Effect of Sleep Duration on Obesity and the Glycemic level in Patients with Type 2 Diabetes

Thressia. P.A. (Sr. Tresa Anto)¹ , Dr. Rajeev. Kumar. N.²

¹Ph.D. Scholar, M.G. University, Kottayam, Kerala

¹Vice Principal, Jubilee Mission College of Nursing, Jubilee Gardens, Kachery, Thrissur-5, Kerala

²Associate Professor ,M.G. University, Kottayam,Kerala. rajeevkumarn@mgu.ac.in

*Corresponding Author Email: srtresaanto@gmail.com

ABSTRACT:

Introduction: Non communicable diseases especially type 2 diabetes is increasing day by day. The present day life style contributes to the alarming rise in the occurrence of this disease. Our society is moving very fast with fast food and tight day and night schedule to achieve something or other in their life. Our current work schedule prevent people from getting enough sleep. Chronic sleep loss is very common in today’s society. There is a need to study the relationship between sleep loss and glycemic level of diabetes patients.

Methods:- A non experimental descriptive design using random sampling technique. Effect of sleep duration on obesity and the glycemic level in patients with type 2diabetes were assessed using self administered questionnaire to a total of 60 type2 diabetes patients between 30-60 years from medical and endocrinology OPD,s of a private medical college. Thrissur, from September 2013 to October 2013.socio demographic values were collected to assess the risk factors for diabetes. Body mass index (BMI) was calculated as weight in kilograms divided by height in meters squared. HbA1c values were obtained from the medical charts. The Pittsburgh Sleep Quality Index(PSQI)questionnaire was used to assess the sleep quality.

Results: Shows that 56 % of participants belongs to the age group between 51-60 years and50 % of them are males. 91.7% them are professionals and 63% of them are staying in rural area. 21.6% of the sample had an HbA1c level below 6.5%, which is the recommended optimal upper level of HbA1c. 10% of them had an HbA1c level above 8%.

51.6% them are having overweight. The present study shows that sleep latency, sleep duration, sleep medication, day time dysfunction, residence and total sleep score were positively associated with HbA1c values. whereas, hours of sleep, age, sex, educational achievement, Occupation, family type, residence, duration of illness, and treatment were not significantly associated with BMI.

Conclusions: The findings of the study highlight that sleep latency, sleep duration, sleep medication, day time dysfunction, residence and total sleep score were associated with glycemic level in patients. present study findings are consistent with previous study findings and suggest that health education for the modification of life style is the need of the hour, and therefore sleep may be an important modifiable factor for the clinical management of patients with type 2 diabetes.

KEY WORDS: Sleep duration , body mass index, glycemic level -HbA1c, type 2diabetes patients

INTRODUCTION:

Changes in human behavior and lifestyle associated with globalization have resulted in a dramatic increase in the prevalence and incidence of type 2 diabetes globally. Until recently, there was a strong emphasis on genetic susceptibility, and on environmental and behavioral factors such as a sedentary lifestyle, overly rich nutrition, and obesity (particularly central adiposity) (1). Diabetes mellitus (DM) is the single most important metabolic disorder that affects nearly every organ system in the body. Diabetes is escalating as an epidemic with the emergence of type 2 diabetes in children and young people. In India, presently about 30 million people are diabetic which will rise to about 60 million by 2017. Much more alarming is the growing incidences of gestational diabetes in our country, of which 60 per cent are known to develop diabetes later in life. These statistics are of great public health concern, because people with diabetes are 25 times more likely to develop blindness, 17 times more likely to develop kidney disease, 30-40 times more likely to undergo amputation, two to four times more likely to develop myocardial infarction and twice as likely to suffer a stroke than non-diabetics. Increasing per capita income, socio-economic status, life expectancy and urbanization are the signs of growth and development but the associated changes in lifestyle, dietary habits, sedentary habits and mental turbulent states contribute more to diabetes and its complications. The added burden of declining cognitive capabilities is still making a huge toll on the human resource utilization (2).The present day life style contributes to the alarming rise in the occurrence of this disease. Lifestyle modifications inclusive of dietary modification, regular physical activity and weight reduction are indicated for prevention of diabetes. Modern society encourages late night activities, such as watching television, using the computer or Internet, round-the-clock entertainment, as well as demanding shift work or night work that further promotes such activities. According to a survey by the National Sleep Foundation (2010), approximately one-fourth of participants stated that their current work schedule prevented them from getting enough sleep(3). Chronic sleep loss is very common in today’s society. Even though sleep professionals and the National Sleep Foundation recommend 8 h of sleep per night, American adults only sleep an average of 6.85 h per night (4). Furthermore, only 37% report obtaining 8 hours of sleep per night, and 31% of adults report sleeping 6 h per night. The amount of sleep individuals obtain also is steadily decreasing over time. Thirty years ago, adults slept 7.68 h per night; 80 years ago, they slept even longer (8.77 h reported by college-aged adults) (5).The cause of this sleep loss is multifactorial. About 45% of adults report that they sleep less to get more work done, 43%stay up watching television or using the internet, and 22% have insomnia (i.e., report having difficulty falling asleep). Because of these figures, many have suggested that we live in a sleep-deprived society. (6)An increasing prevalence of type 2 diabetes and its complications, including macro- and microvascular diseases, is a growing public health concern in both developing and developed countries(7). As a result of the modern lifestyle and 24-h society, and epidemiological evidence has suggested that this is associated with adverse consequences such as obesity or weight gain (8, 9), The health effects of sleep restriction are unclear. However, a recent study demonstrated that sleep deprivation can adversely affect endocrine function(10). Only few studies are currently available regarding the influence of sleep duration on glycemic control in diabetic patients. The objective of the current study was to examine the relationship between sleep duration, obesity, and the glycemic level in type 2 diabetic patients.

MATERIAL AND METHODS:

A non experimental descriptive design using simple random sampling by using lot method. Effect of sleep duration on obesity and the glycemic level in patients with type 2diabetes were assessed using self administered questionnaire to a total of 60 type2 diabetes patients between 35-60 years from medical and endocrinology OPD,s of a private medical college Thrissur, from September 2013 to October 2013. The protocol was approved by the institutional ethical committee and institutional review board, and all participants gave written informed consent. A total of 60 patients completed the study. The sample included 30 men and 30 women. In the present study independent variable is the sleep duration. Dependent variables are the HbA1c and BMI. Patients who provide incomplete responses to the sleep questionnaire. patients without a glycated hemoglobin (hba1c) measurement. Patients claiming to prefer 12 or more hours of sleep per night were excluded from the study. Socio demographic variables such as age, sex, education status, family type, residence, occupation, duration of illness and type of treatment were collected. Body Mass Index (BMI) was calculated as weight in kilograms divided by height in meters squared. HbA1c values were obtained from the medical charts. The Pittsburgh Sleep Quality Index (PSQI) questionnaire was used to assess the sleep quality. It includes 9 questions. The nine questions were grouped into seven component scores, each weighted equally on a 0–3 scale. The seven components were then summed to yield a global PSQI score (range:0–21); higher scores indicate worse sleep quality. The seven components of the PSQI are: (i) subjective sleep quality, (ii) sleep latency, (iii) sleep duration, (iv) sleep efficiency, (v) sleep disturbances, (vi) use of sleeping medications and (vii) daytime dysfunction. In this study design, a PSQI score <5 was also conventionally defined as ‘good sleep quality’, a PSQI score of 5–8 points was defined as ‘average sleep quality’, and a PSQI score > 8 was defined as ‘poor sleep quality’. we used the level of HbA1c as the index for glycaemic control in type 2 diabetic patients in this study. The level of HbA1c < 7% was defined as good glycaemic control based on the American Diabetes Association 2010 Guidelines while a level of HbA1c > 7% was considered poor glycaemic control. Subjects with a BMI > 30 kg/m2 are conventionally considered obese. Descriptive statistics were used for measuring sociodemographic variables and association between sleep, HbA1c and BMI studied using chi square tests.

RESULTS:

Table1:-Distribution of samples according to the selected demographic variables

Sl no

Variables

Frequency (F) Percentage(%)

Age

30-40

41-50

51-60

8.3

35.0

56.7

Sex

Male

Female

Education

College

Technical

Professonal

1.7

6.7

91.7

Family

Nuclear

Extended

35.0

65.0

Residence

Rural

Urban

63.3

36.7

Occupation

House wife

Business

Professional

33.3

26.7

40.0

Duration

<1 years

1-2 years

2-3years

>3years

13.3

8.3

16.7

61.7

Treatment

Tablets

Food restriction

Exercise

None

91.7

6.7

1.7

HbA1c

<6.5

6.5-6.9

7-7.4

7.5-7.9

21.6

20.0

18.3

30.0

10.0

10.

Height

140-145

146-150

151-155

156-160

161-165

8.4

6.7

31.8

21.7

31.6

11.

Weight

50-60

61-70

71-80

81-90

46.8

41.5

10.1

1.7

12.

BMI

18.5-24.9

25-29.9

30-39.9

35.0

51.6

13.3

Table2a:-Association between sleep latency and HbA1c in type2 diabetes patients

Sl. No	Sleep latency	Frequency(F)	Hba1c	Frequency(F)	^X2	df	P value
1.	<15mts	27	<6.5	13	14.406	16	0.05*
2.	16-30mts	25	6.5-6.9	12
3.	31-60mts	6	7-7.4	11
4.	>60mts	2	7.5-7.9	18
5.			>8	06

*p=0.05.

Table2b:-Association between sleep quality and HbA1c in type2 diabetes patients

Sl. No	Sleep quality	Frequency(F)	Hba1c	Frequency(F)	X2	df	P value
1.	Very good	20	<6.5	13	9.228	8	0.323
2.	Fairly good	37	6.5-6.9	12
3.	Fairly bad	3	7-7.4	11
4.	Very bad	0	7.5-7.9	18
5.	worse	0	>8	06

*p=0.05.

Table2c:- Association between sleep duration and HbA1c in type2 diabetes patients.

Sl. No	Sleep duration	Frequency(F)	Hba1c	Frequency(F)		df	P value
1.	>7hrs	1	<6.5	13	21.633	12	0.042*
2.	6-7hrs	3	6.5-6.9	12
3.	5-6hrs	37	7-7.4	11
4.	<5hrs	19	7.5-7.9	18
6.			>8	06

*p<0.05

Table2d:-Association between sleepefficiency and HbA1c in type2 diabetes patients

Sl. No	Sleep efficiency	Frequency(F)	Hba1c	Frequency(F)		df	P value
1.	>85%	58	<6.5	13	4.828	4	0.305
2.	75-84%	02	6.5-6.9	12
3.	65-74%	0	7-7.4	11
4.	<65%	0	7.5-7.9	18
5.		0	>8	06

*p<0.05

Table2e:-Association between sleep disturbance and HbA1c in type2 diabetes patients

Sl. No	Sleep disturbance	Frequency(F)	Hba1c	Frequency(F)	X2	df	P value
1.	Not during the past month	03	<6.5	13	8.173	8	0.417
2.	Less than once a week	53	6.5-6.9	12
3.	Once or twice a week	04	7-7.4	11
4.	Three or more times a week	0	7.5-7.9	18
5.			>8	06

*p<0.05

Table2f:-Association between sleep medication and HbA1c in type2 diabetes patients

Sl. No	Sleep medications	Frequency(F)	HbA1c	Frequency(F)	X2	df	P value
1.	Not during the past month	11	<6.5	13	26.697	12	0.009*
2.	Less than once a week	28	6.5-6.9	12
3.	Once or twice a week	20	7-7.4	11
4.	Three or more times a week	01	7.5-7.9	18
4.	Three or more times a week	01	>8	06

*p<0.05

Table2g:-Association between day time dysfunction and HbA1c in type2 diabetes patients

Sl. No	day time dysfunction	Frequency(F)	Hba1c	Frequency(F)	X2	df	P value
1.	Not during the past month	21	<6.5	13	21.925	08	0.005*
2.	Less than once a week	32	6.5-6.9	12
3.	Once or twice a week	07	7-7.4	11
4.	Three or more times a week	0	7.5-7.9	18
5.		0	>8	06

*p<0.05

Table2h:-Association between total sleep score and HbA1c in type2 diabetes patients

Sl. No	Total sleep score	Frequency(F)	HbA1c	Frequency(F)	X2	df	P value
1.	>7hrs	1	<6.5	13	57.223	40	0.03*
2.	6-7hrs	3	6.5-6.9	12
3.	5-6hrs	37	7-7.4	11
4	<5hrs	19	7.5-7.9	18
			>8	06

*p<0.05

Table3Association between sociodemographi variables and HbA1c in type2 diabetes patients

Sl. No

Frequency

HbA1c

Frequency

P value

Age

30-40

41-50

51-60

<6.5

6.5-6.9

7-7.4

7.5-7.9

9.703

0.287

education

College

Technical

Professonal

<6.5

6.5-6.9

7-7.4

7.5-7.9

12.120

0. 146

Family

Nuclear

Extended

6.5

6.5-6.9

7-7.4

7.5-7.9

5.486

0.241

Residence

Rural

urban

<6.5

6.5-6.9

07-7.4 7.5-7.9

10.6

0.03*

*p<0.05.

DISCUSSION:

Type2 diabetes has become a major public health problem in the country. Ageing, being female, obesity and an unhealthy lifestyle are generally considered to be risk factors for diabetes, but an increasing number of studies have shown that diabetes is associated with sleep quantity and quality. A prospective study including 6599 initially healthy, non-diabetic men with a mean6SD age of 44.564.0 years suggested that sleep disturbances were associated with diabetes prevalence in middle-aged men after a 14.8-year follow-up (11). The present study shows that sleep latency, sleep duration, sleep medication, day time dysfunction, residence and total sleep score were positively associated with HbA1c values. whereas, hours of sleep, age, sex, educational achievement, Occupation, family type, residence, duration of illness, and treatment were not significantly associated with BMI. The present study findings were supported by prospective cohort study conducted for middle-aged and elderly men. They observed a significant U-shaped relationship between self reported sleep duration and incidence of type 2 diabetes. Men reporting either short (5 or 6 h of sleep per night) or long (8 h of sleep per night) sleep duration were at significantly increased risk of developing diabetes. These elevated risks remained after adjustment for age, hypertension, smoking status, self-rated health status, and education (12). the association between self-reported sleep duration, sleep quality and the prevalence of diabetes were investigated in a contemporary sample of Chinese adults: The results suggest that sleep of poor quality and short duration is associated with diabetes (13). Further suggests that habitual short sleep duration may lead to insulin resistance by increasing sympathetic nervous system activity, raising evening cortical levels and decreasing cerebral glucose utilisation. The increased burden on the pancreas from insulin resistance can compromise beta cell function and lead to type 2 diabetes over time(13-15). sleep duration and quality were significant predictors of HbA1c, a key marker of glycemic control. Combined with existing evidence linking sleep loss to increased diabetes risk, these data suggest that optimizing sleep duration and quality should be tested as an intervention to improve glucose control in patients with type 2 diabetes (16). It has been reported that poor sleep is associated with higher HbA1c levels in subjects with type 2 diabetes (17,18). Study shows that poor sleep is associated with a higher risk of developing diabetes in workers without an family history of diabetes (FHD). Promoting healthy sleeping habits may be effective for preventing the development of diabetes in people without an FHD (19).The HbA1c levels showed a association with sleep duration; namely, a shorter or longer sleep duration was associated with a higher level compared with a sleep duration of 6.5–7.4 h (P=,0.001). Furthermore, additional adjustments for obesity, which also showed a U-shaped relationship with sleep duration, did not attenuate the U-shaped sleep-HbA1c association. A significant interaction between sleep duration and age or the use of insulin was observed for the HbA1c levels. Sleep duration was shown to have U-shaped associations with obesity and the HbA1c levels in type 2 diabetic patients (20). The findings of the study highlight that sleep duration, are associated with glycemic level in patients. Present study findings are consistent with previous study findings and suggest that health education for the modification of life style is the need of the hour, and therefore sleep may be an important modifiable factor for the clinical management of patients with type 2 diabetes.

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Received on 02.04.2014 Modified on 15.05.2014

Asian J. Nur. Edu. and Research 4(4): Oct.- Dec., 2014; Page 502-507