Relationship Between Diabetes Mellitus and Excessive Sleepiness During Driving

Abstract

Objectives: It is still unclear whether patients with diabetes feel excessive daytime sleepiness or dose/sleep during driving in patients more frequently.

Methods: A population-based cross-sectional survey was conducted in a rural town. Multivariable-adjusted logistic regression models were used to explore the association between prevalent diabetes cases and excessive daytime sleepiness or dose/sleep during driving.

Results: Of 4540 participants, a total of 470 diabetes cases were identified. Compared with those in the never doze/sleep category, multivariate-adjusted odds ratios of diabetes was 0.41 (95%CI, 0.12-1.35) in slight category of dozing or sleeping when stopped for a few minutes in traffic while driving and 2.97 (95%CI, 1.19-7.41) in the moderate to high categories of dozing or sleeping when stopped for a few minutes in traffic while driving. This association remained significant after adjusting for the presence of poor sleep quality defined by the global Pittsburgh Sleep Quality Index score equal or greater than 5.

Conclusion: Compared to individuals without diabetes, patients with diabetes experienced excessive daytime sleepiness or dozing/sleeping when stopped for a few minutes in traffic while driving more often independent of poor sleep quality. From the public health perspective, all patients with diabetes should be asked about a history of excessive daytime sleepiness or dozing/sleeping while driving, which is a known risk factor for future traffic accidents.

Key words

diabetes - excessive daytime sleep - driving - sleep quality

References

• 1 Philip P, Sagaspe P, Moore N. et al . Fatigue, sleep restriction and driving performance.  Accid Anal Prev. 2005;  37 473-478
• 2 Connor J, Whitlock G, Norton R, Jackson R. The role of driver sleepiness in car crashes: a systematic review of epidemiological studies.  Accid Anal Prev. 2001;  33 31-41
• 3 Connor J, Norton R, Ameratunga S. et al . Driver sleepiness and risk of serious injury to car occupants: population based case control study.  Bmj. 2002;  324 1125
• 4 Philip P, Vervialle F, Breton P Le, Taillard J, Horne JA. Fatigue, alcohol, and serious road crashes in France: factorial study of national data.  Bmj. 2001;  322 829-830
• 5 Lyznicki JM, Doege TC, Davis RM, Williams MA. Sleepiness, driving, and motor vehicle crashes. Council on Scientific Affairs, American Medical Association.  Jama. 1998;  279 1908-1913
• 6 Knipling RR, Wang J-S. Crashes and fatalities related to driver drowsiness/fatigue. Washington, DC: Office of Crash Avoidance Research, US Dept of Transportation 1994
• 7 Pierce RJ. Driver sleepiness: occupational screening and the physician's role.  Aust N Z J Med. 1999;  29 658-661
• 8 Bonow RO, Gheorghiade M. The diabetes epidemic: a national and global crisis.  Am J Med. 2004;  116 ((Suppl 5A)) 2S-10S
• 9 Knutson KL, Ryden AM, Mander BA, Cauter E Van. Role of sleep duration and quality in the risk and severity of type 2 diabetes mellitus.  Arch Intern Med. 2006;  166 1768-1774
• 10 Fletcher GF, Balady GJ, Amsterdam EA. et al . Exercise standards for testing and training: a statement for healthcare professionals from the American Heart Association.  Circulation. 2001;  104 1694-1740
• 11 Buysse DJ, Reynolds  3rd  CF, Monk TH, Berman SR, Kupfer DJ. The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research.  Psychiatry Res. 1989;  28 193-213
• 12 Doi Y, Minowa M, Uchiyama M, Okawa M. Development of the Japanese version of the Pittsburgh Sleep Quality Index.  Japanese Journal of Psychiatry Treatment. 1998;  13 755-763
• 13 Bixler EO, Vgontzas AN, Lin HM. et al . Excessive daytime sleepiness in a general population sample: the role of sleep apnea, age, obesity, diabetes, and depression.  J Clin Endocrinol Metab. 2005;  90 4510-4515
• 14 Nabi H, Gueguen A, Zins M. et al . Awareness of driving while sleepy and road traffic accidents: prospective study in GAZEL cohort.  Bmj. 2006;  333 75
• 15 Grunstein R, Wilcox I, Yang TS, Gould Y, Hedner J. Snoring and sleep apnoea in men: association with central obesity and hypertension.  Int J Obes Relat Metab Disord. 1993;  17 533-540
• 16 Fletcher EC. Sympathetic activity and blood pressure in the sleep apnea syndrome.  Respiration. 1997;  64 ((Suppl 1)) 22-28
• 17 Ayas NT, White DP, Manson JE. et al . A prospective study of sleep duration and coronary heart disease in women.  Arch Intern Med. 2003;  163 205-209
• 18 Kawakami F, Ito M, Matsuda Y, Hayashi I, Ohtsuki K. The effects of cholesterol-3-sulfate (CH-3S) on the phosphorylation of human C3a (hC3a) in vitro and on the ability of hC3a to induce vascular permeability in rats.  Biol Pharm Bull. 2004;  27 282-287
• 19 Nilsson PM, Roost M, Engstrom G, Hedblad B, Berglund G. Incidence of diabetes in middle-aged men is related to sleep disturbances.  Diabetes Care. 2004;  27 2464-2469
• 20 Mallon L, Broman JE, Hetta J. High incidence of diabetes in men with sleep complaints or short sleep duration: a 12-year follow-up study of a middle-aged population.  Diabetes Care. 2005;  28 2762-2767
• 21 Vgontzas AN, Papanicolaou DA, Bixler EO. et al . Elevation of plasma cytokines in disorders of excessive daytime sleepiness: role of sleep disturbance and obesity.  J Clin Endocrinol Metab. 1997;  82 1313-1316
• 22 Pickup JC. Inflammation and activated innate immunity in the pathogenesis of type 2 diabetes.  Diabetes Care. 2004;  27 813-823

Correspondence