第二型糖尿病患者的睡眠品質與血糖控制之相關性探討

The association of the sleep quality on glycemic control in patients with type II Diabetes

10.6288/TJPH201736106048

羅琦(Chyi Lo)；黃建寧(Chien-Ning Huang)；郭青萍(Ching-Pyng Kuo)；黃秀梨(Shiow-Li Hwang)；廖玟君(Wen-Chun Liao)

第二型糖尿病 ； 主客觀睡眠品質 ； 血糖控制 ； type 2 diabetes ； subjective and objective sleep quality ； glycemic control

台灣公共衛生雜誌

36卷5期（2017 / 10 / 15）

497 - 510

繁體中文

目標：第二型糖尿病與其所延伸健康問題威脅著台灣民眾的健康，本研究旨在探討第二型糖尿病病人之主客觀睡眠品質與血糖控制之間關係。方法：以立意取樣中部某醫學中心之第二型糖尿病患者共61位完成研究。主觀睡眠品質以匹茲堡睡眠品質指標量表（PSQI）測量，客觀睡眠品質以腕動計（wrist actigraphy）測量72小時（24小時*3天），並以病歷查閱方式追蹤病人收案後一年內的血糖控制生化值（HbA1c），資料以SPSS 17.0套裝軟體進行統計分析。結果：研究結果發現本研究族群血糖控制不佳，糖化血色素（HbA1c）平均為7.9±1.6%；飯前血糖值（AC sugar）平均為162.1±45.4 mg/dl，HbA1c＞7.0%佔72.2%。主觀睡眠品質之PSQI平均分數為6.6±4.1分，主觀睡眠品質不佳者（PSQI＞5分）佔57.4%；客觀睡眠時數平均為5.7小時，睡眠效率為75.3%，睡眠潛伏期為25.5分鐘、半夜醒來總時間為63.3分鐘。線性複迴歸分析結果發現，自覺睡眠效率（β=-0.040）、糖尿病罹病年數（β=0.07）、BMI（β=0.13）能預測糖化血色素值，解釋32.2%變異量。結論：主觀睡眠品質的好壞與第二型糖尿病患者的血糖控制具有相關性，本研究結果提供臨床照護者將睡眠品質評估納入糖尿病患者血糖控制的重要參考。

Objectives: Type 2 diabetes and the health problems associated with type 2 diabetes threaten the health of the people in Taiwan. The purpose of this study was to determine the relationship between subjective and objective sleep quality on glycemic control of patients with type 2 diabetes. Methods: This study used a purpose sampling and cross-sectional study design to recruit type 2 diabetes patients from an outpatient endocrinology and metabolism clinic at a medical center in central Taiwan. A total of 61 patients completed questionnaires and were followed for 1 year. The Pittsburgh Sleep Quality Index (PSQI) measurements and wrist actigraphy (Somnowatch) measures for 72 h (24 h * 3 days) were collected. Glycemic control was followed for 1 year by reviewing the glycated hemoglobin (HbA1c) data in medical records. The SPSS 17.0 software package was used for statistical analysis. Results: The results showed poor glycemic control in patients with type 2 diabetes, with an average HbA1c of 7.9±1.6% and a fasting glucose value (AC sugar) of 162.1±45.4 mg/dl. The majority of patients (72.2%) had poor glycemic control (HbA1c＞ 7.0%). The subjective sleep quality was poor, with a global PSQI score of 6.6±4.1; 57.4% of patients had a PSQI score ＞ 5. The objective sleep hours were inadequate, as follows: average total sleep time, 5.7 hours; sleep efficiency, 75.3%; sleep latency, 25.5 min; and awake time after sleep onset, 63.3 min. Linear multiple regression analysis showed that perceived sleep efficiency (β=-0.040), duration of diabetes (β=0.07), and BMI (β=0.13) predicted the value of HbA1c with 32.2% of variance. Conclusions: Subjective sleep quality was shown to be associated with glycemic control in patients with type 2 diabetes. The results of this study suggest the importance of assessing patient sleep quality on managing glycemia in patients with type 2 diabetes.

1. 衛生福利部國民健康署：國民營養健康狀況變遷調查。台北：衛生福利部國民健康署，2016。Health Promotion Administration, Ministry of Health and Welfare, R.O.C. (Taiwan). Nutrition and Health Survey in Taiwan (NAHSIT). Taipei: Health Promotion Administration, Ministry of Health and Welfare, R.O.C. (Taiwan), 2016. [In Chinese]
2. 衛生福利部國民健康署：2015年國人死因統計。台北：衛生福利部國民健康署，2016。Health Promotion Administration, Ministry of Health and Welfare, R.O.C. (Taiwan). Annual Report on the Cause of Death Statistics, 2015. Taipei: Health Promotion Administration, Ministry of Health and Welfare, R.O.C. (Taiwan), 2016. [In Chinese]
3. Afsar, B,Elsurer, R(2015).Central hemodynamics, vascular stiffness, and nocturia in patients with type 2 diabetes.Ren Fail,37,359-65.
4. Aronsohn, RS,Whitmore, H,Van Cauter, E,Tasali, E(2010).Impact of untreated obstructive sleep apnea on glucose control in type 2 diabetes.Am J Respir Crit Care Med,181,507-13.
5. Arora, T,Chen, MZ,Omar, OM,Cooper, AR,Andrews, RC,Taheri, S(2016).An investigation of the associations among sleep duration and quality, body mass index and insulin resistance in newly diagnosed type 2 diabetes mellitus patients.Ther Adv Endocrinol Metab,7,3-11.
6. Barone, MT,Menna-Barreto, L(2011).Diabetes and sleep: a complex cause-and-effect relationship.Diabetes Res Clin Pract,91,129-37.
7. Bopparaju, S,Surani, S(2010).Sleep and diabetes.Int J Endocrinol,2010,759509.
8. Buysse, DJ,Reynolds, CF, 3rd,Monk, TH,Berman, SR,Kupfer, DJ(1989).The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research.Psychiatry Res,28,193-213.
9. Chasens, ER,Korytkowski, M,Sereika, SM,Burke, LE(2013).Effect of poor sleep quality and excessive daytime sleepiness on factors associated with diabetes self-management.Diabetes Educ,39,74-82.
10. Chasens, ER,Umlauf, MG,Pillion, DJ,Singh, KP(2000).Sleep apnea symptoms, nocturia, and diabetes in African-American community dwelling older adults.J Natl Black Nurses Assoc,11,25-33.
11. Cho, EH,Lee, H,Ryu, OH,Choi, MG,Kim, SW(2014).Sleep disturbances and glucoregulation in patients with type 2 diabetes.J Korean Med Sci,29,243-7.
12. Cooper, AJ,Westgate, K,Brage, S,Prevost, AT,Griffin, SJ,Simmons, RK(2015).Sleep duration and cardiometabolic r isk factor s among individual s with type 2 diabetes.Sleep Med,16,119-25.
13. Cunha, MR,Silva, ME,Machado, HA(2008).Cardiovascular, metabolic and hormonal responses to the progressive exercise performed to exhaustion in patients with type 2 diabetes treated with metformin or glyburide.Diabetes Obes Metab,10,238-45.
14. Fitzgerald, MP,Litman, HJ,Link, CL,McKinlay, JB,BACH Survey Investigators(2007).The association of nocturia with cardiac disease, diabetes, body mass index, age and diuretic use: results from the BACH survey.J Urol,177,1385-9.
15. Fitzgerald, MP,Mulligan, M,Parthasarathy, S(2006).Nocturic frequency is related to severity of obstructive sleep apnea, improves with continuous positive airways treatment.Am J Obstet Gynecol,194,1399-403.
16. Furukawa, S,Sakai, T,Niiya, T(2016).Microvascular complications and prevalence of nocturia in Japanese patients with type 2 diabetes mellitus: the Dogo Study.Urology,93,147-51.
17. Galer, BS,Gianas, A,Jensen, MP(2000).Painful diabetic polyneuropathy: epidemiology, pain description, and quality of life.Diabetes Res Clin Pract,47,123-8.
18. Ip, M,Mokhlesi, B(2007).Sleep and glucose intolerance/diabetes mellitus.Sleep Med Clin,2,19-29.
19. Johns, MW(1991).A new method for measuring daytime sleepiness: the Epworth sleepiness scale.Sleep,14,540-5.
20. Kara, B,Kilic, O(2015).Predictors of poor sleep quality and excessive daytime sleepiness in Turkish adults with type 2 diabetes.J Clin Nurs,24,1436-9.
21. Kawakami, N,Takatsuka, N,Shimizu, H(2004).Sleep disturbance and onset of type 2 diabetes.Diabetes Care,27,282-3.
22. Knutson, KL,Ryden, AM,Mander, BA,Van Cauter, E(2006).Role of sleep duration and quality in the risk and severity of type 2 diabetes mellitus.Arch Intern Med,166,1768-7.
23. Knutson, KL,Van Cauter, E(2008).Associations between sleep loss and increased risk of obesity and diabetes.Ann N Y Acad Sci,1129,287-304.
24. Knutson, KL,Van Cauter, E,Zee, P,Liu, K,Lauderdale, DS(2011).Cross-sectional associations between measures of sleep and markers of glucose metabolism among subjects with and without diabetes: the Coronary Artery Risk Development in Young Adults (CARDIA) Sleep Study.Diabetes Care,34,1171-6.
25. Kushida, CA,Chang, A,Gadkary, C,Guilleminault, C,Carrillo, O,Dement, WC(2001).Comparison of actigraphic, polysomnographic, and subjective assessment of sleep parameters in sleep-disordered patients.Sleep Med,2,389-96.
26. Lamond, N,Tiggemann, M,Dawson, D(2000).Factors predicting sleep disruption in type II diabetes.Sleep,23,415-6.
27. Lee, SW,Ng, KY,Chin, WK(2017).The impact of sleep amount and sleep quality on glycemic control in type 2 diabetes: a systematic review and meta-analysis.Sleep Med Rev,31,91-101.
28. Leproult, R,Deliens, G,Gilson, M,Peigneux, P(2015).Beneficial impact of sleep extension on fasting insulin sensitivity in adults with habitual sleep restriction.Sleep,38,707-15.
29. Leproult, R,Holmback, U,Van Cauter, E(2014).Circadian misalignment augments markers of insulin resistance and inflammation, independently of sleep loss.Diabetes,63,1860-9.
30. Lou, P,Qin, Y,Zhang, P(2015).Association of sleep quality and quality of life in type 2 diabetes mellitus: a cross-sectional study in China.Diabetes Res Clin Pract,107,69-76.
31. Martin, J,Shochat, T,Ancoli-Israel, S(2000).Assessment and treatment of sleep disturbances in older adults.Clin Psychol Rev,20,783-805.
32. Medeiros, C,Bruin, V,Ferrer, D(2013).Excessive daytime sleepiness in type 2 diabetes.Arq Bras Endocrinol Metabol,57,425-30.
33. Nefs, G,Donga, E,van Someren, E,Bot, M,Speight, J,Pouwer, F(2015).Subjective sleep impairment in adults with type 1 or type 2 diabetes: results from Diabetes MILES -- The Netherlands.Diabetes Res Clin Pract,109,466-75.
34. Ohkuma, T,Fujii, H,Iwase, M(2013).Impact of sleep duration on obesity and the glycemic level in patients with type 2 diabetes: the Fukuoka Diabetes Registry.Diabetes Care,36,611-7.
35. Ohkuma, T,Fujii, H,Iwase, M(2014).U-shaped association of sleep duration with metabolic syndrome and insulin resistance in patients with type 2 diabetes: the Fukuoka Diabetes Registry.Metabolism,63,484-91.
36. Pollak, CP,Tryon, WW,Nagaraja, H,Dzwonczyk, R(2001).How accurately does wrist actigraphy identify the states of sleep and wakefulness?.Sleep,24,957-65.
37. Rajendran, A,Parthsarathy, S,Tamilselvan, B,Seshadri, KG,Shuaib, M(2012).Prevalence and correlates of disordered sleep in southeast asian indians with type 2 diabetes.Diabetes Metab J,36,70-6.
38. Raman, R,Gupta, A,Venkatesh, K,Kulothungan, V,Sharma, T(2012).Abnormal sleep patterns in subjects with type II diabetes mellitus and its effect on diabetic microangiopathies: Sankara Nethralaya Diabetic Retinopathy Epidemiology and Molecular Genetic Study (SN-DREAMS, report 20).Acta Diabetol,49,255-61.
39. Resnick, HE,Redline, S,Shahar, E(2003).Diabetes and sleep disturbances: findings from the Sleep Heart Health Study.Diabetes Care,26,702-9.
40. Shaw, JE,Punjabi, NM,Wilding, JP,Alberti, KG,Zimmet, PZ,International Diabetes Federation Taskforce on Epidemiology and Prevention(2008).Sleep-disordered breathing and type 2 diabetes: a report from the International Diabetes Federation Taskforce on Epidemiology and Prevention.Diabetes Res Clin Pract,81,2-12.
41. Tang, Y,Meng, L,Li, D(2014).Interaction of sleep quality and sleep duration on glycemic control in patients with type 2 diabetes mellitus.Chin Med J,127,3543-7.
42. Tasali, E,Leproult, R,Spiegel, K(2009).Reduced sleep duration or quality: relationships with insulin resistance and type 2 diabetes.Prog Cardiovasc Dis,51,381-91.
43. Taub, LF,Redeker, NS(2008).Sleep disorders, glucose regulation, and type 2 diabetes.Biol Res Nurs,9,231-43.
44. Trento, M,Broglio, F,Riganti, F(2008).Sleep abnormalities in type 2 diabetes may be associated with glycemic control.Acta Diabetol,45,225-9.
45. Tsai, YW,Kann, NH,Tung, TH(2012).Impact of subjective sleep quality on glycemic control in type 2 diabetes mellitus.Fam Pract,29,30-5.
46. Vigg, A(2003).Sleep in type 2 diabetes.J Assoc Physicians India,51,479-81.
47. Wan Mahmood, WA,Draman Yusoff, MS,Behan, LA(2013).Association between sleep disruption and levels of lipids in caucasians with type 2 diabetes.Int J Endocrinol,2013,341506.
48. Williams, CJ,Hu, FB,Patel, SR,Mantzoros, CS(2007).Sleep duration and snoring in relation to biomarkers of cardiovascular disease risk among women with type 2 diabetes.Diabetes Care,30,1233-40.
49. Zhu, B,Hershberger, PE,Kapella, MC,Fritschi, C(2017).The relationship between sleep disturbance and glycaemic control in adults with type 2 diabetes: an integrative review.J Clin Nurs
50. 王拔群、李學禹、莊銘隆(2003)。中文版Epworth嗜睡量表之信效度研究。台灣精神醫學，17，14-22。
51. 林嘉玲、蘇東平、張媚(2003)。機構老人之睡眠品質及其相關因素。台灣醫學，7，174-84。
52. 鄭英裕(2001)。台北=Taipei，台北醫學大學醫學研究所=Institute of Medical, Taipei Medical University。

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