The Korean journal of internal medicine

The Korean Association of Internal Medicine (대한내과학회)
권호 표지
DOI QR코드

DOI QR Code

The relationship between serum asymmetric dimethylarginine levels and subjective sleep quality in normotensive patients with type 2 diabetes mellitus

  • Aribas, Alpay (Department of Cardiology, Meram School of Medicine Hospital, Necmettin Erbakan University) ;
  • Kayrak, Mehmet (Department of Cardiology, Meram School of Medicine Hospital, Necmettin Erbakan University) ;
  • Tekinalp, Mehmet (Cardiology Clinic, Kahramanmaras Necip Fazil City Hospital) ;
  • Akilli, Hakan (Department of Cardiology, Meram School of Medicine Hospital, Necmettin Erbakan University) ;
  • Alibasic, Hayrudin (Cardiology Clinic, Lokman Hekim Van Hospital) ;
  • Yildirim, Serkan (Department of Cardiology, Meram School of Medicine Hospital, Necmettin Erbakan University) ;
  • Gunduz, Mehmet (Department of Cardiology, Ercis Government Hospital) ;
  • Taner, Alpaslan (Department of Biochemistry, Dr Faruk Sukan Maternity and Children's Hospital) ;
  • Unlu, Ali (Department of Biochemistry, Selcuk University School of Medicine)
  • Received : 2014.05.28
  • Accepted : 2014.11.14
  • Published : 2015.05.01
⟨ Previous Next ⟩

Abstract

Background/Aims: Poor sleep quality (SQ) is associated with increased cardiovascular mortality and morbidity. Additionally, asymmetric dimethylarginine (ADMA) is an independent predictor of cardiovascular mortality and morbidity. However, no sufficient data regarding the relationship between ADMA levels and SQ have been reported. The goal of the current study was to evaluate the association between SQ and ADMA levels in normotensive patients with type 2 diabetes mellitus. Methods: The study participants consisted of 78 normotensive type 2 diabetics. The SQ of all participants was assessed using the Pittsburgh Sleep Quality Index (PSQI). Patients with a global PSQI score > 5 were defined as "poor sleepers." Factors associated with poor SQ were analyzed using a multiple regression model. Serum ADMA levels were measured using high performance liquid chromatography. Results: The median ADMA levels of the poor sleepers were increased compared with patients defined as good sleepers (5.5 [4.2 to 6.6] vs. 4.4 [2.9 to 5.4], p < 0.01, respectively). However, the L-arginine/ADMA ratio was decreased in poor sleepers (p < 0.01). Global PSQI scores were positively correlated with ADMA levels (p < 0.01) and negatively correlated with the L-arginine/ADMA ratio (p = 0.02). ADMA levels were correlated with sleep latency (p < 0.01) and sleep efficiency (p = 0.01). Logistic regression analysis showed that ADMA levels (odds ratio [OR], 1.68; 95% confidence interval [CI], 1.16 to 2.44; p = 0.01) and body mass index (OR, 1.15; 95% CI, 1.01 to 1.31; p = 0.04) were associated with poor SQ independently of glomerular filtration rate, sex, age, duration of diabetes, hemoglobin $A_{1c}$, total cholesterol, and systolic blood pressure. Conclusions: Self-reported SQ was independently associated with ADMA levels in normotensive patients with diabetes mellitus.

Keywords

Acknowledgement

Supported by : Selcuk University

References

  1. Martin JL, Fiorentino L, Jouldjian S, Mitchell M, Josephson KR, Alessi CA. Poor self-reported sleep quality predicts mortality within one year of inpatient post-acute rehabilitation among older adults. Sleep 2011;34:1715-1721. https://doi.org/10.5665/sleep.1444
  2. Brekke FB, Waldum B, Amro A, et al. Self-perceived quality of sleep and mortality in Norwegian dialysis patients. Hemodial Int 2014;18:87-94. https://doi.org/10.1111/hdi.12066
  3. Tsai YW, Kann NH, Tung TH, et al. Impact of subjective sleep quality on glycemic control in type 2 diabetes mellitus. Fam Pract 2012;29:30-35. https://doi.org/10.1093/fampra/cmr041
  4. Dew MA, Hoch CC, Buysse DJ, et al. Healthy older adults' sleep predicts all-cause mortality at 4 to 19 years of follow-up. Psychosom Med 2003;65:63-73. https://doi.org/10.1097/01.PSY.0000039756.23250.7C
  5. Almdal T, Scharling H, Jensen JS, Vestergaard H. The independent effect of type 2 diabetes mellitus on ischemic heart disease, stroke, and death: a population-based study of 13,000 men and women with 20 years of follow-up. Arch Intern Med 2004;164:1422-1426. https://doi.org/10.1001/archinte.164.13.1422
  6. Irwin MR, Wang M, Campomayor CO, Collado-Hidalgo A, Cole S. Sleep deprivation and activation of morning levels of cellular and genomic markers of inflammation. Arch Intern Med 2006;166:1756-1762. https://doi.org/10.1001/archinte.166.16.1756
  7. Friedman EM. Sleep quality, social well-being, gender, and inflammation: an integrative analysis in a national sample. Ann N Y Acad Sci 2011;1231:23-34. https://doi.org/10.1111/j.1749-6632.2011.06040.x
  8. Chiu YL, Chuang YF, Fang KC, et al. Higher systemic inflammation is associated with poorer sleep quality in stable haemodialysis patients. Nephrol Dial Transplant 2009;24:247-251.
  9. Ridker PM, Hennekens CH, Roitman-Johnson B, Stampfer MJ, Allen J. Plasma concentration of soluble intercellular adhesion molecule 1 and risks of future myocardial infarction in apparently healthy men. Lancet 1998;351:88-92. https://doi.org/10.1016/S0140-6736(97)09032-6
  10. Abbasi F, Asagmi T, Cooke JP, et al. Plasma concentrations of asymmetric dimethylarginine are increased in patients with type 2 diabetes mellitus. Am J Cardiol 2001;88:1201-1203. https://doi.org/10.1016/S0002-9149(01)02063-X
  11. Krzyzanowska K, Mittermayer F, Wolzt M, Schernthaner G. Asymmetric dimethylarginine predicts cardiovascular events in patients with type 2 diabetes. Diabetes Care 2007;30:1834-1839. https://doi.org/10.2337/dc07-0019
  12. Buysse DJ, Reynolds CF 3rd, 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. https://doi.org/10.1016/0165-1781(89)90047-4
  13. Chen BM, Xia LW, Zhao RQ. Determination of N(G),N(G)-dimethylarginine in human plasma by high-performance liquid chromatography. J Chromatogr B Biomed Sci Appl 1997;692:467-471. https://doi.org/10.1016/S0378-4347(96)00531-2
  14. Cockcroft DW, Gault MH. Prediction of creatinine clearance from serum creatinine. Nephron 1976;16:31-41. https://doi.org/10.1159/000180580
  15. Knutson KL, Ryden AM, Mander BA, Van Cauter E. Role of sleep duration and quality in the risk and severity of type 2 diabetes mellitus. Arch Intern Med 2006;166:1768-1774. https://doi.org/10.1001/archinte.166.16.1768
  16. Can A, Bekpinar S, Gurdol F, Tutuncu Y, Unlucerci Y, Dinccag N. Dimethylarginines in patients with type 2 diabetes mellitus: relation with the glycaemic control. Diabetes Res Clin Pract 2011;94:e61-e64. https://doi.org/10.1016/j.diabres.2011.08.008
  17. Paiva H, Lehtimaki T, Laakso J, et al. Plasma concentrations of asymmetric-dimethyl-arginine in type 2 diabetes associate with glycemic control and glomerular filtration rate but not with risk factors of vasculopathy. Metabolism 2003;52:303-307. https://doi.org/10.1053/meta.2003.50048
  18. Marcovecchio ML, Widmer B, Turner C, Dunger DB, Dalton RN. Asymmetric dimethylarginine in young people with type 1 diabetes: a paradoxical association with HbA(1c). Diabet Med 2011;28:685-691. https://doi.org/10.1111/j.1464-5491.2011.03252.x
  19. Hung HC, Yang YC, Ou HY, Wu JS, Lu FH, Chang CJ. The association between self-reported sleep quality and overweight in a Chinese population. Obesity (Silver Spring) 2013;21:486-492. https://doi.org/10.1002/oby.20259
  20. Koc F, Tokac M, Erdem S, et al. Serum asymmetric dimethylarginine levels in normotensive obese individuals. Med Sci Monit 2010;16:CR536-CR539.
  21. Vitiello MV, Larsen LH, Moe KE. Age-related sleep change: gender and estrogen effects on the subjective-objective sleep quality relationships of healthy, noncomplaining older men and women. J Psychosom Res 2004;56:503-510. https://doi.org/10.1016/S0022-3999(04)00023-6
  22. Huang Y, Mai W, Hu Y, et al. Poor sleep quality, stress status, and sympathetic nervous system activation in nondipping hypertension. Blood Press Monit 2011;16:117-123. https://doi.org/10.1097/MBP.0b013e328346a8b4
  23. de Zambotti M, Covassin N, Sarlo M, De Min Tona G, Trinder J, Stegagno L. Nighttime cardiac sympathetic hyper-activation in young primary insomniacs. Clin Auton Res 2013;23:49-56. https://doi.org/10.1007/s10286-012-0178-2
  24. Augustyniak RA, Victor RG, Morgan DA, Zhang W. L-NAME- and ADMA-induced sympathetic neural activation in conscious rats. Am J Physiol Regul Integr Comp Physiol 2006;290:R726-R732. https://doi.org/10.1152/ajpregu.00768.2004
  25. Hijmering ML, Stroes ES, Olijhoek J, Hutten BA, Blankestijn PJ, Rabelink TJ. Sympathetic activation markedly reduces endothelium-dependent, flow-mediated vasodilation. J Am Coll Cardiol 2002;39:683-688. https://doi.org/10.1016/S0735-1097(01)01786-7
  26. Lockley SW, Skene DJ, Arendt J. Comparison between subjective and actigraphic measurement of sleep and sleep rhythms. J Sleep Res 1999;8:175-183. https://doi.org/10.1046/j.1365-2869.1999.00155.x
  27. Rosenthal LD, Dolan DC. The Epworth sleepiness scale in the identification of obstructive sleep apnea. J Nerv Ment Dis 2008;196:429-431. https://doi.org/10.1097/NMD.0b013e31816ff3bf
  28. Gibbons RJ, Chatterjee K, Daley J, et al. ACC/AHA/ACPASIM guidelines for the management of patients with chronic stable angina: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Management of Patients With Chronic Stable Angina). J Am Coll Cardiol 1999;33:2092-2197. https://doi.org/10.1016/S0735-1097(99)00150-3

Cited by

  1. Procyanidin B2 from lotus seedpod regulate NO/ADMA/DDAH pathway to treat insomnia in rats vol.33, pp.5, 2015, https://doi.org/10.1111/fcp.12462
  2. Sleep Quality and Cognitive Function in Type 1 Diabetes : Findings From the Study of Longevity in Diabetes (SOLID) vol.34, pp.1, 2015, https://doi.org/10.1097/wad.0000000000000351
  3. Dimethylarginines in acute myocardial infarction: Association with lifestyle, sociodemographic, and somatometric factors vol.9, pp.12, 2015, https://doi.org/10.4103/jfmpc.jfmpc_1495_20
  4. Prevalence of Insomnia (Symptoms) in T2D and Association With Metabolic Parameters and Glycemic Control: Meta-Analysis vol.105, pp.3, 2020, https://doi.org/10.1210/clinem/dgz065
  5. Impact of Sleep Patterns on Glycaemic Levels in Healthy Young Adults vol.9, pp.47, 2015, https://doi.org/10.14260/jemds/2020/775
  6. HPLC and LC-MS/MS measurement methods for the quantification of asymmetric dimethylarginine (ADMA) and related metabolites vol.46, pp.4, 2015, https://doi.org/10.1515/tjb-2020-0150