Prevalence and Assessment of Excessive Daytime Sleepiness in Diabetic and Obese Patients.

Objective: To study the prevalence of Excessive Day time Sleepiness [ EDS] in diabetes and obese patients by assessing the quality and quantity of sleep by Epworth[ ESS] and Pittsburgh Sleep Quality Index [PSQI] Scale and also to provide patient education to improve quality and quantity of sleep. Study Design: It is a prospective observational study. Study Site: The study was conducted in the department of Diabetology, Kovai Medical Center and Hospital, a multispecialty hospital in Coimbatore, Tamilnadu. Study Period: The study was conducted over a period of five months from September2011 to January 2012. Study Population: Both male and female patients diagnosed with Type II Diabetes Mellitus & Obesity within the age group of 20-65 were included in the study. CONCLUSION: The study findings observed that excessive day time sleepiness is more prevalent in diabetic obese population. Sleep loss varies considerably by gender in diabetic patients. It was more observed in diabetic females than males. Obesity was also more common in diabetic women than in men while physical activity was less in women compared to men. A sedentary lifestyle has shown to enhance excessive day time sleepiness in diabetic patients. Difference was observed in the ESS scores between both genders. Sleep disturbances were seen more common in older age group of 55-65. Most of the patients observed with EDS had hypertension as a comorbid disease. Sleep exerts marked modulatory effects on glucose metabolism by influencing the balance and levels of hormones, including leptin, ghrelin, insulin and cortisol, in addition to the activity of the sympathetic nervous system(SNS). These physiological defence mechanisms alter glucose tolerance and sensitivity to insulin and leptin, impairing appetite regulation. Therefore, when chronically activated, these stress responses favour the development of obesity and T2DM. In addition, shorter sleepers have more opportunity for food consumption and tend to be more fatigued and less active during the day, which favour obesity. On the other hand, obesity itself, especially when central, leads to OSA, to inflammatory processes, and to the development of T2DM. Thus, we may conclude that it is difficult to isolate a cause and an effect from this neuroendocrine- metabolic misbalance, since sleep characteristics (disorders or duration) may impact neurological and endocrine systems to promote obesity and T2DM, while obesity and T2DM may impact sleep as well. Therefore, while obesity and T2DM are favoured and aggravated by short sleep duration or sleep disorders, sleep may be impaired by these two widespread metabolic conditions. Thus sleep quality is seen poor in diabetic patients. To improve sleep quality, a clinical pharmacist can help patients to follow good sleep habits. The pharmacist encourages patients to engage in good sleep hygiene to reduce daytime sleepiness and instruct patients that adequate high-quality sleep is important to improve daytime function. Good sleep hygiene includes ensuring adequate sleep duration, developing sleep promoting bedtime rituals, avoiding staying in bed if unable to sleep, and avoiding caffeine if it disturbs the patient’s ability to fall asleep. There are many effective treatments for sleep disorders, and the deleterious health effects of insufficient sleep or a coexisting sleep disorder warrant greater attention. Pharmacist can be instrumental in encouraging adherence to treatment for sleep disorders. Although persons with diabetes are instructed to restrict calories and to increase physical activity, the presence of less than optimal sleep may undermine these important treatment goals. Thus, educating patients with type 2 diabetes about the importance of sleep and regular screening for sleep disorders has the potential for a positive clinical outcome