Korean J Intern Med.  2015 May;30(3):316-324. 10.3904/kjim.2015.30.3.316.

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

• Aribas A
• Kayrak M
• Tekinalp M
• Akilli H
• Alibasic H
• Yildirim S
• Gunduz M
• Taner A
• Unlu A

• KMID: 2160704
• DOI: http://doi.org/10.3904/kjim.2015.30.3.316

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.

Keyword

Sleep quality; N,N-dimethylarginine; Asymmetric dimethylarginine; Diabetes mellitus

MeSH Terms

Adult
Arginine/*analogs & derivatives/blood
Biomarkers/blood
Cardiovascular Diseases/blood/*etiology/physiopathology
Chi-Square Distribution
Chromatography, High Pressure Liquid
Cross-Sectional Studies
Diabetes Mellitus, Type 2/blood/*complications/diagnosis/physiopathology
Female
Humans
Logistic Models
Male
Middle Aged
Odds Ratio
Risk Factors
*Sleep
Sleep Wake Disorders/blood/*complications/diagnosis/physiopathology
Surveys and Questionnaires
Arginine
Biomarkers