Dejkhamron Prapai, Tharavanij Thipaporn, Likitmaskul Supawadee, Rawdaree Petch, Santiprabhob Jeerunda, Deerochanawong Chaicharn, Nitiyanant Wannee, Reutrakul Sirimon
Department of Pediatrics, and Northern Diabetes Center, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
Department of Medicine, Faculty of Medicine, Center of Excellence in Applied Epidemiology, Center of Excellence in Nexus for Advanced Intelligence in Law, Engineering, and Medicine (Nail'Em), Thammasat University and Thammasat Diabetes Center of Excellence, Thammasat University Hospital, Pathumthani, Thailand.
Sleep Breath. 2025 Jun 13;29(4):214. doi: 10.1007/s11325-025-03385-1.
Sleep disturbances is common in type 1 diabetes (T1D) and can be associated with poor glycemic control, and possibly hypoglycemia. This study aims to investigate whether poor sleep quality, as assessed by the Pittsburgh Sleep Quality Index (PSQI), was associated with glycemic control or severe hypoglycemia in T1D individuals.
This one-year prospective cohort study included 221 (148 F/63 M) T1D participants (aged ≥ 13 years), receiving intensive insulin therapy. A1C levels were obtained at baseline and during the 12-month follow-up. Incidences of diabetic ketoacidosis (DKA) and severe hypoglycemia were collected.
The mean age of participants was 21.4 ± 8.9 years, with a baseline A1C of 9.27 ± 2.61%. Poor sleep quality was reported in 33.0% of participants. A1C levels improved over the one-year follow-up, but there was no significant difference in A1C reduction between those with good vs. poor sleep quality (-0.42 ± 1.73 vs. -0.42 ± 1.67, P = 0.835), nor in DKA incidence (P = 0.466). However, participants with poor sleep quality experienced more SH episodes (6.53 (2.45-17.41) vs. 0 per 100-person year, P = 0.01). After adjusting for age, body mass index, and glucose monitoring, each one-point increase in PSQI score was associated with a higher severe hypoglycemia risk (OR 1.31, 95%CI 1.13-1.52). Poor sleep quality predicted an increased risk of severe hypoglycemia (OR 24.54, 95%CI 1.31-459.29).
Poor sleep quality is common in T1D individuals and is a risk factor for incident SH. These findings highlight the importance of incorporating sleep assessment into routine T1D diabetes care and the need of targeted interventions to improve sleep quality in T1D individuals. These findings support the importance of addressing sleep quality in T1D management, particularly in relation to hypoglycemia risk.
睡眠障碍在1型糖尿病（T1D）中很常见，可能与血糖控制不佳以及低血糖有关。本研究旨在调查通过匹兹堡睡眠质量指数（PSQI）评估的睡眠质量差是否与T1D患者的血糖控制或严重低血糖有关。
这项为期一年的前瞻性队列研究纳入了221名（148名女性/63名男性）接受强化胰岛素治疗的T1D参与者（年龄≥13岁）。在基线和12个月随访期间获取糖化血红蛋白（A1C）水平。收集糖尿病酮症酸中毒（DKA）和严重低血糖的发生率。
参与者的平均年龄为21.4±8.9岁，基线A1C为9.27±2.61%。33.0%的参与者报告睡眠质量差。在一年的随访中A1C水平有所改善，但睡眠质量好与差的参与者之间A1C降低幅度无显著差异（-0.42±1.73对-0.42±1.67，P = 0.835），DKA发生率也无显著差异（P = 0.466）。然而，睡眠质量差的参与者严重低血糖发作更多（每100人年6.53次（2.45 - 17.41次）对0次，P = 0.01）。在调整年龄、体重指数和血糖监测后，PSQI评分每增加1分与严重低血糖风险更高相关（比值比1.31，95%置信区间1.13 - 1.52）。睡眠质量差预示着严重低血糖风险增加（比值比24.54，95%置信区间1.31 - 459.29）。
睡眠质量差在T1D患者中很常见，是发生严重低血糖的危险因素。这些发现凸显了将睡眠评估纳入T1D常规糖尿病护理的重要性，以及针对T1D患者改善睡眠质量进行有针对性干预的必要性。这些发现支持了在T1D管理中解决睡眠质量问题的重要性，特别是与低血糖风险相关的问题。
