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The roles of obstructive sleep apnea and insomnia on mood, diabetes-related distress, and glycemic control in adults with type 2 diabetes mellitus

Jeon, Bomin (2022) The roles of obstructive sleep apnea and insomnia on mood, diabetes-related distress, and glycemic control in adults with type 2 diabetes mellitus. Doctoral Dissertation, University of Pittsburgh. (Unpublished)

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Abstract

Background: Obstructive sleep apnea (OSA) and insomnia are common sleep disorders and frequently coexist. Mood disturbances and diabetes-related distress are common psychological symptoms in type 2 diabetes mellitus (T2DM) and known barriers to glycemic control. Understanding how comorbid OSA and insomnia (OSA+I) contribute to mood and diabetes-related distress could be significant to improve glycemic outcomes in T2DM.
Purpose: The aims of this study were to 1) compare mood states and diabetes-related distress in OSA+I, OSA, and insomnia in adults with T2DM, 2) examine insomnia as a possible moderator of the association between OSA with mood states and diabetes-related distress in adults with
T2DM and OSA, and 3) examine mood disturbances and diabetes-related distress as potential mediators of the relationship between OSA and insomnia with glucose outcome in adults with
T2DM and OSA.
Methods: This study was a secondary analysis of the pooled baseline data from two independent randomized controlled trials. OSA severity was determined by an Apnea-Hypopnea Index from in-home ApneaLinkPlus® device data. Questionnaires measured insomnia severity, mood states,
and diabetes-related distress. Glucose outcome was measured by hemoglobin A1c (HbA1c). Aim 1 used one-way analysis of covariance and one-way multivariate analysis of covariance. Aim 2used hierarchical multiple linear regression and multivariate linear analysis. Aim 3 used mediation analysis with bootstrapped samples. Clinical and sociodemographic covariates were controlled in all analyses.
Results: Insomnia group had greater mood disturbances (p = .017) and OSA+I group had greater diabetes-related distress than OSA group (p = .033) in adults with T2DM. As insomnia severity increased, the deleterious effect of OSA on mood disturbances decreased (b = -.048, p = .017) and only insomnia was associated with diabetes-related distress in adults with T2DM and OSA (b =1.133, p < .001). Persons with greater insomnia severity had greater diabetes-related distress, which was associated with heightened HbA1c (indirect effect: b = .0169, se = .0083, 95% CI
[.0028, .0348]).
Conclusions: Insomnia, not OSA, was the primary underlying sleep disorder associated with mood disturbances and diabetes-related distress in T2DM. Insomnia could be a modifiable factor to reduce diabetes-related distress and improve glycemic outcomes in T2DM.


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Details

Item Type: University of Pittsburgh ETD
Status: Unpublished
Creators/Authors:
CreatorsEmailPitt UsernameORCID
Jeon, Bominboj8@pitt.eduboj80000-0002-9161-1012
ETD Committee:
TitleMemberEmail AddressPitt UsernameORCID
Committee ChairChasens, Eileen R.chasense@pitt.educhasense
Committee MemberLuyster, Faith S.fsl3@pitt.edufsl3
Committee MemberCallan, Judith A.callanja@pitt.educallanja
Committee MemberSereika, Susan M.ssereika@pitt.edussereika
Committee MemberDiNardo, Monica M.mdinardo21@gmail.com
Date: 28 April 2022
Date Type: Publication
Defense Date: 25 March 2022
Approval Date: 28 April 2022
Submission Date: 27 April 2022
Access Restriction: No restriction; Release the ETD for access worldwide immediately.
Number of Pages: 194
Institution: University of Pittsburgh
Schools and Programs: School of Nursing > Nursing
Degree: PhD - Doctor of Philosophy
Thesis Type: Doctoral Dissertation
Refereed: Yes
Uncontrolled Keywords: Obstructive sleep apnea, Insomnia, Comorbid obstructive sleep apnea and insomnia, Mood, Diabetes-related distress, Glycemic control, Type 2 diabetes mellitus
Date Deposited: 28 Apr 2022 15:03
Last Modified: 28 Apr 2022 15:03
URI: http://d-scholarship.pitt.edu/id/eprint/42773

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