{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,21]],"date-time":"2026-07-21T17:14:30Z","timestamp":1784654070096,"version":"3.55.0"},"reference-count":47,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2021,3,15]],"date-time":"2021-03-15T00:00:00Z","timestamp":1615766400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"National Science Council Grant","award":["NSC 100-2314-B-040-002"],"award-info":[{"award-number":["NSC 100-2314-B-040-002"]}]},{"name":"Chun Shan Medical University Grant","award":["CSH 2012-A-002"],"award-info":[{"award-number":["CSH 2012-A-002"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Purpose: Sleep disturbance is one of the major complaints among patients with diabetes. The status of diabetes control and associated complications may contribute to sleep disturbance. This study explored night time sleep and excessive daytime sleepiness in adults with type 2 diabetes and examined the association of diabetes control and associated complications on their sleep quality. Methods: A retrospective cohort study design was used. Type 2 diabetic patients (87 females and 79 males, aged 63.1 \u00b1 10.5 years) were recruited from the outpatient clinics of the endocrine department. Sleep quality was assessed by the Pittsburg Sleep Quality Index and the Epworth Sleepiness Scale. Diabetes control and complications were obtained by retrospectively reviewing patients\u2019 medical records over 1 year prior to study enrollment. Results: 72.3% of recruited patients had poor glycemic control, and 71.1% had at least one diabetic complication. 56.0% of patients experienced poor sleep quality, and 24.1% had excessive daytime sleepiness. Those who were female (OR = 3.45) and who had ophthalmological problems (OR = 3.17) were associated with poor night time sleep quality, but if they did exercise to the point of sweating (OR = 0.48) reduced the risk of poor sleep quality. Furthermore, poor sleep quality (OR = 4.35) and having nephropathy (OR = 3.78) were associated with a higher risk of excessive daytime sleepiness. Conclusions: Sex, ophthalmological problems, nephropathy, and no exercise to the point of sweating are associated with sleep problems in patients with type 2 diabetes. Both lifestyle behaviors and diabetic complications affect sleep disturbances in patients with diabetes.<\/jats:p>","DOI":"10.3390\/ijerph18063025","type":"journal-article","created":{"date-parts":[[2021,3,15]],"date-time":"2021-03-15T11:38:58Z","timestamp":1615808338000},"page":"3025","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":26,"title":["Sleep Quality and Associated Factors in Adults with Type 2 Diabetes: A Retrospective Cohort Study"],"prefix":"10.3390","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3767-1150","authenticated-orcid":false,"given":"Ching-Pyng","family":"Kuo","sequence":"first","affiliation":[{"name":"School of Nursing, Chung Shan Medical University, Taichung 40201, Taiwan"},{"name":"Department of Nursing, Chung Shan Medical University Hospital, Taichung 40201, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shu-Hua","family":"Lu","sequence":"additional","affiliation":[{"name":"School of Nursing, China Medical University, Taichung 406040, Taiwan"},{"name":"Department of Nursing, China Medical University Hospital, Taichung 404332, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chien-Ning","family":"Huang","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Chung Shan Medical University Hospital, Taichung 40201, Taiwan"},{"name":"Institute of Medicine, Chung Shan Medical University, Taichung 40201, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3148-926X","authenticated-orcid":false,"given":"Wen-Chun","family":"Liao","sequence":"additional","affiliation":[{"name":"School of Nursing, China Medical University, Taichung 406040, Taiwan"},{"name":"Department of Nursing, China Medical University Hospital, Taichung 404332, Taiwan"},{"name":"Department of Nursing, Asia University, Taichung 41354, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4650-395X","authenticated-orcid":false,"given":"Meng-Chih","family":"Lee","sequence":"additional","affiliation":[{"name":"Institute of Medicine, Chung Shan Medical University, Taichung 40201, Taiwan"},{"name":"Department of Family Medicine, Taichung Hospital, Ministry of Health and Welfare, Taichung 40343, Taiwan"},{"name":"Institute of Population Health Sciences, National Health Research Institutes, Miaoli 35053, Taiwan"},{"name":"College of Management, Chaoyang University of Technology, Taichung 413310, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2021,3,15]]},"reference":[{"key":"ref_1","unstructured":"WHO (2016). Global Report on Diabetes. 2016, World Health Organization."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"799","DOI":"10.1016\/j.metabol.2010.07.031","article-title":"Sleep duration is a potential risk factor for newly diagnosed type 2 diabetes mellitus","volume":"60","author":"Chao","year":"2011","journal-title":"Metabolism"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"4053","DOI":"10.1111\/jocn.13899","article-title":"The relationship between sleep disturbance and glycaemic control in adults with type 2 diabetes: An integrative review","volume":"26","author":"Zhu","year":"2017","journal-title":"J. Clin. Nurs."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"415","DOI":"10.1093\/sleep\/23.3.1i","article-title":"Factors Predicting Sleep Disruption in Type II Diabetes","volume":"23","author":"Lamond","year":"2000","journal-title":"Sleep"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"347","DOI":"10.1177\/0145721711400663","article-title":"Sleep Quality and Quality of Life in Adults with Type 2 Diabetes","volume":"37","author":"Luyster","year":"2011","journal-title":"Diabetes Educ."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"S35","DOI":"10.1016\/j.jegh.2015.05.003","article-title":"Prevalence of self-reported sleep duration and sleep habits in type 2 diabetes patients in South Trinidad","volume":"5","author":"Ramtahal","year":"2015","journal-title":"J. Epidemiol. Glob. Health"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1101","DOI":"10.1378\/chest.10-0596","article-title":"Prevalence and Recognition of Obstructive Sleep Apnea in Chinese Patients With Type 2 Diabetes Mellitus","volume":"138","author":"Lam","year":"2010","journal-title":"Chest"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"225","DOI":"10.1007\/s00592-008-0047-6","article-title":"Sleep abnormalities in type 2 diabetes may be associated with glycemic control","volume":"45","author":"Trento","year":"2008","journal-title":"Acta Diabetol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"452","DOI":"10.1016\/j.pcd.2019.02.002","article-title":"Sleep duration is a significant predictor of cardiac autonomic neuropathy in type 2 diabetes mellitus","volume":"13","author":"Bhati","year":"2019","journal-title":"Prim. Care Diabetes"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"129","DOI":"10.1016\/j.diabres.2010.07.011","article-title":"Diabetes and sleep: A complex cause-and-effect relationship","volume":"91","author":"Barone","year":"2010","journal-title":"Diabetes Res. Clin. Pract."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"253","DOI":"10.1038\/nrendo.2009.23","article-title":"Effects of poor and short sleep on glucose metabolism and obesity risk","volume":"5","author":"Spiegel","year":"2009","journal-title":"Nat. Rev. Endocrinol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"868","DOI":"10.4239\/wjd.v6.i6.868","article-title":"Effect of diabetes mellitus on sleep quality","volume":"6","author":"Surani","year":"2015","journal-title":"World J. Diabetes"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"333","DOI":"10.1093\/sleep\/24.3.333","article-title":"The Influence of Lifestyle and Health Status Factors on Sleep Loss Among the Japanese General Population","volume":"24","author":"Ohida","year":"2001","journal-title":"Sleep"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"361","DOI":"10.1111\/j.1600-0447.1983.tb09716.x","article-title":"The Hospital Anxiety and Depression Scale","volume":"67","author":"Zigmond","year":"1983","journal-title":"Acta Psychiatr. Scand."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"2386","DOI":"10.1001\/jama.1993.03500180078038","article-title":"Population-based norms for the Mini-Mental State Examination by age and educational level","volume":"269","author":"Crum","year":"1993","journal-title":"JAMA"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"88","DOI":"10.1038\/nrendo.2017.151","article-title":"Global aetiology and epidemiology of type 2 diabetes mellitus and its complications","volume":"14","author":"Zheng","year":"2018","journal-title":"Nat. Rev. Endocrinol."},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Wold Health Organization (2004). WHO expert consultation, Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies. Lancet, 363, 157\u2013163.","DOI":"10.1016\/S0140-6736(03)15268-3"},{"key":"ref_18","unstructured":"Taiwan Ministry of Health Welfare (2021, February 17). Is Evercyone\u2019s Healthy Weight Standard the Same? 28 October 2019, Available online: https:\/\/www.hpa.gov.tw\/EngPages\/Detail.aspx?nodeid=4106&pid=11731."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"193","DOI":"10.1016\/0165-1781(89)90047-4","article-title":"The Pittsburgh sleep quality index: A new instrument for psychiatric practice and research","volume":"28","author":"Buysse","year":"1989","journal-title":"Psychiatry Res."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"540","DOI":"10.1093\/sleep\/14.6.540","article-title":"A New Method for Measuring Daytime Sleepiness: The Epworth Sleepiness Scale","volume":"14","author":"Johns","year":"1991","journal-title":"Sleep"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"817","DOI":"10.1023\/A:1020818417949","article-title":"Validation of a Chinese version of the Epworth sleepiness scale","volume":"11","author":"Chen","year":"2002","journal-title":"Qual. Life Res."},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"(2018). American Diabetes Association Diabetes Care in the Hospital:Standards of Medical Care in Diabetes\u20142018. Diabetes Care, 41, S144\u2013S151.","DOI":"10.2337\/dc18-S014"},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Jemere, T., Mossie, A., Berhanu, H., and Yeshaw, Y. (2019). Poor sleep quality and its predictors among type 2 diabetes mellitus patients attending Jimma University Medical Center, Jimma, Ethiopia. BMC Res. Notes, 12.","DOI":"10.1186\/s13104-019-4531-6"},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Hashimoto, Y., Sakai, R., Ikeda, K., and Fukui, M. (2020). Association between sleep disorder and quality of life in patients with type 2 diabetes: A cross-sectional study. BMC Endocr. Disord., 20.","DOI":"10.1186\/s12902-020-00579-4"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"147","DOI":"10.1016\/j.urology.2016.03.017","article-title":"Microvascular Complications and Prevalence of Nocturia in Japanese Patients With Type 2 Diabetes Mellitus: The Dogo Study","volume":"93","author":"Furukawa","year":"2016","journal-title":"Urology"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1209","DOI":"10.1007\/s11255-016-1310-3","article-title":"Nocturia indicates a poor health status and increases mortality in male patients with type 2 diabetes mellitus","volume":"48","author":"Liu","year":"2016","journal-title":"Int. Urol. Nephrol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"850","DOI":"10.1590\/S0104-11692008000500009","article-title":"Sleep quality in type 2 diabetics","volume":"16","author":"Cunha","year":"2008","journal-title":"Rev. Lat. Am. Enfermagem."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1269","DOI":"10.1007\/s11255-014-0669-2","article-title":"Prevalence and associated risk factors of nocturia and subsequent mortality in 1,301 patients with type 2 diabetes","volume":"46","author":"Chung","year":"2014","journal-title":"Int. Urol. Nephrol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"41","DOI":"10.1111\/aos.13169","article-title":"Sleep and diabetic retinopathy","volume":"95","author":"Jee","year":"2017","journal-title":"Acta Ophthalmol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"165","DOI":"10.1016\/j.jsmc.2009.01.004","article-title":"Effect of Light on Human Circadian Physiology","volume":"4","author":"Duffy","year":"2009","journal-title":"Sleep Med. Clin."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1085","DOI":"10.1093\/sleep\/30.9.1085","article-title":"American Time Use Survey: Sleep Time and Its Relationship to Waking Activities","volume":"30","author":"Basner","year":"2007","journal-title":"Sleep"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"229","DOI":"10.1016\/j.physbeh.2006.09.015","article-title":"Relationships between sleep, physical activity and human health","volume":"90","author":"Atkinson","year":"2007","journal-title":"Physiol. Behav."},{"key":"ref_33","doi-asserted-by":"crossref","unstructured":"Kuwata, H., Okamura, S., Hayashino, Y., Tsujii, S., and Ishii, H. (2017). Higher levels of physical activity are independently associated with a lower incidence of diabetic retinopathy in Japanese patients with type 2 diabetes: A prospective cohort study, Diabetes Distress and Care Registry at Tenri (DDCRT15). PLoS ONE, 12.","DOI":"10.1371\/journal.pone.0172890"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"F1087","DOI":"10.1152\/ajprenal.00301.2019","article-title":"The renal molecular clock: Broken by aging and restored by exercise","volume":"317","author":"Schmitt","year":"2019","journal-title":"Am. J. Physiol. Renal. Physiol."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"1436","DOI":"10.1111\/jocn.12710","article-title":"Predictors of poor sleep quality and excessive daytime sleepiness in Turkish adults with type 2 diabetes","volume":"24","author":"Kara","year":"2014","journal-title":"J. Clin. Nurs."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"122","DOI":"10.1111\/1753-0407.12825","article-title":"SLEep among diabetic patients and their GlycaEmic control (SLEDGE): A pilot observational study","volume":"11","author":"Raj","year":"2019","journal-title":"J. Diabetes"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"425","DOI":"10.1590\/S0004-27302013000600003","article-title":"Excessive daytime sleepiness in type 2 diabetes","volume":"57","author":"Medeiros","year":"2013","journal-title":"Arq. Bras. Endocrinol. Metabol."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1046\/j.1365-2869.2000.00177.x","article-title":"Sensitivity and specificity of the multiple sleep latency test (MSLT), the maintenance of wakefulness test and the Epworth sleepiness scale: Failure of the MSLT as a gold standard","volume":"9","author":"Johns","year":"2000","journal-title":"J. Sleep Res."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"211","DOI":"10.1016\/j.smrv.2005.01.006","article-title":"Sleep apnea is a manifestation of the metabolic syndrome","volume":"9","author":"Vgontzas","year":"2005","journal-title":"Sleep Med. Rev."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"1035","DOI":"10.3389\/fphys.2020.01035","article-title":"HIF-1\u03b1 as a Mediator of Insulin Resistance, T2DM, and Its Complications: Potential Links With Obstructive Sleep Apnea","volume":"11","author":"Gabryelska","year":"2020","journal-title":"Front. Physiol."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"140","DOI":"10.1016\/j.diabres.2012.07.007","article-title":"The effect of sleep apnea syndrome on the development of diabetic nephropathy in patients with type 2 diabetes","volume":"98","author":"Buyukaydin","year":"2012","journal-title":"Diabetes Res. Clin. Pract."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"9269170","DOI":"10.1155\/2018\/9269170","article-title":"The Relationship between Diabetes-Related Complications and Obstructive Sleep Apnea in Type 2 Diabetes","volume":"2018","author":"Siwasaranond","year":"2018","journal-title":"J. Diabetes Res."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"497","DOI":"10.1038\/ki.2014.86","article-title":"Fatigue in advanced kidney disease","volume":"86","author":"Artom","year":"2014","journal-title":"Kidney Int."},{"key":"ref_44","first-page":"1","article-title":"American Association of Clinical Endocrinologists medical guidelines for clinical practice for the management of diabetes mellitus","volume":"13","author":"Rodbard","year":"2007","journal-title":"Endocr. Pract."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"519","DOI":"10.1007\/s13300-015-0137-8","article-title":"National Variations in Comorbidities, Glycosylated Hemoglobin Reduction, and Insulin Dosage in Asian Patients with Type 2 Diabetes: The FINE-Asia Registry","volume":"6","author":"Ji","year":"2015","journal-title":"Diabetes Ther."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"106","DOI":"10.1002\/(SICI)1098-240X(200004)23:2<106::AID-NUR3>3.0.CO;2-A","article-title":"Age-related changes in initiation and maintenance of sleep: A meta-analysis","volume":"23","author":"Floyd","year":"2000","journal-title":"Res. Nurs. Health"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"275","DOI":"10.1007\/s00125-020-05319-w","article-title":"Impact of age at type 2 diabetes mellitus diagnosis on mortality and vascular complications: Systematic review and meta-analyses","volume":"64","author":"Nanayakkara","year":"2021","journal-title":"Diabetologia"}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/18\/6\/3025\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T05:36:03Z","timestamp":1760160963000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/18\/6\/3025"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,3,15]]},"references-count":47,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2021,3]]}},"alternative-id":["ijerph18063025"],"URL":"https:\/\/doi.org\/10.3390\/ijerph18063025","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,3,15]]}}}