1 型糖尿病患者睡眠变异性与血糖水平达标时间的相关性：横断面研究。
Association between sleep variability and time in range of glucose levels in patients with type 1 diabetes: Cross-sectional study.
机构信息
Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, University of Illinois Chicago, Chicago, Illinois, USA.
College of Nursing, Department of Biobehavioral Nursing Science, University of Illinois Chicago, Chicago, Illinois, USA.
出版信息
Sleep Health. 2023 Dec;9(6):968-976. doi: 10.1016/j.sleh.2023.07.007. Epub 2023 Sep 13.
OBJECTIVE
Sleep and circadian disturbances emerge as novel factors influencing glycemic control in type 1 diabetes (T1D). We aimed to explore the associations among sleep, behavioral circadian parameters, self-care, and glycemic parameters in T1D.
METHODS
Seventy-six non-shift-working adult T1D patients participated. Blinded 7-day continuous glucose monitoring (CGM) and hemoglobin A1C (A1C) were collected. Percentages of time-in-range (glucose levels 70-180 mg/dL) and glycemic variability (measured by the coefficient of variation [%CV]) were calculated from CGM. Sleep (duration and efficiency) was recorded using 7-day actigraphy. Variability (standard deviation) of midsleep time was used to represent sleep variability. Nonparametric behavioral circadian variables were derived from actigraphy activity recordings. Self-care was measured by diabetes self-management questionnaire-revised. Multiple regression analyses were performed to identify independent predictors of glycemic parameters.
RESULTS
Median (interquartile range) age was 34.0 (27.2, 43.1) years, 48 (63.2%) were female, and median (interquartile range) A1C was 6.8% (6.2, 7.4). Sleep duration, efficiency, and nonparametric behavioral circadian variables were not associated with glycemic parameters. After adjusting for age, sex, insulin delivery mode/CGM use, and ethnicity, each hour increase in sleep variability was associated with 9.64% less time-in-range (B = -9.64, 95% confidence interval [-16.29, -2.99], p ≤ .001). A higher diabetes self-management questionnaire score was an independent predictor of lower A1C (B = -0.18, 95% confidence interval [-0.32, -0.04]).
CONCLUSION
Greater sleep timing variability is independently associated with less time spent in the desirable glucose range in this T1D cohort. Reducing sleep timing variability could potentially lead to improved metabolic control and should be explored in future research.
DATA AVAILABILITY STATEMENT
Data are available upon a reasonable request to the corresponding author.
目的
睡眠和昼夜节律紊乱成为影响 1 型糖尿病（T1D）血糖控制的新因素。本研究旨在探讨 T1D 患者睡眠、行为昼夜节律参数、自我护理与血糖参数之间的关系。
方法
纳入 76 名非轮班工作的成年 T1D 患者。采集 7 天连续血糖监测（CGM）和糖化血红蛋白（A1C）数据。CGM 计算葡萄糖达标时间（血糖水平在 70-180mg/dL 之间的时间百分比）和血糖变异性（变异系数 [%CV]）。7 天活动记录仪记录睡眠（时长和效率）。使用中值睡眠时间的标准差表示睡眠变异性。从活动记录仪的活动记录中得出非参数行为昼夜节律变量。糖尿病自我管理问卷修订版（Diabetes Self-Management Questionnaire-Revised，DSMQ-R）测量自我护理情况。采用多元回归分析确定血糖参数的独立预测因子。
结果
中位（四分位间距）年龄为 34.0（27.2，43.1）岁，48 名（63.2%）为女性，中位（四分位间距）A1C 为 6.8%（6.2，7.4）。睡眠时长、效率和非参数行为昼夜节律变量与血糖参数均无相关性。在校正年龄、性别、胰岛素输送模式/CGM 使用和种族后，睡眠变异性每增加 1 小时，与血糖达标时间减少 9.64%相关（B=-9.64，95%置信区间[-16.29，-2.99]，p≤0.001）。糖尿病自我管理问卷评分较高是 A1C 降低的独立预测因子（B=-0.18，95%置信区间[-0.32，-0.04]）。
结论
在本 T1D 队列中，更大的睡眠时相变异性与血糖达标时间减少独立相关。降低睡眠时相变异性可能会导致代谢控制改善，这值得在未来的研究中进一步探索。
数据可用性声明
数据可应要求向通讯作者索取。
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