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Background: Diabetic retinopathy (DR) is a common and major complication of diabetes mellitus (DM), and is the leading cause of preventable blindness in adults of productive age after cataracts. The global prevalence of DR is 34.6% , consisting of proliferative diabetic retinopathy (7.0%), diabetic macular edema (6.8%), and visual threatening diabetic retinopathy (VTDR) (10.2%.) The risk factors for VTDR are age, duration of diabetes, glycemic control, hypertension, obesity, HbAIC levels, and dyslipidemia. In addition, impaired sleep quality is also indicated to be connected with the incidence of VTDR.
Objective: To compare the incidence of VTDR between patients with and without impaired sleep quality.
Methods: This was a cross-sectional comparative analytic observational study involving 178 type 2 diabetes mellitus patients with DR at the National Eye Center of Cicendo Eye Hospital who met the inclusion criteria. Subject characteristic data were taken from medical records and sleep quality data were collected through a structured interview using the Indonesian version of the Shorten Pittsburgh Sleep Quality Index (PSQI) questionnaire. Subjects were distributed into poor and good sleep quality groups. The presence of VTDR was then assessed. The differences were then analyzed statistically using chi-square test with a p value of 0.05 considered statistically significant.Results: Results showed that 66.2% and 71.1% of patients in the poor and good quality sleep group suffered from VTDR, respectively (p> 0.05).
Conclusion: There is no difference in VTDR incidence between patients in productive age with type 2 DM between those with and without impaired sleep quality.
Type 2 DM, DR, productive age, VTDR, impaired sleep quality
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2. Pusat Data dan Informasi Kemenkes RI. INFODATIN Diabetes Melitus. PUSDAT. 2018;
3. Ying Cui, Zhang M, Zhang L, Zhang L, Kuang J, Zhang G, et al. Prevalence and risk factors for diabetic retinopathy in a cross-sectional population-based study from rural southern China: Dongguan Eye Study. BMJ Journals. 2019;9:1–10.
4. Yau JWY, Rogers SL, Kawasaki R, Lamoureux El, Kowalski JW, Bek T, et al. Global Prevalence and Major Risk Factors of Diabetic Retinopathy. Diabetes Care Epidemiol Serv Res. 2012;35:556–64.
5. Sasongko MB, Widyaputri F, Agni AN, Wardhana FS, Kotha S, Gupta P, et al. Prevalence of Diabetic Retinopathy and Blindness in Indonesian Adults With Type 2 Diabetes. Am J Ophthalmol. 2017;181:79–87.
6. Switania A, Halim A. Risk Factors Of Diabetic Retinopathy And Vision Threatening Diabetic Retinopathy Based On Diabetic Retinopathy Screening Program In Greater Bandung, West Java. Bandung; 2018.
7. Duh EJ, Sun JK, Stitt AW. Diabetic retinopathy: current understanding, mechanisms, and treatment strategies. JCI Insight. 2017;20(2):1–14.
8. Riccardo Cheloni, Gandolfi SA, Signorelli C, Odone A. Global prevalence of diabetic retinopathy: protocol for a systematic review and meta-analysis. BMJ Journals. 2019;9(3).
9. Ryan Lee, Wong TY, Sabanayagam C. Epidemiology of diabetic retinopathy, diabetic macular edema and related vision loss. Eye Vis. 2015;2(17).
10. Tan NYQ, Chew M, Tham Y-C, Nguyen QD, Yasuda M, Cheng C-Y, et al. Associations between sleep duration, sleep quality and diabetic retinopathy. PLoS One. 2018;13(5):1–14.
11. Jee D, Keum N, Kang S, Arroyo JG. Sleep and diabetic retinopathy. Acta Ophthalmol. 2016;1–7.
12. Shan Z, Ma H, Xie M, Yan P, Guo Y, Bao W, et al. Sleep Duration and Risk of Type 2 Diabetes: A Meta-analysis of Prospective Studies. Diabetes Care. 2015;38:529–37.
13. Shaun Wen Huey Lee, Ng KY, Chin WK. The impact of sleep amount and sleep quality on glycemic control in type 2 diabetes: A systematic review and meta-analysis. Sleep Med Rev [Internet]. 2017;31:91–101. Available from: http://dx.doi.org/10.1016/j.smrv.2016.02.001
14. M Goyal, Kamboj P, Behgal J, Rathee S, Lather T. Risk factors of diabetic retinopathy in patients with type 2 diabetes mellitus. Diabetes Manag. 2017;7(6):408–11.
15. Sultan F. Magliah, Bardisi W, Attah M Al, Khorsheed MM. The prevalence and risk factors of diabetic retinopathy in selected primary care centers during the 3-year screening intervals. J Prim Med Prim Care. 2018;7(5):975–81.
16. Briançon-Marjollet A, Weiszenstein M, Henri M, Thomas A, Godin-Ribuot D, Polak J. The impact of sleep disorders on glucose metabolism: endocrine and molecular mechanisms. Diabetol Metab Syndr. 2015;7(25):1–16.
17. Ohayon MM. epidemiological Overview of sleep Disorders in the General Population. Epidemiol Sleep Disord. 2011;2:1–9.
18. Kerkhof GA. Epidemiology of sleep and sleep disorders in The NetherlandsNo Title. Sleep Med. 2017;30:229–39.
19. Raudhatul Zahara, Nurchayati S, Woferst R. Gambaran Insomnia Pada Remaja Di SMK Negeri 2 Pekanbaru. J Online Mhs. 2018;5(2):278–86.
20. Rajiv Raman, Gupta A, Venkatesh K, Kulothungan V, Sharma T. Abnormal sleep patterns in subjects with type II diabetes mellitus and its effect on diabetic microangiopathies: Sankara Nethralaya Diabetic Retinopathy Epidemiology and Molecular Genetic Study (SN-DREAMS, report 20). Acta Diabetol. 2012;49:255–61.
21. Dharmastuti D., Agni A., Widyaputri F, Pawiroranu S, Sofro Z., Wardhana F., et al. Associations of Physical Activity and Sedentary Behaviour with Vision-Threatening Diabetic Retinopathy in Indonesia Population with Type 2 Diabetes Mellitus: Jogjakarta Eye Diabetic Study in the Community (JOGED.COM). Ophthalmic Epidemiol. 2017;25(2):113–9.
22. Cantor LB, Rapuano CJ, Cioffi GA. Retina and Vitreous. San Fransisco: American Academy of Ophthalmology; 200–201.
23. Salmon JF. Kanski’s Clinical Ophthalmology. 9th ed. Oxford: Elsevier; 2020. 496–513.
24. Huang OS, Tay WT, Ong PG, Sabanayagam C, Cheng C-Y, Tan GS, et al. Prevalence and determinants of undiagnosed diabetic retinopathy and vision-threatening retinopathy in a multiethnic Asian cohort: the Singapore Epidemiology of Eye Diseases (SEED) study. BMJ Journals. 2015;99(12).
25. Wiley H, Chew E, Ferris F. Nonproliferative diabetic retinopathy and diabetic macular edema. In: Ryan’s RETINA. Elsevier; 2018.
26. Cheung N, Mitchell P, Wong TY. Diabetic retinopathy. Seminar [Internet]. 2010;376:124–36. Available from: https://doi.org/10.1016/S0140-6736(09)62124-3
27. Hodgson NM, Zhu J, Wu F, Ferreyra HA, Zhang K. Diabetic Retinopathy: Genetics and Etiologic Mechanisms. In: Retinal Vascular Disease. Elsevier; 2020. 1038–54.
28. Lang GE. Diabetic Retinopathy. 39th ed. Baumann WB, editor. Basel: Karger; 2007. 48–68.
29. Klein R, Klein BEK. The Epidemiology of Diabetic Retinopathy [Internet]. Sixth Edit. Vols. 2–3, Retina: Fourth Edition. Elsevier Inc.; 2005. 1503–1521 p. Available from: http://dx.doi.org/10.1016/B978-0-323-40197-5.00047-5.
30. Jee D, Lee WK, Kang S. Prevalence and Risk Factors for Diabetic Retinopathy: The Korea National Health and Nutrition Examination Survey 2008–2011. Investig Ophthalmol Vis Sci. 2013;54:6827–33.
31. Naveen P, Venkatesan R, Ashwath Kumar R, Venkidusamy S. Effect of glycemic control on the incidence of microalbuminuria in type II diabetes mellitus individuals. Natl J Physiol Pharm Pharmacol. 2014;4(2):132–4.
32. Polonsky K, Burant C, Melmed S, Larsen P, Kronenberg H. Type 2 Diabetes Mellitus. In: Williams, editor. Textbook of Endocrinology. Philadelphia; 2016. p. 1385–450.
33. Tangvarasittichai S. Oxidative stress, insulin resistance, dyslipidemia and type 2 diabetes mellitus. World J Diabetes. 2015;6(3):456.
34. Zhong Y, Li J, Chen Y, Wang JJ, Ratan R, Zhang SX. Activation of endoplasmic reticulum stress by hyperglycemia is essential for Müller cell-derived inflammatory cytokine production in diabetes. Diabetes. 2012;61(2):492–504.
35. Kong DQ, Li L, Liu Y, Zheng GY. Association between endoplasmic reticulum stress and risk factors of diabetic retinopathy. Int J Ophthalmol. 2018;11(10):1704–10.
36. Li J, Wang JJ, Yu Q, Wang M, Zhang SX. Endoplasmic reticulum stress is implicated in retinal inflammation and diabetic retinopathy. FEBS Lett. 2009;583(9):1521–7.
37. Anne Rübsam, Parikh S, Fort PE. Role of Inflammation in Diabetic Retinopathy. Int J Mol Sci. 2018;19:1–31.
38. Omae T, Nagaoka T, Yoshida A. Effects of habitual cigarette smoking on retinal circulation in patients with type 2 diabetes. Investig Ophthalmol Vis Sci. 2016;57(3):1345–51.
39. Wang W, Lo ACY. Diabetic Retinopathy: Pathophysiology and Treatments. Int J Mol Sci. 2018;19(1816):1–14.
40. Carley DW, Farabi SS. Physiology of Sleep. Am Diabetes Assoc [Internet]. 2016;29(1):5–9. Available from: https://dx.doi.org/10.2337%2Fdiaspect.29.1.5
41. Brinkman JE, Sharma S. Physiology Sleep. 2018; Available from: https://www.ncbi.nlm.nih.gov/pubmed/29494118.
42. Lailiyya N. Anatomi Dan Fisiologi Tidur. In: Islamiyah WR, editor. Panduan Tatalaksana Gangguan Tidur. 2nd ed. Jakarta: Sagung Seto; 2018. 1–28.
43. Colten HR, Altevogt BM, editors. Sleep Disorders and Sleep Deprivation: An Unmet Public Health Problem. In: Sleep Disorders and Sleep Deprivation. Washington DC: Institute of Medicine, Committee on Sleep Medicine and Research; 2006. 1–15.
44. Atchinson E, Barkmeier A. The Role of Systemic Risk Factors in Diabetic Retinopathy. Curr Ophthalmol Rep [Internet]. 2016;4(2):84–9. Available from: https://dx.doi.org/10.1007%2Fs40135-016-0098-8.
45. Goran Medic, Wille M, Hemels ME. Short- and long-term health consequences of sleep disruption. Nat Sci Sleep. 2017;9:151–61.
46. Reutrakul S, Cauter E Van. Interactions between sleep, circadian function, and glucose metabolism: implications for risk and severity of diabetes. Diabetes Obes. 2014;151–173.
47. Lin C-L, Tsai Y-H, Yeh MC. Associations between sleep duration and type 2 diabetes in Taiwanese adults: A population-based study. J Formos Med Assoc [Internet]. 2016;115(9):779–85. Available from: https://doi.org/10.1016/j.jfma.2016.01.013
48. Ling-Ling Meng, Liu Y, Geng R-N, Tang Y-Z, Li D-Q. Association of diabetic vascular complications with poor sleep complaints. Diabetol Metab Syndr. 2016;8(80):1–7.
49. Wei Y, Jiang H, Shi Y, Qu D, Gregori G, Zheng F, et al. Age-Related Alterations in the Retinal Microvasculature, Microcirculation, and Microstructure. Investig Ophthalmol Vis Sci. 2017;58:3804–17.
50. Yan Liu, Yang J, Tao L, Lv H, Jiang X, Zhang M, et al. Risk factors of diabetic retinopathy and sight-threatening diabetic retinopathy: a cross-sectional study of 13 473 patients with type 2 diabetes mellitus in mainland China. BMJ Journals. 2017;7(9):1–11.
51. Rooney D, Lye WK, Tan G, Lamoureux EL, Sabanayagam, Ikram MK, et al. Body mass index and retinopathy in Asian populations with diabetes mellitus. Acta Diabetol. 2014;
52. Zhou Y, Zhang Y, Shi K, Wang C. Body mass index and risk of diabetic retinopathy. Meta-Analysis Obs Study Epidemiol. 2017;96(22).
53. Tomić M, Antunica AG, Ljubić S, Rabatić JS, Karabatić M. Body Mass Index: A Risk Factor for Retinopathy in Type 2 Diabetic Patients. Hindawi. 2013;2013.
54. Chatziralli IP. The Role of Glycemic Control and Variability in Diabetic Retinopathy. Diabetes Ther [Internet]. Springer Healthcare; 2018;9(1):431–4. Available from: https://doi.org/10.1007/s13300-017-0345-5
55. Wibawa IMS, Budhiastra P, Susila NKN. Karakteristik Pasien Retinopati Diabetik di Rumah Sakit Umum Pusat Sanglah Denpasar Periode April 2016 - April 2017. Dir Open Acces Journals. 2018;7(11):1–6.
56. Vivian Schreur, Asten F van, Ng H, Weeda J, Groenewoud JMM, Tack CJ, et al. Risk factors for development and progression of diabetic retinopathy in Dutch patients with type 1 diabetes mellitus. Acta Ophthalmol. 2019;96(5):459–64.
57. Morjaria R, Alexander I, Purbrick RMJ, Safa R, Chong NV, Wulff K, et al. Impact of Diabetic Retinopathy on Sleep, Mood, and Quality of Life. ARVO J. 2019;60(6):2304–10.
58. Banerjee D, Leong WB, Arora T, Nolen M, Punamiya V, Grunstein R, et al. The Potential Association between Obstructive Sleep Apnea and Diabetic Retinopathy in Severe Obesity—The Role of Hypoxemia. PLoS One. 2013;8(11).
59. Scarlata S, Pedone C, Curcio G, Cortese L, Chiurco D, Fontana D, et al. Pre-polysomnographic assessment using the Pittsburgh Sleep Quality Index questionnaire is not useful in identifying people at higher risk for obstructive sleep apnea. J Med Screen. 2013;20(4):220–6.
60. Dutta S, Ghosh S, Ghosh S. Association of sleep disturbance with diabetic retinopathy. Eur J Ophthalmol. 2020;1–7.