Abstract
Background and Aims: Poor sleep quality affects insulin sensitivity and glucose metabolism. There were limited information about sleep quality in individuals with diabetic peripheral neuropathy. The Pittsburgh Sleep Quality Index was used in this study to measure sleep quality and determine how sleep quality and pain were related in patients with diabetic peripheral neuropathy. Methods: This is a secondary analysis of an aerobic exercise research study in patients with diabetic peripheral neuropathy. Participants performed the Pain Inventory and the Pittsburgh Sleep Quality Index at baseline to measure clinical pain and sleep quality, respectively. Pain Inventory consists of two com¬ponents including The Pain Severity Index and the Pain Interference Index. The relationship between pain and sleep quality was evaluated using Pearson’s correlations. Results: The study showed that 77.8% of the subjects had low sleep quality (i.e., Pittsburgh Sleep Quality Index scores > 5) (mean score of Pittsburgh Sleep Quality Index scores was 9.94±4.35). The mean scores of the Pain Interference Index and Pain Severity Index were 3.54±2.90 and 3.36±2.21, respectively. Both Pittsburgh Sleep Quality Index and Brief Pain Inventory-Pain severity index had positive relationship (r≤ 0.642, p ≤ 0.004). In addition, there were positive relationship between Pittsburgh Sleep Quality Index and Brief Pain Inventory-Pain interference index (r≤ 0.591, p ≤ 0.01). Conclusions: The majority of patient with diabetic peripheral neuropathy had low sleep quality. A higher pain intensity and more interference with daily activities were both strongly linked with poor sleep quality. The item of sleep discomfort in everyday activity was highly influenced in patients with diabetic peripheral neuropathy. Future studies are needed to determine if addressing poor sleep quality would impact perception of pain as well as diabetes management.
Keywords: Pain · Sleep · Diabetes · Activity · Daily
References
- 1.Davies M, Brophy S, Williams R, Taycare 2011;34:2220-4. lor A. The prevalence, severity, and 7. Treede RD, Jensen TS, Campbell JN, et impact of painful diabetic peripheral al. Neuropathic pain: redefinition and a neuropathy in type 2 diabetes. Diabetes grading system for clinical and research care 2006;29:1518-22. purposes. Neurology 2008;70:1630-5.
- 2.Young MJ, Bennett JL, Liderth SA, 8. Gordois A, Scuffham P, Shearer A, Veves A, Boulton AJ, Douglas JT. Rhe- Oglesby A, Tobian JA. The Health ological and microvascular parameters Care Costs of Diabetic Peripheral in diabetic peripheral neuropathy. Clin- Neuropathy in the U.S. Diabetes care ical science (London, England : 1979) 2003;26:1790-5. 1996;90:183-7.
- 3.Quattrini C, Harris ND, Malik RA, Tesfaye S. Impaired skin microvascular re-
- 4.Economic Costs of Diabetes in the U.S. in 2012. Diabetes care 2013;36:103346. activity in painful diabetic neuropathy. 10. Roth-Isigkeit A, Thyen U, Stoven H, Diabetes care 2007;30:655-9. Schwarzenberger J, Schmucker P. Pain
- 5.Fowler MJ. Microvascular and Macamong children and adolescents: rerovascular Complications of Diabetes. strictions in daily living and triggering Clinical Diabetes 2008;26:77-82. factors. Pediatrics 2005;115:e152-62.
- 6.Schaefer C, Mann R, Sadosky A, et al. 2013;4:405-9. Burden of illness associated with pe- 20. Buysse DJ, Reynolds CF, 3rd, Monk ripheral and central neuropathic pain TH, Berman SR, Kupfer DJ. The Pittsamong adults seeking treatment in the burgh Sleep Quality Index: a new in- United States: a patient-centered evalstrument for psychiatric practice and uation. Pain medicine (Malden, Mass) research. Psychiatry Res 1989;28:193- 2014;15:2105-19.
- 7.Yoo M, Sharma N, Pasnoor M, Kluding 21. Jenkins CD, Stanton BA, Niemcryk PM. Painful Diabetic Peripheral Neu- SJ, Rose RM. A scale for the estimaropathy: Presentations, Mechanisms, tion of sleep problems in clinical reand Exercise Therapy. Journal of diasearch. Journal of clinical epidemiolobetes & metabolism 2013;Suppl 10. gy 1988;41:313-21.
- 8.Taylor-Stokes G, Pike J, Sadosky A, 22. Sweere Y, Kerkhof GA, De Weerd AW, Chandran A, Toelle T. Association of Kamphuisen HA, Kemp B, Schimpatient-rated severity with other outsheimer RJ. The validity of the Dutch comes in patients with painful diabetic Sleep Disorders Questionnaire (SDQ). peripheral neuropathy. Diabetes, met- Journal of psychosomatic research abolic syndrome and obesity : targets 1998;45:549-55. and therapy 2011;4:401-8.
- 9.Zisapel N, Nir T. Determination of the
- 10.Benbow SJ, MacFarlane IA. Painful diminimal clinically significant differabetic neuropathy. Bailliere’s best pracence on a patient visual analog sleep tice & research Clinical endocrinology quality scale. Journal of sleep research & metabolism 1999;13:295-308. 2003;12:291-8.
- 11.Young M, Jones G. Diabetic neuropa- 24. Benbow S, Wallymahmed M, MacFarthy: symptoms, signs and assessment. lane I. Diabetic peripheral neuropathy Diabetic neuropathy 1997:41. and quality of life. Qjm 1998;91:733-7.
- 12.Kim SS, Won JC, Kwon HS, et al. Va- 25. Pan Z, Peian L, Guiqiu C, et al. Comlidity of the medical outcomes study 90 bined effects of sleep quality and de- The Relationship Between Pain, Daily Function, and Sleep Quality in Diabetic Neuropathy Majmaah Journal of Health Sciences ,Vol. 12, Issue 1 , January - 2024, Jumada Al-Akhir - 1445 pression on quality of life in patients 32. Maislin G, Pack AI, Kribbs NB, et al. A with type 2 diabetes. BMC Family survey screen for prediction of apnea. Practice 2016;17:1-7. Sleep 1995;18:158-66.
- 13.Tolle T, Xu X, Sadosky AB. Painful 33. Roth T, Zammit G, Kushida C, et al. A diabetic neuropathy: a cross-sectional new questionnaire to detect sleep dissurvey of health state impairment and orders. Sleep medicine 2002;3:99-108. treatment patterns. Journal of diabetes 34. Chhangani BS, Roehrs TA, Harris EJ, and its complications 2006;20:26-33. et al. Pain sensitivity in sleepy pain27. Hoffman DL, Sadosky A, Dukes EM, free normals. Sleep 2009;32:1011-7. Alvir J. How do changes in pain se- 35. Roehrs T, Roth T. Sleep and pain: interverity levels correspond to changes in action of two vital functions. Seminars health status and function in patients with painful diabetic peripheral neuropathy? Pain 2010;149:194-201.
- 14.Roehrs TA, Harris E, Randall S, Roth T. Pain sensitivity and recovery from mild chronic sleep loss. Sleep 2012;35:1667-72.
- 15.Ellis BW, Johns MW, Lancaster R, Raptopoulos P, Angelopoulos N, Priest RG. The St. Mary’s Hospital sleep questionnaire: a study of reliability. Sleep 1981;4:93-7.
- 16.Spoormaker VI, Verbeek I, van den Bout J, Klip EC. Initial validation of the SLEEP-50 questionnaire. Behavioral sleep medicine 2005;3:227-46.
- 17.Douglass AB, Bornstein R, Nino-Murcia G, et al. The Sleep Disorders Questionnaire. I: Creation and multivariate structure of SDQ. Sleep 1994;17:160-7. in neurology 2005;25:106-16.
- 18.Lautenbacher S, Kundermann B, Krieg JC. Sleep deprivation and pain perception. Sleep medicine reviews 2006;10:357-69.
- 19.Smith MT, Haythornthwaite JA. How do sleep disturbance and chronic pain inter-relate? Insights from the longitudinal and cognitive-behavioral clinical trials literature. Sleep medicine reviews 2004;8:119-32.
- 20.Lautenbacher S, Kundermann B, Krieg J-C. Sleep deprivation and pain perception. Sleep medicine reviews 2006;10:357-69.
- 21.Onen SH, Alloui A, Jourdan D, Eschalier A, Dubray C. Effects of rapid eye movement (REM) sleep deprivation on pain sensitivity in the rat. Brain research 2001;900:261-7. The Relationship Between Pain, Daily Function, and Sleep Quality in Diabetic Neuropathy 91 Majmaah Journal of Health Sciences ,Vol. 12, Issue 1 , January - 2024, Jumada Al-Akhir - 1445
- 22.Hicks RA, Moore JD, Findley P, Hirshfield C, Humphrey V. REM sleep lated quality of life. Behavioral sleep medicine 2008;6:234-50. deprivation and pain thresholds in rats. 46. Foley KM. Opioids and chronic neuroPercept Mot Skills 1978;47:848-50. pathic pain. The New England journal
- 23.Kundermann B, Krieg J-C, Schreiber of medicine 2003;348:1279-81. W, Lautenbacher S. The effects of sleep 47. Buysse DJ, Reynolds CF, Monk TH, deprivation on pain. Pain Research and Berman SR, Kupfer DJ. The Pittsburgh Management 2004;9:25-32. Sleep Quality Index: a new instrument
- 24.Onen SH, Alloui A, Gross A, Eschallier for psychiatric practice and research. A, Dubray C. The effects of total sleep Psychiatry research 1989;28:193-213. deprivation, selective sleep interruption 48. Zelman DC, Brandenburg NA, Gore M. and sleep recovery on pain tolerance Sleep impairment in patients with painthresholds in healthy subjects. Journal of sleep research 2001;10:35-42. ful diabetic peripheral neuropathy. The Clinical journal of pain 2006;22:681-5.
- 25.Gore M, Brandenburg NA, Dukes E, 49. Viala-Danten M, Martin S, Guillemin I, Hoffman DL, Tai K-S, Stacey B. Pain Hays RD. Evaluation of the reliability severity in diabetic peripheral neuropathy is associated with patient functioning, symptom levels of anxiety and depression, and sleep. Journal of pain and symptom management 2005;30:374-85.
- 26.Ramsawh HJ, Stein MB, Belik S-L, and validity of the Medical Outcomes Study sleep scale in patients with painful diabetic peripheral neuropathy during an international clinical trial. Health and quality of life outcomes 2008;6:113. Jacobi F, Sareen J. Relationship of 50. Yoo M, D’Silva LJ, Martin K, et al. anxiety disorders, sleep quality, and Pilot Study of Exercise Therapy on functional impairment in a community sample. Journal of psychiatric research 2009;43:926-33. Painful Diabetic Peripheral Neuropathy. Pain medicine (Malden, Mass) 2015;16:1482-9.
- 27.Palermo TM, Fonareva I, Janosy NR. 51. Kluding PM, Pasnoor M, Singh R, et Sleep quality and efficiency in adolesal. Safety of aerobic exercise in people cents with chronic pain: Relationship with activity limitations and health-re92 with diabetic peripheral neuropathy: single-group clinical trial. Physical The Relationship Between Pain, Daily Function, and Sleep Quality in Diabetic Neuropathy Majmaah Journal of Health Sciences ,Vol. 12, Issue 1 , January - 2024, Jumada Al-Akhir - 1445 therapy 2015;95:223-34. somatic research 1998;45:5-13.
- 28.Singleton JR, Bixby B, Russell JW, et 58. Zelman DC, Gore M, Dukes E, Tai KS, al. The Utah Early Neuropathy Scale: Brandenburg N. Validation of a modia sensitive clinical scale for early senfied version of the brief pain inventory sory predominant neuropathy. Jourfor painful diabetic peripheral neuropanal of the Peripheral Nervous System thy. Journal of pain and symptom man- 2008;13:218-27. agement 2005;29:401-10.
- 29.Lunetta M, Le Moli R, Grasso G, San- 59. Cleeland CS, Ryan K. The Brief giorgio L. A simplified diagnostic test Pain Inventory. Available onli ne: for ambulatory screening of peripheral https://www mdanderson org/educadiabetic neuropathy. Diabetes research tion-andresearch/departments-proand clinical practice 1998;39:165-72. grams-and-labs/departments-and-di-
- 30.Al-Geffari M. Comparison of different visions/symptom-research/ screening tests for diagnosis of diabetic peripheral neuropathy in Primary Health Care setting. International Joursymptomassessment-tools/BPI_UserGuide pdf (accessed on 1 March 2016) 1994. nal of Health Sciences 2012;6:127-34. 60. Cleeland C. The Brief Pain Inventory, a
- 31.Moghtaderi A, Bakhshipour A, Rashidi H. Validation of Michigan neuropathy measure of cancer pain and its impact. Quality of Life Newsletter 1994;9:5-6. screening instrument for diabetic pe- 61. Zelman DC, Gore M, Dukes E, Tai KS, ripheral neuropathy. Clinical neurolo- Brandenburg N. Validation of a modigy and neurosurgery 2006;108:477-81. fied version of the Brief Pain Inventory
- 32.Buysse DJ, Monk TH, Reynolds CF, for painful diabetic peripheral neuropa- Mesiano D. Patterns of sleep episodes in young and elderly adults during a 36-hour constant routine. Sleep: Jourthy. Journal of vascular nursing : official publication of the Society for Peripheral Vascular Nursing 2005;23:97-104. nal of Sleep Research & Sleep Medi- 62. Zelman DC, Brandenburg NA, Gore M. cine 1993.
- 33.Fishbain DA, Hall J, Meyers AL, Gontioning, symptom levels of anxiety and zales J, Mallinckrodt C. Does pain medepression, and sleep. J Pain Symptom diate the pain interference with sleep Manage 2005;30:374-85. problem in chronic pain? Findings 70. Cheatle MD, Foster S, Pinkett A, Lefrom studies for management of diasneski M, Qu D, Dhingra L. Assessing betic peripheral neuropathic pain with duloxetine. Journal of Pain & Symptom Management 2008;36:639-47. and Managing Sleep Disturbance in Patients with Chronic Pain. Anesthesiology clinics 2016;34:379-93.
- 34.Koffel E, Kroenke K, Bair MJ, Lever- 71. Koffel E, Kroenke K, Bair MJ, Leverty D, Polusny MA, Krebs EE. The bity D, Polusny MA, Krebs EE. The bidirectional relationship between sleep complaints and pain: Analysis of data from a randomized trial. 2015.
- 35.Sivertsen B, Lallukka T, Petrie KJ, Stedirectional relationship between sleep complaints and pain: Analysis of data from a randomized trial. Health Psychology 2016;35:41. ingrímsdóttir ÓA, Stubhaug A, Nielsen 72. Bouhassira D, Letanoux M, Hartemann CS. Sleep and pain sensitivity in adults. A. Chronic pain with neuropathic Pain 2015;156:1433-9.
- 36.Schmader KE. Epidemiology and impact on quality of life of postherpetic characteristics in diabetic patients: a French cross-sectional study. PloS one 2013;8:e74195. neuralgia and painful diabetic neu- 73. Krueger JM, Obal F. A neuronal group ropathy. The Clinical journal of pain theory of sleep function. Journal of 2002;18:350-4. sleep research 1993;2:63-9.
- 37.Benbow SJ, Wallymahmed ME, Mac- 74. Colloca L, Ludman T, Bouhassira D, Farlane IA. Diabetic peripheral neuet al. Neuropathic pain. Nature reviews ropathy and quality of life. QJM : monthly journal of the Association of 94 Disease primers 2017;3:17002-.
- 38.Lavie L. Obstructive sleep apnoea syn- The Relationship Between Pain, Daily Function, and Sleep Quality in Diabetic Neuropathy Majmaah Journal of Health Sciences ,Vol. 12, Issue 1 , January - 2024, Jumada Al-Akhir - 1445 drome–an oxidative stress disorder. Sleep medicine reviews 2003;7:35-51.
- 39.Gopalakrishnan A, Li Ji L, Cirelli C. Sleep deprivation and cellular responses to oxidative stress. SLEEP-NEW YORK THEN WESTCHESTER- 2004;27:27-35.
- 40.Kasznicki J, Kosmalski M, Sliwinska A, et al. Evaluation of oxidative stress markers in pathogenesis of diabetic neuropathy. Molecular Biology Reports 2012;39:8669-78.
- 41.Shan Z, Ma H, Xie M, et al. Sleep duration and risk of type 2 diabetes: a meta-analysis of prospective studies. Diabetes Care 2015;38:529-37.
- 42.Devor M, Wood I, Sharav Y, Zakrzewska JM. Trigeminal neuralgia during sleep. Pain Practice 2008;8:263-8.
- 43.Rafael Benoliel B, Eliav E, Sharav Y, Benoliel R. Self-reports of pain-related awakenings in persistent orofacial pain patients. Self 2009;23:330-8 The Relationship Between Pain, Daily Function, and Sleep Quality in Diabetic Neuropathy 95
Peer review
Peer reviewed by 2 reviewers, who chose to remain anonymous.