CORRELACION ENTRE INSOMNIO Y NEUROPATIA DIABETICA EN PACIENTES DE LA CONSULTA EXTERNA DEL CENTRO DE SALUD SANTA ANA YENSHU MEDIANTE APLICACIÓN DE CUESTIONARIO DE INDICE DE SEVERIDAD DE INSOMNIO

Abstract

In Mexico, Diabetes is the first cause of death, and it is estimated that the rate of mortality elevates 3% every year, and this consumes between 4.7% and 6.5% of the national health budget. Diabetes Mellitus is a chronic illness that requires continuing medical care and ongoing patient selfmanagement education and support to prevent acute complications and to reduce the risk of long-term complications. Diabetes care is complex and requires that many issues, beyond glycemic control, be addressed. In 2004, Mexico recorded 65,662 hospital discharges with DM, of which 12,681 were due to Diabetic Feet hospitalizations, with 5,327 amputations. In 2008, 6,223 amputations took place in private health institutions. Diabetic Feet hospital discharges increased in 10% between 2004 and 2005, amputations due to DM also increased in 4%. With all this information we put in evidence the importance of the nervous affectation in DM. Studies done to look at the association of DM as an etiologic factor for sleep apnea have suggested that autonomic neuropathy may be a responsible for dysfunction of central respiratory control of the diaphragm and decreased upper airway tone. Somers et al. found that sleep disturbance negatively affects glucose metabolism and endocrine function. Other reports showed that 25% of diabetic individuals with autonomic neuropathy have sleep apnea, a proportion greater than in diabetic subjects without autonomic neuropathy. Diabetes may be a cause or consequence of SDB, or possibly both. One study showed that experimentally 6 induced acute sleep deprivation could cause a state of glucose intolerance. Other studies demonstrated crosssectional relationships between sleep apnea and both fasting insulin and insulin resistance and between sleep apnea and overt diabetes. Snoring, which is a common symptom of SDB, has also been shown to predict the onset of diabetes in both men and women. Based on all of the above, this study is made in search of an association between the clinical manifestation of Diabetic Neuropathy and the disturbance of sleep quality, speculating that sleep disorders in diabetic patients are generated by damage to the nervous tissue, which pathophysiologic mechanism shares similarity with that of the Diabetic Neuropathy. Having at the same time correlation with the degree of peripheral neural damage or perhaps suggesting different mechanisms.