The Phenotype of Elderly Patients with Type 2 Diabetes Mellitus and Poor Sleep Quality

Hypnotic drug use and rehabilitation outcomes in post-acute geriatric hip fracture patients: A retrospective study

INTRODUCTION

The use of hypnotic drugs is common in the elderly and is associated with negative health outcomes. Our aim was to evaluate the prevalence of hypnotic drug usage amongst hip fracture patients undergoing a rehabilitation program and investigate any potential associations between hypnotic drug use and rehabilitation outcomes in a post-acute care setting.

METHODS

A retrospective analysis of 440 geriatric hip fracture patients was conducted from 1/1/2019 to 12/2021 in a geriatric rehabilitation center. The main outcome measures were the Functional Independence Measure (FIM), the motor FIM effectiveness and length of stay (LOS).

RESULTS

Two hundred and twenty-eight (51.7 %) patients out of the entire cohort (440)), were prescribed hypnotic drugs. These patients exhibited a significantly lower rate of diabetes (p = 0.025), a higher rate of depression (p = 0.003), and lower albumin levels (p = 0.023) upon admission to rehabilitation in comparison to untreated patients. No significant differences were observed between the two patient groups in functional rehabilitation outcomes or LOS. Moreover, no correlation was established between the hypnotic drug burden during rehabilitation and the outcome measures. Furthermore, no significant differences were found between patients treated with hypnotic drugs on admission and those who were prescribed these drugs during rehabilitation. The type of hypnotic drug did not affect these results.

CONCLUSION

The use of hypnotic drugs by elderly individuals undergoing a rehabilitation program after a hip fracture is unlikely to have an adverse impact on their short-term rehabilitation outcomes. Consequently, there may not be an immediate necessity to discontinue these drugs upon admission. Nevertheless, the use of hypnotic drugs should be approached with caution and minimized whenever possible due to an increased fall risk and other adverse effects.

Quality of Sleep and Its Determinants Among People with Diabetes Mellitus in Sub-Saharan Africa: A Systematic Review and Meta-Analysis

BACKGROUND

Poor sleep quality is a serious concern among diabetes mellitus patients, adversely affecting glycemic management and the prognosis of diabetic patients. Therefore, the main aim of this study was to estimate the overall pooled prevalence of poor sleep quality and its associated factors among diabetic patients in Sub-Saharan Africa.

METHODS

Several search databases were employed to retrieve the eligible studies. A standardized data extraction format was used to extract the data, and the analysis was conducted using STATA version 14. To determine heterogeneity, the I2 test was conducted, and both the funnel plot and Egger's regression test were used to assess the publication bias. A random effects model meta-analysis was performed to estimate the overall prevalence and associated factors of poor sleep quality.

RESULTS

In the current meta-analysis, a total of 11 studies with 3,766 study participants were included. The overall pooled prevalence of poor sleep quality among diabetic patients was 53.22% (95% CI: 36.26, 70.19). Poor sleep quality was significantly associated with longer duration of diabetes (OR = 2.94, 95% CI: 1.85, 4.67), poor glycemic control (OR = 2.24, 95% CI: 1.51, 3.32), depression (OR = 4.09, 95% CI: 2.07, 8.05) and comorbidity (OR = 1.94, 95% CI: 1.31, 2.88).

CONCLUSION

In this study, more than half of diabetic patients in Sub-Saharan Africa had poor sleep quality. Therefore, healthcare providers should give more attention to sleep disorders when screening diabetic patients to improve their poor sleep quality.

Poor sleep quality is an overlooked risk for geriatric syndromes in older adults with type 2 diabetes mellitus

BACKGROUND

Aging and type 2 diabetes mellitus (DM) are two different conditions that impair sleep quality. The primary objective of this study was to investigate the impact of sleep quality on geriatric syndromes in older diabetic adults.

METHODS

Comprehensive geriatric assessment was performed on 236 patients. The assessment included the Geriatric Depression Scale (GDS), Beck Anxiety Inventory (BAI), European Quality of Life Questionnaire (EQ-5D), Mini Mental Statement Examination (MMSE), Pittsburgh Sleep Quality Index (PSQI), Mini Nutritional Assessment, and measurement of handgrip strength (HGS).

RESULTS

Of the participants, 55% had DM, and 61.4% had poor sleep quality. Poor sleep prevalence was higher in diabetic patients (68.5%) than in non-diabetics (52.8%). Diabetic patients with poor sleep quality had higher frequencies of chronic pain, recurrent urinary tract infections, confirmed sarcopenia, and frailty (p = 0.015, p < 0.001, p = 0.027, and p < 0.001, respectively), a higher number of comorbidities and higher GDS and BAI scores (p = 0.046, p < 0.001 and p < 0.001, respectively), and lower scores of activities of daily living, HGS, and EQ-5D index (p = 0.023, p = 0.004, and p < 0.001, respectively) compared to diabetic patients with good sleep quality. According to the correlation analysis results, PSQI score had a positive correlation with GDS score (r = 0.461, p < 0.001) and a negative correlation with Mini Nutritional Assessment score (r = -0.317, p < 0.001), skeletal muscle mass index (r = -0.283, p = 0.002) and HGS (r = -0.307, p < 0.001) scores in diabetic older adults.

CONCLUSION

Poor sleep quality in older diabetic patients has a negative impact on several geriatric syndromes. Our findings suggest that poor sleep quality is an independent risk factor for depression, malnutrition, and lower muscle mass in older diabetic adults. Improving sleep quality may play a crucial role in preventing and managing geriatric syndromes in this population.

Correlation between Sleep Time, Sleep Quality, and Emotional and Cognitive Function in the Elderly

Background

To explore the relationship between sleep time, sleep quality, and emotional and cognitive function in the elderly.

Methods

A total of 150 elderly patients over 65 years old who were admitted to our hospital from February 2019 to April 2021 were divided into a normal cognitive function group (Mini-Mental State Examination (MMSE) score: illiteracy, >17; primary school, >20; and middle school and above, >24; N = 86) and cognitive impairment group (MMSE score: illiteracy, ≤17; primary school, ≤20; and middle school or above, ≤24; N = 64). The sleep quality was evaluated by the Pittsburgh Sleep Quality Index (PSQI), and anxiety and depression were evaluated by Hamilton anxiety scale (HAMA) and Hamilton depression scale (HAMD), respectively. The cognitive function between the two groups was compared via the Montreal Cognitive Assessment (MoCA) score, visual spatial execution, and attention. Pearson correlation analysis was used to analyze the correlation between sleep quality, sleep time, and emotional and cognitive function.

Results

In the comparison of sleep quality between the two groups, the total score of PSQI, sleep quality, falling asleep time, sleep time, and sleep efficiency of patients with cognitive impairment were higher than those of patients with normal cognitive function (P < 0.05). There was no significant difference in the scores of hypnotic use and daytime dysfunction between the two groups, but the scores of nocturnal sleep disorders and ESS in the cognitive impairment group were significantly higher than those in the normal group (P > 0.05). Compared between the two groups, the MoCA score, visual spatial execution, and attention in the cognitive impairment group were significantly lower than those in the normal group, and the difference was statistically significant (P < 0.05). The delayed recall in the cognitive impairment group was significantly higher than that in the control group (P < 0.05). There was no significant difference in orientation, naming, language, and abstract ability between the two groups (P > 0.05). The scores of HAMA and HAMD in the cognitive impairment group were significantly higher than those in the normal group. Pearson correlation analysis was used to analyze the correlation between sleep therapy, sleep time, and the score of cognitive scale. The results showed that PSQI was negatively correlated with MoCA and MMSE, and ESS was negatively correlated with MoCA and MMSE. Pearson correlation analysis results indicated that PSQI was positively correlated with HAMA and HAMD, while ESS was negatively correlated with HAMA and HAMD.

Conclusion

The sleep quality and sleep time of elderly patients are positively correlated with their cognitive function. The worse the sleep quality is, the worse their cognitive function is and the more serious their anxiety and depression are. In the course of clinical therapeutics, more attention should be paid to the sleep quality of elderly.

Sleep Quality and Its Determinants Among Type 2 Diabetes Patients with Comorbid Metabolic Syndrome

PURPOSE

The prevalence of poor sleep quality in patients with diabetes was higher than the general population. This study aimed to explore risk factors for not only poor sleep quality, but also long sleep latency, short sleep duration and low sleep efficiency, in type 2 diabetes patients (T2DM) with comorbid metabolic syndrome (MS).

PATIENTS AND METHODS

A total of 281 patients aged 18-75 years were enrolled from Ningbo First Hospital during October 2021 to March 2022. Sleep quality was evaluated by the Pittsburgh Sleep Quality Index (PSQI). Sleep latency, sleep duration and sleep efficiency were obtained by a response to the questionnaire. Descriptive, independent two-sample t-test, Chi-square test and multiple logistic regression were conducted using SPSS Version 28.

RESULTS

The prevalence of poor sleep quality in T2DM with comorbid MS patients was 59.10%. The factors significantly associated with poor sleep quality were depression symptoms (OR = 3.10, 95% CI: 1.38 to 6.96, P = 0.006), poor quality of life (OR = 2.49, 95% CI: 1.24 to 4.99, P = 0.010), and age (OR = 1.07, 95% CI: 1.04 to 1.10, P < 0.001). The factor significantly associated with long sleep latency was depression symptoms (OR = 2.19, 95% CI: 1.15 to 4.16, P = 0.017). The factors significantly related to short sleep duration were depression symptoms (OR = 2.56, 95% CI: 1.31 to 5.00, P = 0.006) and age (OR = 1.05, 95% CI: 1.02 to 1.08, P = 0.002). The factor significantly related to short sleep efficiency was age (OR = 1.03, 95% CI: 1.01 to 1.06, P = 0.019).

CONCLUSION

This study found that depression symptoms, together with poor quality of life, and increasing age were associated with poor sleep quality. Symptoms of depression were related to long sleep latency and short sleep duration. The increasing age was associated with short sleep duration and low sleep efficiency.

Association Between Diabetic Retinopathy and Insomnia Risk: A Nationwide Population-Based Study

BACKGROUND

Previous studies have suggested a close link between sleep disturbances and diabetic retinopathy (DR). However, to date, no confirmatory findings have been reported. We aimed to explore the risk of insomnia in DR by considering demographic factors and diabetes mellitus (DM)-related variables.

METHODS

A nationwide population-based cohort of 2,206,619 patients with type 2 diabetes from the Korean National Insurance Service Database was followed up for insomnia incidence. DR, non-proliferative DR (NPDR), and proliferative DR (PDR) were defined according to ICD-10 codes. The interactive effects of sex, age, and DM-related variables were analyzed to evaluate their impact on insomnia risk in DR.

RESULTS

Compared with the non-DR group, insomnia risk was increased in the DR [(adjusted hazard ratio (aHR): 1.125, 95% confidence interval (CI):1.108-1.142), NPDR (aHR:1.117, 95% CI:1.099-1.134), and PDR (aHR:1.205, 95% CI: 1.156-1.256), even after controlling for comorbidities, lifestyle factors, and DM-related variables. The men and youngest age groups (<40 years) were most vulnerable to insomnia risk. Sex, age, DM duration, and chronic kidney disease (CKD) status exerted interactive effects with DR status in increasing the insomnia risk. In the PDR group, sex, age, DM duration, insulin therapy status, and CKD status exerted interactive effects that increased the risk of insomnia.

CONCLUSION

Insomnia risk is significantly higher in patients with DR, and clinical attention is warranted.

Quality of Sleep in Elderly Patients with Diabetes Mellitus from Turkey: A Cross-Sectional Observational Study

BACKGROUND

Elderly patients frequently experience poor sleep quality. We aimed to determine its prevalence and risk factors in diabetic elderly patients from Turkey.

METHODS

An observational cross-sectional study of 220 diabetic elderly patients with a mean age of 70.4 ± 5.9 was conducted between June 2019 and December 2019. Pittsburgh Sleep Quality Index (PSQI) questionnaire was used. Patients were divided based on sleep quality into poor (PSQI> 5) and good (PSQI≤ 5) sleep quality groups. Geriatric Depression Scale, Beck Anxiety Inventory, and Hendrich II Fall Risk Model were adopted. The prevalence of poor sleep quality and risk factors were evaluated.

RESULTS

Prevalence of poor sleep quality was 58.6%. Poor sleepers were significantly older, were more likely to be divorced, had more comorbidities, and used more medicines (ps<0.05). Longer duration of diabetes, higher incidence of hypoglycemic events, and diabetic complications were significantly associated with poor sleep quality (ps<0.05). Poor sleepers had higher levels of blood glucose and HbA1c levels (ps<0.05). PSQI was significantly correlated with age, HbA1c, duration of diabetes, higher depression, anxiety, and falling risk (ps<0.05). Severe depression, anxiety, and higher falling risk were independent risk factors.

CONCLUSION

Most patients experienced poor sleep quality. It was associated with a longer duration of diabetes, chronic diabetes-related complications, and higher HbA1c levels. Severe depression, anxiety, and higher falling risk were risk factors for poor sleep quality.