Insomnia and Health- Related Quality of Life in Adults with Type 2 Diabetes

Transcription

1 Insomnia and Health- Related Quality of Life in Adults with Type 2 Diabetes Eileen R. Chasens, PhD, RN, FAAN Letitia Y. Graves, MSN Susan M. Sereika, PhD University of Pittsburgh

2 Conflicts of interest Research support from Phillips Respironics and ResMed Inc. The material presented in this lecture has no relationship with either of these potential conflicts.

3 Background Impaired sleep including obstructive sleep apnea (OSA) highly prevalent and associated with worse glucose control in adults with type 2 diabetes mellitus (T2DM) 1-7 Insomnia, especially with short sleep duration, is associated with increased risk for T2DM 8 Depression is associated with decreased healthrelated quality of life (HRQoL) in persons with diabetes 9 Strong evidence that depression has a bidirectional association with insomnia 10 Punjabi et al. (2004, 2009) 1,2 ; Pamidi et al. (2010) 3 ; Mahmood et al.(2009) 4 ; Reutrakul et al.(2017) 5 ; Reichmuth et al. (2005) 6 ; Fredheim et al.(2011) 7 ; Vgonzas et al. (2009) 8 ; Anderson et al. (2001) 9; Buysse et al. (2004) 10

4 Purpose This study evaluated if moderate-to-severe insomnia was associated with reduced physical and mental HRQoL in adults with T2DM.

5 Design Secondary analysis of baseline data from the DSTT, an ongoing randomized controlled trial (1R01DK096028) Parent study examines the effect of treatment of OSA on glycemic control and diabetes selfmanagement in participants with type 2 diabetes and OSA

6 Inclusion Criteria for Baseline Assessment Recruited because of poor sleep and symptoms of OSA Diagnosis of T2DM Age>18 CPAP naïve No car accidents 2 nd to excessive sleepiness Willing to be randomized (if eligible to continue)

7 Measures OSA : Apnea Link Plus Clinical assessment A1C : global glucose control over last days; 8% impaired glycemic control Height and weight measured to calculate BMI kg/m 2

8 Questionnaires Problem Areas in Diabetes [PAID], 11 with higher scores = more distress diabetes related distress Insomnia Severity Index (ISI) 12 : 7- item self-report instrument with a 5-point Likert scale Pittsburgh Sleep Quality Index [PSQI] 13 SF-12v2 MCS and PCS 14 component scores ( with higher scores = better mental or physical HRQoL Demographics (sex, age, race, marital status, education) Welch, Jacobson, & Polonsky (1997) 11 Morin et al. (2011) 12 ; Buysse et al. (1987) 13 ; Ware et al. (1996) 14

9 Analysis Analysis performed using SPSS v23. ISI: continuous variable and dichotomized Descriptive statistics Bivariate associations Binary logistic regression model to predict impaired glucose control Linear multiple regression models to predicted mental and physical HRQoL Statistical significance was set at p<.05

10 Characteristics of Sample (N=194) Mean (SD) and Range or Frequency (%) Sex Age Race Male Female Caucasian African-American n=90 (46%) n=104 (54%) 56.8 ± 10.7 years [range: years] n= 105 (54%) n= 89 (46%) Education < College Graduate College Graduate n=134 (69%) n=60 (31%) BMI 34.7 ± 6.8 kg/m 2 [range: 22-55] A1C 7.9 ± 1.8% [range 5%-14.4%] Insomnia (ISI) 13.2 (6.4) [range 0-28; 41% with ISI > 15] Apnea + Hypopnea Index (AHI) Normal (AHI <5) Mild (AHI 5-14) Moderate (AHI 15-29) Severe (AHI> 30) ± 15 [range 0-95) n = 57 (29%) n= 65 (34%) n= 47 (24%) N= 17 (9%) **missing 8 (4%)

11 Description of the Sample Variables Correlation or Mean (SD) p- value A1C and Age r= -.18 p=.015 A1C and Race White African- American A1C and Education College Graduate < College Graduate BMI No/Mild Insomnia Mod/Severe Insomnia ISI Total Score & A1C A1C < 8.0% A1C> 8.0% 7.62 (1.31) 8.29 (2.26) p= (1.32) (1.99) p= (6.68) (6.95) p= (6.31) (6.38) p=.061

12 Characteristics of the Sample Variables Correlation or Mean (SD) p- value Age & SF12 MCS r=.25 p=<.001 PAID No/Mild Insomnia Mod/Severe Insomnia (19.31) (21.86) p=<.001 SF12 PCS No/Mild Insomnia Mod/Severe Insomnia SF12 MCS No/Mild Insomnia Mod/Severe Insomnia (9.89) (10.14) p= (9.86) (10.14) p=.001 No differences were observed in mental or physical HRQoL (MCS, PCS) by sex, race, marital status; participants with a college education had significantly (p<.01) increased physical HRQoL.

13 Correlations Variables Age 2. A1C -.18* 3. BMI PSQI -.15* ISI SF-12 PCS SF-12 MCS PAID PSQI= Pittsburgh Sleep Quality Index, ISI= Insomnia Severity Index, PCS=Physical Component Score, MCS=Mental Component Score, PAID= Problem Areas in Diabetes. *=p<.05; + = p<.o1

14 Correlations Variables Age 2. A1C -.18* 3. BMI PSQI -.15* ISI SF-12 PCS SF-12 MCS PAID PSQI= Pittsburgh Sleep Quality Index, ISI= Insomnia Severity Index, PCS=Physical Component Score, MCS=Mental Component Score, PAID= Problem Areas in Diabetes. *=p<.05; + = p<.o1

15 Correlations Variables Age 2. A1C -.18* 3. BMI PSQI -.15* ISI SF-12 PCS SF-12 MCS PAID PSQI= Pittsburgh Sleep Quality Index, ISI= Insomnia Severity Index, PCS=Physical Component Score, MCS=Mental Component Score, PAID= Problem Areas in Diabetes. *=p<.05; + = p<.o1

16 Correlations Variables Age 2. A1C -.18* 3. BMI PSQI -.15* ISI SF-12 PCS SF-12 MCS PAID PSQI= Pittsburgh Sleep Quality Index, ISI= Insomnia Severity Index, PCS=Physical Component Score, MCS=Mental Component Score, PAID= Problem Areas in Diabetes. *=p<.05; + = p<.o1

17 Binary Logistic Regression to Predict A1C Group (A1C <8% / > 8.%) Predictor b SE B β OR Moderate-Severe Insomnia 95%C.I. Lower Upper *Adjusted for age, sex, race, college graduate

18 Linear Regression to Predict Physical Health Related Quality of Life Predictor b SE B β p Age HS Graduate BMI <.001 PAID Insomnia F=6.371; R 2 =.388; R 2 adjusted =.127; p=.001

19 Linear Regression to Predict Mental Health Related Quality of Life Predictor b SE B β p Age HS Graduate BMI PAID Insomnia F=14.194; R 2 =.283; R 2 adjusted =.263; p=.001

20 Limitations Secondary analysis/cross sectional design Sleep duration or OSA severity were not controlled for in the analysis Modest sample size

21 Conclusion Moderate-to-severe insomnia was highly prevalent in the sample of adults with T2DM Moderate-to-severe insomnia was a significant risk factor for impaired glucose control Insomnia insomnia was found to have significant negative impact on mental and physical HRQoL.

22 Future Implications Future research is needed to determine if insomnia is associated with worse glucose control or diabetes self-management behavior Results suggest testing interventions in persons with T2DM and insomnia to determine their effect on improve glycemic control

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