trials assessing the effect of treating sleep disorders in this patient population.

“Special research focus is warranted on the effects of both pharmacological and non-pharmacological treatment options on health outcomes in type 2 diabetes,” wrote investigators.

This study, “Sleep disorders in people with type 2 diabetes and associated health outcomes: a review of the literature,” was published in Diabetologia.