1) Welcome to a new #accredited #tweetorial on the intersection of #T2D & #sleep_disorders, 🔭
— @CKD_ce (@ckd_ce) December 21, 2022
💤importance of duration & quality of sleep as major metabolic RFs
💤association T2D ↔️ obstructive sleep apnoea/hypopnoea syndrome (#OSAHS)
💤tips on practicing healthy sleep hygiene
3) We spend up to a third of our lives sleeping, yet sleep has received, hitherto, much less awareness than it deserves. #Sleep_disorders are underappreciated & common #PublicHealth problems having wide-ranging effects on #population health.
— @CKD_ce (@ckd_ce) December 21, 2022
(Figs from https://t.co/mfpoZktQUS) pic.twitter.com/6LmAf8vaGS
5a) A recent online survey (https://t.co/UpMMVsAddK) demonstrated a massive ⬇️ in sleep quality over the last 12 months affecting adults living in the UK.
— @CKD_ce (@ckd_ce) December 21, 2022
6a) The #COVID pandemic has of course contributed towards this ⬇️ in sleep quality, however rates of both suboptimal sleep duration & poor-quality sleep have been ⬆️ for many years & are inextricably linked to our modern Western 24-hour lifestyles. pic.twitter.com/p6tQ269yRC
— @CKD_ce (@ckd_ce) December 21, 2022
7) Our global epidemic of type 2 diabetes & obesity has also contributed towards this ⬇️ in sleep quality due to the ⬆️ prevalence of #OSAHS with these conditions & the nocturnal symptoms of #hypoglycaemia, urinary frequency & painful peripheral neuropathy associated with #T2D
— @CKD_ce (@ckd_ce) December 21, 2022
9) Long (>8 hours) & short (<6 hours) sleep durations negatively impact #HbA1c.
— @CKD_ce (@ckd_ce) December 21, 2022
💤Irregular sleep results in suboptimal glucose levels likely driven by the ⬆️ prevalence of sleep disorders in #T2D e.g., #insomnia, #OSAHS & restless legs syndrome #RLS
11) There is strong evidence demonstrating ⬇️ in glucose & #insulin levels, #bloodpressure, #HbA1c & #lipid levels with good sleep quality. pic.twitter.com/9IkVtKnCat
— @CKD_ce (@ckd_ce) December 21, 2022
12b) cf. 7 hours sleep, 1 hour ⬇️ in sleep duration was associated with a 9% ⬆️ risk of developing #T2D & an hour ⬆️ in sleep duration was associated with a 14% ⬆️ risk of developing T2D pic.twitter.com/TwaTsaj4mF
— @CKD_ce (@ckd_ce) December 21, 2022
13b) Additionally, duration of insomnia mattered; those with <4 years insomnia had a 14% ⬆️ risk of #T2D whilst those with insomnia >8 years had a staggering 51% ⬆️ risk of developing T2D pic.twitter.com/Jbi2TeDfZC
— @CKD_ce (@ckd_ce) December 21, 2022
14b) Short sleep duration (<5-6 hrs/night) resulted in a 59% ⬆️ risk of progression from pre-diabetes to #T2D
— @CKD_ce (@ckd_ce) December 21, 2022
16a) #Nightshift work was also found to negatively impact the risk of progressing to #T2D
— @CKD_ce (@ckd_ce) December 21, 2022
17a) A similar SR & MA https://t.co/4ymBv9RvFK looked at sleep duration & sleep quality on glycaemic control in people living with #T2D
— @CKD_ce (@ckd_ce) December 21, 2022
💤Again, a U-shaped curve was found between sleep duration & HbA1c levels.
💤Adequate sleep ⬇️ #HbA1c by up to 0.35%.
17c) The authors tell us that sleep health is an important & modifiable risk factor for ⬇️glycaemia in people living with #T2D
— @CKD_ce (@ckd_ce) December 21, 2022
ACTION POINT 🧨: Counselling about #sleep should be an integral part of every #diabetes consultation pic.twitter.com/kplYnyZypY
19) Mark your response and RETURN TOMORROW for the remainder of this tweetorial and your link to CE/#CME credit! And get a good night's 🛌tonight!!
— @CKD_ce (@ckd_ce) December 21, 2022
👏@ACinNYC2K19 @DrFrankLipman @ShreyaShah22 @ginihealth @DaHeG0 @oxsci #FOAMed #endotwitter #cardiotwitter @MedTweetorials
20b) Yesterday's quiz? The correct answer is A (see tweets 11, 13, 14)
— @CKD_ce (@ckd_ce) December 22, 2022
21b) #OSAHS affects around 6-13% of adults in the 🇬🇧. viz. it is as least as common as #T2D, but remains underdiagnosed in primary care. pic.twitter.com/y3pb9ZSlEi
— @CKD_ce (@ckd_ce) December 22, 2022
23a) There is a higher ⬆️ of #OSAHS in people living with #T2D; around 25% of people living with T2D have OSAHS
— @CKD_ce (@ckd_ce) December 22, 2022
👉Conversely, around 15-30% of people living with OSAHS have T2D
23c) #OSA was associated with a 37% ⬆️ risk of #T2D (independent of demographic, lifestyle, co-morbidities & anthropometric factors) whereas people living with T2D & treated with insulin had a 43% ⬆️ risk of OSA (independent of #adiposity) particularly women. Bidirectional!
— @CKD_ce (@ckd_ce) December 22, 2022
24) ACTION POINT 🧨: Check an #HbA1c in all patients with #OSAHS & not known to have #T2D
— @CKD_ce (@ckd_ce) December 22, 2022
ACTION POINT 🧨: Consider screening for OSAHS in all patients living with T2D & not known to have any sleep disorders using the #Epworth_sleepiness_scale & #STOP_Bang questionnaire pic.twitter.com/vY1tXXvtD3
25b) #OSA was an independent predictor of progression to pre-proliferative & proliferative DR over 4 years
— @CKD_ce (@ckd_ce) December 22, 2022
👉Treatment of OSA with continuous positive airways pressure (#CPAP) therapy was associated with a ⬇️ in pre-proliferative & proliferative DR pic.twitter.com/yJpvSH10di
27) Finally, how do we as #HCPs & our patients practice healthy sleep hygiene? pic.twitter.com/5dfiBO6y3X
— @CKD_ce (@ckd_ce) December 22, 2022
29a) Some further detail on #screentime & #blue_light exposure…#Melatonin is secreted by the #pineal gland during darkness and helps regulate our #circadian rhythms
— @CKD_ce (@ckd_ce) December 22, 2022
30) Here are some great resources for sleep hygiene: pic.twitter.com/6C4fZgF7FE
— @CKD_ce (@ckd_ce) December 22, 2022
32) 1⃣ We need to wake up to sleep as a major #metabolic risk factor: enquiring & counselling about sleep quality & sleep duration should be integral to every #diabetes consultation pic.twitter.com/vEWFPAWkf5
— @CKD_ce (@ckd_ce) December 22, 2022
34) 3⃣ #Sleep_hygiene is more than just a bedtime buzzword; counsel patients how to practice healthy sleep hygiene but individualise, modify, and compromise where necessary! pic.twitter.com/nccoayfllV
— @CKD_ce (@ckd_ce) December 22, 2022
35b) You got it–a & c, right? The #PSQI is a self-report questionnaire that assesses sleep quality over a 1-month time interval, but is less sensitive than the other two as a screen for #OSA.
— @CKD_ce (@ckd_ce) December 22, 2022
💤 And now . . . you have earned some rest!!
36) Click 🖱️ to https://t.co/5WPPFGIRs5 and claim your 🆓0.5hr CE/#CME certificate. We trust you didn't sleep-walk through this program. FOLLOW US for more expert-led accredited education delivered wholly on Twitter! I am @drkevinfernando
— @CKD_ce (@ckd_ce) December 22, 2022