「糖尿病と睡眠障害の関連」についてReuters Health(ロイター・ヘルス)誌の取材にコメント

「糖尿病と睡眠障害の関連」についてReuters Health(ロイター・ヘルス)誌の取材に、院長がコメントしました(英文)


【コメントの要旨(和訳)】

・睡眠障害は糖尿病発症の生活環境要因の一つである

・糖尿病診療において睡眠(入床、入眠、中途覚醒、起床時間)についての問診は必須である

・睡眠障害を有する場合は睡眠衛生指導や睡眠薬による治療を行う必要がある


「糖尿病と睡眠障害」に関する当院の論文・学会発表業績一覧(リンク)


以下、全文

December 13, 2016

By Will Boggs MD

NEW YORK (Reuters Health) - Shorter sleep duration and worse sleep efficiency are independently associated with the occurrence of hyperglycemia during hospitalization in patients with and without diabetes, a new study shows.

"While some think sleep loss in the hospital is inevitable, it's important to note that there are many ways to improve the sleep environment in the hospital," said Dr. Vineet M. Arora from the University of Chicago Sleep Metabolism and Health Center.

"This study adds to other studies that show that sleep loss in the hospital may be linked to worse health outcomes, so improving sleep in the hospital is more than just a patient experience issue; it's also about improving health," he told Reuters Health by email.

Earlier works shows that medical patients sleep an average of two hours less while hospitalized than when at home, Dr. Arora and colleagues note in a report online November 30 in Diabetes Care; even a few days of sleep loss can result in impaired glucose tolerance.

Hyperglycemia during hospitalization contributes to worse patient outcomes, they add, including higher risks of myocardial infarction and stroke.

The team used data from a prospective cohort study of sleep in 212 patients >=50 years of age hospitalized on a general medicine ward to assess whether sleep duration and sleep efficiency during hospitalization are associated with greater odds of hyperglycemia among patients with and without diabetes.

Mean objective sleep duration was 318 minutes, and mean sleep efficiency (69.7%) was below the normal threshold of 80%, with similar averages regardless of diabetes status.

Patients had impaired fasting glucose for 14.4% of mornings and hyperglycemia for 24.7% of mornings; mean fasting glucose and rates of hyperglycemia were higher among patients with diabetes than among those without.

Each additional hour of sleep in the hospital the night before was associated with 11% lower odds of having elevated or hyperglycemic blood glucose levels (p=0.043), and each 10% increase in sleep efficiency was associated with 18% lower odds of experiencing a higher glucose category (p

These relationships persisted when controlling for diabetes diagnosis, age, sex, overweight body mass index, African American race, and risk of obstructive sleep apnea.

"While this study was not designed to prove that sleep loss causes high blood sugar in the hospital, it does highlight that when you see a patient who has worsening blood sugar in the hospital, you should consider improving their sleep, since it's likely that the patient is not sleeping well," Dr. Arora said. "Also, we often reach for medications to control blood sugar right away, and this study suggests that there may be other factors related to sleep to consider."

The team suggests that future research should explore whether the sleep disturbances associated with hospitalization "could be an underlying cause of hyperglycemia," and "if interventions to optimize sleep duration and quality result in better glucose control."

Dr. Koichiro Yoda from Osaka City University Graduate School of Medicine in Japan, who recently reported an association between poor sleep quality, poor glycemic control, and increased arterial thickening in type 2 diabetic patients, said he was surprised by the new findings.

"This paper supports the fact that sleep disorder is an environmental factor in the onset of diabetes," he told Reuters Health by email. "In daily practice, this report shows the necessity of positively interviewing the state of sleep (bedding, sleeping, halfway awakening, getting up), and in case it is insufficient, treatment with sleep hygiene guidance and medication."

 

SOURCE: http://bit.ly/2hsydXn

Diabetes Care 2016.

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