Sleep variability, 6-sulfatoxymelatonin, and diabetic retinopathy

Multidimensional sleep health and diabetic retinopathy: Systematic review and meta-analysis

Diabetic retinopathy (DR) is one of the most prevalent microvascular diabetic complications. Poor sleep health and obstructive sleep apnea (OSA) are risk factors for diabetes and poor glycemic control. Recent studies have suggested associations between poor sleep health/OSA and DR. Furthermore, there have been suggestions of melatonin dysregulation in the context of DR. We conducted a systematic review and meta-analysis exploring the associations between multidimensional sleep health (duration, satisfaction, efficiency, timing/regularity and alertness), OSA and melatonin with DR. Forty-two studies were included. Long, but not short sleep, was significantly associated with DR, OR 1.41 (95%CI 1.21, 1.64). Poor sleep satisfaction was also significantly associated with DR, OR 2.04 (1.41, 2.94). Sleep efficiency and alertness were not associated with DR, while the evidence on timing/regularity was scant. Having OSA was significantly associated with having DR, OR 1.34 (1.07, 1.69). Further, those with DR had significantly lower melatonin/melatonin metabolite levels than those without DR, standardized mean difference -0.94 (-1.44, -0.44). We explored whether treating OSA with continuous positive airway pressure (CPAP) led to improvement in DR (five studies). The results were mixed among studies, but potential benefits were observed in some. This review highlights the association between poor multidimensional sleep health and DR.

Explanatory variables of objectively measured 24-h movement behaviors in people with prediabetes and type 2 diabetes: A systematic review

AIM

Physical activity (PA), sedentary behavior (SB) and sleep (i.e. 24-h movement behaviors) are associated with health indicators in people with prediabetes and type 2 diabetes (T2D). To optimize 24-h movement behaviors, it is crucial to identify explanatory variables related to these behaviors. This review aimed to summarize the explanatory variables of 24-h movement behaviors in people with prediabetes or T2D.

METHODS

A systematic search of four databases (PubMed, Web of Science, Scopus & Embase) was performed. Only objective measurements of 24-h movement behaviors were included in the search strategy. The explanatory variables were classified according to the levels of the socio-ecological model (i.e. intrapersonal, interpersonal and environmental). The risk of bias was assessed using the Joanna Briggs Institute appraisal checklist.

RESULTS

None of the 78 included studies investigated 24-h movement behaviors. The majority of the studies investigated PA in isolation. Most studied explanatory variables were situated at the intrapersonal level. Being male was associated with more moderate to vigorous PA but less light PA in people with T2D, and more total PA in people with prediabetes. An older age was associated with a decrease in all levels of PA in people with T2D. HbA1c was positively associated with sleep and SB in both groups. No associations were found at the interpersonal or environmental level.

CONCLUSION

The results of this review underscore the lack of a socio-ecological approach toward explanatory variables of 24-h movement behaviors and the lack of focus on an integrated 24-h movement behavior approach in both populations.

Association of Poor Quality of Sleep with Vision-Threatening Diabetic Retinopathy: A Matched Case-Control Study

INTRODUCTION

Vision-threatening diabetic retinopathy, a long-term microvascular complication of diabetes in the eye, is a major cause of blindness worldwide. Sleep is regulated by a special area of the brain, and poor quality of sleep has been implicated in long-term diabetic complications, including diabetic retinopathy. The study was aimed at exploring whether poor sleep quality is associated with the likelihood of developing vision-threatening diabetic retinopathy.

METHODS

A matched case-control study was conducted from 6 May 2022 to 6 September 2022. The study was based on patients with diabetes (both type 1 and type 2), attending a retina clinic of the referral center. Patients with confirmed vision-threatening diabetic retinopathy were defined as cases and matched with control study subjects. Rating of sleep quality was done by Pittsburgh Sleep Quality Index assessment tool. Conditional logistic regression model was applied to assess the effect of overall poor sleep quality on vision-threatening diabetic retinopathy.

RESULTS

The study recruited a total of 126 (63 duration-matched pairs) patients with diabetes. The overall quality of sleep was poor among 71.90% of patients in the case groups, significantly higher compared with those of the control groups (28.10%) (p < 0.00). The mean quality of sleep for cases [mean (M) = 7.10, standard deviation (SD) = 4.30] was higher than the control group (M = 3.60, SD = 2.70). The magnitude of the difference [M difference = 3.50, 95% confidence interval (CI): 2.25-4.75] was significant. Poor sleep quality predicted the chance of developing vision-threatening diabetic retinopathy in a diabetic cohort.

CONCLUSIONS

This study revealed a significant association between the overall poor quality of sleep and vision-threatening diabetic retinopathy. Co-management of sleep disruption and vision-threatening diabetic retinopathy, and better sleep advisory are warranted.

Effectiveness of emotional freedom techniques (EFT) vs sleep hygiene education group therapy (SHE) in management of sleep disorders among elderly

Sleep disorders are common among elderly persons, with deleterious effects on their physical and mental health. Many approaches are used to manage such disorders. To compare the Emotional Freedom Techniques–Insomnia (EFT-I) and Sleep Hygiene Education (SHE) group therapy as two treatments for insomnia in a geriatric population when delivered, and their effects on sleep quality, depression, and life satisfaction. This open-label randomized controlled trial study was conducted at El-Abbasia Mental Hospital and Osana family wellness elderly nursing home at Maadi, Cairo. It included 60 elderly patients suffering insomnia sleep problems randomized into two equal groups: one group received a Sleep Hygiene Education (SHE) intervention, the other had a form of Emotional Freedom Techniques (EFT) adapted for use with insomnia (EFT-I). A self-administered questionnaire with tools for sleep quality (Pittsburgh Sleep Quality Index [PSQI]), depression, and life satisfaction was used to collect data. The fieldwork was from January to March 2021. The two groups had equal median age (70 years), and almost similar gender and place of residence distribution. After the intervention, 73.3% of the EFT group had good sleep quality, compared to 100.0% in the SHE group (P = 0.005); the median score of depression (3.00) was higher in the EFT group compared with 0.00 in the SHE group (P < 0.001); as for life satisfaction, the difference was not statistically significant. The multivariate analyses identified the study intervention as the main statistically significant negative predictor of PSQI and depression scores, and a positive predictor of life satisfaction. Being in the SHE group was a negative predictor of PSQI and depression scores. Both SHE and EFT approaches are beneficial for elderly patients’ sleep quality, with SHE being more effective in ameliorating sleep. Further replication of this study is needed on a large probability sample from different geographical areas to help for the generalization of the results.

Meta-Analysis of Relationship of Sleep Quality and Duration With Risk of Diabetic Retinopathy

OBJECTIVE

A meta-analysis is used to explore the relationship of sleep quality and duration with the risk of diabetic retinopathy (DR).

METHOD

Cochrane Library, PubMed, Embase, and other databases are searched from their establishment to April 2022. Literature on the relationship of sleep quality and duration with DR risk published in various databases is collected, and two researchers independently screen the literature, extract data, and evaluate the quality of the included articles. The meta-analysis is performed with Review Manage 5.4.1 software.

RESULTS

A total of 7 articles are selected, including 4,626 subjects. The results show a strong correlation between sleep quality and DR risk. When comparing the sleep quality scores of "DR" (experimental group) and "NO DR" (control group), the Pittsburgh sleep quality index(PSQI) score of the DR group is significantly higher than that of the NO DR group (MD = 2.85; 95% confidence interval [CI] 1.92, 3.78, P<0.001), while the ESS score of the DR group is also significantly higher than that of the NO DR group (MD = 1.17; 95% confidence interval [CI] 0.14 to 2.30, P=0.04), so the sleep quality score of the DR group is higher than that of the NO DR group in both the PSQI and ESS scores, which confirms that low sleep quality is a risk factor for DR. Long sleep duration is also associated with the risk of developing DR; the number of adverse events (DR prevalence) is higher for "long sleep duration" than "normal sleep duration" [OR = 1.83, 95%CI 1.36-2.47, P < 0.001], suggesting that long sleep duration can cause increased DR risk. Short sleep duration is also associated with the occurrence of DR [OR = 1.49, 95%CI 1.15-1.94), P = 0.003] and can increase DR risk.

CONCLUSION

Sleep quality and duration (including long and short sleep duration) are significantly associated with DR. To reduce DR risk, sleep intervention should be actively carried out, lifestyle changes should be made, and attention should be paid to the role of DR management.

Effects of Melatonin on Diabetic Neuropathy and Retinopathy

Diabetes mellitus (DM) leads to complications, the majority of which are nephropathy, retinopathy, and neuropathy. Redox imbalance and inflammation are important components of the pathophysiology of these complications. Many studies have been conducted to find a specific treatment for these neural complications, and some of them have investigated the therapeutic potential of melatonin (MEL), an anti-inflammatory agent and powerful antioxidant. In the present article, we review studies published over the past 21 years on the therapeutic efficacy of MEL in the treatment of DM-induced neural complications. Reports suggest that there is a real prospect of using MEL as an adjuvant treatment for hypoglycemic agents. However, analysis shows that there is a wide range of approaches regarding the doses used, duration of treatment, and treatment times in relation to the temporal course of DM. This wide range hinders an objective analysis of advances and prospective vision of the paths to be followed for the unequivocal establishment of parameters to be used in an eventual therapeutic validation of MEL in neural complications of DM.

Investigation on the expression regulation of RIPK1/RIPK3 in the retinal ganglion cells (RGCs) cultured in high glucose

Diabetic retinopathy (DR) represents the most typical complication of type 2 diabetes mellitus and one of the most primary oculopathy causing blindness. However, the mechanism of DR remains unknown. RIPK1/RIPK3, as homologous serine/threonine kinases, are key elements in mediating necroptosis and may have functions in DR development. To clarify the relationship between DR and RIPK1/RIPK3, this study established a model of apoptosis using high-glucose induced RGCs, which were treated with 7.5, 19.5, and 35 mM D-glucose for 12, 24, and 48 h, respectively. Subsequently, the expression of RIPK1/RIPK3 was determined and the protective effect of necrostatin-1 on RGCs injury induced by high glucose was explored. The results demonstrated that the expression of RIPK1 and RIPK3 in the cells was increased markedly following 12 h treatment with 19.5 mM D-glucose. Additionally, following an addition of 100 μM necrostatin-1 in 19.5 mM D-glucose medium for RGCs treatment 12 h, the protein expression of RIPK1 and RIPK3 was decreased markedly, and the number of Nissl bodies in cells was increased substantially. The findings of the present study indicated that high glucose could induce the expression of RIPK1/RIPK3, and necrostatin-1 could effectively protect RGCs from D-glucose-induced cell necrosis.