Factors influencing sleep quality and its impact on glycemic control in patients with type II diabetes mellitus - A hospital based cross sectional study

Background: The absolute number of diabetic population worldwide has raised from 108 million in 1980 to 422 million in 2014. Many western studies documented that diabetes affects the patient’s sleep quality negatively and also imbalance in sleep quality considerably influences the adequacy of glycemic control. Little attention is given to this vital aspect in clinical care of diabetic population in India due to scarcity of studies on the subject. Aim: To assess the prevalence of poor sleep quality and factors influencing it in type II diabetes mellitus patients and also to assess the impact of sleep quality on glycemic control. Materials and methods: The study is a hospital based descriptive cross sectional study, conducted in a tertiary care teaching hospital. A total of 100 Patients of type II diabetes mellitus attending the study setting were recruited sequentially into the study. Sleep pattern was assessed by Pittsburg Sleep Quality Index (PSQI), a person with PSQI global score of 5 and above was considered as “poor sleeper”. HbA1 c level of ? 7 was considered as poor glycemic control as per Standards of Medical Care in Diabetes, 2016 guidelines. Results: Sleep pattern (PSQI global score ?5) was poor in 64% (54.2% to 72.7%) of the study subjects. The odds of poor glycemic control were 3.56 (95 % CI 1.47 to 8.60, p value 0.004) times higher in people with poor sleep quality, compared to people with good sleep quality. Multivariate logistic regression analysis showed higher risk of poor sleep with increasing age, male gender and combined insulin and OHA therapy. Diabetic neuropathy had the strongest association with poor sleep pattern, with an Odds ratio of 3.5 (95% CI 1.27 to 9.59, p value 0.05). Conclusion: The prevalence of poor sleep quality is very high in diabetic patients and is strongly associated with diabetic neuropathy. Poor sleep quality is associated with poor glycemic control.