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The relationship between sleep and cognitive function in patients with prediabetes and type 2 diabetes

A Letter to the Editor to this article was published on 20 July 2018



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.

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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.

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Corresponding author

Correspondence to Sirimon Reutrakul.

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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

Informed consent was obtained from all patients for being included in the study.

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Managed by Antonio Secchi.

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Saetung, S., Nimitphong, H., Siwasaranond, N. et al. The relationship between sleep and cognitive function in patients with prediabetes and type 2 diabetes. Acta Diabetol 55, 917–925 (2018).

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  • Sleep
  • Sleep quality
  • Sleep duration
  • Obstructive sleep apnea
  • Cognitive function
  • Diabetes