Daytime Sleepiness in Diabetes Mellitus

Daytime drowsiness and other sleep problems may cause accidents, decline, and inefficiency at work.  Previous studies have connected somnolence with higher morbidity and mortality rates in varied clinical settings. There is indeed a link between excessive daytime somnolence and health problems. It has been observed that diabetic patients are more likely to be sleepy-eyed throughout the day than non-diabetic ones. Furthermore, a larger risk for traffic accidents attributable to drowsiness has been shown in diabetic patients. Additionally it has been found out that somnolence is related to a general decrease in motivation to interact in activities. This is especially important to consider in the management and control of diabetes.

Recently a study by Medeiros et al aimed to evaluate excessive daytime sleepiness in type 2 diabetes and its associations with depressive symptoms, other sleep complaints, and clinical or laboratory variables. This is a cross sectional study of patients with type 2 diabetes. In this trial, 110 patients with type 2 diabetes were evaluated using Epworth Sleepiness Scale (EDS), sleep quality (Pittsburgh Sleep Quality Index), depressive symptoms (Beck Depression Inventory), Restless Legs Syndrome (RLS), risk of obstructive sleep apnoea (OSA) (Berlin questionnaire), and comorbidity severity (Charlson Comorbidity Index). Patients were compared with individuals with arterial hypertension and without diabetes.

The results revealed that diabetic patients have more EDS, depressive symptoms, and higher comorbidity severity than hypertensive patients. In diabetic patients, poor quality sleep, and high risk of OSA and RLS were found; EDS was associated with depressive symptoms present in individuals.

These results show that excessive daytime somnolence is common in type-2 diabetes and affects quite 1/2 the patients. It is also interesting to note that excessive daytime somnolence is related to depressive symptoms. This is often in agreement with previous reports showing that daytime drowsiness is coupled with depressive symptoms within the general population and within the old. Diabetic patients showed, in some studies, a lot of somnolence, a lot of depressive symptoms, and comorbidity severity than patients with cardiovascular disease. These findings recommend that depressive symptoms play a vital role within the genesis of daytime drowsiness in the face of diabetes mellitus. Depression may end up increasing inflammatory mediators which will more contribute to daytime somnolence. Prospective studies might check the effects of antidepressants in daytime drowsiness, cognitive processes, reduced alertness, and impairment in driving ability.

This particular study emphasises that sleep problems in patients with diabetes are common. Excessive daytime sleepiness is related to depression in these patients. It is not yet known whether there is a physiological mechanism behind this. More studies should be done regarding the causes for this relationship. More studies should also be done as to whether the control of diabetic signs and symptoms may improve sleep problems and depression.

Reference:

Medeiros C, Bruin V, Férrer D, Paiva T, Montenegro Júnior R, Forti A, Bruin P. Excessive daytime sleepiness in type 2 diabetes. Arq Bras Endocrinol Metabol. 2013 Aug; 57(6):425-30.

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