Disturbed subjective sleep characteristics in adult patients with long-standing type 1 diabetes mellitus

Abstract

Aims/hypothesisDecreased sleep duration and/or impaired sleep quality negatively influence glucoregulation. The aim of this study was to assess subjective sleep characteristics in patients with type 1 diabetes, to relate sleep characteristics to long-term glycaemic control and to assess possible risk factors for impaired sleep.MethodsWe studied 99 adult patients with type 1 diabetes (55 men, 44 women, duration of diabetes 26.9 ± 1.2 years) and 99 age-, sex- and BMI-matched non-diabetic controls. Subjective sleep characteristics were assessed by validated questionnaires, i.e. Pittsburgh Sleep Quality Index, Epworth Sleepiness Scale and the Berlin Questionnaire. Glucoregulation was assessed by HbA1c values. Clinical variables were obtained from medical charts. Depression was assessed by the Hospital Anxiety and Depression Scale (HADS). Peripheral polyneuropathy was assessed by neurological examination and quantitative sensory testing.ResultsOf the patients with type 1 diabetes, 35% had subjective poor sleep quality compared with 20% of the control participants (p = 0.021). A higher proportion of the patients with type 1 diabetes were at increased risk for obstructive sleep apnoea (OSA) (17.2% vs 5.1%, p = 0.012). There was no significant association between individual sleep characteristics and HbA1c values. On logistic regression analysis, the HADS depression score, presence of peripheral polyneuropathy, habitual snoring and other sleep disturbances (e.g. hypoglycaemia) were independently associated with poor sleep quality.Conclusions/interpretationAdult patients with long-standing type 1 diabetes mellitus have disturbed subjective sleep quality and a higher risk for OSA compared with control participants. Subjective sleep disturbances are part of the complex syndrome of long-standing type 1 diabetes.

Sleep and glycemic control in type 1 diabetes

“…In addition, worse sleep quality was previously reported in individuals with T1DM (13,14), which we did not observe in the present study. In Jauch-Chara and cols.…”

“…The absence of correlation between sleep duration and glycemic control was not surprising, since other groups have reported similar results before (10,14). In our study, differently from findings of other groups that studied T1DM children and adolescents (10,12), and in accordance with a study with T1DM adults (14), sleep duration was not different between T1DM and control subjects.…”

“…In addition, authors comparing T1DM adults with controls reported that T1DM subjects presented changes in sleep architecture, with increased proportion of stage 2, besides higher levels of epinephrine and growth hormone during the entire night, and higher ACTH and cortisol during part of the first half of the night (13). As a consequence, T1DM subjects report less restorative sleep (13), and present higher risk for obstructive sleep apnea and poorer sleep quality than control subjects (14).…”

Hyperglycemia is associated with simultaneous alterations in electrical brain activity in youths with type 1 diabetes mellitus

“…Previous reports demonstrated abnormal sleep pattern in T1DM population (van Dijk et al, 2011;Perfect et al, 2012). Electrographical changes in brain activity during sleep in association with hyperglycemic excursions, as we present in our study, may underlie these abnormalities.…”

Validity of Actigraphy in Measurement of Sleep in Young Adults With Type 1 Diabetes

“…Because PSG studies have identified poor sleep quality 9,10 and altered sleep architecture in individuals with T1DM, 11,12 it is important for ongoing research to determine if actigraphy provides a valid measure of sleep in individuals with T1DM. The aim of this investigation was to compare Actiwatch2-and PSG-based measures of sleep in young adults with T1DM, and to determine which threshold setting provides the best correspondence.…”