Physical Activity and Its Synergistic Interaction With Low Platelet-Lymphocyte Ratio Levels Increasing the Sleep Quality in Type 2 Diabetes Mellitus

Purpose: The purpose of the study was to explore the effect of synergistic interaction and the independence of physical activity and inflammatory markers, including platelet-lymphocyte ratio (PLR) and neutrophil-to-lymphocyte ratio (NLR), on sleep quality in persons with type 2 diabetes mellitus (T2DM). Methods: This descriptive cross-sectional study included 294 persons with T2DM in East Java, Indonesia. Fasting blood was analyzed for inflammation markers, including NLR and PLR. Physical activity and sleep quality were assessed using Metabolic Equivalent of Task and Pittsburgh Sleep Quality Index, respectively. Multivariate logistic regression, chi-square test, and independent t test were performed. Results: There was an independently significant relationship between physical activity, NLR, and PLR with sleep quality. Persons with both active physical activity and low PLRs were 12.52 times more likely to have high sleep quality scores than those with low physical activity and high PLRs. A positive additive interaction of active physical activity and low PLRs for high sleep quality scores was identified. Conclusion: Physical activity, NLR, and PLR revealed an independently significant relationship with sleep quality. Persons with both active physical activity levels and low PLR were the most substantial synergistic effect of high sleep quality. Further studies are necessary to examine the problems and solutions for sleep quality in this population.