Canadian journal of diabetes · 2026
Characterizing Subjective Sleep Quality and Sleep Apnea Risk in Adults With Type 1 Diabetes.
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Zuniga-Kennedy Miranda, Hansen Devon, Bulger Jane D, Grinspoon Elizabeth, Jung Laneé, Kudva Yogish C, Fonseca Luciana Mascarenhas, Pratley Richard, Rickels Michael R, Rizvi Shafaq R, Sliwinski Martin, Weinstock Ruth S, Germine Laura T, Chaytor Naomi
Аннотация
OBJECTIVE: Individuals with type 1 diabetes (T1D) experience poor subjective sleep quality and are at an increased risk for obstructive sleep apnea (OSA), yet the contribution of diabetes-related characteristics remains unclear.
METHODS: This study evaluated associations between diabetes characteristics, affect, and sleep in 210 adults with T1D (M age=45.6 years, SD=15.6; 52.9% female) from the Glycemic Variability and Fluctuations in Cognitive Status in Adults with Type 1 Diabetes study. Participants completed measures of sleep quality (Pittsburgh Sleep Quality Index), OSA risk (STOP-Bang), and affect (Generalized Anxiety Disorder-7, Perceived Stress Scale, Patient Health Questionnaire-8). Blinded continuous glucose monitoring data were collected for up to 20 days (M=18.8, SD=2.5). Bivariate correlations and hierarchical regressions evaluated relationships among subjective sleep quality and OSA risk with affect and diabetes variables.
RESULTS: Overall, 47% and 37% of participants scored above clinical cutoffs on the Pittsburgh Sleep Quality Index and STOP-Bang. Those with microvascular complications reported poorer sleep quality (β=0.13, t(188)=2.23, p=0.03). Microvascular complications (β=0.15, t(200)=3.10, p=0.002) and cardiovascular disease (β=.014, t(200)=2.89, p=0.004) were associated with a higher OSA risk. Continuous glucose monitoring metrics were not associated with the outcomes.
CONCLUSIONS: In this sample of adults with T1D, nearly half reported poor sleep quality, and more than one-third were at elevated risk for OSA, with microvascular complications associated with poorer sleep quality and both microvascular and cardiovascular complications associated with a higher OSA risk. Aggregate glycemic metrics were not associated with sleep outcomes. Future research should evaluate the relationships between daily variation in sleep and glucose to inform targeted clinical interventions.
METHODS: This study evaluated associations between diabetes characteristics, affect, and sleep in 210 adults with T1D (M age=45.6 years, SD=15.6; 52.9% female) from the Glycemic Variability and Fluctuations in Cognitive Status in Adults with Type 1 Diabetes study. Participants completed measures of sleep quality (Pittsburgh Sleep Quality Index), OSA risk (STOP-Bang), and affect (Generalized Anxiety Disorder-7, Perceived Stress Scale, Patient Health Questionnaire-8). Blinded continuous glucose monitoring data were collected for up to 20 days (M=18.8, SD=2.5). Bivariate correlations and hierarchical regressions evaluated relationships among subjective sleep quality and OSA risk with affect and diabetes variables.
RESULTS: Overall, 47% and 37% of participants scored above clinical cutoffs on the Pittsburgh Sleep Quality Index and STOP-Bang. Those with microvascular complications reported poorer sleep quality (β=0.13, t(188)=2.23, p=0.03). Microvascular complications (β=0.15, t(200)=3.10, p=0.002) and cardiovascular disease (β=.014, t(200)=2.89, p=0.004) were associated with a higher OSA risk. Continuous glucose monitoring metrics were not associated with the outcomes.
CONCLUSIONS: In this sample of adults with T1D, nearly half reported poor sleep quality, and more than one-third were at elevated risk for OSA, with microvascular complications associated with poorer sleep quality and both microvascular and cardiovascular complications associated with a higher OSA risk. Aggregate glycemic metrics were not associated with sleep outcomes. Future research should evaluate the relationships between daily variation in sleep and glucose to inform targeted clinical interventions.