Sleep in children with type 1 diabetes and their parents in the T1D Exchange

Abstract

Objectives: Sleep has physiological and behavioral impacts on diabetes outcomes, yet little is known about the impact of sleep disturbances in children with type 1 diabetes. The current study sought to characterize sleep in children with type 1 diabetes and in their parents and to examine the associations between child sleep, glycemic control and adherence, parent sleep and well-being, parental fear of hypoglycemia, and nocturnal caregiving behavior.

Methods: Surveys were emailed to parents of 2- to 12-year-old participants in the Type 1 Diabetes (T1D) Exchange clinic registry. Clinical data were obtained from the registry for the 515 respondents.

Results: In our sample, 67% of children met criteria for poor sleep quality. Child sleep quality was related to glycemic control (HbA1c of 7.9% [63 mmol/mol] in children with poor sleep quality vs 7.6% [60 mmol/mol] in children with non-poor sleep quality; P < 0.001) but not mean frequency of blood glucose monitoring (BGM) (7.6 times/day vs 7.4 in poor/non-poor quality; P = 0.56). Associations were similar for sleep duration. Children with poor sleep quality were more likely to experience severe hypoglycemia (4% in children with poor sleep quality vs 1% in children with non-poor sleep quality; P = 0.05) and more likely to experience DKA (7% vs 4%, respectively; P < 0.001). Poorer child sleep quality was associated with poorer parental sleep quality, parental well-being, and fear of hypoglycemia (P < 0.001 for all). Child sleep was not related to the use of diabetes-related technology (CGM, insulin pump).

Conclusions: Sleep may be a modifiable factor to improve glycemic control and reduce parental distress.

Keywords: Glycemic control; Sleep quality; Type 1 diabetes.

Fig. 1.

A. Association between Parent-Reported HbA1c and Child Sleep Disturbances (CSHQ). ^aP-value calculated from a linear regression model adjusting for clinic site, race/ethnicity, and insurance status. B. Association between Occurrence of ≥1 Severe Hypoglycemia Events in the 3 Months Prior to Questionnaire Completion and Child Sleep Disturbances (CSHQ). ^aP-value from a multivariable logistic regression model adjusting for race/ethnicity, sex, type of insurance, and fear of hypoglycemia score (HFS survey score). C. Association between Occurrence of ≥1 DKA Events in the 3 Months Prior to Questionnaire Completion and Child Sleep Disturbances (CSHQ). ^aP-value from a multivariable logistic regression model adjusting for race/ethnicity, type of insurance, and use of an insulin pump. D. Association between Parental Well-Being (WHO-5) and Child Sleep Disturbances (CSHQ). ^aP-value calculated from a linear regression model adjusting for race/ethnicity and child age at start of questionnaire. E. Association between Parental Sleep Quality (PSQI) and Child Sleep Disturbances (CSHQ). ^aP-value calculated from a linear regression model adjusting for race/ethnicity and sex.

Fig. 2.

A. Characteristics Associated with Child Sleep Disturbances (CSHQ). ^aP-value calculated from a linear regression model adjusted for clinic site, race/ethnicity, and child age at questionnaire start. B. Characteristics Associated with Parental Sleep Quality (PSQI). ^aP-value calculated from a linear regression model adjusted for race/ethnicity and sex.