Short sleep duration measured by wrist actimetry is associated with deteriorated glycemic control in type 1 diabetes

Abstract

Objective: Sleep restriction has been associated with deteriorated insulin sensitivity. The effects of short sleep duration have been explored little in patients with type 1 diabetes. This study addresses the question of whether sleep curtailment affects HbA1c levels in patients with type 1 diabetes.

Research design and methods: Seventy-nine adult patients with type 1 diabetes (median age 40 years [IQR 23-49]; 47% men) were recruited to wear a wrist actimetry sensor during 3 consecutive days to assess mean sleep duration during normal daily life. A subsample of 37 patients also performed 24-h ambulatory blood pressure monitoring (ABPM). Medical history, sleep questionnaires, and diabetes-related quality of life (DQOL) were assessed.

Results: Patients having shorter sleep duration--less than 6.5 h (n=21)--had higher levels of HbA1c (P=0.01) than patients with longer sleep duration, above 6.5 h (n=58). In a multivariable regression model including shorter versus longer sleep duration, diabetes duration, DQOL score, and daily activity, sleep duration was the only variable independently associated with HbA1c (R2=10%). In patients who performed 24-h ABPM, patients with a nondipping pattern of blood pressure exhibited shorter sleep duration than patients with a dipping pattern of blood pressure.

Conclusions: Shorter sleep duration is associated with higher HbA1c levels in patients with type 1 diabetes, as well as with a nondipping pattern of blood pressure, anticipating a long-term deleterious impact on the risk of microvascular complications. Further studies should test whether extending the duration of sleep may improve both HbA1c and blood pressure in type 1 diabetes.

Trial registration: ClinicalTrials.gov NCT01017965.

Figure 1

Distribution of HbA_1c levels in patients with shorter (<6.5 h) vs. longer (>6.5 h) sleep duration. Comparisons between short vs. normal sleepers were determined using one-way ANOVA and were statistically significant (P = 0.001).

Figure 2

Sleep characteristics of patients with a dipping vs. nondipping pattern of nocturnal blood pressure. A: Sleep duration. B: Sleep latency. C: Fragmentation index. D: Sleep efficiency derived from actimetric measurement. Results are mean (SD). For each patient, the data were the mean of the 3 consecutive days of measurements. *P < 0.05.