Comment on “Hyperglycemia in pregnancy: sleep alterations, comorbidities and pharmacotherapy”

Dear editor,

We are pleased to read the article entitled “Hyperglycemia in pregnancy: sleep alterations, comorbidities and pharmacotherapy.” This cross-sectional study examined sleep alterations and related factors in pregnant women with diabetes mellitus¹. In this study, the authors found that poor sleep quality was detected in 58.8% of patients, regardless of the cause of hyperglycemia. In addition, another interesting finding was that metformin treatment and higher parity were associated with poorer sleep quality only in patients with gestational diabetes. Undoubtedly, the conclusions of this study will help further improve the sleep quality of diabetics. However, in our point of view, there are still some issues that deserve further discussion.

First, the purpose of this study was to explore the factors associated with poor sleep quality in patients with diabetes. However, some potential important factors have been overlooked. Obviously, the duration of diabetes is related to sleep quality, which has been confirmed in previous studies²,³. In a study² involving 198 participants, the authors found that the duration of diabetes was significantly associated with poor sleep quality (AOR 4.88; 95%CI 1.27–18.66; p=0.021), implying that longer duration of diabetes results in a significant reduction in sleep quality. Furthermore, although this study reported glycemia level, it was still inadequate. Another retrospective study³ indicated that nocturnal glycemic variability was associated with poor sleep quality in patients with type 1 diabetes, indicating that it is still obviously insufficient to use only glycemia level to judge the sleep quality of patients. Therefore, it is suggested that it is necessary to include the duration of diabetes and nocturnal blood glucose variables for subsequent analysis when exploring the influencing factors related to sleep quality in diabetic patients.

Second, metformin treatment was found to be associated with poorer sleep quality only among patients with gestational diabetes. However, given that type 1 diabetes, type 2 diabetes, and gestational diabetes belong to different disease subtypes, there may also be significant differences in the dose and use of metformin. One possible hypothesis is that metformin affects sleep quality in all three diabetic subtypes, but is ignored due to different doses and usages. Thus, from our perspective, to further determine the effects of metformin on sleep quality in patients with different diabetes subtypes, it is necessary to provide more information about metformin.

• Funding: none.

REFERENCES

• ¹
  Façanha C, Bruin V, Bruin P, Façanha A, Rocha HC, Araujo M, et al. Hyperglycemia in pregnancy: sleep alterations, comorbidities and pharmacotherapy. Rev Assoc Med Bras (1992). 2021;67(1):45-51. https://doi.org/10.1590/1806-9282.67.01.20200216
  » https://doi.org/10.1590/1806-9282.67.01.20200216
• ²
  Jemere T, Mossie A, Berhanu H, Yeshaw Y. Poor sleep quality and its predictors among type 2 diabetes mellitus patients attending Jimma University Medical Center, Jimma, Ethiopia. BMC Res Notes. 2019;12(1):488. https://doi.org/10.1186/s13104-019-4531-6
  » https://doi.org/10.1186/s13104-019-4531-6
• ³
  Martyn-Nemeth P, Phillips SA, Mihailescu D, Farabi SS, Park C, Lipton R, et al. Poor sleep quality is associated with nocturnal glycaemic variability and fear of hypoglycaemia in adults with type 1 diabetes. J Adv Nurs. 2018;74(10):2373-80. https://doi.org/10.1111/jan.13765
  » https://doi.org/10.1111/jan.13765

Publication Dates

• Publication in this collection
  19 Sept 2022
• Date of issue
  Aug 2022

History

• Received
  17 Apr 2022
• Accepted
  28 Apr 2022