Original Article

Association of Diabetic Retinopathy and Sleep Quality

Abstract

Sleep disorders are more common in diabetes mellitus (DM) cases rather than normal ones. In addition, this condition could be associated with diabetic retinopathy (DR) development with more inflammatory indices in circulation. In the present study, we have evaluated the association between DR and sleep quality. This cross-sectional study is a part of the second phase of the study of the elderly cohort of Amirkola City, which was conducted in 2015-2016 on all people aged 60 and higher. Of all diabetic cases, 44 cases had retinopathy and were selected as the case group. To compare two control groups, 135 diabetic patients without retinopathy and 135 people without diabetes were randomly selected. The presence and type of retinopathy were determined based on an eye physical examination by an ophthalmologist. In addition, sleep quality was evaluated based on the Pittsburgh Questionnaire. The obtained data were analyzed by ANOVA, t-test, and linear regression tests. In the present study, there was a significant difference in the score of the Pittsburgh questionnaire between people with DR (45.5±68.2) compared to diabetic people without retinopathy (76.5±48.2) and people without diabetes (95.4±36.2) (P=0.470), but diabetic people without retinopathy had significantly worse sleep quality than people without diabetes (P=0.019). Also, sleep quality in women with DR was worse than in men (P=014). In the linear regression analysis, it was observed that age, gender, diabetes, and history of depression significantly affect the sleep quality of the evaluated cases (P<0.05 for all). According to the results of the present study, DR does not negatively influence the quality of sleep, and DR is not related to sleep disorders.

1. Khalil M, Power N, Graham E, Deschênes SS, Schmitz N. The association between sleep and diabetes outcomes–A systematic review. Diabetes Res Clin Pract 2020;161:108035.
2. Schipper SB, Van Veen MM, Elders PJ, van Straten A, Van Der Werf YD, Knutson KL, et al. Sleep disorders in people with type 2 diabetes and associated health outcomes: A review of the literature. Diabetologia 2021;64:2367-77.
3. Sun J, Lou P, Zhang P, Shang Y, Wang J, Chang G. Prevalence and Risk Factors of Diabetic Retinopathy in Xuzhou, China: A Cross-Sectional Study. J Diabetes Metab 2018;9:5.
4. Morjaria R, Alexander I, Purbrick RM, Safa R, Chong NV, Wulff K, et al. Impact of diabetic retinopathy on sleep, mood, and quality of life. Invest Ophthalmol Vis Sci 2019;60:2304-10.
5. Ishibashi F, Tavakoli M. Thinning of macular neuroretinal layers contributes to sleep disorder in patients with type 2 diabetes without clinical evidences of neuropathy and retinopathy. Front Endocrinol (Lausanne) 2020;11:69.
6. D'Souza H, Kapoor KG. Retinal vascular manifestations of obstructive sleep apnea. Curr Opin Ophthalmol 2020;31:508-13.
7. Ramasamy K, Mishra C. Commentary: Obstructive sleep apnea: A silent associate of diabetic retinopathy. Indian J Ophthalmol 2021;69:3357-8.
8. Tan NY, Chew M, Tham YC, Nguyen QD, Yasuda M, Cheng CY, et al. Associations between sleep duration, sleep quality and diabetic retinopathy. PLoS One 2018;13:e0196399.
9. Ng DS, Chiang PP, Tan G, Cheung CG, Cheng CY, Cheung CY, et al. Retinal ganglion cell neuronal damage in diabetes and diabetic retinopathy. Clin Exp Ophthalmol 2016;44:243-50.
10. Buysse DJ, Reynolds CF 3rd, Monk TH, Berman SR, Kupfer DJ. The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research. Psychiatry Res 1989;28:193-213.
11. Hasanzadeh M, Alavi KNK, Ghalehbandi M, Yad EZ, Gharaei B, Sadeghikia A. Sleep quality in Iranian drivers recognized as responsible for severe road accidents. J Res Behav Sci 2008;6.
12. Iyer SR. Sleep and type 2 diabetes mellitus-clinical implications. J Assoc Physicians India 2012;60:42-7.
13. Jee D, Keum N, Kang S, Arroyo JG. Sleep and diabetic retinopathy. Acta Ophthalmol 2017;95:41-7.
14. Raman R, Gupta A, Krishna S, Kulothungan V, Sharma T. Prevalence and risk factors for diabetic microvascular complications in newly diagnosed type II diabetes mellitus. Sankara Nethralaya Diabetic Retinopathy Epidemiology and Molecular Genetic Study (SN-DREAMS, report 27). J Diabetes Complications 2012;26:123-8.
15. Meng LL, Liu Y, Geng RN, Tang YZ, Li DQ. Association of diabetic vascular complications with poor sleep complaints. Diabetol Metab Syndr 2016;8:80.
16. Cappuccio FP, D'Elia L, Strazzullo P, Miller MA. Quantity and quality of sleep and incidence of type 2 diabetes: a systematic review and meta-analysis. Diabetes Care 2010;33:414-20.
17. Shah AR, Gardner TW. Diabetic retinopathy: research to clinical practice. Clin Diabetes Endocrinol 2017;3:9.
18. Knutson KL, Ryden AM, Mander BA, Van Cauter E. Role of sleep duration and quality in the risk and severity of type 2 diabetes mellitus. Arch Intern Med 2006;166:1768-74.
19. Vitiello MV, Larsen LH, Moe KE. Age-related sleep change: gender and estrogen effects on the subjective–objective sleep quality relationships of healthy, noncomplaining older men and women. J Psychosom Res 2004;56:503-10.
20. Bjorvatn B, Sagen IM, Øyane N, Waage S, Fetveit A, Pallesen S, et al. The association between sleep duration, body mass index and metabolic measures in the Hordaland Health Study. J Sleep Res 2007;16:66-76.
21. Lamond N, Tiggemann M, Dawson D. Factors predicting sleep disruption in Type II diabetes. Sleep 2000;23:415-6.
Files
IssueVol 61 No 8 (2023) QRcode
SectionOriginal Article(s)
DOI https://doi.org/10.18502/acta.v61i8.14905
Keywords
Sleep latency Sleep initiation and maintenance disorders Daytime dysfunction Diabetic retinopathy
Rights and permissions
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
How to Cite
1.
Panahi NM, Khosravi H, Hosseini SR, Bijani A, Roustaei GA, Ghasemi M, Mikaniki E, Ghadimi R, Rasoulinejad SA. Association of Diabetic Retinopathy and Sleep Quality. Acta Med Iran. 2024;61(8):477-481.