{"id":50847,"date":"2023-09-30T10:40:19","date_gmt":"2023-09-30T10:40:19","guid":{"rendered":"https:\/\/biomedpharmajournal.org\/?p=50847"},"modified":"2023-10-07T11:26:42","modified_gmt":"2023-10-07T11:26:42","slug":"a-cross-sectional-study-on-the-assessment-of-sleep-quality-and-associated-factors-among-diabetes-mellitus-patients","status":"publish","type":"post","link":"https:\/\/biomedpharmajournal.org\/staging\/vol16no3\/a-cross-sectional-study-on-the-assessment-of-sleep-quality-and-associated-factors-among-diabetes-mellitus-patients\/","title":{"rendered":"A Cross-Sectional Study on the Assessment of Sleep Quality and Associated Factors Among Diabetes Mellitus Patients"},"content":{"rendered":"\n

Introduction <\/strong><\/p>\n\n\n\n

The human body and mind must function properly, which requires sleep. It is produced after a time of wakefulness based on a circadian rhythm and homeostatic pressure.1<\/sup> Humans spend about 30% of their lives sleeping, making sleep an essential living component. 2<\/sup> This is an essential component of well-being and health because it supports cognitive capacity, physiology, emotional management, physical development, and standard of living. It aids in altering the body temperature, cardiovascular, also hormonal activity, leading to a much-needed restoration and the right operation of the body system. 3<\/sup> In addition to being linked to several diseases and ailments, inadequate sleep has also been linked to subpar performance and occupational mishaps.1<\/sup><\/p>\n\n\n\n

One of the main\nhealth issues for diabetics is poor sleep. Its symptoms include trouble falling\nasleep and staying asleep, a disrupted sleep-wake cycle, excessive somnolence, and\ndysfunctions related to sleep and sleep stages. Poor sleep quality is a medical\ncondition that affects sleep patterns. 4<\/sup> Sleep issues have been\nlinked to poorer glycaemic management in type 2 diabetes patients and are risk\nfactors for diabetes.  5<\/sup> But\nit’s becoming more widely acknowledged that pathologic sleep disruption and\ninsufficient sleep could also have serious negative cardiovascular effects.  2<\/sup> <\/p>\n\n\n\n

Numerous studies\nhave found that insulin use, aging, a lower score on activity (personality)\ntraits, low income, smoking, increased morbidities and a higher body mass\nindex, and depressive symptoms were significantly associated with poor\nhealth-related quality of life in adults with type II diabetes mellitus.\nMeanwhile, many studies have shown that type II diabetes mellitus frequently\nincludes sleep problems.  6<\/sup><\/p>\n\n\n\n

However, how poor\nsleep quality affects functional well-being in persons with type 2 diabetes is\nstill unknown.  7<\/sup> To evaluate\nthe sleep quality and key factors among patients with diabetes mellitus, this\nstudy was conducted.<\/p>\n\n\n\n

Materials and Methods<\/strong><\/p>\n\n\n\n

Using a convenience sample technique, a prospective\ncross-sectional study was conducted for eight months (October 2021\u2013June 2022)\nin the Department of General Medicine, Justice K S Hegde Charitable Hospital,\nMangaluru. The trial received institutional ethical committee (IEC) approval\nand was also registered in the Clinical Trial Registry of India\n(CTRI\/2021\/09\/036851) with reference number NGSMIPS\/IEC\/16\/2021. The proportion\nof poor sleep quality (p) = 0.365 and precision (d) = 0.05 (0.5%) at the 95%\nconfidence level were used to compute the sample size. 356 samples were\nrevealed to be the necessary number. The study included adults older than 18\nyears of age having an inpatient or outpatient medical history of diabetes\nmellitus. Patients who refused to provide consent were not included.<\/p>\n\n\n\n

A patient data collection was prepared to collect\nall the necessary demographic details like age, gender, diagnosis, family\nhistory and social habits. Pittsburgh Sleep Quality Index (PSQI), Generalized\nAnxiety Disorder Item 7 (GAD-7), Patient Health Questionnaire Item 2 (PHQ-2),\nand International Physical Activity Questionnaire Item 7 (IPAQ-7) were used to\ngather data regarding sleep quality, anxiety, depression possibility and\nphysical activity respectively. The Statistical Package for Social Sciences\n(SPSS) version 28.0 was used to analyse the data. Binary logistic regression\nwas used to find the association between the risk factors and sleep quality. Statistically\nsignificant was considered at the p-value <0.05.<\/strong><\/p>\n\n\n\n

Results<\/strong><\/p>\n\n\n\n

Sociodemographic details of the study subjects<\/strong><\/p>\n\n\n\n

A total of 356 participants, 215 (60.4%) of whom were men, and 141 (39.6%) of whom were women. Age between 61-70 was a majority with 107 (30.05%), followed by only 2 (0.56%) belonging to the 18-30 category. 291 (81.74%) patients didn\u2019t have any habits, 38 (10.67%) patients had a history of alcohol consumption, 14 (3.93%) patients were smokers and 13 (3.65%) patients had a history of both smoking and alcohol consumption. The majority of the patients (n=135, 37.92%) had hypertension as a common co-morbidity. Out of 356 patients, almost 153 (42.98%) patients had a family history of diabetes mellitus with one or more blood relatives being diabetic and 252 patients had hypertension with some other co-morbidities such as kidney, heart, liver, and lung-related issues. In addition, 321 patients followed a mixed diet, whereas only 35 had a vegetarian diet. The details are depicted in Table 1.<\/p>\n\n\n\n

Table 1: Socio-demographic details<\/strong>.<\/p>\n\n\n\n\n\n\n\n\n\n\n\n
\n

Variables<\/strong><\/p>\n<\/td>\n

\n

Category<\/strong><\/p>\n<\/td>\n

\n

Frequency (n)<\/strong><\/p>\n<\/td>\n

\n

Percentage (%)<\/strong><\/p>\n<\/td>\n<\/tr>\n

\n

Sex<\/p>\n<\/td>\n

\n

Male<\/p>\n

Female<\/p>\n<\/td>\n

\n

215<\/p>\n

141<\/p>\n<\/td>\n

\n

60.40<\/p>\n

39.60<\/p>\n<\/td>\n<\/tr>\n

\n

Age group (In years)<\/p>\n<\/td>\n

\n

18-30<\/p>\n

31-40<\/p>\n

41-50<\/p>\n

51-60<\/p>\n

61-70<\/p>\n

71-80<\/p>\n<\/td>\n

\n

2<\/p>\n

4<\/p>\n

65<\/p>\n

103<\/p>\n

107<\/p>\n

73<\/p>\n<\/td>\n

\n

0.56<\/p>\n

1.12<\/p>\n

18.25<\/p>\n

28.93<\/p>\n

30.05<\/p>\n

20.5<\/p>\n<\/td>\n<\/tr>\n

\n

Social habits<\/p>\n<\/td>\n

\n

No habits<\/p>\n

Alcoholic<\/p>\n

Smoking<\/p>\n

Alcoholic + Smoking<\/p>\n<\/td>\n

\n

291<\/p>\n

38<\/p>\n

14<\/p>\n

13<\/p>\n<\/td>\n

\n

81.74<\/p>\n

10.67<\/p>\n

3.93<\/p>\n

3.65<\/p>\n<\/td>\n<\/tr>\n

\n

Family history of diabetes mellitus<\/p>\n<\/td>\n

\n

Present<\/p>\n

 <\/p>\n

Absent<\/p>\n<\/td>\n

\n

153<\/p>\n

 <\/p>\n

203<\/p>\n<\/td>\n

\n

42.98<\/p>\n

 <\/p>\n

57.02<\/p>\n<\/td>\n<\/tr>\n

\n

Co-morbidities<\/p>\n<\/td>\n

\n

Hypertension<\/p>\n

Hypertension + Kidney related disease<\/p>\n

Hypertension + Heart related disease<\/p>\n

Hypertension + Heart related disease + Kidney related disease<\/p>\n

Hypertension + Liver related disease<\/p>\n

Hypertension + Lung related disease<\/p>\n

Others<\/p>\n<\/td>\n

\n

135<\/p>\n

19<\/p>\n

 <\/p>\n

60<\/p>\n

 <\/p>\n

6<\/p>\n

 <\/p>\n

4<\/p>\n

 <\/p>\n

19<\/p>\n

 <\/p>\n

9<\/p>\n<\/td>\n

\n

37.92<\/p>\n

5.33<\/p>\n

 <\/p>\n

16.85<\/p>\n

 <\/p>\n

1.68<\/p>\n

 <\/p>\n

1.12<\/p>\n

 <\/p>\n

5.33<\/p>\n

 <\/p>\n

2.52<\/p>\n<\/td>\n<\/tr>\n

\n

Diet<\/p>\n<\/td>\n

\n

Vegetarian<\/p>\n

Mixed<\/p>\n<\/td>\n

\n

35<\/p>\n

321<\/p>\n<\/td>\n

\n

9.84<\/p>\n

90.16<\/p>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n

Sleep quality of study subjects<\/strong><\/p>\n\n\n\n

The results of the PSQI scale show that 163 (45.78%) subjects rated their sleep quality as very good, whereas 4 (1.12%) subjects rated it as very bad. The details are presented in Table 2.<\/p>\n\n\n\n

Table 2: Subjective Sleep Quality<\/strong>.<\/p>\n\n\n\n\n\n\n\n\n\n
\n

Subjective Sleep Quality<\/strong><\/p>\n<\/td>\n

\n

Frequency (n)<\/strong><\/p>\n<\/td>\n

\n

Percentage (%) <\/strong><\/p>\n<\/td>\n<\/tr>\n

\n

Very Good<\/p>\n<\/td>\n

\n

163<\/p>\n<\/td>\n

\n

45.78<\/p>\n<\/td>\n<\/tr>\n

\n

Fairly Good<\/p>\n<\/td>\n

\n

164<\/p>\n<\/td>\n

\n

46.06<\/p>\n<\/td>\n<\/tr>\n

\n

Fairly Bad<\/p>\n<\/td>\n

\n

25<\/p>\n<\/td>\n

\n

7.02<\/p>\n<\/td>\n<\/tr>\n

\n

Very Bad<\/p>\n<\/td>\n

\n

4<\/p>\n<\/td>\n

\n

1.12<\/p>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n

PSQI results<\/strong><\/p>\n\n\n\n

The\nsleep quality was assessed by using the PSQI questionnaire. PSQI includes seven\ncomponents namely subjective sleep quality, sleep latency, sleep duration,\nhabitual sleep efficiency, step disturbances, use of sleeping medication and\ndaytime dysfunction. Each component’s score ranges from 0 to 3 points, here \u201c0\u201d\nrefers to no difficulty and 3 refers to severe difficulty. <\/p>\n\n\n\n

In our study, it was observed the majority of the subjects (84.83%) took 15 mins to fall asleep after getting into bed. The average sleep duration for subjects was 8 hours 23 mins. The majority of the subjects, 317 (89.04%), had a sleep duration of more than 7 hours. Only a few subjects had less than 6 hours of sleep. Out of 356 subjects, the majority, 354 (99.43%), had good sleep efficacy. Out of 356 subjects, 243 subjects experienced sleep disturbance once a week. Overall, 339 (95.22%) subjects didn\u2019t use any medication for sleep and a few subjects consumed the medicines for sleep at least 1 time a week. 250 (70.22%) of the 356 participants reported having daytime dysfunction at least once or twice per week. It was observed that the majority of the subjects, 313 (87.92%), had good sleep quality and only 43 subjects had poor sleep quality. The details of PSQI results are summarised in table 3.<\/p>\n\n\n\n

Table 3: PSQI results<\/strong><\/p>\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n
\n

Variables<\/strong><\/p>\n<\/td>\n

\n

Category<\/strong><\/p>\n<\/td>\n

\n

Frequency (n)<\/strong><\/p>\n<\/td>\n

\n

Percentage (%)<\/strong><\/p>\n<\/td>\n<\/tr>\n

\n

Sleep latency<\/p>\n<\/td>\n

\n

0\u201315 minutes (0)<\/p>\n<\/td>\n

\n

302<\/p>\n<\/td>\n

\n

84.83<\/p>\n<\/td>\n<\/tr>\n

\n

16\u201330 minutes (1)<\/p>\n<\/td>\n

\n

42<\/p>\n<\/td>\n

\n

11.79<\/p>\n<\/td>\n<\/tr>\n

\n

31\u201360 minutes (2)<\/p>\n<\/td>\n

\n

11<\/p>\n<\/td>\n

\n

3.08<\/p>\n<\/td>\n<\/tr>\n

\n

>60 minutes (3)<\/p>\n<\/td>\n

\n

1<\/p>\n<\/td>\n

\n

0.28<\/p>\n<\/td>\n<\/tr>\n

\n

Sleep duration<\/p>\n<\/td>\n

\n

>7 hours<\/p>\n<\/td>\n

\n

317<\/p>\n<\/td>\n

\n

89.04<\/p>\n<\/td>\n<\/tr>\n

\n

6\u20137 hours<\/p>\n<\/td>\n

\n

33<\/p>\n<\/td>\n

\n

9.26<\/p>\n<\/td>\n<\/tr>\n

\n

5\u20136 hours<\/p>\n<\/td>\n

\n

6<\/p>\n<\/td>\n

\n

1.68<\/p>\n<\/td>\n<\/tr>\n

\n

<5 hours<\/p>\n<\/td>\n

\n

0<\/p>\n<\/td>\n

\n

0<\/p>\n<\/td>\n<\/tr>\n

\n

Sleep efficacy<\/p>\n<\/td>\n

\n

\u226585%<\/p>\n<\/td>\n

\n

354<\/p>\n<\/td>\n

\n

99.43<\/p>\n<\/td>\n<\/tr>\n

\n

75\u201384%<\/p>\n<\/td>\n

\n

1<\/p>\n<\/td>\n

\n

0.28<\/p>\n<\/td>\n<\/tr>\n

\n

65\u201374%<\/p>\n<\/td>\n

\n

0<\/p>\n<\/td>\n

\n

0<\/p>\n<\/td>\n<\/tr>\n

\n

<65%<\/p>\n<\/td>\n

\n

1<\/p>\n<\/td>\n

\n

0.28<\/p>\n<\/td>\n<\/tr>\n

\n

Sleep disturbance<\/p>\n<\/td>\n

\n

Never (0)<\/p>\n<\/td>\n

\n

3<\/p>\n<\/td>\n

\n

0.84<\/p>\n<\/td>\n<\/tr>\n

\n

1 time a week (1)<\/p>\n<\/td>\n

\n

243<\/p>\n<\/td>\n

\n

68.25<\/p>\n<\/td>\n<\/tr>\n

\n

1\u20132 times a week (2)<\/p>\n<\/td>\n

\n

105<\/p>\n<\/td>\n

\n

29.49<\/p>\n<\/td>\n<\/tr>\n

\n

\u22653 times a week (3)<\/p>\n<\/td>\n

\n

5<\/p>\n<\/td>\n

\n

1.40<\/p>\n<\/td>\n<\/tr>\n

\n

Used sleep medication<\/p>\n

 <\/p>\n<\/td>\n

\n

Never (0)<\/p>\n<\/td>\n

\n

339<\/p>\n<\/td>\n

\n

95.22<\/p>\n<\/td>\n<\/tr>\n

\n

1\u20132 once a week (1)<\/p>\n<\/td>\n

\n

13<\/p>\n<\/td>\n

\n

3.65<\/p>\n<\/td>\n<\/tr>\n

\n

3 times a week (2)<\/p>\n<\/td>\n

\n

4<\/p>\n<\/td>\n

\n

1.12<\/p>\n<\/td>\n<\/tr>\n

\n

Daytime dysfunction<\/p>\n<\/td>\n

\n

No problem (0)<\/p>\n<\/td>\n

\n

37<\/p>\n<\/td>\n

\n

10.39<\/p>\n<\/td>\n<\/tr>\n

\n

1\u20132 times a week (1)<\/p>\n<\/td>\n

\n

250<\/p>\n<\/td>\n

\n

70.22<\/p>\n<\/td>\n<\/tr>\n

\n

3 times a week (2)<\/p>\n<\/td>\n

\n

65<\/p>\n<\/td>\n

\n

18.25<\/p>\n<\/td>\n<\/tr>\n

\n

>3 times a week (3)<\/p>\n<\/td>\n

\n

4<\/p>\n<\/td>\n

\n

1.12<\/p>\n<\/td>\n<\/tr>\n

\n

Overall sleep quality<\/p>\n<\/td>\n

\n

Good<\/p>\n<\/td>\n

\n

313<\/p>\n<\/td>\n

\n

87.92<\/p>\n<\/td>\n<\/tr>\n

\n

Poor<\/p>\n<\/td>\n

\n

43<\/p>\n<\/td>\n

\n

12.07<\/p>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n

Depression\nand anxiety among the study subjects<\/strong><\/strong><\/p>\n\n\n\n

PHQ-2 & GAD-7 questionnaires were used to assess depression and anxiety. PHQ-2 comprises two questions. The score ranges for each question from 0 to 3 and the total score for PHQ-2 ranges from 0 to 6. If the score is \u22653 considered that the individual is likely to have depression. GAD-7 includes seven questions, and for each question, the score ranges from 0 to 3 and the total score for GAD-7 ranges from 0 to 21. Anxiety is further categorized into four types based on the score ranges including minimal anxiety (0-4), mild anxiety  (5-9), moderate anxiety (10-14), and severe anxiety (15-21). Analysis of depression and anxiety among the participants showed that 61(17.13%) of them had depression, whereas 169 (47.47%) had major anxiety. The details are presented in Table 4.<\/p>\n\n\n\n

Table 4: Depression and anxiety among the patients<\/strong><\/p>\n\n\n\n\n\n\n\n\n\n\n\n
\n

Variable<\/strong><\/p>\n<\/td>\n

\n

Category<\/strong><\/p>\n<\/td>\n

\n

Frequency (n)<\/strong><\/p>\n<\/td>\n

\n

Percentage (%)<\/strong><\/p>\n<\/td>\n<\/tr>\n

\n

 <\/p>\n

Depression<\/p>\n<\/td>\n

\n

Yes<\/p>\n<\/td>\n

\n

61<\/p>\n<\/td>\n

\n

17.13<\/p>\n<\/td>\n<\/tr>\n

\n

No<\/p>\n<\/td>\n

\n

295<\/p>\n<\/td>\n

\n

82.87<\/p>\n<\/td>\n<\/tr>\n

\n

 <\/p>\n

Anxiety<\/p>\n<\/td>\n

\n

Minimal<\/p>\n<\/td>\n

\n

29<\/p>\n<\/td>\n

\n

8.14<\/p>\n<\/td>\n<\/tr>\n

\n

Mild<\/p>\n<\/td>\n

\n

129<\/p>\n<\/td>\n

\n

36.23<\/p>\n<\/td>\n<\/tr>\n

\n

Moderate<\/p>\n<\/td>\n

\n

169<\/p>\n<\/td>\n

\n

47.47<\/p>\n<\/td>\n<\/tr>\n

\n

Severe<\/p>\n<\/td>\n

\n

29<\/p>\n<\/td>\n

\n

8.14<\/p>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n

Factors associated with sleep disturbance\namong study subjects<\/strong><\/p>\n\n\n\n

Our study’s findings showed that men (7.86%) had a higher likelihood of having trouble sleeping than women (4.21%). Poor sleep quality was more in the age group of 61-70 years compared to 71-80 years, which is 1.059 times greater than that of the reference age group (71-80). In the majority of subjects, it was seen that social habits did not affect sleep quality. It was observed that subjects with a mixed diet had 1.518 times greater poor sleep quality compared to those with a vegetarian diet. It was observed that poor sleep quality was more in subjects with co-morbidities (8.76%) compared to subjects without co-morbidities (3.37%). When compared to patients without a family history of diabetes mellitus, those with a 0.946 times higher likelihood of experiencing poor sleep quality. Comparing participants with individuals with other categories of anxiety, those with severe anxiety have a larger percentage (17.24%) of subjects with poor sleep quality.   When compared to individuals without depression, subjects who tested positive for depression were 0.753 times more likely to have poor sleep quality. When compared to people who were more physically active, subjects with low levels of physical activity had a 0.899-times higher likelihood of having poor sleep quality. The details are presented in table 5.<\/p>\n\n\n\n

Table 5: Factors associated with sleep disturbance<\/strong><\/p>\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n
\n

Variables<\/p>\n<\/td>\n

\n

Poor Sleep Quality<\/p>\n<\/td>\n

\n

OR 95% CI<\/p>\n<\/td>\n

\n

P-value<\/p>\n<\/td>\n<\/tr>\n

\n

YES<\/p>\n<\/td>\n

\n

NO<\/p>\n<\/td>\n<\/tr>\n

\n

Gender<\/p>\n<\/td>\n

\n

 <\/p>\n<\/td>\n

\n

 <\/p>\n<\/td>\n

\n

 <\/p>\n<\/td>\n

\n

 <\/p>\n<\/td>\n

\n

 <\/p>\n<\/td>\n<\/tr>\n

\n

Male<\/p>\n<\/td>\n

\n

28<\/p>\n<\/td>\n

\n

187<\/p>\n<\/td>\n

\n

0.795 (0.408-1.548)<\/p>\n<\/td>\n

\n

0.500<\/p>\n<\/td>\n<\/tr>\n

\n

Female<\/p>\n<\/td>\n

\n

15<\/p>\n<\/td>\n

\n

126<\/p>\n<\/td>\n

\n

Ref<\/p>\n<\/td>\n

\n

Ref<\/p>\n<\/td>\n<\/tr>\n

\n

Age<\/p>\n<\/td>\n

\n

 <\/p>\n<\/td>\n

\n

 <\/p>\n<\/td>\n

\n

 <\/p>\n<\/td>\n

\n

 <\/p>\n<\/td>\n

\n

 <\/p>\n<\/td>\n<\/tr>\n

\n

18-30<\/p>\n<\/td>\n

\n

0<\/p>\n<\/td>\n

\n

2<\/p>\n<\/td>\n

\n

.000<\/p>\n<\/td>\n

\n

0.999<\/p>\n<\/td>\n<\/tr>\n

\n

31-40<\/p>\n<\/td>\n

\n

0<\/p>\n<\/td>\n

\n

4<\/p>\n<\/td>\n

\n

.000<\/p>\n<\/td>\n

\n

0.999<\/p>\n<\/td>\n<\/tr>\n

\n

41-50<\/p>\n<\/td>\n

\n

8<\/p>\n<\/td>\n

\n

57<\/p>\n<\/td>\n

\n

0.998 (0.361-2.760)<\/p>\n<\/td>\n

\n

0.997<\/p>\n<\/td>\n<\/tr>\n

\n

51-60<\/p>\n<\/td>\n

\n

12<\/p>\n<\/td>\n

\n

91<\/p>\n<\/td>\n

\n

0.928 (0.369-2.330)<\/p>\n<\/td>\n

\n

0.873<\/p>\n<\/td>\n<\/tr>\n

\n

61-70<\/p>\n<\/td>\n

\n

14<\/p>\n<\/td>\n

\n

93<\/p>\n<\/td>\n

\n

1.059 (0.432-2.594)<\/p>\n<\/td>\n

\n

0.900<\/p>\n<\/td>\n<\/tr>\n

\n

71-80<\/p>\n<\/td>\n

\n

9<\/p>\n<\/td>\n

\n

64<\/p>\n<\/td>\n

\n

Ref<\/p>\n<\/td>\n

\n

Ref<\/p>\n<\/td>\n<\/tr>\n

\n

Social Habits<\/p>\n<\/td>\n

\n

 <\/p>\n<\/td>\n

\n

 <\/p>\n<\/td>\n

\n

 <\/p>\n<\/td>\n

\n

 <\/p>\n<\/td>\n

\n

 <\/p>\n<\/td>\n<\/tr>\n

\n

No Habits<\/p>\n<\/td>\n

\n

37<\/p>\n<\/td>\n

\n

254<\/p>\n<\/td>\n

\n

1.748 (0.444-5.189)<\/p>\n<\/td>\n

\n

0.597<\/p>\n<\/td>\n<\/tr>\n

\n

Alcoholic<\/p>\n<\/td>\n

\n

4<\/p>\n<\/td>\n

\n

34<\/p>\n<\/td>\n

\n

1.412 (0.143-13.913)<\/p>\n<\/td>\n

\n

0.768<\/p>\n<\/td>\n<\/tr>\n

\n

Smoking<\/p>\n<\/td>\n

\n

1<\/p>\n<\/td>\n

\n

13<\/p>\n<\/td>\n

\n

0.923 (0.052-16.456)<\/p>\n<\/td>\n

\n

0.957<\/p>\n<\/td>\n<\/tr>\n

\n

Alcoholic + Smoker<\/p>\n<\/td>\n

\n

1<\/p>\n<\/td>\n

\n

12<\/p>\n<\/td>\n

\n

Ref<\/p>\n<\/td>\n

\n

Ref<\/p>\n<\/td>\n<\/tr>\n

\n

Diet<\/p>\n<\/td>\n

\n

 <\/p>\n<\/td>\n

\n

 <\/p>\n<\/td>\n

\n

 <\/p>\n<\/td>\n

\n

 <\/p>\n<\/td>\n

\n

 <\/p>\n<\/td>\n<\/tr>\n

\n

Mixed<\/p>\n<\/td>\n

\n

40<\/p>\n<\/td>\n

\n

281<\/p>\n<\/td>\n

\n

1.518 (0.444-5.189)<\/p>\n<\/td>\n

\n

0.505<\/p>\n<\/td>\n<\/tr>\n

\n

Vegetarian<\/p>\n<\/td>\n

\n

3<\/p>\n<\/td>\n

\n

32<\/p>\n<\/td>\n

\n

Ref<\/p>\n<\/td>\n

\n

Ref<\/p>\n<\/td>\n<\/tr>\n

\n

Diabetes mellitus with co-morbidities<\/p>\n<\/td>\n

\n

31<\/p>\n<\/td>\n

\n

221<\/p>\n<\/td>\n

\n

1.075 (0.529-2.186)<\/p>\n<\/td>\n

\n

0.841<\/p>\n<\/td>\n<\/tr>\n

\n

Diabetes mellitus without co-morbidities<\/p>\n<\/td>\n

\n

12<\/p>\n<\/td>\n

\n

92<\/p>\n<\/td>\n

\n

Ref<\/p>\n<\/td>\n

\n

Ref<\/p>\n<\/td>\n<\/tr>\n

\n

Family History<\/p>\n<\/td>\n

\n

 <\/p>\n<\/td>\n

\n

 <\/p>\n<\/td>\n

\n

 <\/p>\n<\/td>\n

\n

 <\/p>\n<\/td>\n

\n

 <\/p>\n<\/td>\n<\/tr>\n

\n

Present<\/p>\n<\/td>\n

\n

19<\/p>\n<\/td>\n

\n

134<\/p>\n<\/td>\n

\n

0.946 (0.498-1.797)<\/p>\n<\/td>\n

\n

0.864<\/p>\n<\/td>\n<\/tr>\n

\n

Absent<\/p>\n<\/td>\n

\n

24<\/p>\n<\/td>\n

\n

179<\/p>\n<\/td>\n

\n

Ref<\/p>\n<\/td>\n

\n

Ref<\/p>\n<\/td>\n<\/tr>\n

\n

Anxiety<\/p>\n<\/td>\n

\n

 <\/p>\n<\/td>\n

\n

 <\/p>\n<\/td>\n

\n

 <\/p>\n<\/td>\n

\n

 <\/p>\n<\/td>\n

\n

 <\/p>\n<\/td>\n<\/tr>\n

\n

Minimal<\/p>\n<\/td>\n

\n

4<\/p>\n<\/td>\n

\n

25<\/p>\n<\/td>\n

\n

1.080 (0.338-3.452)<\/p>\n<\/td>\n

\n

0.897<\/p>\n<\/td>\n<\/tr>\n

\n

Mild<\/p>\n<\/td>\n

\n

19<\/p>\n<\/td>\n

\n

110<\/p>\n<\/td>\n

\n

0.609 (0.187-1.983)<\/p>\n<\/td>\n

\n

0.410<\/p>\n<\/td>\n<\/tr>\n

\n

Moderate<\/p>\n<\/td>\n

\n

15<\/p>\n<\/td>\n

\n

154<\/p>\n<\/td>\n

\n

1.302 (0.312-5.436)<\/p>\n<\/td>\n

\n

0.717<\/p>\n<\/td>\n<\/tr>\n

\n

Severe<\/p>\n<\/td>\n

\n

5<\/p>\n<\/td>\n

\n

24<\/p>\n<\/td>\n

\n

Ref<\/p>\n<\/td>\n

\n

Ref<\/p>\n<\/td>\n<\/tr>\n

\n

Depression Possibility<\/p>\n<\/td>\n

\n

 <\/p>\n<\/td>\n

\n

 <\/p>\n<\/td>\n

\n

 <\/p>\n<\/td>\n

\n

 <\/p>\n<\/td>\n

\n

 <\/p>\n<\/td>\n<\/tr>\n

\n

Present<\/p>\n<\/td>\n

\n

9<\/p>\n<\/td>\n

\n

52<\/p>\n<\/td>\n

\n

0.753 (0.341-1.66)<\/p>\n<\/td>\n

\n

0.482<\/p>\n<\/td>\n<\/tr>\n

\n

Absent<\/p>\n<\/td>\n

\n

34<\/p>\n<\/td>\n

\n

261<\/p>\n<\/td>\n

\n

Ref<\/p>\n<\/td>\n

\n

Ref<\/p>\n<\/td>\n<\/tr>\n

\n

Physical Activity<\/p>\n<\/td>\n

\n

 <\/p>\n<\/td>\n

\n

 <\/p>\n<\/td>\n

\n

 <\/p>\n<\/td>\n

\n

 <\/p>\n<\/td>\n

\n

 <\/p>\n<\/td>\n<\/tr>\n

\n

Low<\/p>\n<\/td>\n

\n

15<\/p>\n<\/td>\n

\n

87<\/p>\n<\/td>\n

\n

0.899 (0.442-1.825)<\/p>\n<\/td>\n

\n

0.767<\/p>\n<\/td>\n<\/tr>\n

\n

Moderate<\/p>\n<\/td>\n

\n

22<\/p>\n<\/td>\n

\n

142<\/p>\n<\/td>\n

\n

0.414 (0.153-1.118)<\/p>\n<\/td>\n

\n

0.082<\/p>\n<\/td>\n<\/tr>\n

\n

High<\/p>\n<\/td>\n

\n

6<\/p>\n<\/td>\n

\n

84<\/p>\n<\/td>\n

\n

Ref<\/p>\n<\/td>\n

\n

Ref<\/p>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n

Discussion<\/strong><\/p>\n\n\n\n

Sleep quality\nshould be assessed chiefly in subjects suffering from any chronic illness as it\nwill affect psychological, physical and cognitive health in a multifaceted way.\nIn the department of general medicine, 356 participants took part in a\ncross-sectional study to assess the sleep quality of subjects diagnosed with diabetes\nmellitus and to perceive if any relation exists between other factors such as\nanxiety, depression, and physical activity. Other factors such as gender, age,\nfamily history, social habits, diet, and other co-morbidities were also\nconsidered for assessing these factors and the quality of sleep.<\/p>\n\n\n\n

According to the\nstudy’s findings, men (60.40%) outnumbered women (39.60%) in the population.\nThis outcome was discovered to be comparable to one from a study by Edmealem A\net al., where 53.4% of them were men. 8<\/sup>Most participants\nwere between the ages of 61 and 70, which is consistent with the research done\nby Birhanu TT et al.  3<\/sup> It\nindicates that the prevalence of diabetes increases with that age. Furthermore,\n10.67% of the participants were alcoholics, and 3.93% were smokers. However, it\ncontradicted the Dong D et al., <\/em>study, where 17.3% of participants were\nsmokers and 11.9% were alcohol drinkers.  9<\/sup> Alcoholism leads to impaired\nsecretion of insulin and reduced insulin sensitivity over a period of time and\nultimately leads to the development of diabetes.  10<\/sup><\/p>\n\n\n\n

Only 12.07% of the\npatients in the study had poor sleep quality, compared to an overall incidence\nof good sleep quality of 87.92%. The values of poor sleep quality were\nsignificantly lower compared to a study conducted in Ethiopia (36.5%)  8<\/sup>, Pittsburgh (55%)  11<\/sup>, and China (33.6%) 9<\/sup>\nTurkey (67.9%).  12<\/sup> The\ndiscrepancies in the result might be due to sociocultural differences, a\ndifferent measurement tool, the difference in sampling technique and the\nsetting in which the study was carried out. In our study, 95.22% of the\nparticipants reported that they have never used sleep medication, reflecting\nrational medication usage by the patients and the physicians.<\/p>\n\n\n\n

According to the\ncurrent study, 47.47% of the patients showed significant anxiety, while 17.13%\nexperienced mild depressive symptoms. However, in descriptive research carried\nout by Y\u00fccel, \u015e.\u00c7. et al.,  19.8% of the patients exhibited anxiety, while\n13.6% of the patients experienced mild depressive symptoms. 12<\/sup> The\nprevalence of depression and anxiety may be related to participants’\nperceptions of sickness, their fear of hospitals, and intrusive procedures used\nin therapy. In a multivariable logistic regression analysis, patients with\nsocial habits did not have much effect on their sleep quality. However,\ncompared to those who followed a vegetarian diet, those who followed a mixed\ndiet had 1.518 times more nights of bad sleep.<\/p>\n\n\n\n

Participants who\nhad co-morbid conditions were 1.075 more likely to have poor sleep than\nparticipants who did not have co-morbid conditions. It had a similar trend to a\nstudy conducted in Ethiopia.  13<\/sup>\nSimilar to a study by Edmealem A et al., which found that patients with anxiety\nwere four times more likely to have bad sleep habits, the subjects with\nsignificant anxiety (17.24%) were more likely to experience poor sleep quality.\n8<\/sup> Patients who tested positive for depression were 0.753 times more\nlikely to experience poor sleep than patients who did not. This was in contrast\nto a survey performed by Birhanu TT et al.<\/em> It was observed that patients\nwith low physical activity had more poor sleep quality (14.70%) compared to\npatients with high physical activity. It could be justified since many research\nstudies show that physical activity directly correlates to sleep quality.  3<\/sup><\/p>\n\n\n\n

The results of the\nstudy have a few limitations. No objective measurements of sleep were used to inspect\nthe quality of sleep. Since it was a cross-sectional study, it could not rule\nout the possibility of a cause-effect relationship. Lastly, the greater sample\nsize would have provided more statistical power to the study.<\/p>\n\n\n\n

Conclusion<\/strong><\/p>\n\n\n\n

The study’s\nfindings indicate that a smaller percentage of the participants had sleep\ndisturbances. Poor sleep quality was observed more among elderly subjects.\nFactors such as gender, age, diet, comorbidities, depression, severe anxiety,\nand inadequate physical activity all impacted sleep quality even though they\nwere not statistically significant. We propose that counselling sessions for\npatients with depression and anxiety would enhance the participants’ quality of\nsleep.<\/p>\n\n\n\n

Acknowledgement<\/strong><\/p>\n\n\n\n

The authors would\nlike to thank all the faculties of the Department of Pharmacy Practice, NGSM\nInstitute of Pharmaceutical Sciences and Department of General Medicine, K S\nHegde Medical Academy, and Justice K S Hegde Charitable Hospital, for their\nvaluable suggestions. The authors also would like to express their sincere\ngratitude to Nitte (Deemed to be University), Mangaluru, for providing the\nrequired facilities to carry out our research work.<\/p>\n\n\n\n

References<\/strong><\/p>\n\n\n\n

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