Multidimensional Sleep Health, Glycemic Control, and Self-reported Outcomes in Type 1 Diabetes: A Cross-sectional Study.

Abstract

Sleep health is multidimensional. While studies have shown associations between certain sleep dimensions and health in type 1 diabetes (T1D), global sleep health has rarely been considered. To examine the associations between individual sleep dimensions and multidimensional sleep health (MSH) on glycemic control and self-reported outcomes in T1D. Data from 116 adults with T1D participating in a sleep study (NCT04506151) were analyzed. Sleep satisfaction and alertness were assessed by questionnaires. Sleep timing, efficiency, duration, and regularity were derived from 7-day actigraphy. A composite MSH score was created by counting "healthy sleep" across these 6 measures. Glycemic control was assessed by 7-day continuous glucose monitoring and hemoglobin A1C (A1C). Self-reported outcomes were collected through questionnaires. After adjusting for covariates, greater sleep irregularity was associated with higher glycemic variability (b = 5.048, P < .01), less time in range (TIR) (b = -10.806, P < .01), higher time above range (TAR) (b = 7.40, P < .05), and higher A1C (b = .365, P < .05)]. Poor sleep satisfaction was associated with higher diabetes distress and depression (b = .29, P < .05, b = 3.59, P < .05), respectively. Later sleep timing was associated with higher depression (b = 1.545, P < .05), while lower sleep efficiency was associated with higher depression (b = 1.545, P < .01). Worse MSH was significantly associated with lower TIR (b = 2.376, P < .05), higher TAR, higher A1C, and depression (b = -2.38, P < .05; b = -.177, P < .01; b = -1.275, P < .05, respectively). Sleep irregularity likely drives the association between MSH and glycemic control, while poor sleep satisfaction, lower efficiency, and later timing contribute to the association between MSH and depression. These results highlight the importance of comprehensive sleep health evaluation in T1D.