The relationship between sleep and cognitive function in patients with prediabetes and type 2 diabetes
- 370 Downloads
Diabetes is linked to cognitive impairment. Sleep plays a role in memory consolidation. Sleep disturbances, commonly found in patients with diabetes, were shown to be related to cognitive dysfunction. This study explored the role of sleep in cognitive function of patients with abnormal glucose tolerance.
A total of 162 patients (81 type 2 diabetes and 81 prediabetes) participated. Sleep duration and sleep efficiency (an indicator of sleep quality) were obtained using 7-day actigraphy recordings. Obstructive sleep apnea (OSA) was screened using an overnight in-home monitor. Cognitive function was assessed using the Montreal Cognitive Assessment (MoCA). Three sub-scores of MoCA, visuoexecutive function, attention and delayed recall, were also analyzed.
Mean age was 54.8 (10.2) years. OSA was diagnosed in 123 participants (76.9%). Mean sleep duration was 6.0 (1.0) h and sleep efficiency was 82.7 (8.1) %. Sleep duration and OSA severity were not related to MoCA scores. Higher sleep efficiency was associated with higher MoCA scores (p = 0.003), and having diabetes (vs. prediabetes) was associated with lower MoCA scores (p = 0.001). After adjusting covariates, both having diabetes (vs. prediabetes) (B = − 1.137, p = 0.002) and sleep efficiency (B = 0.085, p < 0.001) were independently associated with MoCA scores. In addition, diabetes (B = − 0.608, p < 0.001) and sleep efficiency (B = 0.038, p < 0.001) were associated with visuoexecutive function. Sleep parameters were not related to delayed recall or attention scores.
Lower sleep efficiency is independently associated with lower cognitive function in patients with abnormal glucose tolerance. Whether sleep optimization may improve cognitive function in these patients should be explored.
KeywordsSleep Sleep quality Sleep duration Obstructive sleep apnea Cognitive function Diabetes
This work was funded by a grant from Mahidol University, Bangkok, Thailand; and a grant from the Health Systems Research Institute (HSRI), Thailand and National Research Council of Thailand (Grant no. 60-042); and was supported in part by a research grant from Investigator-Initiated Studies Program of Merck Sharp & Dohme Corp, MSIP 0000-349. The opinion expressed in this paper are those of the authors and do not necessarily represent those of study sponsors or Merck Sharp & Dohme Corp.
Compliance with ethical standards
Conflict of interest
Dr. Reutrakul reports grants from Merck Sharp and Dohme, non-financial support from ResMed, personal fees from Novo Nordisk, personal fees from Sanofi Aventis, personal fees from Medtronic, outside the submitted work. All other authors have nothing to disclose.
Human and animal rights
All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) A and with the Helsinki Declaration of 1975, as revised in 2008.
Informed consent was obtained from all patients for being included in the study.
- 10.Kanaya AM, Barrett-Connor E, Gildengorin G, Yaffe K (2004) Change in cognitive function by glucose tolerance status in older adults: a 4-year prospective study of the Rancho Bernardo study cohort. Arch Intern Med 164:1327–1333. https://doi.org/10.1001/archinte.164.12.1327 CrossRefPubMedGoogle Scholar
- 11.Hugenschmidt CE, Lovato JF, Ambrosius WT et al (2014) The cross-sectional and longitudinal associations of diabetic retinopathy with cognitive function and brain MRI findings: the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial. Diabetes Care 37:3244–3252. https://doi.org/10.2337/dc14-0502 CrossRefPubMedPubMedCentralGoogle Scholar
- 12.Cukierman-Yaffe T, Gerstein HC, Williamson JD et al (2009) Relationship between baseline glycemic control and cognitive function in individuals with type 2 diabetes and other cardiovascular risk factors: the action to control cardiovascular risk in diabetes-memory in diabetes (ACCORD-MIND) trial. Diabetes Care 32:221–226. https://doi.org/10.2337/dc08-1153 CrossRefPubMedPubMedCentralGoogle Scholar
- 14.Snowden MB, Steinman LE, Bryant LL et al (2017) Dementia and co-occurring chronic conditions: a systematic literature review to identify what is known and where are the gaps in the evidence? Int J Geriatr Psychiatry 32:357–371. https://doi.org/10.1002/gps.4652 CrossRefPubMedPubMedCentralGoogle Scholar
- 21.Tworoger SS, Lee S, Schernhammer ES, Grodstein F (2006) The association of self-reported sleep duration, difficulty sleeping, and snoring with cognitive function in older women. Alzheimer Dis Assoc Disord 20:41–48. https://doi.org/10.1097/01.wad.0000201850.52707.80 CrossRefPubMedGoogle Scholar
- 28.Kushida CA, Nichols DA, Holmes TH et al (2012) Effects of continuous positive airway pressure on neurocognitive function in obstructive sleep apnea patients: the Apnea Positive Pressure Long-term Efficacy Study (APPLES). Sleep 35:1593–1602. https://doi.org/10.5665/sleep.2226 CrossRefPubMedPubMedCentralGoogle Scholar
- 32.Tangwongchai S, Charenboon T, Phanasathit M et al (2009) The validity of thai version of the montreal cognitive assessment (MoCA-T). Dement Neuropsychol 3:172Google Scholar
- 34.Trangkasombat U, Larpboonsarp V, Havanond P (1997) CES-D as a screen for depression in adolescents. J Psychiatr Assoc Thail 42:2–13Google Scholar
- 35.Ploylermsang C (2005) Contructive validity of the CES-D depression sclae among student. IJPS 1:25–39Google Scholar
- 41.Yaffe K, Blackwell T, Barnes DE, Ancoli-Israel S, Stone KL (2007) Preclinical cognitive decline and subsequent sleep disturbance in older women. Neurology 69:237–242. https://doi.org/10.1212/01.wnl.0000265814.69163.da CrossRefPubMedGoogle Scholar
- 49.Allain H, Patat A, Lieury A et al (1995) Comparative study of the effects of zopiclone (7.5 mg), zolpidem, flunitrazepam and a placebo on nocturnal cognitive performance in healthy subjects, in relation to pharmacokinetics. Eur Psychiatry 10(Suppl 3):129 s–135 s. https://doi.org/10.1016/0924-9338(96)80094-0 CrossRefGoogle Scholar