The Relationship Between Serum Asymmetric Dimethylarginine Levels and Subjective Sleep Quality in Normotensive Patients with Type 2 Diabetes Mellitus

Overview

Journal Korean J Intern Med

Specialty General Medicine

Date 2015 May 22

PMID 25995662

Citations 3

Authors

Alpay Aribas

Mehmet Kayrak

Mehmet Tekinalp

Hakan Akilli

Hayrudin Alibasic

Serkan Yildirim

Mehmet Gunduz

Alpaslan Taner

Ali Unlu

Affiliations

Soon will be listed here.

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 A1c, total cholesterol, and systolic blood pressure.

Conclusions: Self-reported SQ was independently associated with ADMA levels in normotensive patients with diabetes mellitus.

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References

Almdal T, Scharling H, Skov Jensen J, 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(13):1422-6. DOI: 10.1001/archinte.164.13.1422. View

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. 2012; 23(1):49-56. DOI: 10.1007/s10286-012-0178-2. View

Buysse D, Reynolds 3rd C, Monk T, BERMAN S, Kupfer D . The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research. Psychiatry Res. 1989; 28(2):193-213. DOI: 10.1016/0165-1781(89)90047-4. View

Augustyniak R, Victor R, Morgan D, Zhang W . L-NAME- and ADMA-induced sympathetic neural activation in conscious rats. Am J Physiol Regul Integr Comp Physiol. 2005; 290(3):R726-32. DOI: 10.1152/ajpregu.00768.2004. View

Irwin M, Wang M, Campomayor C, Collado-Hidalgo A, Cole S . Sleep deprivation and activation of morning levels of cellular and genomic markers of inflammation. Arch Intern Med. 2006; 166(16):1756-62. DOI: 10.1001/archinte.166.16.1756. View

Knutson K, Ryden A, Mander B, Van Cauter E . Role of sleep duration and quality in the risk and severity of type 2 diabetes mellitus. Arch Intern Med. 2006; 166(16):1768-74. DOI: 10.1001/archinte.166.16.1768. View

Hung H, Yang Y, Ou H, Wu J, Lu F, Chang C . The association between self-reported sleep quality and overweight in a Chinese population. Obesity (Silver Spring). 2013; 21(3):486-92. DOI: 10.1002/oby.20259. View

Brekke F, Waldum B, Amro A, Osthus T, Dammen T, Gudmundsdottir H . Self-perceived quality of sleep and mortality in Norwegian dialysis patients. Hemodial Int. 2013; 18(1):87-94. DOI: 10.1111/hdi.12066. View

Abbasi F, Asagmi T, Cooke J, Lamendola C, McLaughlin T, Reaven G . Plasma concentrations of asymmetric dimethylarginine are increased in patients with type 2 diabetes mellitus. Am J Cardiol. 2001; 88(10):1201-3. DOI: 10.1016/s0002-9149(01)02063-x. View

10.

Hijmering M, Stroes E, Olijhoek J, Hutten B, Blankestijn P, Rabelink T . Sympathetic activation markedly reduces endothelium-dependent, flow-mediated vasodilation. J Am Coll Cardiol. 2002; 39(4):683-8. DOI: 10.1016/s0735-1097(01)01786-7. View

11.

Dew M, Hoch C, Buysse D, Monk T, Begley A, Houck P . Healthy older adults' sleep predicts all-cause mortality at 4 to 19 years of follow-up. Psychosom Med. 2003; 65(1):63-73. DOI: 10.1097/01.psy.0000039756.23250.7c. View

12.

Paiva H, Lehtimaki T, Laakso J, Ruokonen I, Rantalaiho V, Wirta O . 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(3):303-7. DOI: 10.1053/meta.2003.50048. View

13.

Vitiello M, Larsen L, Moe K . 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(5):503-10. DOI: 10.1016/S0022-3999(04)00023-6. View

14.

Chen B, Xia L, Zhao R . Determination of N(G),N(G)-dimethylarginine in human plasma by high-performance liquid chromatography. J Chromatogr B Biomed Sci Appl. 1997; 692(2):467-71. DOI: 10.1016/s0378-4347(96)00531-2. View

15.

Ridker P, Hennekens C, Stampfer M, Allen J . Plasma concentration of soluble intercellular adhesion molecule 1 and risks of future myocardial infarction in apparently healthy men. Lancet. 1998; 351(9096):88-92. DOI: 10.1016/S0140-6736(97)09032-6. View

16.

Gibbons R, Chatterjee K, Daley J, Douglas J, Fihn S, Gardin J . ACC/AHA/ACP-ASIM 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.... J Am Coll Cardiol. 1999; 33(7):2092-197. DOI: 10.1016/s0735-1097(99)00150-3. View

17.

Lockley S, Skene D, Arendt J . Comparison between subjective and actigraphic measurement of sleep and sleep rhythms. J Sleep Res. 1999; 8(3):175-83. DOI: 10.1046/j.1365-2869.1999.00155.x. View

18.

Krzyzanowska K, Mittermayer F, Wolzt M, Schernthaner G . Asymmetric dimethylarginine predicts cardiovascular events in patients with type 2 diabetes. Diabetes Care. 2007; 30(7):1834-9. DOI: 10.2337/dc07-0019. View

19.

Rosenthal L, Dolan D . The Epworth sleepiness scale in the identification of obstructive sleep apnea. J Nerv Ment Dis. 2008; 196(5):429-31. DOI: 10.1097/NMD.0b013e31816ff3bf. View

20.

Chiu Y, Chuang Y, Fang K, Liu S, Chen H, Yang J . Higher systemic inflammation is associated with poorer sleep quality in stable haemodialysis patients. Nephrol Dial Transplant. 2008; 24(1):247-51. DOI: 10.1093/ndt/gfn439. View