Published date: Mar 31 2020

Journal Title: Sudan Journal of Medical Sciences

Issue title: Sudan JMS: Volume 15 (2020), Issue No. 1

Pages: 1-9

DOI: 10.18502/sjms.v15i1.6696

Hyder Osman Mirghanis.hyder63@hotmail.comMedical Department, Faculty of Medicine, University of Tabuk, Saudi Arabia

Background: Fatigue, nonrestorative sleep, and other sleep disorders could be pointers to serious medical problems like obstructive sleep apnea; when present in patients with diabetes, they exacerbate each other deleterious consequences. The present study aimed to assess fatigue, nonrestorative sleep, sleep duration, and daytime sleepiness among patients with type 2 diabetes.

Methods: This cross-sectional descriptive study was conducted among 103 consecutive patients with type 2 diabetes and 121 healthy controls attending an outpatient clinic in Omdurman, Sudan during the period from December 2015 to June 2016. All participants signed a written informed consent and were interviewed using a questionnaire based on Epworth Sleepiness Scale to assess subjective nonrestorative sleep, sleep duration, and snoring. A blood sample was taken for the HbA1c. The local ethical committee approved the research, and chi-square test and t-test were used for data analysis.

Results: Highly significant statistical differences were observed between the diabetic patients and the control subjects regarding fatigue, nonrestorative sleep, sleep duration, snoring, and excessive daytime sleepiness (P-value < 0.001). Patients with fatigue had higher nonrestorative sleep than those without, no significant differences were found between patients with the symptoms of fatigue and those without regarding excessive daytime sleepiness, snoring, sleep duration, and the HbA1c (P-value > 0.05).

Conclusions: Fatigue, nonrestorative sleep, sleep duration, excessive daytime sleepiness, and snoring were common among patients with type 2 diabetes than their healthy counterparts, diabetic patients with fatigue had more nonrestorative sleep than those without. The reliance on a self-administered questionnaire is a limitation of the study. 

Keywords: fatigue, nonrestorative sleep, excessive daytime sleepiness, diabetes mellitus, Sudan

[1] Acharya KG, Shah KN, Solanki ND, et al. (2013). Evaluation of antidiabetic prescriptions, cost and adherence to treatment guidelines: A prospective, cross-sectional study at a tertiary care teaching hospital. Journal of Basic and Clinical Pharmacy, vol. 4, no. 4, pp. 82–87.

[2] World Health Organization. (1985). Diabetes mellitus: report of a WHO study group (Tech Report Ser No. 727). Geneva: World Health Organization.

[3] International Diabetes Federation, IDF Diabetes Atlas, 7th edition. Middle East and North Africa 2015.

[4] Lasselin J, Layé S, Dexpert S, et al. (2012). Fatigue symptoms relate to systemic inflammation in patients with type 2 diabetes. Brain, Behavior, and Immunity, vol. 26, no. 8, pp. 1211–1219. DOI: 10.1016/j.bbi.2012.03.003

[5] Martine M.G, Cees JT, Elles S, et al. (2014). Chronic fatigue in type1 diabetes: highly prevalent but not explained by hyperglycemia or glucose variability. Diabetes Care, vol. 37, no. 1, pp. 73–80.

[6] Fukuda K, Straus SE, Hickie I, et al. (1994). The chronic fatigue syndrome: a comprehensive approach to its definition and study. Annals of Internal Medicine, vol. 121, no. 12, pp. 953–959.

[7] Reeves WC, Lloyd A, Vernon SD, et al. (2003). Identification of ambiguities in the 1994 chronic fatigue syndrome research case definition and recommendations for resolution. BMC Health Services Research, vol. 3, no. 1, p. 25.

[8] Weijman I, Ros WJ, Rutten GE, et al. (2005). Frequency and perceived burden of diabetes self-management activities in employees with insulin-treated diabetes: relationships with health outcomes. Diabetes Research and Clinical Practice, vol. 68, no. 1, pp. 56–64.

[9] Hewlett S, Chalder T, Choy E, et al. (2011). Fatigue in rheumatoid arthritis: time for a conceptual model. Rheumatology, vol. 50, no. 6, pp. 1004–1006.

[10] Ayas NT, White DP, Al-Delaimy WK, et al. (2003). A prospective study of self-reported sleep duration and incident diabetes in women. Diabetes Care, vol. 26, no. 2, pp. 380–384.

[11] Vgontzas AN, Bixler EO, Lin HM, et al. (2001). Chronic insomnia is associated with nyctohemeral activation of the hypothalamic-pituitary-adrenal axis: clinical implications. Journal of Clinical Endocrinology & Metabolism, vol. 86, no. 8, pp. 3787–3794.

[12] Stepanski E, Glinn M, Zorick F, et al. (1994). Heart rate changes in chronic insomnia. Stress Medicine, vol. 10, no. 4, pp. 261–266.

[13] Bonnet MH, Arand DL. (1995). 24-hour metabolic rate in insomniacs and matched normal sleepers. Sleep, vol. 18, no. 7, pp. 581–588.

[14] Vernon MK, Dugar A, Revicki D, et al. (2010). Measurement of non-restorative sleep in insomnia: a review of the literature. Sleep Medicine Reviews, vol. 14, no. 3, pp. 205–212. DOI: 10.1016/j.smrv.2009.10.002

[15] Sarsour K, Van Brunt DL, Johnston JA, et al. (2010). Associations of nonrestorative sleep with insomnia, depression, and daytime function. Stress Medicine, vol. 11, no. 10, pp. 965–972. DOI: 10.1016/j.sleep.2010.08.007

[16] Mirghani HO, Merghani TH, Saadalla AM, et al. (2016). Daytime sleepiness and chronic sleep deprivation in patients with type II diabetes mellitus and their relation o diabetic control. Basic Research Journal of Medicine and Clinical Sciences, vol. 5, no. 1, pp. 12–16.

[17] Shehatah A, Rabie MA, Al-Shahry A. Prevalence and correlates of depressive disorders in elderly with type-2 diabetes in primary health care settings. Journal of Affective Disorders 2010, vol. 123, no. 1–3, pp. 197–201.

[18] Johns MW. (1999). A new method for measuring daytime sleepiness: the Epworth sleepiness scale. Sleep, vol. 14, no. 6, pp. 540–545.

[19] Singh R, Kluding PM. (2013). Fatigue and related factors in people with type 2 diabetes. The Diabetes Educator, vol. 39, no. 3, pp. 320–326. DOI: 10.1177/0145721713479144

[20] Drivsholm T, de Fine Olivarius N, Nielsen AB, et al. (2005). Symptoms, signs and complications in newly diagnosed type 2 diabetic patients, and their relationship to glycaemia, blood pressure and weight. Diabetologia, vol. 48, no. 2, pp. 210–214.

[21] Weijman I, Kant I, Swaen GM. (2004). Diabetes, employment and fatigue-related complaints: a comparison between diabetic employees, “healthy” employees, and employees with other chronic diseases. Journal of Occupational and Environmental Medicine, vol. 46, no. 8, pp. 828–836.

[22] McCormick M, Quinn L. (2002). Treatment of type 2 diabetes mellitus: pharmacologic intervention. Journal of Cardiovascular Nursing, vol. 16, no. 2, pp. 55–67.

[23] Resnick HE, Redline S, Shahar E. (2003). Diabetes and sleep disturbances: findings from the Sleep Heart Health Study. Diabetes Care, vol. 26, no. 3, pp. 702–709.

[24] Ikehara S, Iso H, Date C, et al. (2009). Association of sleep duration with mortality from cardiovascular disease and other causes for Japanese men and women: the JACC study. Sleep, vol. 32, no. 3, pp. 295–301

[25] Cespedes EM, Dudley KA, Sotres-Alvarez D, et al. (2016). Joint associations of insomnia and sleep duration with prevalent diabetes: The Hispanic Community Health Study/Study of Latinos (HCHS/SOL). Journal of Diabetes, vol. 8, no. 3, pp. 387–397. DOI:10.1111/1753-0407.12308

[26] Matsumoto T, Tabara Y, Murase K, et al. (2017). Combined association of clinical and lifestyle factors with non-restorative sleep: The Nagahama Study. PLOS ONE, vol. 12, no. 3, e0171849. DOI:10.1371/journal.pone.0171849

[27] Hasan A, Uzma N, Swamy TL, et al. (2012). Correlation of clinical profiles with obstructive sleep apnea and metabolic syndrome. Sleep Breath, vol. 16, no. 1, pp. 111–116. DOI:10.1007/s11325-010-0463-z

[28] Mirghani HO, Elbadawi AS. (2016). Depression, anxiety, and daytime sleepiness among type 2 diabetic patients and their correlation with the diabetes control: a case-control. Journal of Taibah University Medical Sciences, vol. 11, no. 4, pp. 374–379.

[29] Kelly E, Cullen G, McGurk C. (2007). Obstructive sleep apnea in patients with type 2 diabetes. Thorax, vol. 62, p. 651.

[30] Marchiseni G, Pontiroli A, Salvioli G, et al. (2004). Snoring, hypertension and Type2 diabetes in obesity. Protection by physical activity. Journal of Endocrinological Investigation, vol. 27, no. 2, pp. 150–157.

[31] Telford RD. (2007). Low physical activity and obesity: causes of chronic disease or simply predictors? Medicine & Science in Sports & Exercise, vol. 39, no. 8, pp. 1233–1240.