Daytime sleepiness in patients with type 2 Diabetes Mellitus – a prospective cohort study


  • João Paulo Vasconcelos Universidade Federal do Ceará
  • Thiago Medeiros da Costa Daniele Univesidade Federal do Ceará
  • Pedro Felipe Carvalhedo de Bruin Universidade Federal do Ceará
  • Adriana Costa e Forti Universidade Federal do Ceará
  • Veralice Meireles Sales de bruin Universidade Federal do Ceará


diabetes, sleepiness, physical activity, stroke, gender differences


Introduction: Daytime sleepiness is an independent factor for increased health care utilization and all cause mortality. Diabetic patients are more likely to be sleepy during the daytime than non-diabetics.

Objectives to examine factors influencing the evolution of daytime sleepiness in patients with type 2 diabetes (T2D) in a two-year follow-up study.

Methods: Patients (N=145) aged from 40 to 60 (55.0±3.3) of both genders were consecutively recruited and evaluated for comorbidity severity (Charlson Comorbidity Index), depressive symptoms (Beck Depression Inventory, BDI II), sleep quality (Pittsburgh Sleep Quality Index) and physical activity levels (International Physical Activity Questionnaire, IPAQ). Daytime sleepiness was assessed by the Epworth Sleepiness Scale (ESS)

Results: Excessive daytime sleepiness (ESS>10) was found in 51 (35.2%) patients. Initially, men had more excessive daytime sleepiness; however, women evolved with more sleepiness after two years. Levels of physical activity were independently associated with more excessive daytime sleepiness and patients with a sedentary lifestyle developed worse levels of daytime sleepiness after two years. Active lifestyle was more beneficial for reducing daytime sleepiness in women. In this study, among all, levels of physical activity (IPAQ) improved after two years.

Conclusion: Excessive daytime sleepiness affects approximately 1/3 of T2D patients and women evolve with more sleepiness. Better levels of physical activity are independently associated with less daytime sleepiness reinforcing the concept that a sedentary lifestyle has a negative influence in sleep-wake alterations. The implementation of physical exercise is a possible break of chain involving sleep-wake alterations and comorbidities in T2D.

Author Biographies

João Paulo Vasconcelos, Universidade Federal do Ceará

Laboratório do Sono e ritmos biológicos

Thiago Medeiros da Costa Daniele, Univesidade Federal do Ceará

Laboratório do sono e ritmos biológicos

Pedro Felipe Carvalhedo de Bruin, Universidade Federal do Ceará

Laboratório do sono e ritmos biológicos

Adriana Costa e Forti, Universidade Federal do Ceará

Laboratório do sono e ritmos biológicos

Veralice Meireles Sales de bruin, Universidade Federal do Ceará

Laboratório do sono e ritmos biológicos


Empana JP et al., Excessive daytime sleepiness is an independent risk indicator for cardiovascular mortality in community-dwelling elderly: the three city study. Stroke, 2009; 40(4): 19-24.

Ronksley PE et al., Excessive daytime sleepiness is associated with increased health care utilization among patients referred for assessment of OSA. Sleep, 2011; 34(3): 363-70.

Gooneratne NS et al., Sleep disordered breathing with excessive daytime sleepiness is a risk factor for mortality in older adults. Sleep, 2011; 34(4): 435-42.

Medeiros C et al., Excessive daytime sleepiness in type 2 diabetes. Arq Bras Endocrinol Metabol, 2013; 57(6): 425-30.

Kreier, F et al., "Diabetes of the elderly" and type 2 diabetes in younger patients: possible role of the biological clock. Exp Gerontol, 2007; 42(1-2): 22-7.

Roth T, Roehrs TA. Etiologies and sequelae of excessive daytime sleepiness. Clin Ther, 1996; 18(4): p. 562-76.

Lee SA et al. Clinical, polysomnographic, and CPAP titration features of obstructive sleep apnea: Mixed versus purely obstructive type. J Neurol Sci, 2015. 355(1-2): p. 150-4.

Ceccato F, Bernkopf E, Scaroni C. Sleep apnea syndrome in endocrine clinics. J Endocrinol Invest, 2015; 38(8): 827-34.

Wu Y, Zhai L, Zhang D. Sleep duration and obesity among adults: a meta-analysis of prospective studies. Sleep Med, 2014; 15(12): 1456-62.

Lou P et al. Effects of sleep duration and sleep quality on prevalence of type 2 diabetes mellitus: A 5-year follow-up study in China. Diabetes Res Clin Pract, 2015; 109(1): 178-84.

Todea DA et al. Relationship between type 2 diabetes mellitus and obstructive sleep apnea syndrome. Chest, 2014. 145(3 Suppl): p. 576A.

Lecomte P et al. Underdiagnosis of obstructive sleep apnoea syndrome in patients with type 2 diabetes in France: ENTRED 2007. Diabetes Metab, 2013; 39(2): 139-47.

Bonanni E et al. Sleep disturbances in elderly subjects: an epidemiological survey in an Italian district. Acta Neurol Scand, 2010.

Daniele TM et al. Associations among physical activity, comorbidities, depressive symptoms and health-related quality of life in type 2 diabetes. Arq Bras Endocrinol Metabol, 2013; 57(1): 44-50.

Ryan AS. Exercise in aging: its important role in mortality, obesity and insulin resistance. Aging health, 2010; 6(5): 551-63.

Crawford AG et al. Prevalence of obesity, type II diabetes mellitus, hyperlipidemia, and hypertension in the United States: findings from the GE Centricity Electronic Medical Record database. Popul Health Manag, 2010; 13(3): 151-61.

Reichert J et al. Smoking cessation guidelines--2008. J Bras Pneumol, 2008; 34(10): 845-80.

Qureshi AI et al. Prevalence and trends of prehypertension and hypertension in United States: National Health and Nutrition Examination Surveys 1976 to 2000. Med Sci Monit, 2005; 11(9).

Charlson ME et al. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis, 1987; 40(5): 373-83.

Beck AT et al. An inventory for measuring depression. Arch Gen Psychiatry, 1961. 4: p. 561-71.

Bassett, DR. International physical activity questionnaire: 12-country reliability and validity. Med Sci Sports Exerc, 2003; 35(8).

Johns MW. A new method for measuring daytime sleepiness: the Epworth sleepiness scale. Sleep, 1991; 14(6): 540-5.

Akerstedt T. et al. Subjective sleepiness is a sensitive indicator of insufficient sleep and impaired waking function. J Sleep Res, 2014.

Chasens ER, Umlauf MG, Weaver TE. Sleepiness, physical activity, and functional outcomes in veterans with type 2 diabetes. Appl Nurs Res, 2009; 22(3): 176-82.

Cipriani G. et al. Sleep disturbances and dementia. Psychogeriatrics, 2015; 15(1): 65-74.

Bruin VM, Bittencourt LR, Tufik S. Sleep-wake disturbances in Parkinson's disease: current evidence regarding diagnostic and therapeutic decisions. Eur Neurol, 2012; 67(5): 257-67.

Chatzinikolaou A. et al. The microcycle of inflammation and performance changes after a basketball match. J Sports Sci, 2014; 32(9): 870-82.

Alves ES et al. Does physical exercise reduce excessive daytime sleepiness by improving inflammatory profiles in obstructive sleep apnea patients? Sleep Breath, 2013; 17(2): 505-10.

Basta M et al. Lack of regular exercise, depression, and degree of apnea are predictors of excessive daytime sleepiness in patients with sleep apnea: sex differences. J Clin Sleep Med, 2008; 4(1): 19-25.

Richter E et al. Sleep disorders among French anaesthesiologists and intensivists working in public hospitals: A self-reported electronic survey. Eur J Anaesthesiol, 2014.

Cavalcanti PR, Campos TF, Araujo JF. Circadian and homeostatic changes of sleep-wake and quality of life in stroke: implications for neurorehabilitation. NeuroRehabilitation, 2013; 32(2): 337-43.

Da Rocha PC et al. Predictive factors of subjective sleep quality and insomnia complaint in patients with stroke: implications for clinical practice. An Acad Bras Cienc, 2013; 85(3): 197-206.

Bakken LN et al. Subjective sleep quality in relation to objective sleep estimates: comparison, gender differences and changes between the acute phase and the six-month follow-up after stroke. J Adv Nurs, 2014; 70(3): 639-50.

Kendzerska TB et al. Evaluation of the measurement properties of the Epworth sleepiness scale: A systematic review. Sleep Med Rev, 2013.

Sil A, Barr G. Assessment of predictive ability of Epworth scoring in screening of patients with sleep apnoea. J Laryngol Otol, 2012; 126(4): 372-9.

Lee SJ, Kang HW, Lee LH. The relationship between the Epworth Sleepiness Scale and polysomnographic parameters in obstructive sleep apnea patients. Eur Arch Otorhinolaryngol, 2012. 269(4): p. 1143-7.

Killgore WD, Capaldi VF. Nocturnal polysomnographic correlates of daytime sleepiness. Psychol Rep, 2012; 110(1): 63-72.

Barone MTU, Menna-Barreto L. Type I diabetes associated with sleep disorders. Sleep Science, 2009; 2(2): 96-98.

Kajbaf F et al. The relationship between metformin therapy and sleep quantity and quality in patients with Type 2 diabetes referred for potential sleep disorders. Diabet Med, 2014; 31(5): 577-80.

Buysse, DJ et al. Relationships between the Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS), and clinical/polysomnographic measures in a community sample. J Clin Sleep Med, 2008; 4(6): 563-71.