Denic-Roberts Hristina, Costacou Tina, Orchard Trevor J
Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, 3512 Fifth Ave, Pittsburgh, PA 15213, USA.
Diabetes Res Clin Pract. 2016 Sep;119:1-12. doi: 10.1016/j.diabres.2016.06.013. Epub 2016 Jun 18.
To date, studies on sleep disturbances in type 1 diabetes (T1D) have been limited to youth and/or small samples. We therefore assessed the prevalence of subjective sleep disturbances and their associations with glycemia and estimated insulin sensitivity in individuals with long-standing T1D.
We conducted a cross-sectional study including 222 participants of the Epidemiology of Diabetes Complications study of childhood-onset T1D attending the 25-year examination (mean age=52years, diabetes duration=43years). The Berlin Questionnaire (risk of obstructive sleep apnea, OSA), the Epworth Sleepiness Scale (daytime sleepiness), and the Pittsburgh Sleep Quality Index (sleep quality, bad dreams presence, and sleep duration) were completed. Associations between sleep disturbances and poor glycemic control (HbA1c⩾7.5%/58mmol/mol), log-transformed HbA1c, and estimated insulin sensitivity (estimated glucose disposal rate, eGDR, squared) were assessed in multivariable regression.
The prevalences of high OSA risk, excessive daytime sleepiness, poor sleep quality, and bad dreams were 23%, 13%, 41%, and 26%, respectively, with more women (51%) reporting poor sleep quality than men (30%, p=0.004). Participants under poor glycemic control were twice as likely to report bad dreams (p=0.03), but not independently (p=0.07) of depressive symptomatology. Sleep duration was directly associated with HbA1c among individuals with poor glycemic control, but inversely in their counterparts (interaction p=0.002), and inversely associated with eGDR (p=0.002).
These findings suggest important interrelationships between sleep, gender, depressive symptomatology, and glycemic control, which may have important clinical implications. Further research is warranted to examine the mechanism of the interaction between sleep duration and glycemic control.
迄今为止，关于1型糖尿病（T1D）睡眠障碍的研究仅限于青少年和/或小样本。因此，我们评估了长期患T1D个体主观睡眠障碍的患病率及其与血糖和估计胰岛素敏感性的关联。
我们进行了一项横断面研究，纳入了222名参加25年随访检查的儿童期发病T1D糖尿病并发症流行病学研究的参与者（平均年龄 = 52岁，糖尿病病程 = 43年）。完成了柏林问卷（阻塞性睡眠呼吸暂停风险，OSA）、爱泼华嗜睡量表（日间嗜睡）和匹兹堡睡眠质量指数（睡眠质量、是否有噩梦及睡眠时间）。在多变量回归中评估睡眠障碍与血糖控制不佳（糖化血红蛋白[HbA1c]≥7.5%/58 mmol/mol）、对数转换后的HbA1c以及估计胰岛素敏感性（估计葡萄糖处置率，eGDR，平方）之间的关联。
高OSA风险、日间过度嗜睡、睡眠质量差和有噩梦的患病率分别为23%、13%、41%和26%，报告睡眠质量差的女性（51%）多于男性（30%，p = 0.004）。血糖控制不佳的参与者报告有噩梦的可能性是其他人的两倍（p = 0.03），但在排除抑郁症状影响后无统计学意义（p = 0.07）。在血糖控制不佳的个体中，睡眠时间与HbA1c直接相关，但在血糖控制良好的个体中则呈负相关（交互作用p = 0.002），且与eGDR呈负相关（p = 0.002）。
这些发现表明睡眠、性别、抑郁症状和血糖控制之间存在重要的相互关系，这可能具有重要的临床意义。有必要进一步研究以探讨睡眠时间与血糖控制之间相互作用的机制。
