AANP: Pain May Be a Major Factor for Sleep Disturbances in Diabetes

INDIANAPOLIS, June 25 -- A pilot study suggests that patients with long-standing type 2 diabetes should be evaluated for sleep quality. In those with sleep problems, pain should be assessed as a major contributor.

"Diabetes is a very complex disease and clinicians are so worried about things like blood sugars, high blood pressure, and heart problems that they very often don't even consider disturbed sleep," Leslie-Faith Morritt Taub, DNSc, APN-C, of the University of Medicine and Dentistry of New Jersey School of Nursing, told attendees at the annual meeting of the American Academy of Nurse Practitioners here.

"This is an extra burden for a person with chronic illness," Dr. Taub said. "We should be asking patients about their sleep patterns."

To find out the pattern of sleep disturbance, Dr. Taub and her colleague, Nancy Redeker, Ph.D., R.N., enrolled 31 patients with type 2 diabetes in a cross-sectional study. Participants were drawn from the New Jersey cohort of the Translating Research Into Action for Diabetes (TRIAD) study. Their mean age was nearly 61 and duration of illness was 14.5 years. They were 54% women and 74.2% white.

Each participant was assessed for depression, pain, sleep quality, fatigue, excessive daytime sleepiness, and medical comorbidities using well-established scales. Sleep quantity, onset, and waking after sleep onset (WASO) was measured using a wrist Actigraph. To measure nocturia, patients were asked about how often they got up at night to go to the bathroom.

Just under half the participants reported poor sleep quality and excessive sleepiness during the day, with more than one-fourth saying they had moderate to severe fatigue.

There were also large percentages of participants with possible depression and 3 or more comorbid illnesses. The average amount of pain seen for the entire group was twice that of the general population. Nearly one in three experienced nocturia two or more times a night.

A comparison of sleep variables by gender found that women had longer sleep onset latency (P=0.024), poorer efficiency of sleep (P=0.019), and shorter waking after sleep onset (P=0.049) and more fatigue (P=0.035).

When the researchers generated a model of variables that explained differences in sleep quality across the entire group, only pain reached significance (P=0.018), explaining 42% of the variance in sleep quality.

"The biggest surprise was the dichotomy we saw between men and women," said Dr. Taub. "Women actually did have poorer sleep and actually did wake up more often in the night. Not only did they complain about fatigue, but there were real measurable differences in their sleep patterns."

Dr. Taub concluded that sleep quality should be evaluated in all people with long-standing diabetes. In those with concerns, the amount and type of pain is an important contributor to sleep disturbances.

In addition, she said, complaints of fatigue, excessive sleepiness during the daytime, nocturia, and symptoms of depression should not be overlooked when investigating possible causes of sleep complaints.