increase morbidity and mortality.

linked to increase morbidity and mortality.(1)
Poor sleep quality may independently increase the incidence of diabetes.(2)
Shorter sleep duration over the weekdays called social jetlag is associated with worse glycemic control in type 1 diabetes. (3)
A total of 90 elder patients with diabetes in Beijing Hospital. Questionnaires of Pittsburgh Sleep Quality Index(PSQI) and Holter was applied to evaluate heart rate
variability (HRV). Other related clinical data such as, catecholamine[epinephrine(E); norepinephrine(NE); dopamine(DA)]and diabetes complications were collected.
Patients were divided into three groups: the poor-sleeper group, the common-sleeper group and the good-sleeper group according to PSQI score. HRV and the level of
catecholamine were compared among three groups. RESULTS: The level of HRV. The level of catecholamine in poor-sleeper group were lower than both the common-sleeper
group and the good-sleeper group suggesting a dysfunction in autonomic nervous system in subject in the poor-sleeper group. CONCLUSION: Sleep quality is associated
with the severity of diabetic autonomic neuropathy. (4)
Prospective cohort study of Chinese population concluded that poor sleep quality, short sleep duration, and long sleep duration increase risk of developing diabetes
mellitus (DM). Study also shows that there are additive interactions between poor sleep quality and short sleep duration in increasing diabetes. (5)
A community based study of US Hispanic/Latino population, age 18-74 years reports that sleep duration is highly variable among US Hispanics/Latinos, varying by
socioeconomic status. Short sleep duration was remained significantly associated with obesity but not with diabetes, hypertension, or heart disease. In contrast, long
sleep was not associated with any of these conditions. (6)
In a study with 291 patients the prevalence of patients with poor sleep was 63.9%. Poor sleep was associated with age, intensive anti-diabetic treatment and longer
duration of diabetes. Short sleep was associated with intensive anti-diabetic treatment and BMI, while EDS was associated with increased BMI. In a sample of patients
with type 2 diabetes, a high prevalence of self-reported sleep duration and unhealthy sleep habits was found. (7)
In an observational study of 56 032 patients with diabetes , compared with a sleep duration of 6-7.9 h, longer sleep duration was associated with a higher prevalence
of hypertension and poor glycaemic control in people with diabetes. (8)
Cross-sectional study including 15,227 participants (mean age 41; range 18-74 years) from the Hispanic Community Health Study/Study of Latinos. Both decreased quantity
and quality of sleep are associated with diabetes in Hispanic/Latinos, with the greatest odds among those with short sleep duration and insomnia. (9)
Cross-sectional analysis of the Hispanic Community Health Study/Study of Latinos from a sample of 14,440 individuals, moderate SDB was associated with being male,
obese, and older age. SDB was associated with an increased adjusted odds of impaired glucose tolerance, diabetes), and hypertension. (10)
In a cross-sectional study, Dutch adults with type 1 (n=267) or type 2 diabetes (n=361) completed an online survey, including the Pittsburgh Sleep Quality Index
(PSQI), socio-demographic, clinical, self-care and psychological measures. Poor subjective sleep quality is prevalent both in adults with type 1 and type 2 diabetes,
and is related to poor daytime functioning and higher self-care burden. (11)
A population-based cross-sectional study included a total of 1670 subjects aged >40 years with diabetes in the Korean National Health and Nutrition Examination Survey
during 2008-2012.Pperformed standardized interviews, including self-reported sleep duration, and comprehensive ophthalmic examinations.Short and long sleep was
associated with high prevalence of DR in men.(<5 hr sleep, and >9 hr sleep), compared to in subjects with 6-8 hr sleep, after adjusting for potential confounders
including age, body mass index (BMI), diabetes duration, fasting glucose level, haemoglobin A1c levels and hypertension. In women, however, no significant association
between sleep duration and DR was found.(12)
Sleep complaints are common in hemodialysis (HD) patients. Sleep quality (SQ) is a predictor of quality of life and mortality risk in HD. Cross-sectional analytic
study, 138 end-stage renal disease patients receiving maintenance HD for >3 months, The Pittsburgh Sleep Quality Index (PSQI) was used to measure individual’s SQ.
Patients with a global PSQI score >5 were assumed as poor sleepers. Eighty-eight patients (64%) were classified as poor sleepers. Poor sleepers were older and more
likely had diabetes. They had significantly higher serum ferritin and calcium levels and lower serum parathyroid hormone level (all P-values <0.05). Poor SQ was common
among our HD patients, especially among diabetic cases and, therefore, there is a need to pay more attention to the care of this subgroup with regard to the diagnosis
and management of sleep complaints. (13)
To investigate the temporal association between frequency of non-nocturnal hypoglycemia and sleep quality among patients with diabetes receiving insulin
from 1513 patients sleep quality measured by the Pittsburgh Sleep Quality Index.Experiencing non-nocturnal severe hypoglycemia (NNSH) once in the past 90 days
significantly increased the risk of poor sleep quality by 1.54 episodes (95% CI, 1.16-2.05; p=0.003). (14)
498 patients with DM type 2 and 58 patients with DM type 1 from 15 centres, using a screening device determining airflow and pulse oximetry. Among the patients, 37.4%
had an apnoea-hypopnoea index (AHI) >15/h suggestive of OSA. The prevalence of an AHI > 15/h among the patients with DM type 1 was 10.3%. One hundred ninety-three
(35.2%) patients suffered from neuropathy. We found a higher prevalence for neuropathy, nephropathy, hypertension, cardiovascular disease and heart failure in the
group with an AHI > 15/h. CONCLUSIONS: The prevalence of sleep disordered breathing is increased in patients with DM. Most of these patients had no typical clinical
symptoms of OSA and would have been undiagnosed without diagnostic assessment of OSA. (15)
eight adult patients with uncomplicated type 1 diabetes and eight matched nondiabetic control subjects with hyperinsulinemic stepped hypoglycemic clamps The diabetic
subjects exhibited markedly reduced awakening from sleep during hypoglycemia. We conclude that autonomic responses to hypoglycemia are reduced during sleep in type 1
diabetes, and that, probably because of their reduced sympathoadrenal responses, patients with type 1 diabetes are substantially less likely to be awakened by
hypoglycemia. (16)
1. Ancoli-Israel S, Kripke DF, Klauber MR, Fell R, Stepnowsky C, Estline E, Khazeni N, Chinn A. Morbidity, mortality and sleep-disordered breathing in community
dwelling elderly. Sleep. 1996;19:277–282
2. Lee JA; Sunwoo S; Kim YS; Yu BY; Park HK; Jeon TH; Yoo BW. The Effect of Sleep Quality on the Development of Type 2 Diabetes in Primary Care Patients. Journal
of Korean Medical Science. 31(2):240-6, 2016 Feb.
3. Larcher S; Gauchez AS; Lablanche S; Pepin JL; Benhamou PY; Borel AL. Impact of sleep behavior on glycemic control in type 1 diabetes: the role of social
jetlag.European Journal of Endocrinology. 175(5):411-9, 2016 Nov.
4. Zhang J; Zhang L; Guo L. The relationship between sleep quality and diabetic autonomic neuropathy in elder patients with type 2 diabetes mellitus. Chung-Hua
NeiKoTsaChih Chinese Journal of Internal Medicine. 55(3):196-201, 2016 Mar.
5. P. Lou, P. Zhang, L. Zhang, P. Chen, G. Chang, N. Zhang, et al. Effects of sleep duration and sleep quality on prevalence of type 2 diabetes mellitus: a 5-year
follow-up study in China. Diabetes Res ClinPract, 109 (2015), pp. 178–184
6. Patel SR; Sotres-Alvarez D; Castaneda SF; Dudley KA; Gallo LC; Hernandez R; Medeiros EA; Penedo FJ; Mossavar-Rahmani Y; Ramos AR; Redline S; Reid KJ; Zee PC.
Social and Health Correlates of Sleep Duration in a US Hispanic Population: Results from the Hispanic Community Health Study/Study of Latinos. Sleep. 38(10):1515-22,
2015 Oct 01.
7. Ramtahal R; Khan C; Maharaj-Khan K; Nallamothu S; Hinds A; Dhanoo A; Yeh HC; Hill-Briggs F; Lazo M. Prevalence of self-reported sleep duration and sleep habits
in type 2 diabetes patients in South Trinidad. Journal of Epidemiology and Global Health. 5(4 Suppl 1):S35-43, 2015 Dec.
8. Wang T; Lu J; Wang W; Mu Y; Zhao J; Liu C; Chen L; Shi L; Li Q; Yang T; Yan L; Wan Q; Wu S; Liu Y; Wang G; Luo Z; Tang X; Chen G; Huo Y; Gao Z; Su Q; Ye Z;
Wang Y; Qin G; Deng H; Yu X; Shen F; Chen L; Zhao L; Xu M; Sun J; Bi Y; Lai S; Bloomgarden ZT; Li D; Ning G. Sleep duration and snoring associate with hypertension and
glycaemic control in patients with diabetes. Diabetic Medicine. 32(8):1001-7, 2015 Aug.
9. Cespedes EM; Dudley KA; Sotres-Alvarez D; Zee PC; Daviglus ML; Shah NA; Talavera GA; Gallo LC; Mattei J; Qi Q; Ramos AR; Schneiderman N; Espinoza-Giacinto RA;
Patel SR. Joint associations of insomnia and sleep duration with prevalent diabetes: The Hispanic Community Health Study/Study of Latinos (HCHS/SOL). Journal Of
Diabetes. 8(3):387-97, 2016 May.
10. Redline S; Sotres-Alvarez D; Loredo J; Hall M; Patel SR; Ramos A; Shah N; Ries A; Arens R; Barnhart J; Youngblood M; Zee P; Daviglus ML. Sleep-disordered
breathing in Hispanic/Latino individuals of diverse backgrounds. The Hispanic Community Health Study/Study of Latinos.American Journal of Respiratory & Critical Care
Medicine. 189(3):335-44, 2014 Feb 01.
11. Nefs G; Donga E; van Someren E; Bot M; Speight J; Pouwer F. Subjective sleep impairment in adults with type 1 or type 2 diabetes: Results from Diabetes
MILES–The Netherlands. Diabetes Research & Clinical Practice. 109(3):466-75, 2015 Sep.
12. Jee D; Keum N; Kang S; Arroyo JG. Sleep and diabetic retinopathy.ActaOpthalmologica. 95(1):41-47, 2017 Feb.
13. Edalat-Nejad M; Jafarian N; Yousefichaijan P. Diabetic nephropathy: a strong predictor of sleep quality in hemodialysis patients.Saudi Journal of Kidney
Diseases & Transplantation. 25(4):774-80, 2014 Jul.
14. Hayashino Y; Tsujii S; Ishii H; Diabetes Distress and Care Registry at Tenri Study Group. High frequency of non-nocturnal hypoglycemia was associated with poor
sleep quality measure by Pittsburg Sleep Quality Index in patients with diabetes receiving insulin therapy: Diabetes Distress and Care Registry at Tenri (DDCRT
4).Experimental & Clinical Endocrinology & Diabetes. 121(10):628-34, 2013 Nov.
15. Schober AK; Neurath MF; Harsch IA. Prevalence of sleep apnoea in diabetic patients.The clinical respiratory journal. 5(3):165-72, 2011 Jul.
16. Banarer S; Cryer PE. Sleep-related hypoglycemia-associated autonomic failure in type 1 diabetes: reduced awakening from sleep during hypoglycemia.Diabetes. 52
(5):1195-203, 2003 May.