Instructor of Nursing, Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio, 44106, USA.
Beatrice Renfield Term Professor of Nursing & Professor of Medicine, Yale University, School of Nursing and School of Medicine, West Haven, Connecticut, 06477, USA.
Pediatr Diabetes. 2020 Dec;21(8):1493-1501. doi: 10.1111/pedi.13117. Epub 2020 Sep 28.
We used multilevel models (MLMs) to determine person (between-persons) and day level (within-person) associations between glucose variability indices and sleep characteristics in adolescents with type 1 diabetes (T1D).
Adolescents with T1D (Mean age 13.4 ± 1.8 years; 37.8% male; mean HbA1c 8.2 ± 1.2%, 66 mmol/mol) monitored their sleep and glucose patterns concurrently for 3-7 days with a wrist actigraph on their non-dominant wrist and a continuous glucose monitor (CGM) (their own or a provided, blinded CGM). Glucose variability indices included J index, coefficient of variation, low and high blood glucose risk indices (LBGI and HBGI), time in range, and sleep characteristics, including bedtime, wake time, total sleep time, sleep efficiency, wake after sleep onset, awakenings, and sleep fragmentation index.
More overall glucose variability was associated within person, more sleep disruptions (more awakenings and more fragmentation) or poorer sleep in our study (earlier wake time or longer wake after sleep onset). Also, more time spent in hypoglycemia <70 mg/dL and a higher LBGI was associated within person with earlier wake time indicating poorer sleep. However, a lower LBGI was associated with a later between-persons wake time.
Monitoring over a longer period of time in subsequent studies would allow researchers to determine the within person association between habitual short sleep duration and glucose variability. Providers should regularly assess sleep habits in adolescents as a way to improve glycemic control. Targeting a euglycemic range overnight is also important to promote better sleep and to decrease sleep disruptions.
我们使用多层模型（MLMs）来确定青少年 1 型糖尿病（T1D）患者中葡萄糖变异性指标与睡眠特征的个体间（人与人之间）和日内（个体内）关联。
T1D 青少年（平均年龄 13.4±1.8 岁；37.8%为男性；平均 HbA1c 8.2±1.2%，66mmol/mol）使用非优势手腕上的腕动仪和连续血糖监测仪（CGM）（自己的或提供的、盲法 CGM）同步监测 3-7 天的睡眠和血糖模式。葡萄糖变异性指标包括 J 指数、变异系数、高低血糖风险指数（LBGI 和 HBGI）、血糖达标时间和睡眠特征，包括上床时间、醒来时间、总睡眠时间、睡眠效率、睡眠起始后觉醒时间、觉醒次数和睡眠碎片化指数。
在我们的研究中，个体内的总体葡萄糖变异性越大，睡眠中断越多（觉醒次数越多，碎片化程度越高）或睡眠质量越差（醒来时间越早或睡眠起始后觉醒时间越长）。此外，个体内低血糖时间（<70mg/dL）和 LBGI 越高与醒来时间越早有关，表明睡眠质量越差。然而，较低的 LBGI 与个体间较晚的醒来时间有关。
在后续研究中进行更长时间的监测将使研究人员能够确定习惯性短睡眠时间和葡萄糖变异性之间的个体内关联。提供者应定期评估青少年的睡眠习惯，以改善血糖控制。夜间目标血糖控制在正常范围内对于促进更好的睡眠和减少睡眠中断也很重要。
