Study Explores Links Between Pediatric Hypoglycemia and Sleep Quality Measures

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A longer time spent in hypoglycemia over a 24-hour period was associated with disrupted sleep among children with type 1 diabetes.

Time spent in hypoglycemia may have a negative impact on quality of sleep for children with type 1 diabetes, suggests a new study presented at the American Diabetes Association’s (ADA) 81st Scientific Sessions.

Angela Karami, BS, and a team at Barbara Davis Center for Diabetes, Colorado, utilized objective measures to evaluate quality of sleep among type 1 diabetic children and their parents.

To do this, they used actigraphy watches among 26 children and 26 parents, which captured about 7 nights of sleep outcomes. Total sleep time in hours, sleep efficiency (ratio of total sleep time to time in bed), wake after sleep onset, and number of awakenings during sleep periods were all recorded. 

Nighttime hours were defined as between 12 am – 6 am, while the overall day was considered a 24-hour period. During either time frame, the investigators collected glycemic data from the pediatric patients using Dexcom G6 continuous glucose monitor (CGM).

The team used mixed models to test the associations of sleep outcomes with both time-in-range and time in hypoglycemia.

The Findings

The mean age of the pediatric population was 10.7 years with equal proportions of male and female. For the parent population, the mean age was 42.5 years with the majority (84.6%) being female.

The mean duration of type 1 diabetes was 1.98 years, and mean HbA1c was 7.2.

“Significant associations were found between hypoglycemia and child wake after sleep onset, awakenings, and total sleep time,” the investigators reported. However, no associations were observed between sleep measures and time in range.

Similarly, there were no observed associations between time in hypoglycemia during sleep and any of the sleep measures. In her presentation, Karami indicated that it is possible that overall time spent in hypoglycemia may have more of an impact on sleep quality than nighttime glycemic ranges.

“Time spent in hypoglycemia was associated with more nocturnal awakenings and long wake after sleep onset in youth with type 1 diabetes,” Karami and colleagues wrote.

They noted that the associations between overall time in hypoglycemia and child total sleep time as well as child sleep efficiency and time-in-range during nighttime hours were unexpected findings. As such, there is a need to continue further evaluation of these links.

Furthermore, a larger sample size would be needed to better assess these links between glycemic and sleep outcomes. Nevertheless, the investigators stressed the importance of providing tools to reduce hypoglycemia so as to improve sleep quality among this pediatric population.

The study, “Association of Glycemic Ranges and Sleep Measures in Youth with T1D and Their Parents,” was presented at ADA 2021.