SLEEP DISORDERS PREDICT FRAILTY PROGRESSION IN TYPE 2 DIABETES WITHOUT AND WITH CHRONIC KIDNEY DISEASE: A LONGITUDINAL COHORT STUDY

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Abstract Title *

SLEEP DISORDERS PREDICT FRAILTY PROGRESSION IN TYPE 2 DIABETES WITHOUT AND WITH CHRONIC KIDNEY DISEASE: A LONGITUDINAL COHORT STUDY

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Co-author 1

Jui Wang romanray92@gmail.com National Taiwan University College of Public Health Institute of Epidemiology and Preventive Medicine Taipei Taiwan -

Co-author 2

Chia-Ter Chao b88401084@gmail.com National Taiwan University Hospital Department of Internal Medicine Taipei Taiwan *

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Introduction

Type 2 diabetes mellitus (DM) is associated with accelerated functional decline and an increased risk of frailty. Sleep disorders are highly prevalent in this population, yet their role in frailty progression remains unclear. We aimed to investigate the association between sleep disorders and worsening frailty among patients with type 2 DM.

Methods

We conducted a retrospective cohort study using the National Taiwan University Hospital Integrated Medical Database (2008–2016). Adults ≥40 years with type 2 DM, without baseline frailty, were included. Sleep disorders were identified based on physician-assigned diagnostic codes. Frailty status was assessed with the FRAIL scale, and worsening frailty was defined as an increase of ≥1 FRAIL component during follow-up. Cox proportional hazards models, adjusted for demographic, clinical, and laboratory variables, were used to examine the association between sleep disorders and frailty progression.

Results

Among 20,562 patients (mean age 64.2 ± 10.9 years, 44.8% female), 19.2% had sleep disorders at baseline. Over a median follow-up of 3.9 years, 5,698 patients (27.7%) developed worsening frailty. Patients with sleep disorders had a significantly higher incidence of frailty progression (log-rank p<0.01). After multivariable adjustment, sleep disorders were associated with an increased risk of worsening frailty (HR 1.15, 95% CI 1.08–1.23). Subgroup analyses revealed stronger associations in middle-aged adults, men, and those with preserved kidney function (eGFR ≥60 mL/min/1.73m2) (HR 1.22, 95% CI 1.12-1.33), but not those with chronic kidney disease.

Conclusion

Sleep disorders independently predict frailty progression in type 2 DM, whereas CKD presence eclipses such effect. Screening and targeted interventions to identify sleep disorders and improve sleep may represent novel strategies to mitigate frailty and its adverse outcomes in this high-risk population.

Kewords