Sleep in patients with type 2 diabetes: the impact of sleep apnoea, sleep duration, and sleep quality on clinical outcomes

Altaf, Quratul-ain (2018). Sleep in patients with type 2 diabetes: the impact of sleep apnoea, sleep duration, and sleep quality on clinical outcomes. University of Birmingham. M.D.

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Introduction: Type 2 Diabetes (T2DM) and sleep-related disorders share common risk factors such as obesity; but the interrelationships between T2DM and sleep disorders are not well examined.

Aims: In this thesis I aimed to assess:
1. The longitudinal impact of obstructive sleep apnoea (OSA) on micro vascular complications in patient with T2DM.
2. The relationship between sleep quality, sleep duration and adiposity in patients with T2DM

Methods: To examine the first aim, I utilized the data collected from a previous project that examined the cross-sectional associations between OSA and micro vascular complications in patients with T2DM and followed up the study participants longitudinally using 1-2-1 interviews and electronic health records. For aim 2, I conducted a crosssectional study in patients with young-onset T2DM who were recruited from Heart of England NHS Foundation Trust and primary care.

For Aim 1: Depending on the micro vascular outcome examined, we had approximately 200 patients in the analysis. Patients were followed up for 2.5 years for renal outcomes, and 4-4.5 years for retinopathy and neuropathy outcomes. The prevalence of OSA was 63%. I found that baseline OSA was significantly associated with greater decline of eGFR and greater progression to pre-proliferative and proliferative retinopathy. I also found that OSA was associated with progression to a combined outcome of foot insensitivity or diabetic foot ulceration but this was a non-significant trend (p=0.06). In addition, I found that patients who received and were compliant with continuous positive airway pressure (CPAP) treatment (delivered during routine care) had improvements in heart rate variability parameters by study end.
For Aim 2: Poor sleep quality and shorter sleep duration were associated with increased total body fat% after adjustment for potential confounders.

Conclusion: I found that OSA plays an important role in the progression of micro vascular complications in patients with T2DM. Whether treatment with CPAP has a favourable impact on micro vascular complications is currently being examined in a randomized controlled trial. I also found that sleep duration and quality are associated with increased adiposity. The direction of this relationship need to be examined in longitudinal studies and interventional trials.

Type of Work: Thesis (Higher Doctorates > M.D.)
Award Type: Higher Doctorates > M.D.
College/Faculty: Colleges (2008 onwards) > College of Medical & Dental Sciences
School or Department: Institute of Clinical Sciences, School of Clinical and Experimental Medicine
Funders: None/not applicable
Subjects: Q Science > QH Natural history > QH301 Biology
R Medicine > R Medicine (General)


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