Sleep medicine · 2025
Differential impact of timing of nocturnal hypoglycemia on subjective sleep quality in people with type 1 diabetes.
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Rama Chandran Suresh, Tan Hong Chang, Zin Oo May, Gardner Daphne, J Gooley Joshua
Аннотация
BACKGROUND: The impact of nocturnal hypoglycemia (NH) on subjective sleep quality in type 1 diabetes (T1D) is unclear. Awareness to stimuli varies across sleep stages-lower during early slow-wave sleep and higher during late sleep-which may influence the impact of NH on perceived sleep quality. This study examines whether NH timing affects subjective sleep quality in T1D.
METHODS: Adults with T1D using multiple daily injections or basic insulin pumps (excluding real-time continuous glucose monitoring [CGM] users) wore a blinded CGM (Freestyle Libre Pro) for 14-28 days and rated sleep quality each morning using a single-item Likert scale (1 = very poor; 5 = very well). Sleep time was defined as 0000-0600 h, split into early (0000-0300) and late (0300-0600) periods. NH was categorized as Time-Below-Range, TBR1 (<70 mg/dL) and TBR2 (<54 mg/dL). A cumulative link mixed model assessed the impact of NH during early (TBR-E) and late (TBR-L) sleep on sleep quality, with participant as a random effect.
RESULTS: Among 27 participants (18 women), median age was 30.6 years, mean BMI 24 kg/m2, median diabetes duration 16 years, and median HbA1c 7.6 %. Over half used insulin pumps, all used insulin analogs. NH during late sleep significantly reduced the odds of reporting better sleep quality (OR 0.90, 95 % CI: 0.86-0.94, p < 0.001). TBR1-E and TBR2 showed no association. Adjusting for age, gender, BMI, HbA1c, and diabetes duration did not change these findings.
CONCLUSION: NH timing may be a key determinant of subjective sleep quality in T1D.
METHODS: Adults with T1D using multiple daily injections or basic insulin pumps (excluding real-time continuous glucose monitoring [CGM] users) wore a blinded CGM (Freestyle Libre Pro) for 14-28 days and rated sleep quality each morning using a single-item Likert scale (1 = very poor; 5 = very well). Sleep time was defined as 0000-0600 h, split into early (0000-0300) and late (0300-0600) periods. NH was categorized as Time-Below-Range, TBR1 (<70 mg/dL) and TBR2 (<54 mg/dL). A cumulative link mixed model assessed the impact of NH during early (TBR-E) and late (TBR-L) sleep on sleep quality, with participant as a random effect.
RESULTS: Among 27 participants (18 women), median age was 30.6 years, mean BMI 24 kg/m2, median diabetes duration 16 years, and median HbA1c 7.6 %. Over half used insulin pumps, all used insulin analogs. NH during late sleep significantly reduced the odds of reporting better sleep quality (OR 0.90, 95 % CI: 0.86-0.94, p < 0.001). TBR1-E and TBR2 showed no association. Adjusting for age, gender, BMI, HbA1c, and diabetes duration did not change these findings.
CONCLUSION: NH timing may be a key determinant of subjective sleep quality in T1D.