Disclosures: The authors report no relevant financial disclosures.
February 16, 2021
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Older adults with type 2 diabetes report fewer mood disturbances with OSA, insomnia

Disclosures: The authors report no relevant financial disclosures.
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Adults aged at least 65 years with type 2 diabetes, obstructive sleep apnea and insomnia experienced less diabetes-related stress and better mood and functional outcomes compared with younger peers, according to study data.

“Although previous studies reported that older adults are at a higher risk for type 2 diabetes and sleep disorders, mood disturbances and daytime sleepiness than younger adults, the findings of this study suggested that younger adults who were less than 65 years had worse mood and higher diabetes-related distress compared to older adults who were older than 65 years,” Bomin Jeon, MSN, from the University of Pittsburgh School of Nursing, and colleagues wrote in a study published in The Diabetes Educator. “In addition, older adults with type 2 diabetes and comorbid obstructive sleep apnea and insomnia had better daytime functional outcomes than younger adults. These findings indicate that the associations between sleep disorders and mood, diabetes-related distress and daytime functional outcomes are different between younger and older adults with type 2 diabetes.”

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Researchers analyzed pooled baseline data from two randomized trials. The Diabetes Sleep Treatment Trial was a multisite study comparing the efficacy of continuous positive airway pressure for obstructive sleep apnea (OSA) with vs. sham continuous positive airway pressure on glucose control and diabetes self-management. The Diabetes Sleep Treatment Trial: Insomnia was a single-site pilot feasibility study comparing the efficacy of online cognitive behavioral treatment for insomnia vs. information control on glucose control and diabetes self-management.

Participants in both trials were recruited from endocrinology and sleep medicine clinics. All were aged 18 years or older with type 2 diabetes and had not been involved in any sleepiness-related near-miss or automobile accidents. Researchers used the Apnea-Hypopnea Index to determine OSA severity and the Insomnia Severity Index to measure insomnia. The Profile of Mood States Survey was used to measure mood, the Problem Areas in Diabetes Survey measured diabetes-related distress, and the Functional Outcome of Sleep Questionnaire was used to measure daytime functional outcomes.

Data on 145 trial participants (67.6% white; 46.2% men) were analyzed. The study population was divided into a group younger than 65 years (n = 109) and a group of participants aged 65 years and older (n = 36).

Older adults had better self-reported mood scores (P < .05) and less diabetes-related distress (P = .001) compared with younger adults. In a survey measuring daytime functional outcomes, older adults reported having an easier time with general productivity, social outcomes, activity and vigilance, and had an overall better score compared with younger adults (P < .05 for all).

Insomnia severity was associated with worse mood, more diabetes-related distress and better performance of daytime functional outcomes (P < .001 for all). Insomnia severity was also a significant predictor for a poorer mood (P = .041). Insomnia severity and age were predictors for diabetes-related distress, with greater insomnia severity associated with more distress (P < .001) and older age associated with less distress (P = .04). Greater insomnia severity was also associated with lower functional outcomes, more daytime sleepiness (P < .001) and a longer duration of type 2 diabetes (P = .002). OSA was not significantly associated with mood changes, diabetes-related distress or functional outcomes.

The researchers added that the findings showed older age may increase an adult’s ability to cope with the negative effects of sleep disturbances because of their longer experience with type 2 diabetes. They advised clinicians to consider sleep as a modifiable risk factor for mood disturbances in adults with type 2 diabetes.

“Diabetes care and education specialists need to recognize the effect that OSA and insomnia may have on mood, diabetes-related distress and functional outcomes in their patients with diabetes,” the researchers wrote. “In addition, it is important to screen for excessive daytime sleepiness because sleep disorders are the most common causes of it.”