Aims: Fear of hypoglycaemia (FOH) can contribute to impaired sleep for adults with type 1 diabetes (T1D) and parents of children with T1D, although it is unknown how FOH may affect sleep for adolescents with T1D. This study examines the relationship between adolescent FOH and sleep and assessed the influences of continuous glucose monitor (CGM) and insulin pump use. Methods: Adolescents ages 14-18 years with T1D completed questionnaires evaluating FOH (Child Hypoglycemia Fear Survey) and sleep (Pittsburgh Sleep Quality Index, PSQI). Analyses included linear and logistic regression, t-tests and Fisher's exact tests. Results: Participants included 95 adolescents (52 female) with a median (IQR) age of 16.5 (15.3-17.7) years and a T1D duration of 5.7 (2.5-9.6) years. Analyses showed increased FOH-Worry subscale scores were associated with reduced sleep duration (β = −0.03, p = 0.042, adjusting for BMI z-score, race and ethnicity) and increased sleep disturbances (OR = 1.1, p = 0.038, adjusting for race and ethnicity). Frequent CGM users had longer sleep duration (average 7.5 h) compared with infrequent or non-CGM users (average = 6.8 h; p = 0.029), and pump users had overall improved sleep health as determined by PSQI score (p = 0.019). Technology use did not have significant interactions in the relationships between FOH and sleep duration or sleep disturbances. Conclusions: Worrying about hypoglycaemia was associated with impaired sleep for adolescents with T1D. Diabetes technology users have some sleep improvements, but CGM and pump use do little to alter the relationship between FOH and sleep outcomes.

Background: Adolescents with type 1 diabetes (T1D) are vulnerable to sleep difficulties that may negatively affect mental health and glycemic control. Fear of hypoglycemia (FOH) may contribute to these sleep problems. Although parental FOH has been associated with poor sleep quality in children with T1D, little is known about the relationship between adolescent FOH and sleep outcomes. Objective: To examine the association between adolescent FOH and sleep parameters and assess how continuous glucose monitor (CGM) use influences these relationships. Methods: Adolescents ages 14-18 years with T1D completed questionnaires evaluating FOH (Child Hypoglycemia Fear Survey) and sleep parameters (Pittsburgh Sleep Quality Index). Meaningful CGM use was defined as reporting using the device ≥ 50% of the time. Analyses included linear regression and T-tests. Results: One hundred adolescents (56 female) with a median (IQR) age of 16.3 (15.3,17.6) years and duration of T1D of 5.7 (2.5, 9.5) years completed surveys, and 45 used CGM. FOH was inversely associated with sleep duration (r=0.25, p=0.01) and quality (r=0.22 p=0.03), and positively associated with sleep disturbances (r=0.24, p=0.01). A stratified analysis showed that the inverse relationship between FOH and sleep duration (r=0.29, p=0.03), as well as the association with sleep disturbances (r=0.31, p=0.02) was only significant among those not using CGM. Furthermore, average sleep duration was longer in those using CGM [7.5 hours with CGM vs. 6.8 hours without, p=0.02] and the associations between FOH and sleep duration or disturbance were not significant among CGM users. Conclusions: Among adolescents with T1D, FOH is associated with reduced sleep duration, poor sleep quality and increased sleep disturbance. Our findings suggest that CGM use could mitigate the negative contribution of FOH on various sleep parameters in this population, a previously unrecognized benefit. Disclosure T.A. Hitt: None. J. Smith: None. E.L. Forth: None. P. Garren: None. D. Olivos-Stewart: None. M. De La Vega: None. F. Stuart: None. C.P. Hawkes: None. S.M. Willi: Advisory Panel; Self; Boehringer Ingelheim International GmbH. Research Support; Self; Eli Lilly and Company, Janssen Pharmaceuticals, Inc., Tolerion, Inc. Other Relationship; Self; Caladrius Biosciences, Inc. J. Gettings: None.