Sleep Quality and Diabetic Peripheral Neuropathy among Patients with Type 2 Diabetes: A Cross-sectional Survey in Jordan.
Authors: Abu-Shennar Jawad Ahmad , Bebis Hatice Bebis , Bayraktar Nurhan Bayraktar 
Published: August 2020

Abstract
Objective: The aims of this study were to quantify the prevalence of DPN as was assessed by the MNSI, and to evaluate sleep quality as was assessed by the PSQI. Also, to assess the relevance of other factors to sleep quality and DPN among patients with T2DM.Methods: A cross-sectional study was carried out at the Jordanian Ministry of Health in Amman, Jordan, during the period from the 1 st of June 2018 to the 1 st of September 2018. A total of 549 (269 male and 280 female) patients with type 2 diabetes were recruited. Data were collected using the MNSI to assess DPN a cutoff point of MNSI based on history score of ≥ 7, and physical examination based on the score of ≥ 2. While the PSQI to assess sleep quality with a cutoff point of PSQI ≥8. Participants' demographic background data were also recorded. Statistical analysis was conducted using SPSS version 20. Mean and standard deviation values were used to summarize continuous variables, and proportions were used for categorical variables. Chi-square was used to test the independent distribution of categorical variables where appropriate. Binary logistic regressions were used to examine the net effect for each of the proposed variables. A p-value of less than 0.05 was considered statistically significant.Results: The sample comprised 269 male and 280 female T2DM patients with a mean (SD) age of 2.00 (±0.574) years. Mean (SD) BMI was 3.58 (±0.617) kg/m2, and the mean (SD) duration of diabetes was 1.74 (±0.806) years. The prevalence of DPN based on a history score of ≥ 7 was 31.7% and 33.7% based on physical examination based on the score of ≥ 2 using MNSI. Besides, the results of the study revealed that the mean (SD) PSQI score of the study patients was 6.11(±7.01), with 32.8% who had a PSQI score ≥8. While, logistic regression analyses were conducted to identify factors independently related to DPN were marital status, working status, smoking status, diet regimen, physical activity, regularly visit treatment physicians, cardiovascular disease, dyslipidemia, retinopathy, hypertension, type of treatment (such as insulin and oral hypoglycemia agents or both), with the type of medications (such as a statin, and metformin). Also, uncontrolled diabetes, HDL-cholesterol levels, and duration of diabetes. On the other hand, multivariate logistic regression analyses were conducted to identify factors independently related to sleep quality were cardiovascular disease, dyslipidemia, retinopathy, hypertension, type of treatment (such as insulin and oral hypoglycemia agents or both), with the type of medications (such as a statin, and metformin). The study showed that subjective sleep quality and quantity, night sleep disturbance, and daytime dysfunction were the risk factors for poor glycemic control.Conclusions and recommendations: The high prevalence of DPN and poor sleep quality and patients with T2DM in addition to unawareness and poor management of DPN require more physician and health care professionals’ better management of DPN and improve sleep quality at the Jordanian Ministry of Health. Also, the results highlighted the need for intensive programs targeting early detection and prompt implementation of health education. Also, more attention is needed to prevent late-onset DPN complications, even in asymptomatic patients. Old patients with long-standing DM should be screened continuously for DPN. Moreover, the initial measures to prevent DPN and improves sleep quality include glycemic control and implementation with modification of lifestyle and behavioral changes such as appropriate diet, exercise, and regularly visit treating physician.