Type 2 diabetes (T2D) is estimated to affect 23.4 million people in the United States, including 2.5 million Hispanic Americans 20 years or older. Sleep disorders have also been an understudied area in the context of the growing number of Hispanic people with T2D. A study published in Journal of Primary Care & Community Health sought to examine the relationship between T2D-related complications and sleep complaints in older Mexican Americans with diabetes over 9 years of follow-up.
The researchers used the Hispanic Established Populations for the Epidemiological Study of the Elderly, a longitudinal study based on interviews with noninstitutionalized Mexican Americans 65 years and older from Texas, California, Arizona, Colorado, and New Mexico. This study used data from 2007 to 2016, as questions about sleep were first collected in 2007.
Sleep measures were subjective, with patients answering how often they experienced trouble falling asleep, waking several times per night, had difficulty staying asleep, and waking up after the usual amount of sleep and feeling tired. Frequency of these events was also asked.
The mean (SD) age of the 310 participants of this study was 82.04 (3.62) years, and 69% were female.
Forty percent of the participants reported having any of the sleeping problems for 15 or more days in a month, with waking up several times (36.45%) the most common issue, followed by trouble falling asleep (16.13%), trouble staying asleep (15.16%), and waking up after the usual amount of sleep feeling tired (12.90%).
Approximately 22% of the participants used insulin injections, and 51% experienced diabetic complications. Most of the complications were in the eye (58.23%) and circulation (70.25%). Complications in the kidney (15.19%) and amputation (4.43%) were less common. Complications were 37.34% macrovascular and microvascular, 32.91% macrovascular only, and 29.75% microvascular only.
Participants who experienced trouble falling asleep for 15 or more days (72%) had greater percentages diabetic complications vs those who experienced the complaint for less than 15 days (46.92%). In addition, people who woke up several times a night for 15 or more days, vs those who did not, had greater occurrence of diabetic complications, at 59.29% vs 46.19%.
Participants who had difficulty staying asleep for 15 or more days had greater percentages of diabetic complications (70.21%) vs those who experienced this for less than 15 days (47.53%), as did participants who felt tired or worn out after normal sleep for 15 or more days vs those who experienced this for less than 15 days, at 75% vs 47.41%.
Sleep complaints at baseline was associated with trouble falling asleep in the past month (odds ratio [OR], 2.49; 95% CI, 1.22-5.05). Having macro diabetic complications (OR, 3.51; 95% CI, 1.81-6.81), micro complications (OR, 3.30; 95% CI, 1.66-6.56), both (OR, 3.35; 95% CI, 1.84-6.12), and any sleep complaints at baseline (OR, 1.78; 95% CI, 1.09-2.90) were associated with waking up several times a night.
Sleep complaints at baseline (OR, 2.62; 95% CI, 1.10-6.23) and having macro- and micro-diabetic complications (OR, 2.73; 95% CI, 1.03-7.21) were associated with difficulty staying asleep. Micro- and macro-diabetic complications (OR, 3.70; 95% CI, 1.45-9.49), high depressive symptoms (OR, 1.06; 95% CI, 1.02-1.11), and any sleep complaints at baseline (OR, 2.57; 95% CI, 1.12-5.89) were associated with waking up after a normal amount of sleep and feeling tired.
There were some limitations to this study. This study did not use polysomnography data, so the researchers could not conduct a more rigorous analysis. Further, self-reporting was used for this study which can produce recall bias, especially in an older age population.
The researchers concluded that their findings “underscore the need to incorporate screening for sleep disorders in persons with diabetes, especially those with T2D complications.”
Sultana R, Downer B, Chen NW, Raji M, Fernandez D, Snih SA. Relationship between diabetes-related complications and sleep complaints in older Mexican Americans. J Prim Care Community Health. Published online September 9, 2022. doi:10.1177/21501319221123471