in PeopleWith Type 2 Diabetes The Edinburgh Type 2 Diabetes Study

OBJECTIVEdSleep-disordered breathing and sleepiness cause metabolic, cognitive, and be-havioral disturbance. Sleep-disordered breathing is common in type 2 diabetes, a condition that requires adherence to complex dietary, behavioral, and drug treatment regimens. Hypo-glycemia is an important side effect of treatment, causing physical and psychological harm and limiting ability to achieve optimal glycemic control. We hypothesized that sleep disorder might increase the risk of hypoglycemia through effects on self-management and glucose regulation. RESEARCH DESIGN AND METHODSdPeople with type 2 diabetes (n 5 898) com-pleted questionnaires to assess sleep-disordered breathing, daytime sleepiness, and occurrence of severe hypoglycemia. RESULTSdSubjects who scored highly on the Epworth Sleepiness Scale were significantly more likely to have suffered from severe hypoglycemia. This was a significant predictor of severe hypoglycemia in regression analysis including the variables age, sex, duration of diabetes, HbA1c, BMI, and treatment type. CONCLUSIONSdDaytime sleepiness may be a novel risk factor for hypoglycemia. Diabetes Care 36:4157–4159, 2013 Hypoglycemia is an adverse side ef-fect of insulin and sulfonylureatreatment for type 2 diabetes. Fac-tors influencing risk of severe hypoglyce-mia (requiring external assistance) include duration of diabetes (1), duration of insulin treatment (2), renal impairment (2), age (1), comorbidities (3), and im-paired awareness of hypoglycemia (4). Sleep-disordered breathing with associ-ated daytime somnolence is reported in up to 75 % of people with type 2 diabetes (5) and is linked to a range of cardiovas-cular and metabolic morbidities (6). We hypothesized that sleep disorder and increased daytime sleepiness would be as-sociated with increased frequency of severe hypoglycemia in people with diabetes