Sleep variability was also associated with increased daily insulin requirement, suggesting more insulin resistance in these individuals. In our study of 41 working-age adults with T1D, those with SD of sleep duration > 1 h had significantly higher A1C than those with SD sleep duration ≤ 1 h (median 7.2% vs. Sleep variability (SD of sleep duration as objectively measured by actigraphy) explained 8.2% to 15.8% of the variance in glycemic control. Supporting this hypothesis, recent studies have reported that sleep variability is an independent predictor of glycemic control in T1D. Thus, sleep variability could be detrimental to glycemic control. The circadian system plays an important role in glucose metabolism, and experimental circadian misalignment results in impaired glucose tolerance. Up to 73% of adults with T1D have sleep variability (> 1 h). In addition to insufficient sleep, sleep variability (a potential marker of circadian misalignment) can impact glycemic control. Up to 40% of adults with T1D had insufficient sleep (sleep duration 6 h had 0.24% lower A1C levels than those sleeping ≤ 6 h. Negative health consequences of insufficient and irregular sleep may be amplified for persons with type 1 diabetes (T1D), who must cope with the added burden of managing a chronic condition. Work commitments, family and social obligations, and general stress have also been linked with poor sleep. Each hour of increased sleep variability, as measured by standard deviation (SD) of sleep duration, was associated with a 27% higher odds of metabolic syndrome in a multi-ethnic population. Sleep times of less than 5 h have been associated with up to four times the mortality risk of those with greater than 5 h. These include changes in appetite and eating patterns, obesity, insulin resistance, increased systemic inflammation, metabolic syndrome, dysglycemia, risk for incident diabetes, depression, and a higher prevalence of cardiovascular disease. Sleep variability and insufficient sleep duration have negative health consequences in the general population. Trial registrationĬlinical Trial Registration: NCT04506151. DiscussionĪ better understanding of strategies to improve sleep in persons with T1D has the potential to be an important component of diabetes. Baseline measures will be repeated at midpoint, program completion, and post-program (weeks 6, 12, and 24, respectively) to determine differences between the two groups and sustainability of the intervention. The attention control group will participate in a healthy living information program. Our behavioral intervention employs four elements: a wearable sleep tracker, didactic content, an interactive smartphone application, and brief telephone counseling. Sleep-Opt is a technology-assisted behavioral sleep intervention that we recently developed that leverages the rapidly increasing public interest in sleep tracking. A 1-week run-in period is planned, with baseline measures of sleep by actigraphy (sleep variability and duration), glycemia (A1C and related glycemic measures: glycemic variability and TIR using continuous glucose monitoring), and other secondary outcomes: diabetes distress, self-management behaviors, quality of life, and additional patient-reported outcomes. Eligible subjects will be randomized to the Sleep-Opt intervention group or healthy living attention control group for 12 weeks. Participants will be screened for habitual sleep variability (> 1 h/week) or insufficient sleep duration (< 6.5 h per night). MethodsĪ randomized controlled parallel-arm study will be employed in 120 adults (aged 18 to 65 years) with T1D. The purpose of this study is to determine the efficacy of a T1D-specific sleep optimization intervention (Sleep-Opt) on the primary outcomes of sleep variability, sleep duration, and glycemic control (A1C) other glycemic parameters (glycemic variability, time-in-range ) diabetes distress self-management behaviors quality of life and other patient-reported outcomes in adults with T1D and habitual increased sleep variability or short sleep duration. A significant gap of knowledge exists regarding interventions to improve sleep and the effects of sleep optimization on glycemic control in T1D. Diabetes distress, poor self-management behaviors, and reduced quality of life have also been linked to sleep variability and insufficient sleep duration. Sleep is increasingly recognized as a potentially modifiable target for improving glycemic control. Despite improvements in treatment regimens and technology, less than 20% of adults with type 1 diabetes (T1D) achieve glycemic targets.
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