Overview: The negative impact of diabetes mellitus on the quality of life is not limited to the clinical aspects, it also extends to the psychological and economic sides of their lives. Deteriorated sleep quality is one of the major factors that affect diabetics' health-related quality of life. This research is an attempt to track the pathophysiology of sleep disturbance in type 2 diabetic patients by evaluating serum melatonin levels as a key hormone that induces sleep. Methods: Eighty-eight relatively glycemic-controlled type 2 diabetic patients were recruited in a cross-sectional study to evaluate their quality of sleep. The study then tends to examine the nighttime serum melatonin levels in both good and poor sleepers groups. Results: Poor sleepers were dominant, with 47 patients out of 88. A significant difference was recorded in serum melatonin levels between good and poor sleep quality. Melatonin concentrations were 17.32+ 2.26 pg/mL in good sleepers; on the other hand, poor sleepers recorded mean serum melatonin of 11.15+2.81 (p-value 0.001). Waist circumferences were noted to be significantly different, with a mean of 97.8+11.37 cm and 105.614.34 cm for the good and poor sleepers, respectively (p-value = 0.007). Conclusion: Poor sleep quality is more prevalent in the type 2 diabetic sample population, with a significantly lower nighttime serum melatonin level in the patients with poor sleep quality.


[1] Clement-Carbonell V, Portilla-Tamarit I, Rubio-Aparicio M, Madrid-Valero JJ. Sleep quality, mental and physical health: a differential relationship. Int J Environ Res Publ Health 2021 Jan 8;18(2):460. https://doi.org/10.3390/ijerph18020460. PMID: 33435528; PMCID: PMC7826982.

[2] Mosavat M, Mirsanjari M, Arabiat D, Smyth A, Whitehead L. The role of sleep curtailment on leptin levels in obesity and diabetes mellitus. Obes Facts 2021;14(2):214e21. https:// doi.org/10.1159/000514095. Epub 2021 Mar 23. PMID: 33756469; PMCID: PMC8138234.

[3] Arendt J, Aulinas A. Physiology of the pineal gland and melatonin. In: Feingold KR, Anawalt B, Blackman MR, Boyce A, Chrousos G, Corpas E, et al., editors. Endotext [internet]. South Dartmouth (MA): MDText.com, Inc.; 2022 Oct 30. PMID: 31841296.

[4] Kvetnoy I, Ivanov D, Mironova E, Evsyukova I, Nasyrov R, Kvetnaia T, et al. Melatonin as the cornerstone of neuroimmunoendocrinology. Int J Mol Sci 2022;23(3):1835. https:// doi.org/10.3390/ijms23031835.

[5] Berson DM. Retinal ganglion cell types and their central projections. ISBN 9780123708809. Academic Press; 2008. p. 491e519. https://doi.org/10.1016/B978-012370880-9.00280- 2.

[6] Ostrin LA. Ocular and systemic melatonin and the influence of light exposure. Clin Exp Optom 2019 Mar;102(2):99e108. https://doi.org/10.1111/cxo.12824. Epub 2018 Aug 3. PMID: 30074278.

[7] Kalsbeek A, Garidou ML, Palm IF, Van Der Vliet J, Simonneaux V, Pevet P, et al. Melatonin sees the light: blocking GABA-ergic transmission in the paraventricular nucleus induces daytime secretion of melatonin. Eur J Neurosci 2000 Sep;12(9):3146e54. https://doi.org/10.1046/ j.1460-9568.2000.00202.x. PMID: 10998098.

[8] Ng KY, Leong MK, Liang H, Paxinos G. Melatonin receptors: distribution in mammalian brain and their respective putative functions. Brain Struct Funct 2017 Sep;222(7):2921e39. https://doi.org/10.1007/s00429-017-1439-6. Epub 2017 May 6. PMID: 28478550.

[9] Slominski RM, Reiter RJ, Schlabritz-Loutsevitch N, Ostrom RS, Slominski AT. Melatonin membrane receptors in peripheral tissues: distribution and functions. Mol Cell Endocrinol 2012 Apr 4;351(2):152e66. https://doi.org/10.1016/ j.mce.2012.01.004. Epub 2012 Jan 8. PMID: 22245784; PMCID: PMC3288509

[10] Nikolaev G, Robeva R, Konakchieva R. Membrane melatonin receptors activated cell signaling in physiology and disease. Int J Mol Sci 2021 Dec 31;23(1):471. https://doi.org/10.3390/ ijms23010471. PMID: 35008896; PMCID: PMC8745360.

[11] Sampaio RV, Conceiçao S, Miranda MS, Sampaio LdeF, ~ Ohashi OM. MT3 melatonin binding site, MT1 and MT2 melatonin receptors are present in oocyte, but only MT1 is present in bovine blastocyst produced in vitro. Reprod Biol Endocrinol: RB Elektron 2012;10:103. https://doi.org/10.1186/ 1477-7827-10-103.

[12] Ahmad Sheikh Bilal, Ali Aarif, Bilal Midhat, Rashid Mudasir, Shahzada, Wani Amir, et al. Melatonin and health: insights of melatonin action, biological functions, and associated disorders. Cell Mol Neurobiol 2023:1e22. https://doi.org/ 10.1007/s10571-023-01324-w.

[13] Favero G, Franceschetti L, Bonomini F, Rodella LF, Rezzani R. Melatonin as an anti-inflammatory agent modulating inflammasome activation. Int J endocrinology 2017; 2017:1835195. https://doi.org/10.1155/2017/1835195.

[14] Beker MC, Caglayan B, Caglayan AB, Kelestemur T, Yalcin E, Caglayan A, et al. Interaction of melatonin and Bmal1 in the regulation of PI3K/AKT pathway components and cellular survival. Sci Rep 2019;9(1):19082. https://doi.org/ 10.1038/s41598-019-55663-0.

[15] Ibanez V, Silva J, Cauli O. A survey on sleep questionnaires ~ and diaries. Sleep Med 2018 Feb;42:90e6. https://doi.org/ 10.1016/j.sleep.2017.08.026. Epub 2017 Oct 23. PMID: 29458752.

[16] Buysse DJ, Reynolds 3rd CF, Monk TH, Berman SR, Kupfer DJ. The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research. Psychiatr Res 1989 May;28(2):193e213. https://doi.org/10.1016/0165- 1781(89)90047-4. PMID: 2748771.

[17] Backhaus J, Junghanns K, Broocks A, Riemann D, Hohagen F. Test-retest reliability and validity of the Pittsburgh Sleep Quality Index in primary insomnia. J Psychosom Res 2002 Sep;53(3):737e40. https://doi.org/ 10.1016/s0022-3999(02)00330-6. PMID: 12217446.

[18] Parvan K, Lakdizaji S, Roshangar F, Mostofi M. Quality of sleep and its relationship to quality of life in hemodialysis patients. J Caring Sci 2013 Nov 30;2(4):295e304. https:// doi.org/10.5681/jcs.2013.035. PMID: 25276738; PMCID: PMC4134147.

[19] Hosseini M, Nasrabadi M, Mollanoroozy E, Khani F, Mohammadi Z, Barzanoni F, et al. Relationship of sleep duration and sleep quality with health-related quality of life in patients on hemodialysis in Neyshabur. Sleep Med X 2023 Feb 11;5:100064. https://doi.org/10.1016/j.sleepx.2023.100064. PMID: 36865567; PMCID: PMC9972367.

[20] Tutuncu NB, Batur MK, Yildirir A, Tutuncu T, Deger A, Koray Z, et al. Melatonin levels decrease in type 2 diabetic patients with cardiac autonomic neuropathy. J Pineal Res 2005 Aug;39(1):43e9. https://doi.org/10.1111/j.1600- 079X.2005.00213.x. PMID: 15978056.

[21] Kalere I, Konrade I, Proskurina A, Upmale S, Zak¸ e T, Limba N, et al. Melatonin concentrations and sleep quality in patients with type 2 diabetes and obesity. Proc Latv Acad Sci Sect B Nat Exact Appl Sci 2019 May 1;73(2):152e7. https:// doi.org/10.2478/prolas-2019-0024