Characterizing Subjective Sleep Quality and Sleep Apnea Risk in Adults With Type 1 Diabetes

Objective: Individuals with type 1 diabetes (T1D) experience poor subjective sleep quality and are at an increased risk for obstructive sleep apnea (OSA), yet the contribution of diabetes-related characteristics remains unclear. Methods: This study evaluated associations between diabetes characteristics, affect, and sleep in 210 adults with T1D (M age=45.6 years, SD=15.6; 52.9% female) from the Glycemic Variability and Fluctuations in Cognitive Status in Adults with Type 1 Diabetes study. Participants completed measures of sleep quality (Pittsburgh Sleep Quality Index), OSA risk (STOP-Bang), and affect (Generalized Anxiety Disorder—7, Perceived Stress Scale, Patient Health Questionnaire—8). Blinded continuous glucose monitoring data were collected for up to 20 days (M=18.8, SD=2.5). Bivariate correlations and hierarchical regressions evaluated relationships among subjective sleep quality and OSA risk with affect and diabetes variables. Results: Overall, 47% and 37% of participants scored above clinical cutoffs on the Pittsburgh Sleep Quality Index and STOP-Bang. Those with microvascular complications reported poorer sleep quality (β=0.13, t(188)=2.23, p=0.03). Microvascular complications (β=0.15, t(200)=3.10, p=0.002) and cardiovascular disease (β=.014, t(200)=2.89, p=0.004) were associated with a higher OSA risk. Continuous glucose monitoring metrics were not associated with the outcomes. Conclusions: In this sample of adults with T1D, nearly half reported poor sleep quality, and more than one-third were at elevated risk for OSA, with microvascular complications associated with poorer sleep quality and both microvascular and cardiovascular complications associated with a higher OSA risk. Aggregate glycemic metrics were not associated with sleep outcomes. Future research should evaluate the relationships between daily variation in sleep and glucose to inform targeted clinical interventions.