Skip to main content

06-06-2018 | Mental health | Article

The relationship between sleep and cognitive function in patients with prediabetes and type 2 diabetes

Journal: Acta Diabetologica

Authors: Sunee Saetung, Hataikarn Nimitphong, Nantaporn Siwasaranond, Rungtip Sumritsopak, Panitha Jindahra, Orapitchaya Krairit, Ammarin Thakkinstian, Thunyarat Anothaisintawee, Sirimon Reutrakul

Publisher: Springer Milan



Diabetes is linked to cognitive impairment. Sleep plays a role in memory consolidation. Sleep disturbances, commonly found in patients with diabetes, were shown to be related to cognitive dysfunction. This study explored the role of sleep in cognitive function of patients with abnormal glucose tolerance.


A total of 162 patients (81 type 2 diabetes and 81 prediabetes) participated. Sleep duration and sleep efficiency (an indicator of sleep quality) were obtained using 7-day actigraphy recordings. Obstructive sleep apnea (OSA) was screened using an overnight in-home monitor. Cognitive function was assessed using the Montreal Cognitive Assessment (MoCA). Three sub-scores of MoCA, visuoexecutive function, attention and delayed recall, were also analyzed.


Mean age was 54.8 (10.2) years. OSA was diagnosed in 123 participants (76.9%). Mean sleep duration was 6.0 (1.0) h and sleep efficiency was 82.7 (8.1) %. Sleep duration and OSA severity were not related to MoCA scores. Higher sleep efficiency was associated with higher MoCA scores (p = 0.003), and having diabetes (vs. prediabetes) was associated with lower MoCA scores (p = 0.001). After adjusting covariates, both having diabetes (vs. prediabetes) (B = − 1.137, p = 0.002) and sleep efficiency (B = 0.085, p < 0.001) were independently associated with MoCA scores. In addition, diabetes (B = − 0.608, p < 0.001) and sleep efficiency (B = 0.038, p < 0.001) were associated with visuoexecutive function. Sleep parameters were not related to delayed recall or attention scores.


Lower sleep efficiency is independently associated with lower cognitive function in patients with abnormal glucose tolerance. Whether sleep optimization may improve cognitive function in these patients should be explored.
Moheet A, Mangia S, Seaquist ER (2015) Impact of diabetes on cognitive function and brain structure. Ann N Y Acad Sci 1353:60–71. https://​doi.​org/​10.​1111/​nyas.​12807 CrossRefPubMedPubMedCentral
American Psychiatric Association (2013) Diagnostic and statistical manual of mental disorders, Fifth Edition (DSM-5). American Psychiatric Publishing, Washington, D.C.CrossRef
Simó R, Ciudin A, Simó-Servat O, Hernández C (2017) Cognitive impairment and dementia: a new emerging complication of type 2 diabetes—the diabetologist’s perspective. Acta Diabetol 54:417–424. https://​doi.​org/​10.​1007/​s00592-017-0970-5 CrossRefPubMed
Manschot SM, Brands AM, van der Grond J et al (2006) Brain magnetic resonance imaging correlates of impaired cognition in patients with type 2 diabetes. Diabetes 55:1106–1113CrossRefPubMed
Grodstein F, Chen J, Wilson RS, Manson JE (2001) Type 2 diabetes and cognitive function in community-dwelling elderly women. Diabetes Care 24:1060–1065CrossRefPubMed
Chatterjee S, Peters SA, Woodward M et al (2016) Type 2 diabetes as a risk factor for dementia in women compared with men: a pooled analysis of 2.3 million people comprising more than 100,000 cases of dementia. Diabetes Care 39:300–307. https://​doi.​org/​10.​2337/​dc15-1588 PubMedCrossRef
Biessels GJ, Reijmer YD (2014) Brain changes underlying cognitive dysfunction in diabetes: what can we learn from MRI? Diabetes 63:2244–2252. https://​doi.​org/​10.​2337/​db14-0348 CrossRefPubMed
van Harten B, de Leeuw FE, Weinstein HC, Scheltens P, Biessels GJ (2006) Brain imaging in patients with diabetes: a systematic review. Diabetes Care 29:2539–2548. https://​doi.​org/​10.​2337/​dc06-1637 CrossRefPubMed
Hassing LB, Grant MD, Hofer SM et al (2004) Type 2 diabetes mellitus contributes to cognitive decline in old age: a longitudinal population-based study. J Int Neuropsychol Soc 10:599–607. https://​doi.​org/​10.​1017/​S135561770410416​5 CrossRefPubMed
Kanaya AM, Barrett-Connor E, Gildengorin G, Yaffe K (2004) Change in cognitive function by glucose tolerance status in older adults: a 4-year prospective study of the Rancho Bernardo study cohort. Arch Intern Med 164:1327–1333. https://​doi.​org/​10.​1001/​archinte.​164.​12.​1327 CrossRefPubMed
Hugenschmidt CE, Lovato JF, Ambrosius WT et al (2014) The cross-sectional and longitudinal associations of diabetic retinopathy with cognitive function and brain MRI findings: the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial. Diabetes Care 37:3244–3252. https://​doi.​org/​10.​2337/​dc14-0502 CrossRefPubMedPubMedCentral
Cukierman-Yaffe T, Gerstein HC, Williamson JD et al (2009) Relationship between baseline glycemic control and cognitive function in individuals with type 2 diabetes and other cardiovascular risk factors: the action to control cardiovascular risk in diabetes-memory in diabetes (ACCORD-MIND) trial. Diabetes Care 32:221–226. https://​doi.​org/​10.​2337/​dc08-1153 CrossRefPubMedPubMedCentral
Sullivan MD, Katon WJ, Lovato LC et al (2013) Association of depression with accelerated cognitive decline among patients with type 2 diabetes in the ACCORD-MIND trial. JAMA Psychiatry 70:1041–1047. https://​doi.​org/​10.​1001/​jamapsychiatry.​2013.​1965 CrossRefPubMedPubMedCentral
Snowden MB, Steinman LE, Bryant LL et al (2017) Dementia and co-occurring chronic conditions: a systematic literature review to identify what is known and where are the gaps in the evidence? Int J Geriatr Psychiatry 32:357–371. https://​doi.​org/​10.​1002/​gps.​4652 CrossRefPubMedPubMedCentral
Punthakee Z, Miller ME, Launer LJ et al (2012) Poor cognitive function and risk of severe hypoglycemia in type 2 diabetes: post hoc epidemiologic analysis of the ACCORD trial. Diabetes Care 35:787–793. https://​doi.​org/​10.​2337/​dc11-1855 CrossRefPubMedPubMedCentral
Scullin MK, Bliwise DL (2015) Sleep, cognition, and normal aging: integrating a half century of multidisciplinary research. Perspect Psychol Sci 10:97–137. https://​doi.​org/​10.​1177/​1745691614556680​ CrossRefPubMedPubMedCentral
Virta JJ, Heikkila K, Perola M et al (2013) Midlife sleep characteristics associated with late life cognitive function. Sleep 36:1533–1541. https://​doi.​org/​10.​5665/​sleep.​3052 (1541A) CrossRefPubMedPubMedCentral
Xu L, Jiang CQ, Lam TH et al (2014) Sleep duration and memory in the elderly Chinese: longitudinal analysis of the Guangzhou Biobank Cohort Study. Sleep 37:1737–1744. https://​doi.​org/​10.​5665/​sleep.​4162 CrossRefPubMedPubMedCentral
Keage HA, Banks S, Yang KL (2012) What sleep characteristics predict cognitive decline in the elderly? Sleep Med 13:886–892. https://​doi.​org/​10.​1016/​j.​sleep.​2012.​02.​003 CrossRefPubMed
Benito-Leon J, Louis ED, Bermejo-Pareja F (2013) Cognitive decline in short and long sleepers: a prospective population-based study (NEDICES). J Psychiatr Res 47:1998–2003. https://​doi.​org/​10.​1016/​j.​jpsychires.​2013.​09.​007 CrossRefPubMed
Tworoger SS, Lee S, Schernhammer ES, Grodstein F (2006) The association of self-reported sleep duration, difficulty sleeping, and snoring with cognitive function in older women. Alzheimer Dis Assoc Disord 20:41–48. https://​doi.​org/​10.​1097/​01.​wad.​0000201850.​52707.​80 CrossRefPubMed
Bubu OM, Brannick M, Mortimer J et al (2017) Sleep, cognitive impairment, and Alzheimer’s disease: a systematic review and meta-analysis. Sleep. https://​doi.​org/​10.​1093/​sleep/​zsw032 PubMedCrossRef
Blackwell T, Yaffe K, Laffan A et al (2014) Associations of objectively and subjectively measured sleep quality with subsequent cognitive decline in older community-dwelling men: the MrOS sleep study. Sleep 37:655–663. https://​doi.​org/​10.​5665/​sleep.​3562 CrossRefPubMedPubMedCentral
Reutrakul S, Van Cauter E (2014) Interactions between sleep, circadian function, and glucose metabolism: implications for risk and severity of diabetes. Ann N Y Acad Sci 1311:151–173. https://​doi.​org/​10.​1111/​nyas.​12355 CrossRefPubMed
Lal C, Strange C, Bachman D (2012) Neurocognitive impairment in obstructive sleep apnea. Chest 141:1601–1610. https://​doi.​org/​10.​1378/​chest.​11-2214 CrossRefPubMed
Boland LL, Shahar E, Iber C (2002) Measures of cognitive function in persons with varying degrees of sleep-disordered breathing: the Sleep Heart Health Study. J Sleep Res 11:265–272CrossRefPubMed
Olaithe M, Skinner TC, Hillman D, Eastwood PE, Bucks RS (2015) Cognition and nocturnal disturbance in OSA: the importance of accounting for age and premorbid intelligence. Sleep Breath 19:221–230. https://​doi.​org/​10.​1007/​s11325-014-1000-2 CrossRefPubMed
Kushida CA, Nichols DA, Holmes TH et al (2012) Effects of continuous positive airway pressure on neurocognitive function in obstructive sleep apnea patients: the Apnea Positive Pressure Long-term Efficacy Study (APPLES). Sleep 35:1593–1602. https://​doi.​org/​10.​5665/​sleep.​2226 CrossRefPubMedPubMedCentral
Holingue C, Wennberg A, Berger S, Polotsky VY, Spira AP (2018) Disturbed sleep and diabetes: a potential nexus of dementia risk. Metab Clin Exp. https://​doi.​org/​10.​1016/​j.​metabol.​2018.​01.​021 PubMedCrossRef
Li H, Gong Q, Shao J, Liu X, Zhao Y (2014) Cognitive dysfunction in type 2 diabetes patients accompanied with obstructive sleep apnea syndrome. Pak J Med Sci 30:1388–1392. https://​doi.​org/​10.​12669/​pjms.​306.​5861 PubMedPubMedCentralCrossRef
American Diabetes Association (2017) Standards of medical care in diabetes-2017. Diabetes Care 40:S1–S142CrossRef
Tangwongchai S, Charenboon T, Phanasathit M et al (2009) The validity of thai version of the montreal cognitive assessment (MoCA-T). Dement Neuropsychol 3:172
Radloff L (1977) The CES-D scale: a self-report depression scale for research in the general population. Appl Psychol Meas 1:385–401CrossRef
Trangkasombat U, Larpboonsarp V, Havanond P (1997) CES-D as a screen for depression in adolescents. J Psychiatr Assoc Thail 42:2–13
Ploylermsang C (2005) Contructive validity of the CES-D depression sclae among student. IJPS 1:25–39
Yuceege M, Firat H, Demir A, Ardic S (2013) Reliability of the Watch-PAT 200 in detecting sleep apnea in highway bus drivers. J Clin Sleep Med 9:339–344. https://​doi.​org/​10.​5664/​jcsm.​2584 PubMedPubMedCentralCrossRef
Zou D, Grote L, Peker Y, Lindblad U, Hedner J (2006) Validation a portable monitoring device for sleep apnea diagnosis in a population based cohort using synchronized home polysomnography. Sleep 29:367–374CrossRefPubMed
Lambiase MJ, Gabriel KP, Kuller LH, Matthews KA (2014) Sleep and executive function in older women: the moderating effect of physical activity. J Gerontol Ser A Biol Sci Med Sci 69:1170–1176. https://​doi.​org/​10.​1093/​gerona/​glu038 CrossRef
Holanda FWNJ., de Almondes KM (2016) Sleep and executive functions in older adults: a systematic review. Dement Neuropsychol 10:185–197. https://​doi.​org/​10.​1590/​s1980-5764-2016dn1003004 CrossRef
Lim AS, Kowgier M, Yu L, Buchman AS, Bennett DA (2013) Sleep fragmentation and the risk of incident Alzheimer’s disease and cognitive decline in older persons. Sleep 36:1027–1032. https://​doi.​org/​10.​5665/​sleep.​2802 CrossRefPubMedPubMedCentral
Yaffe K, Blackwell T, Barnes DE, Ancoli-Israel S, Stone KL (2007) Preclinical cognitive decline and subsequent sleep disturbance in older women. Neurology 69:237–242. https://​doi.​org/​10.​1212/​01.​wnl.​0000265814.​69163.​da CrossRefPubMed
Blackwell T, Yaffe K, Ancoli-Israel S et al (2006) Poor sleep is associated with impaired cognitive function in older women: the study of osteoporotic fractures. J Gerontol Ser A Biol Sci Med Sci 61:405–410CrossRef
Ju YE, McLeland JS, Toedebusch CD et al (2013) Sleep quality and preclinical Alzheimer disease. JAMA Neurol 70:587–593. https://​doi.​org/​10.​1001/​jamaneurol.​2013.​2334 CrossRefPubMedPubMedCentral
Lim AS, Yu L, Kowgier M (2013) Modification of the relationship of the apolipoprotein E epsilon4 allele to the risk of Alzheimer disease and neurofibrillary tangle density by sleep. JAMA Neurol 70:1544–1551. https://​doi.​org/​10.​1001/​jamaneurol.​2013.​4215 CrossRefPubMed
Stamatakis KA, Punjabi NM (2010) Effects of sleep fragmentation on glucose metabolism in normal subjects. Chest 137:95–101. https://​doi.​org/​10.​1378/​chest.​09-0791 CrossRefPubMed
Willette AA, Bendlin BB, Starks EJ et al (2015) Association of insulin resistance with cerebral glucose uptake in late middle-aged adults at risk for Alzheimer disease. JAMA Neurol 72:1013–1020. https://​doi.​org/​10.​1001/​jamaneurol.​2015.​0613 CrossRefPubMedPubMedCentral
Ekblad LL, Rinne JO, Puukka P et al (2017) Insulin resistance predicts cognitive decline: an 11-year follow-up of a nationally representative adult population sample. Diabetes Care. https://​doi.​org/​10.​2337/​dc16-2001 CrossRefPubMed
Lucassen EA, Piaggi P, Dsurney J et al (2014) Sleep extension improves neurocognitive functions in chronically sleep-deprived obese individuals. PLoS One 9:e84832. https://​doi.​org/​10.​1371/​journal.​pone.​0084832 CrossRefPubMedPubMedCentral
Allain H, Patat A, Lieury A et al (1995) Comparative study of the effects of zopiclone (7.5 mg), zolpidem, flunitrazepam and a placebo on nocturnal cognitive performance in healthy subjects, in relation to pharmacokinetics. Eur Psychiatry 10(Suppl 3):129 s–135 s. https://​doi.​org/​10.​1016/​0924-9338(96)80094-0 CrossRef
Sattar L, Renneboog B, Decaux G (2017) Hyperglycemia induces attention and gait deficits in diabetic mellitus patients. Acta Diabetol 54:953–959. https://​doi.​org/​10.​1007/​s00592-017-1034-6 CrossRefPubMed
Sang YM, Wang LJ, Mao HX, Lou XY, Zhu YJ (2018) The association of short-term memory and cognitive impairment with ghrelin, leptin, and cortisol levels in non-diabetic and diabetic elderly individuals. Acta Diabetol. https://​doi.​org/​10.​1007/​s00592-018-1111-5 PubMedCrossRef
Trento M, Charrier L, Salassa M et al (2015) Depression, anxiety and cognitive function in patients with type 2 diabetes: an 8-year prospective observational study. Acta Diabetol 52:1157–1166. https://​doi.​org/​10.​1007/​s00592-015-0806-0 CrossRefPubMed
van Bussel FC, Backes WH, van Veenendaal TM et al (2016) Functional brain networks are altered in type 2 diabetes and prediabetes: signs for compensation of cognitive decrements? The Maastricht Study. Diabetes 65:2404–2413. https://​doi.​org/​10.​2337/​db16-0128 CrossRefPubMed

Be confident that your patient care is up to date

Medicine Matters is being incorporated into Springer Medicine, our new medical education platform. 

Alongside the news coverage and expert commentary you have come to expect from Medicine Matters diabetes, Springer Medicine's complimentary membership also provides access to articles from renowned journals and a broad range of Continuing Medical Education programs. Create your free account »