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Review
. 2022 Jan;78(1):14-25.
doi: 10.1111/jan.14947. Epub 2021 Jul 2.

Sleep and hypoglycaemia symptom perception in adults with type-1 diabetes mellitus: A mixed-methods review

Austin Matus  1 , Kimberly K Trout  1 , Amy M Sawyer  1 , Barbara Riegel  1   2   3
Affiliations
Review

Sleep and hypoglycaemia symptom perception in adults with type-1 diabetes mellitus: A mixed-methods review

Austin Matus et al. J Adv Nurs. 2022 Jan.

Abstract

Aims: The study aims to review, synthesize and integrate primary research on the relationship between sleep and hypoglycaemia symptom perception in adults with type-1 diabetes.

Design: This mixed-methods review follows a convergent segregated approach to synthesis and integration of qualitative and quantitative evidence.

Data sources: With assistance of a biomedical librarian, a search of four databases was conducted (PubMed, CINAHL, Embase and PsycINFO) in June 2020. The review included primary research measuring sleep and hypoglycaemia symptom perception in adults (age ≥ 18 years) with type-1 diabetes in English. Studies that exclusively addressed children, type-2 diabetes or outcomes unrelated to sleep and hypoglycaemia symptom perception were excluded.

Review methods: Screening focused on title and abstract review (n = 624). Studies not excluded after screening (n = 35) underwent full-text review. References of each study selected for inclusion (n = 6) were hand searched with one study added. All studies included in the review (n = 7) were critically appraised with JBI Critical Appraisal tools, and then data were extracted with systematic evaluation.

Results: Quantitative synthesis found sleep reduces the magnitude of detectable symptoms and one's capacity to detect them. Qualitative synthesis found that individuals with type-1 diabetes perceive unpredictable severity, frequency and awareness of symptoms while asleep as an oppressive, lingering threat. Integration of findings highlights the troublesome duality of sleep's relationship with hypoglycaemia symptom perception.

Conclusions: Sleep presents a challenging time for individuals with type-1 diabetes. Further research examining the relationship between sleep and hypoglycaemia symptom perception is recommended as the number of studies limits this review.

Impact: Symptom perception is the main physiologic defense against severe hypoglycaemia in type-1 diabetes. This review found that sleep's relationship with hypoglycaemia symptoms has unique physiological and psychological components to address when providing comprehensive care. This review may inform future lines of inquiry that develop into interventions, improvements in practice and risk reduction for hypoglycaemia-related complications.

Keywords: diabetes; hypoglycaemia; signs and symptoms; sleep; systematic review; type 1.

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References

REFERENCES

    1. Amiel, S. A. (2009). Hypoglycemia: From the laboratory to the clinic. Diabetes Care, 32(8), 1364-1371. https://doi.org/10.2337/dc09-0113
    1. Banarer, S., & Cryer, P. E. (2003). Sleep-related hypoglycemia-associated autonomic failure in type 1 diabetes: Reduced awakening from sleep during hypoglycemia. Diabetes, 52(5), 1195-1203. https://doi.org/10.2337/diabetes.52.5.1195
    1. Bendtson, I., Gade, J., Thomsen, C. E., Rosenfalck, A., & Wildschiødtz, G. (1992). Sleep disturbances in IDDM patients with nocturnal hypoglycemia. Sleep, 15(1), 74-81. https://doi.org/10.1093/sleep/15.1.74
    1. Berry, R., Brooks, R., & Gamaldo, C. (2020). The AASM manual for the scoring of sleep and associated events: Rules, terminology and technical specifications, version 2.6.0. American Academy of Sleep Medicine.
    1. Borel, A. L., Benhamou, P. Y., Baguet, J. P., Debaty, I., Levy, P., Pepin, J. L., & Mallion, J. M. (2009). Short sleep duration is associated with a blood pressure nondipping pattern in type 1 diabetes: The DIAPASOM study. Diabetes Care, 32(9), 1713-1715. https://doi.org/10.2337/dc09-0422

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