Sleep characteristics in young adults with type 1 diabetes

Abstract

Only 14% of young adults with Type 1 Diabetes (T1D) achieve targets for glycemic control (HbA1C < 7.0%), with deterioration over time. Complex cognitive processes required to manage glycemia are vulnerable to sleep deficiency. Using Whittemore and Knafl's approach, we conducted an integrative review of research literature on sleep characteristics and glycemia in these young adults. Quality was assessed using the Mixed Methods Appraisal Tool (v. 2011). Multiple databases were searched for articles published in English in peer-reviewed journals from 2003 to 2018, using search terms 'sleep' and 'T1D' with age limiters 18-40. Of 218 studies initially retrieved, 17 original studies met the inclusion criteria. The following themes were identified in young adults with T1D: (1) They had poorer objective and subjective sleep quality, more variability, and impaired awakening response to hypoglycemia compared with controls; (2) They had poorer glycemic control that was associated with shorter sleep duration, poorer sleep quality, and less time in deep sleep; and (3) Hypoglycemia negatively impacted diabetes management, sleep quality, and next day functioning. Sleep deficiency, as indicated by short sleep duration is associated with a range of negative health outcomes for people with T1D; therefore, optimizing sleep should be a priority in practice and research.

Keywords: Glycemic control; Self-management; Sleep; Type 1 diabetes.

Figure 1.

Sleep Characteristics in Type 1 Diabetes Search Strategy Inclusion criteria for search: (1) primary research; (2) key terms “sleep” and “type 1 diabetes”; (3) published in English from 2003–2018. Inclusion criteria for studies: (1) young adult participants between the ages of 18–40 years who had T1D; and that (2) reported sleep characteristics with subjective (e.g., self-report) and/or objective measures (e.g., polysomnography [PSG], or actigraphy

Figure 2.

Proposed Model of the Associations between Sleep Characteristics and Glycemic Control in T1D Note: Solid line indicates known sleep factors associated with poorer glycemic control in young adults. Dotted line indicates a known sleep factor associated with poorer glycemic control in other ages. Key for defining variables: Sleep deficiency (≤ 6.5h), less sleep efficiency (< 85%), Longer sleep onset latency (> 30 mins, Higher fragmentation (> 25), Less time in deep sleep (< 5%)