Financial Hardship and its Associations with Perceived Sleep Quality in Participants with Type 2 Diabetes and Obstructive Sleep Apnea

Objectives The purpose of this study was to explore social determinants of health (SDoH), and disease severity as predictors of sleep quality in persons with both Obstructive Sleep Apnea (OSA) and type 2 diabetes (T2D). Methods Disease severity was measured by Apnea-Hypopnea Index [(AHI) ≥ 5] and HbA1c for glycemic control. SDoH included subjective and objective financial hardship, race, sex, marital status, education, and age. Sleep quality was measured by Pittsburgh Sleep Quality Index (PSQI). Results The sample (N = 209) was middle-aged (57.6 ± 10.0); 66% White and 34% African American; and 54% men and 46% women. Participants carried a high burden of disease (mean AHI = 20.7 ± 18.1, mean HbA1c = 7.9% ± 1.7%). Disease severity was not significantly associated with sleep quality (all p >.05). Worse sleep quality was associated with both worse subjective (b = -1.54, p = .015) and objective (b = 2.58, p <.001) financial hardship. Characteristics significantly associated with both subjective and objective financial hardship included being African American, female, ≤ 2 years post high school, and of younger ages (all p < .01). Discussion: Financial hardship is a more important predictor of sleep quality than disease severity, age, sex, race, marital status, and educational attainment, in patients with OSA and T2D

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1056 Perceived Financial Difficulty Predicts Sleep Quality In Participants With Type 2 Diabetes And Obstructive Sleep Apnea

SLEEP ◽

10.1093/sleep/zsaa056.1052 ◽

2020 ◽

Vol 43 (Supplement_1) ◽

pp. A401-A401

Author(s):

J L Morris ◽

L Baniak ◽

S M Belcher ◽

C Imes ◽

F Luyster ◽

...

Keyword(s):

Type 2 Diabetes ◽

Obstructive Sleep Apnea ◽

African American ◽

Sleep Quality ◽

Disease Severity ◽

Poor Sleep ◽

Financial Difficulty ◽

Poor Sleep Quality ◽

Obstructive Sleep

Abstract Introduction People with multiple chronic conditions such as type 2 diabetes (T2D) and obstructive sleep apnea (OSA) are at increased risk for poor sleep quality. It is unclear if social determinants of health (SDoH) such as race, perceived financial difficulty, education, gender, and marital status are associated with sleep quality in this population. The purpose of this cross-sectional secondary analysis of data from the Diabetes Sleep Treatment Trial was to explore SDoH and disease severity as predictors of sleep quality in persons with both OSA and T2D. Methods Disease severity was measured by Apnea-Hypopnea Index [(AHI) ≥ 5] and A1C for glycemic control. SDoH included perceived financial difficulty (none/moderate-severe), race (White/African American), sex (f/m), marital status (no/yes), education (≤ or > 2 years post high school), and age. Sleep quality was measured by Pittsburgh Sleep Quality Index (PSQI). Correlations and linear regression modeling investigated associations between SDoH and disease severity on sleep quality. Post-hoc correlations were explored for significant relations among SDoH. Results The sample (N = 229) was middle-aged (57.6 ± 10.0; 66 % White and 34% African American; and 54 % men vs. 46% women. Participants carried a high burden of disease (mean AHI = 20.7±18.1, mean A1C = 7.9 %±1.7%). Disease severity was not significantly associated with sleep quality (all p >.05). The perception of worse financial difficulty was the only SDoH that predicted worse sleep quality (b=-1.54, p=.015). Characteristics significantly associated with worse financial difficulty were being African American, female, ≤ 2 years post high school, and younger (all p<.01). Conclusion Financial difficulty may be a more important predictor of subjective measures of sleep quality than disease severity in patients with OSA and T2D. Researchers and clinicians should be aware of these characteristics as potential markers of vulnerability to poor sleep quality in this population. Support The National Institute of Diabetes and Digestive and Kidney Diseases (R01DK096028) and through the Clinical +Translational Research Institute grants UL1TR001857 and UL1TR000005.

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I’m sleeping my day away. Improving diabetes self-management using CPAP treatment in patients with obstructive sleep apnea and type 2 diabetes: A qualitative explorative study (Preprint)

10.2196/preprints.27062 ◽

2021 ◽

Author(s):

Ditte Hjorth Laursen ◽

Gitte Rom ◽

Anne Margareta Banghoej ◽

Lise Tarnow ◽

Lone Schou

Keyword(s):

Physical Activity ◽

Type 2 Diabetes ◽

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Sleep Quality ◽

Daily Life ◽

Self Management ◽

Cpap Treatment ◽

Obstructive Sleep

BACKGROUND There is a high prevalence of unexplained and unexplored obstructive sleep apnea (OSA) in patients with type 2 diabetes. Daytime symptoms of OSA include severe fatigue, cognitive problems, decreased quality of life, and reduced motivation to provide self-care, which impairs the management of both diabetes and daily life. OSA may thereby cause negative implications for diabetes self-management. Treatment for OSA is offered through Continuous Positive Airway Pressure (CPAP) which has the potential to improve sleep quality, insulin resistance and glycemic control. Although the benefits of using CPAP as treatment for OSA are clear, noncompliance is high and there is poor evidence on the perceived effect of CPAP treatment in this group of patients. OBJECTIVE The purpose of this study is to explore the impact of comorbid diabetes and OSA on daily life among older adults, and to investigate the perceived effect of CPAP treatment for OSA on patients’ diabetes self-management. METHODS A qualitative follow-up study, with in-depth semi-structured dyad interviews with couples before and after an intervention with CPAP treatment (N=22). Patients were recruited from Hilleroed Hospital in Denmark and were all diagnosed with type 2 diabetes, age > 18 years and apnea-hypopnea index (AHI) ≥ 15. All interviews were coded and analyzed using thematic analysis. RESULTS Patients and partners do not consider OSA a serious disorder as they consider OSA symptoms similar to the process of aging. Patients experience poor nocturnal sleep, frequent daytime naps, reduced cognitive function, low levels of physical activity, and a high-calorie diet, that all negatively influence their diabetes self-management. Despite the immediate benefit of the CPAP treatment, most patients have technical challenges when using the CPAP. Only patients with severe OSA symptoms inflicting their daily life overcome the challenges of CPAP and thereby improve their diabetes self-management. Patients with less life inflicting symptoms rate the CPAP challenges as more burdensome than their symptoms. CONCLUSIONS If used correctly CPAP has the potential to improve OSA resulting in better sleep quality, improved physical activity, improved diet and a better diabetes self-management. But there are many barriers in CPAP treatment and only few patients manage to overcome the barriers and comply to correct treatment. CLINICALTRIAL The study was approved by the Danish Data Protection Agency (J.nr. 2012-58-0004).

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