Sleep quality and diabetic neuropathy: A review with exploratory meta-analysis

Diabetic neuropathy and reduced sleep quality are both frequent complications of diabetes mellitus, yet their interaction and mutual influence remain poorly understood. This review aimed to synthesize current evidence on the association between diabetic neuropathy and sleep quality. A systematic literature search was conducted in PubMed, Embase, and the Cochrane Library. Of 1356 identified records, 32 studies met the inclusion criteria. Three randomized clinical trials were included in a post-hoc exploratory meta-analysis to evaluate the effect of gabapentinoids on Sleep Interference Scores in people with painful diabetic peripheral neuropathy. Our evidence synthesis showed that sleep disturbances were more prevalent in people with diabetic peripheral neuropathy compared to people without, especially in those experiencing neuropathic pain. Obstructive sleep apnea was common in individuals with autonomic neuropathy. Furthermore, poor sleep quality in diabetes mellitus may itself increase the risk of developing diabetic neuropathy. The pooled overall mean difference in Sleep Interference Scores was −1.07 (95% CI: −1.86 to −0.28), although heterogeneity was high (I 2 = 83%). These findings indicate that poor sleep quality is highly prevalent in people with diabetic neuropathy, especially in those with neuropathic pain. Gabapentinoids appear to reduce Sleep Interference Scores in people with painful diabetic peripheral neuropathy. • Poor sleep quality is more prevalent in patients with diabetic peripheral neuropathy • Diabetic autonomic neuropathy is a critical risk factor for obstructive sleep apnea • Impaired sleep quality increases the risk of developing neuropathic complications • Central nervous system changes in diabetic sleep disturbances remain a knowledge gap • Gabapentinoids appear to reduce sleep interference in diabetic neuropathy