ISSN: 2451-0629
Archives of Medical Science - Atherosclerotic Diseases
Current volume Archive About the journal Editorial board Abstracting and indexing Contact Instructions for authors Ethical standards and procedures
Official journal of the International Lipid Expert Panel (ILEP)
vol. 5
Letter to the Editor

Prevalence and correlates of sleep disorders in Greek patients with type 2 diabetes: comparison of an urban and a semi-urban population

Athanasia K. Papazafiropoulou
Maria Stamatelatou
Louisa Mpoumi
Elias Georgopoulos
Maria Dasenaki
Andreas Melidonis 

First Department of Internal Medicine and Diabetes Center, General Hospital “Tzaneio”, Piraeus, Greece
Department of Internal Medicine and Diabetes Clinic, General Hospital – Health Center of Sitia, Greece
Arch Med Sci Atheroscler Dis 2020; 5: e198–e199
Online publish date: 2020/07/21
Article file
Get citation
JabRef, Mendeley
Papers, Reference Manager, RefWorks, Zotero

Sleep disturbances are common in type 2 diabetes (T2D) patients [1]. To promote better management of T2D, sleep disorders must be addressed in these patients and treated early [2]. Therefore, the aim of the present study was to estimate the prevalence and correlates of sleep disorders in Greek patients with T2D, comparing an urban and a semi-urban population.

The study population comprised 308 T2D patients: 139 (80 men, mean age ± standard deviation: 65.5 ±10.1 years, glycated hemmoglobin (HbA1c) 7.3 ±1.4%, body mass index (BMI) 30.7 ±6.1 kg/m2, duration of T2D 10.9 ±7.9 years) attending the Diabetes Center of “Tzaneio” General Hospital of Piraeus (urban population, group A) and 169 (82 men, mean age: 67.9 ±12.4 years, HbA1c 7.0 ±1.3%, BMI 30.8 ±6.1 kg/m2, duration of T2D 11.2 ±8.7 years) attending the Diabetes Clinic of General Hospital – Health Center of Sitia (semi-urban population, group B) from July to December 2018. Quality of sleep was evaluated by administering the Pittsburgh Sleep Quality Index (PSQI), a self-report questionnaire that assesses sleep quality and quantity over a month-long period [3].

The mean PSQI score of group A was 11.22 ±6.44, while 88.5% of participants had a PSQI score ≥ 5, indicating poor quality of sleep. The same pattern was observed in group B where the mean PSQI score was 12.48 ±5.85, and 88.8% had a PSQI score ≥ 5. Participants with a PSQI score ≥ 5 did not differ between study groups (p = 0.13). Logistic regression analysis, after adjustment for sex, BMI, presence of hypertension and dyslipidemia, smoking, diabetes micro- and macrovascular complications, and oral antidiabetic treatment, showed that poor quality of sleep (PSQI score ≥ 5) in the total sample population was associated with insulin treatment (odds ratio (OR) = 0.03, 95% confidence interval (95% CI): 0.31–0.99) and HbA1c (OR = 6.56, 95% CI: 1.93–16.14). In group A, poor quality of sleep was associated with insulin treatment (OR = 0.02, 95% CI: 0.10–0.84) and HbA1c (OR = 7.55, 95% CI: 1.97–18.81). In group B, poor quality of sleep was associated only with age (OR = 1.36, 95% CI: 1.06–1.74).

Our study suggested that Greek patients with T2D have a high prevalence of sleep disorders. There was no significant difference regarding sleep disorders between studied populations. Our analysis also indicated that insulin treatment and HbA1c were the greatest predictors of sleep disorders. It is well known that sleep disturbances among T2D patients are associated with increased HbA1c levels [4]. On the other hand, continuous positive airway pressure therapy of obstructive sleep apnea in T2D patients improves glycemic control [5]. In accordance with our findings, recent studies in T2D patients correlated poor sleep quality with insulin treatment [6, 7]. Interestingly, insulin administration has been reported to be significantly correlated with sympathetic overactivity and may increase sympathetic activity [8].

In conclusion, Greek patients with T2D have a high prevalence of sleep disorders. Therefore, it is important to emphasize the need for early identification of sleep disorders in T2D patients in order to treat them early and improve patients’ quality of life.

Conflict of interest

The authors declare no conflict of interest.



Chattu VK, Chattu SK, Burman D, Spence DW, Pandi-Perumal SR , authors. The interlinked rising epidemic of insufficient sleep and diabetes mellitus. Healthcare. 2019. 7:E37


Tan X, van Egmond L, Chapman CD, Cedernaes J, Benedict C , authors. Aiding sleep in type 2 diabetes: therapeutic considerations. Lancet Diabetes Endocrinol. 2018. 6:p. 60–8


Mollayeva T, Thurairajah P, Burton K, Mollayeva S, Shapiro CM, Colantonio A , authors. The Pittsburgh Sleep Quality Index as a screening tool for sleep dysfunction in clinical and non-clinical samples: a systematic review and meta-analysis. Sleep Med Rev. 2016. 25:p. 52–73


Pillai A, Warren G, Gunathilake W, Idris I , authors. Effects of sleep apnea severity on glycemic control in patients with type 2 diabetes prior to continuous positive airway pressure treatment. Diabetes Technol Ther. 2011. 13:p. 945–9


Dawson A, Abel SL, Loving RT, et al. , authors. CPAP therapy of obstructive sleep apnea in type 2 diabetics improves glycemic control during sleep. J Clin Sleep Med. 2008. 4:p. 538–42


Song Y, Ye X, Ye L, Li B, Wang L, Hua Y , authors. Disturbed subjective sleep in Chinese females with type 2 diabetes on insulin therapy. PLoS One. 2013. 8:p. e54951


Rajendran A, Parthsarathy S, Tamilselvan B, Seshadri KG, Shuaib M , authors. Prevalence and correlates of disordered sleep in southeast asian indians with type 2 diabetes. Diabetes Metab J. 2012. 36:p. 70–6


Perciaccante A, Fiorentini A, Paris A, Serra P, Tubani L , authors. Circadian rhythm of the autonomic nervous system in insulin resistant subjects with normoglycemia, impaired fasting glycemia, impaired glucose tolerance, type 2 diabetes mellitus. BMC Cardiovasc Disord. 2006. 6:p. 19

Copyright: © 2020 Termedia & Banach. This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International (CC BY-NC-SA 4.0) License (, allowing third parties to copy and redistribute the material in any medium or format and to remix, transform, and build upon the material, provided the original work is properly cited and states its license.
Quick links
© 2020 Termedia Sp. z o.o. All rights reserved.
Developed by Bentus.
PayU - płatności internetowe