Hussain Hafiz Rashid, Ahmed Nabeel, Akram Muhammad Waseem, Gulzar Faisal, Khan Jawad Akbar, Asad Muhammad, Tahseen Sana, Ahmed Tanveer, Malik Abdul, Akhtar Suhail, Shahid Ayesha, Noor Mah, Pervaiz Maryam, Rahman Muneeb Ur
College of Pharmacy, University of Sargodha, Sargodha, Pakistan.
School of Economics, University of Wollongong, Wollongong, NSW, Australia.
Front Endocrinol (Lausanne). 2025 Apr 28;16:1456641. doi: 10.3389/fendo.2025.1456641. eCollection 2025.
Every one in seven people with Type-I or Type-II diabetes suffers from fear of hypoglycemia (FOH). Its impact on quality of life, glycemic control, and health outcomes is well studied. However, its relationship with sleep quality remains underexplored, particularly in developing societies. We hypothesize that FOH is a key predictor of sleep quality in Type-I and Type-II patients with diabetes and, therefore, needs detailed investigation.
A multicentric study was conducted across five cities and six centers of Punjab. Data from 310 diabetes patients were analyzed using the Hypoglycemia Fear Survey-II (HFS-II) Scale and the Pittsburgh Sleep Quality Index (PSQI). Statistical analyses explored subgroup variations, correlations, regression models, and receiver operator curve (ROC) estimation.
The study reports 57.70% of patients with poor sleep among whom 47% had elevated FOH. Sleep quality, age, gender, diabetes duration, and insulin route significantly correlated with FOH (p < 0.05), while glycemic control and insulin use did not. Binary logistics regression showed that for every one-unit increase in FOH, the odds of experiencing poor sleep increased by approximately 3.7% ( < 0.001; OR 1.037). Five out of seven sleep components (sleep quality, efficiency, disturbance, medication use, and daytime dysfunction) were significantly related to FOH. We hypothesize that FOH might specifically influence the quality rather than the initiation or termination of the sleep cycle. ROC analysis revealed that HFS-II may be better at diagnosing poor sleep in patients than by chance (p < 0.001) with an AUC of 0.691.
FOH is a key predictor of sleep quality among patients with diabetes. Healthcare providers should prioritize patient education targeting common FOH concerns and assess patients with disturbed sleep for elevated FOH levels, as it may contribute to sleep disturbances.
每七名1型或2型糖尿病患者中就有一人患有低血糖恐惧（FOH）。其对生活质量、血糖控制和健康结果的影响已得到充分研究。然而，其与睡眠质量的关系仍未得到充分探索，尤其是在发展中社会。我们假设FOH是1型和2型糖尿病患者睡眠质量的关键预测因素，因此需要进行详细调查。
在旁遮普邦的五个城市和六个中心进行了一项多中心研究。使用低血糖恐惧调查-II（HFS-II）量表和匹兹堡睡眠质量指数（PSQI）对310名糖尿病患者的数据进行了分析。统计分析探讨了亚组差异、相关性、回归模型和受试者操作特征曲线（ROC）估计。
该研究报告称，57.70%的患者睡眠质量较差，其中47%的患者FOH升高。睡眠质量、年龄、性别、糖尿病病程和胰岛素给药途径与FOH显著相关（p < 0.05），而血糖控制和胰岛素使用则无相关性。二元逻辑回归显示，FOH每增加一个单位，睡眠质量差的几率就增加约3.7%（< 0.001；OR 1.037）。七个睡眠成分中的五个（睡眠质量、效率、干扰、药物使用和日间功能障碍）与FOH显著相关。我们假设FOH可能特别影响睡眠周期的质量，而不是其开始或结束。ROC分析显示，HFS-II在诊断患者睡眠质量差方面可能比随机诊断更有效（p < 0.001），AUC为0.691。
FOH是糖尿病患者睡眠质量的关键预测因素。医疗保健提供者应优先针对常见的FOH问题进行患者教育，并评估睡眠障碍患者的FOH水平是否升高，因为这可能导致睡眠障碍。
